Analyzing disease instantly: the medical tricorder has been one of the most exciting futuristic technologies in medicine since Star Trek. But will it ever get to the black bag of General Practitioners?
As a movie fan, I love talking about how the science fiction movies of the last 100 years have shaped our ideas about medical technology. When university students doing film studies asked me to give a talk on how sci-fi influenced medical technology, I dedicated a whole section to technology inspired by StarTrek. The long list includes telepresence, the hypospray for painless injections, voice–activated communicators, the iPad, diagnostic beds that tracked numerous vital signs, and of course the famous medical tricorder.
A working tricorder
When Dr McCoy grabbed his tricorder and scanned a patient, the portable, hand–held device immediately listed vital signs, other parameters, and a diagnosis. It was the Swiss Army knife for physicians. When our class discussion turned to potential medical uses, a doubtful student asked how such a thing could work in real when it came from science fiction. I then gave him another list to consider. A visual display device from StarTrek is Google Glass now. The heads–up display in Minority Report is air touch technology. Iron Man is currently being developed by DARPA. The self–directed vacuum cleaner from The Jetsons now exists as Roomba. I could go on.
A working tricorder could bring about a new era in medicine. Instead of expensive machines and long waiting times, information would be available immediately. Physicians could scan a patient, or patients could scan themselves and receive a list of diagnostic options and suggestions. Imagine the influence it could have on underdeveloped regions. It should not substitute for medical supervision, but when there is none it comes in handy.
It could be useful when a diagnosis needs confirming or when standard laboratory equipment is not available. A high–power microscope with a smartphone, for example, could analyze swab samples and photos of skin lesions. Sensors could pick up abnormalities in DNA, or detect antibodies and specific proteins. An electronic nose, an ultrasonic probe, or almost anything we have now could be yoked to a smartphone and augment its features.
An in–person doctor visit includes assessing the patient’s condition, health parameters, and other data. Much of this could be performed without needing the presence of a medical professional. I’m merely pointing out an absence of medical staff is the case in many regions of the world.
Competitions move this forward
This situation is an impetus behind the Nokia Sensing X Challenge that has called for teams to design prototypes of a working tricorder. It should measure a wide range of biomarkers with a droplet of blood, be able to diagnose malaria, high blood pressure, and similar conditions, as well as monitor epilepsy. The winning finalist teams are expected to test their prototypes with thousands of users in 2015.
The Qualcomm Tricorder X Prize was announced in 2012 to motivate innovators in this direction. It featured 230 teams from thirty countries, and promised an award of $10 million to the first team to build a working medical tricorder. The device had to correctly diagnose fifteen different medical conditions from a sore throat to sleep apnea and colon cancer.
Using these devices should also be intuitive so that anyone who understands a smartphone should be able to operate them. Consumer usability is almost as important as medical accuracy. A friendly interface will count when choosing a winner. Teams from Northern Ireland, the US, Slovenia, India, Taiwan, Canada, and the United Kingdom are working on systems that can analyze samples of blood, urine, and saliva.
I must warn that these competitions do not and cannot substitute for clinical trials. There are safety, privacy, legal, and liability issues that can only be assessed during strict trials.
Examples from real life
The first working medical tricorder is the Scanadu Scout, a hand–held sensor held against a patient’s forehead. It measures heart rate, breathing rate, blood oxygenation percentage, and body temperature. It can also take a reading of blood pressure, the electrocardiogram, and stress levels. The company is also working on ScanaduUrine for home use, which will give users data about liver, kidney, urinary tract, and metabolic functions. A smartphone app will guide users through the test procedure, processes the test results, and explain them. This is also a big potential for error or human misinterpretation.
Viatom Technology in China released CheckMe in 2014. It measures ECG, pulse, oxygen saturation, blood pressure, body temperature, sleep quality, and daily activity. Vitaliti from CloudDx measures the same and sends data to the cloud. It lets users know about posture, physical activities and vital signs.
US researchers just announced a new sensor that can be worn on the chest and tracks biochemical and electrical signals in the human body. It provides real-time data on electrocardiogram (EKG) heart signals and levels of lactate, a biochemical that helps chart physical effort.
A big part of practicing medicine today is the way to obtain vital signs. The tricorder could bypass this problem by making vital signs and even lab markers immediately available either at home, at the doctor’s office, or at remote locations that lack medical supervision. Today a doctor’s expertise is needed to analyze as well as collect the data. The creativity and wisdom of physicians will be hard to get replaced. But obtaining data with a device should be something a 5 year–old could perform, and only technology can bring this to us. Empathy and a patient’s emotions cannot be scanned, but vital signs can be.
It is possible that the FDA or other authorities will oppose the development of such a device, or that physicians will not be happy about patients getting the chance to do a health checkup themselves. They cannot stop this, but they could regulate the industry.
The question is when we will start using medical tricorders, not whether we will use them. This is a good chance if we want people to access affordable care.