EMVision Medical Devices Limited (ASX:EMV) today announced that the prototype of its 2nd Generation ultra-light weight helmet scanner, designed for use in road and air ambulances,is ready for bench testing. EMVision’s 2nd gen device is intended to address a huge unmet clinical need in first responder brain imaging.
The Gen 2 headset weighs under 10kgs and will be transported to the point-of-care via a backpack. Its 3D antenna array is designed to cover the entire brain coverage in a single scan.
This advanced prototype is a precursor to the ‘proof of concept’ system, suitable for pre-hospital deployment, which is on track to be assembled in the first half of calendar year 2024, in line with the company’s development timetable.
Awarded top innovator in AFR's top 10 innovations, health industries.
Couldn't find a link to an online article.
My notes on the 30 min conversation with CEO Scott Kirkland this morning. As the communcation from EMV to the market on its journey have been clear and regular, nothing earth shatteringly new. It was a really good conversation to take a step backwards and look at how the various pieces tie together, the bigger picture of what is coming ahead and evolving management thinking on the revenue model - it does indeed look very positive and promising from all angles.
Discl: Held IRL and on SM
Progress of Trials
Path to Commercialisation
Radiation Dose of the Scanners
Secret Sauce of the Data
Positioning of Use of EMV Scanners
EMV released their latest imaging and clinical trial results to the market on 22nd August 2023.
Trial Result Highlights are below:
• Completion of initial imaging case studies using an advanced AI-powered probabilistic imaging technique being developed by the Company.
• Confirmation of 100% scan success rate through Stage 1 of EMVision’s clinical trial for production of processable signals with mean time for completion of full workflow and brain scan of 9.2 minutes.
• Device met safety objectives of Stage 1, with no patient adverse events nor any adverse device effects occurring.
• Latest imaging case studies will be presented at Stroke Society of Australasia (SSA) conference alongside an abstract on Stage 1 clinical trial insights in press at the International Journal of Stroke.
Particularly encouraged by the statement made by the Principal investigator at Liverpool Hospital Dr Dennis Cortado. He commented “This is an exciting development in stroke and neurological care. We have found the EMVision scanner to be a very user-friendly portable imaging modality. The EMVision scanner has the potential for wide application in both the prehospital and acute hospital settings.”
EMVision Medical Devices Limited (ASX:EMV) price target maintained based on APPENDIX 4C – 30 June 2023 QUARTERLY ACTIVITIES & CASHFLOW REPORT
EMV management are continuing to achieve milestones they have set.
Strong likelihood that future targets can be met and non-dilutive funding provided as a result.
• Gen 1 device multi-site clinical trial progressing with positive momentum. Stage 2 has commenced with targeted 150 patient recruitment expected to be achieved within Q4 CY 2023 based on current recruitment rates.
• Original Equipment Manufacturer (OEM) Agreement with Keysight Technologies (NYSE:KEYS) for the customised VNA renewed for a further 12 months, on substantially equivalent terms. Keysight and EMVision will be jointly showcasing EMVision’s breakthrough point-of-care scanners, which incorporate Keysight’s VNA, at the 2023 Radiological Society of North America Scientific Assembly (RSNA) annual meeting in Chicago this November.
• Gen 2 device development progressing well, on track to have an advanced prototype fabricated by quarter’s end, for further bench testing and subsequent healthy human volunteer testing.
• The Company is well-funded with cash reserves of $9.9 million and $4.45 million in non-dilutive grant funding remaining as at 30 June 2023. EMVision benefited from substantial non-dilutive cash funding in the quarter of $2.35 million from the Modern Manufacturing Initiative grant ($1.75 million) and the ASA ($0.6 million).
EMVISION has today announced that their clinical trial enrolment is progressing well and the Australian Stroke Alliance (ASA) project enrolment milestone has been achieved.
• All three clinical trial sites now enrolling, with Princess Alexandra Hospital, Brisbane now live.
• Enrolment milestone reached under Project Agreement with the Australian Stroke Alliance (ASA) to trigger a further $600,000 non-dilutive milestone payment.
• Maintaining excellent enrolment rates, exemplifying the non-invasive and user-friendly nature of the EMVision brain scanner, alongside the dedication of our clinical research collaborators.
• A successful outcome from the pre-validation and validation trial phases will demonstrate that EMVision’s portable brain scanner can provide crucial insights that enable clinicians to make critical decisions earlier in stroke care, when time matters, at the point-of-care. In addition, it intends to generate the prerequisite data for major market regulatory submissions, including FDA.
EMVision Medical Devices Limited (ASX:EMV) has advised that Stage 2 enrolment has started at their second clinical trial site, The Royal Melbourne Hospital.
The Royal Melbourne Hospital is a comprehensive stroke care centre with a world renowned tertiary academic unit that provides leading care for patients across Victoria.
In addition, enrolment at their first clinical site Liverpool Hospital, has exceeded initial recruitment rate expectations. The third site, Princess Alexandra Hospital in Brisbane, is anticipated to go live in the coming weeks. Stage 2 will enrol up to 150 acute stroke and stroke mimic patients presenting to the Emergency Departments of the three hospital sites. EMVision states that it is encouraged by the early progress with enrolment and grateful for the excellent support and commitment of its clinical collaborators.
Pleased to know that Stage 2 recruitment in Liverpool Hospital was "oversubscribed" and that recruitment is being achieved according to previously stated timelines.
EMVision Medical Devices Limited (ASX:EMV) today advised that it has received a cash progress payment of $1,750,000 under its Modern Manufacturing Initiative (MMI) grant award.
EMVision was awarded $5 million under the Federal Government’s MMI Medical Products Translation stream to establish commercial production of EMVision’s world first portable brain scanner 1st Gen product. EMV states that pleasing progress has been made against project milestones under the program, including design verification, progression of systems testing and certification, and preparation of technical documentation for release of the product in its multi-site clinical trials. In addition, activities to set up production layout and processes, alongside work and test instructions have progressed well. These are prerequisites for product verification and validation activities that form part of regulatory submissions and for the establishment of commercial manufacturing capabilities. The final project milestones ‘manufacturing capability established’ and ‘first production run’ are anticipated to be achieved before May 2024 under the program, which is when the final grant payment of $1,250,000 is due.
Happy to continue holding EMV as they remain on track to reach their target of commercial viability in FY2025.
Not much of a contribution on my part but can confirm what @TycoonTerry is saying.
At the moment mobile stroke units using CTs (about US$1.2m capex and US$1m in opex for staff) are used primarily to direct patients to best point of care e.g. a primary stroke center.
Downsides to CT include the need to stop traffic while taking image (vibration distorts image) - not ideal.
This has roughly led to patients being treated 45 minutes faster than they otherwise would with every second having a pretty profound impact (1.9m neurons die a minute - it can be the difference between walking and being confined to a wheelchair).
So I would agree that the question is not whether there is a clinical need, but whether their device can prove comparable (at a minimum) to the current standard of care. Given the clinical risk involved in making a type II error (null hypothesis being ischaemic stroke) I imagine they will need a lot of data to back it up and a lot of time/education before clinicians are confident in the device.
If it delivers there is a key cost benefit (capex + opex) which will allow for mobile stroke units to become widespread.
Also would like to highlight that while its natural to have a "Aus" centric view of this companies future, the opportunity is most likely to be furnished in the US.
^info above came from NY based stroke neurologist
I dont exactly agree with what @Silky84 has said, but might further clarify that the functional outcomes that are achieved via any method of stroke treatment (thrombolysis or clot busters Vs thrombectomy) are more dependant on 'time to treatment'. Regardless of opinions on treatments, we can all agree on time equalling functional tissue.
It is correct to say that this technology could have some say in that department. HOWEVER. I dont see this reinventing the treatment cascade anytime soon. Consider that this trial is occurring in the hospital, i.e the patients are already in hospital with their symptoms. It is a phase 1 trial really just aiming to prove the method of scanning is not INFERIOR to a conventional CT or MRI. In essence, the sole goal of these initial scans are to determine 1: are these symptoms actually caused by a stroke and 2: is the stroke embolic (clot) or haemorrhagic (bleed).
I dont have the data to back this up, but I was a Paramedic in a past life and feel that it is fair to say most, if not all patients who have an acute, i.e treatable stroke arrive at hospital via ambulance. In the past I have written that I would avoid investing in this company with the longest pole I could find, based on information at the time that the clinical trials would be run with NSW Ambulance service. I said this because I know the logistic hurdles and government red tape that would be involved.
Now sure, further down the road, if this tech was proven to be non-inferior to conventional imaging in regards to quality AND time to acquisition of image. Then there could be a compelling arguement to put one of these scanners in the back of an ambulance, and recognise TREATABLE strokes earlier, and expedite that patient to a hospital that has the facilities to provide that treatment.
Consider an example where perhaps a patient is taken to a hospital that does not provide these treatments who could instead be identified sooner and just taken directly to the best place. In Sydney, as a general rule any patient who presents with 'stroke like' symptoms within 4-6 hours will be taken (by ambulance) to one of the big 5 or 6 hospital that do currently do this. So another consideration would be 'does the time taken to acquire the image in an ambulance actuallly change the destination', or furthermore, does it change the 'time to treatment'? Personally, I would argue that in a metropolitan area this would not be the case. The next step to that line of thought would be 'what about regional and rural?'. For example an area like Lithgow or semi urban. This WOULD make a difference (if the tech and time to acquisition was proven non inferior).
I am still steering well wide of this from an investment point of view, but to answer all the above questions + the nuance and all the other things I havn't considered I would say would take a minimum of 5-8 years. Trials, phase 1, 2 + 3 including data saturation and proving benefits against conventional CT..... Any doctor in this chat can attest to how freaking fast a CT is these days, at least in the ones I have been involved in from my Paramedic days where we would call ahead and would transfer from the ambulance bed to the CT scanner, hit the button and the radiologist would give a verbal report on 'clot vs bleed' on the spot. Pretty cool, also pretty hard to disrupt.
something to consider- having acces to rapid portable scans to aid stroke diagnosis seems like an amazing tool to have at our disposal. However it is worth knowing that the treatment which rapid scans enables to occur, stroke thrombolysis, is yet to be proven to work! (A controversial statement which currently induces rapturous debate between neurologists and emergency physicians) It is a potentially life threatening treatment for a non life threatening, but function threatening illness.
emergency clot retrieval- an alternative treatment to thrombolysis- requires a huge level of expertise and is currently only offered in a few large tertiary centres in australia and around the world
the above arguement has nothing to do directly with EM visions technology development. But an important consideration in the area in which they intend to operate. I dont really have any thoughts on current valuation and i may be completely overthinking things
Hi all, first ever straw since joining as Premium member last week. Overwhelmed as a newbie with the expertise here!
Was totally engaged in the EMV session this morning. It was my first intro to the company but I have a bit of affinity for new technology companies across industries, so was able to follow and see the opportunity. Post the meeting, and following a quick review of the straws here, I opened a small starting position in EMV, in my SMSF portfolio, as well as my Strawman portfolio to "get into it".
Here are my notes from the meeting and throughts thereof. Likely to be mistakes as I went off memory, but this was what drove my investment decision.
KEY TAKEAWAYS FROM 21 FEB 2023 ZOOM SESSION
An encouraging start to EMVision's year long clinical trial of their brain scanning device.
Of course, it's very common for things to fail in the final stages when it comes to clinical trials (or at least not be as good as expected). So it's not something to get too excited over, in and of itself.
Still, nice to hear things are off to a positive start.
Will no doubt get a bit more detail from Scott when we meet with him later today.
Definitely looks like the insiders know something is coming.Chart looks very nice, should keep going up. Good luck.
Mary Lou Jepsen, the CEO of Openwater.
Picked by: Jeff Huber, a cofounder and general partner at Triatomic Capital (Huber sits on Openwater's board but is not an active investor in the company)
What it does: The San Francisco startup is working to improve imaging in medicine.
Funding raised: $40 million, PitchBook said
Why it's poised to take off in the next year: Openwater was founded by CEO Mary Lou Jepsen, a former Facebook and Google executive who helped design the Oculus. While Openwater has been around for six years, Huber said it's poised to take off as it expects to publish its first use case in a medical journal within the next 12 months. The startup has developed imaging technology that can detect strokes faster, which could help improve patient outcomes.
The device — a wearable electronic headset — could potentially be used in ambulances to help first responders figure out if someone is having a stroke caused by a blocked artery or uncontrolled bleeding. The two types of stroke have similar symptoms but are treated differently. Openwater's approach could bring MRI-like imaging directly into ambulances at a fraction of the traditional cost. "The implications for global health and affordability and accessibility are huge," Huber said.
EMVision is in a trading halt pending an announcement in response to a Government media release:
I believe this is the media release they are referring to:
Obviously, the Government didn't give them a heads up before the announcement, but I suppose they are more focused on getting out the message ahead of the election :)
Anyway, seems like it's good -- albeit not Earth shattering -- news
Emvision just sent me a research report from MST Access. You can read it here:
Note, this research report was commissioned, so it's no surprise it gives an extremely bullish valuation. While the current market price of EMV is $2.06, MST believe shares are worth $5.52.
Although they provide some forecasts, there's no information on how the valuation was derived. EG. They see the business as loss making out to FY24 and indeed, assume a market cap that is only slightly above the current level at that point.
Personally, i'm extremely sceptical of paid for research -- the result is ALWAYS going to be favourable. (I bet if i paid MST to value the local corner shop they would say it's worth $10m!!)
Anyway, thought i'd share it here anyway. You'll also see a link in the report to a video EMVision has done (here).
I have a very small position, mainly as a watching brief. I like the tech and think it has good potential. But it's still quite risky and will take several years before it starts to play out.
EMVision looks optimstically valued to me. Here's my valuation after the site visit @Strawman arranged last week. But I acknowledge that with a pre-revenue business, it all comes down to assumptions and perceived likelihood of them achieving commercial success. So I put together a valuation for a base case if they succeed, but then adjust that down given the majority of companies at a similar life stage won't succeed.
1. Guide for sale per unit US$150k (they have stated this several times)
2. Consumables per unit per year: US$50k (based on some insights they gave us at site visit)
3. Length of life per unit: 5 years (they have stated this several times)
4. Avg rev per unit per year (capital and consumables): (US$150k + 5 x US$50k)/5 =US$80k (and this is close to what they suggested at the site visit they might be looking to charge for a subscription/service model as an alternative to a capital purchase model)
5. Addressable global market: 20,000 units (they have said in a couple of different forums there are about 10,000 potential sites in the US, so doubling that for the rest of the world)
6. Penetration: they would be doing very well to get 10% = 2,000 units in 10 years times
7. Rev per year in 10 years time = 2000 units x US$80k per year = US$160m/yr
8. Net income: 10% margin (roughly what Nanosonics has achieved in recent years) = US$16m/yr
9. PE: 25 (at penetration of 10% they would be doing well to be growing at 15%, so a PE of 25 seems reasonable) = market cap of US$400m in 10 years
10. Additional capital raising over next 10 years: 20% (they will almost certainly need more money before they become self-sustaining and acknowledged as much at the site visit, plus likely options vesting if they succeed) = US$400m/1.2 = US$333m market cap based on current outstanding shares
11. Discounting 10% per year across 10 years gives current market cap of US$128m today
12. Convert to A$ = $170m valuation IF they succeed
13. Adjusting down given majority of similar businesses won't succeed: $170m x 0.8 (assumes about 30% chance of achieving or exceeding the above level of success) = A$136m risk-adjusted valuation
14. Divided by 77.3m shares on issue = $1.76 per share
Big picture, I think there's a lot of optimism already baked into the current price. Not a bargain and not enough room for error in my view. But of course, if you have a different view on some the above assumptions, I can see how someone can come up with a vastly different valuation.
A brief overview of EMVision ahead of our chat with the co-founder this Thursday, Scott Kirkland (a substantial shareholder with a 5% interest in the business).
The business is attempting to develop and commercialise a portable brain imaging device to diagnose and monitor strokes. This is traditionally done using CT and MRI scanning, which remains the gold standard, but are very large, expensive and limited in availability.
The EMVision device (below) has been in development for around ten years, with the work being pioneered at the the University of Queensland. It has the benefits of being very low radiation (less than an iPhone), portable (comparable to an ultrasound device, and the 2nd generation device can actually be installed in an ambulance) and fast (can render images in 30 seconds). If you know anyone who has had a stroke, you'll know that early detection and treatment is critical -- the so-called "golden hour".
A recent trial was conducted, comparing scan results with MRI images. As can be seen below, the EMVision scans (middle and right) aligned exceptionally well with the MRI standard, and are also able to distinguish between the two types of stroke (clot or bleed)
There's a broader trial due to start this year, and the company has already engaged with the FDA's breakthrough technology program, as well as having early discussions with potential manufacturers and distributors.
One interesting tidbit i learned was that the company has so far met all of the milestones it has presented to the market. Followers of this industry would know that this is pretty rare.
The market is, of course, massive, and as far as I can tell there's no comparable device in development (although this is something to check in our meeting).
The CEO, Dr Ron Weinberger, is a former Executive Director and CEO of Nanosonics (ASX:NAN) where he helped develop and successfully launch their Trophon disinfection device. He holds around 1.9m shares. He gives a good overview of the business at an ASX presentation last year (see here)
As with Nanosonics, the company is looking to deliver the device on both a capital sales and subscription basis. The former of which also has a (very high margin) consumables component (a cap for the patients head I believe). There will also be servicing and training revenues. The device is expected to be priced at around $150k on the capital sales model. For comparison, an MRI machine can cost upwards of US$1.2m (based on a quick google search -- any medicos let me know if that's not correct)
The company listed in late 2018 and has yet to generate any sales revenue (although has other income of around $1.8m from grants and R&D incentives etc). Last year it had about $10m in costs and currently has around $10m in cash at hand.
All told, this is a very early stage company that is likely at least a couple years away from a successful commercialisation. Given costs and the cash balance, i'd expect at least a few capital raisings ahead. It will almost certainly be extremely volatile.
That being said, the technology is progressing well with some very encouraging results to date. The market opportunity is massive and the business is led by a team of experienced players with a lot of past success in this space. At a current market valuation of $192m, and given it's stage of development, it's probably comparable to Nanosonics in (roughly) 2010.
As was seen there, a successful commercialisation led to a 10x return for shareholders from that point over the following decade. BUT, as we've also seen plenty of times before, the path to commercialisation is fraught with difficulty and companies can bleed huge amounts of cash along the way...
If you have any questions you'd like me to put to Scott, you can do so here
Personally, i'll be looking to get a sense of the expected cash burn, timelines for regulatory approval, milestones for product build and distribution partnerships.
Ice cold water bear case:
The headlines on this do look good I will give it that, its a headline grabbing breakthrough if it was to work and I am certainly not saying that it wont, its just at least 5-10 years minimum away.
I work for NSW Ambulance and study medicine, currently NSWA is in discussion with another company called medfield who have developed a similar device, they might even be collaborating I am not sure but just wanted to add context. https://www.medfielddiagnostics.com/products/.. Look at the strokefinder product.
Discussions are between NSWA and a European Ambulance service to run pilot study for efficacy. If NSWA is chosen it would be run in Newcastle NSW and this is where my context begins. As Chagsy has said, most Paramedics would not feel comfortable making these sorts of decisions, (specifically because there is a long term 'risk off' attitide by both clinical and management staff'). Extending from Chagsy comments about number needed to treat. Consider how many strokes are required to be identified and run through the trial when it is only operating in Newcastle with Paramedics involved feeling skeptical and out of depth.
From a simple investment thesis approach the problem is definitly there, however I dont see this as the solution. If there was telehealth involvement of medical radiology experts looking at the same scans (this might be in the plans im not sure) then it has more of a chance but I would be steering clear.
Hi again General,
Thanks for the update regarding 2nd generation scanner and revised strategy.
I hope you dont mind me adding some more cold water. Sorry!
Some years ago there was much excitement regarding thrombolysis (clot busting drugs) for ischaemic strokes. There was clear evidence of benefit for using thrombolytics in heart attacks: the thrombolytics were given in through a drip, dissolved the clot that was blocking the blood and oxygen flow getting to a part of the heart. The oxygen starved section of heart (and patient) got better. A small percentage of patients had life-threatening bleeds into their guts or brain for example. A number of them died, but mostly the risk of giving the drug and stopping the patient dying from a heart attack significantly outweighed the risk of dying from a heart attack. Studies were done proving this, with 10s of thousands of patients.
here is a link showing the numbers of pooled results from multiple studeis showing that the "number needed to treat" (NNT) to cause a good outcome, vastly outweighs the NNT to cause harm.
For years, in medicine we have argued about the risk:benefit ratio for thrombolysis in acute ischaemic CVA. The studies done were never of the same size (couple of hundred) which reduces the power and statistical validity. A bunch got stopped halfway through as they caused more harm than good - never a good look. Most of the push to use thrombolytics came from the AHA (American Heart Association) and people questioned what they were doing poking their oar into a neurolgocial condition. The spotlight beam sharpened when it was pointed out that their (the AHA) major financial sponsor was the manufacturer of tPA (which just happened to be the drug used for thrombolysis). And so it went on. A new study would come out and the talking heads would be dissecting the numbers to validate their underlying biases.
It is likely that, on balance, thrombolysis is helpful in a carefully selected group of patients who are younger, present earlier, have just the right size of stroke and no contra-indications:
That is the premise for this product: identify these patients in the driveway, prove they have an ischaemic stroke and give them the brain saving thrombolysis.
Only problem is that we dont give thrombolysis anymore. We do clot retrieval. The patient is taken to a stroke hospital to have the catheter thingy I talked about earlier, fed up into the artery supplying the brain to suck out the clot. NO thrombolysis.
There is a case for something called "bridging thrombolysis": if a patient accidentally goes to a hospital without clot retrieval, gets a scan proving the "goldilocks size" and time of Stroke, have it discussed with a stroke team, get accepted for transfer for clot retrieval and have no contra-indications for thrombolysis; then thrombolysis is useful - probably. (I have done it once in the last 15 years of working as an Emergency Physician).
So, to apply these thoughts to pre-hospital thrombolysis:
patient gets loaded into back of ambulance with a possible stroke
establish that the stroke is within the time window for treatment (longer time = greater chance of bleeding and death or bad outcome if given thrombolysis)
establish the stroke is of goldilocks size (usually performed by a stroke physician or at a push an Emergency physician with an interest). But in this secenario, by an ambulance officer - I can't see them being overly keen to take that responsibility!
put the scanner on the patient and run the scan
get the result and have a scan with sufficient accuracy that it has a zero chance of misinterpreting the ischaemic stroke as a bleed (or you kill the patient)
Adminster the thrombolytic the drug, and drive off to the stroke unit.
All that has to happen faultlessly in one cohort of patients.
Then you have to compare that cohort of patients to the current standard of care and prove that patients will do better with our new fancy scanner + driveway thrombolysis option. You would need to run a trial with 100s and likely 1000s of patients to demonstrate an improvement in outcome. This will take many years to recruit into and run, and cost millions of dollars. There is a very real chance of it causing more harm than good (my guess is that this would indeed be the case).
And finally, as per previous, you would then need to demonstrate a cost:benefit case to convince health providers that this is worth the dollar spend, as opposed to every other good idea and interest group out there clamouring for funding.
Jeez that went for a bit longer than i intended, but I hope I have demonstrated just how difficult it is to make any money with a new "medical breakthrough". I lost money hand over fist when I started out investing, mostly on just such companies. I am not going back there again. High ROE, high margin, low cost of capital, no/low debt, structural tailwinds, predominantly FCF positive and asymmetric risk companies for me from now on.
All the best
Totally agree with @Chagsy, largely why I have avoided this one. Its also a fairly competitve space albeit with different approaches. IMO many investors are likely backing the man (ex NAN) rather than focusing too much on the detail.
It's great to see an evolving medtech company on the ASX. This is an amazing bit of technology, however.....
They are a long, long way away from demonstrating a use case, and even further away from demonstrating an adequate accuracy to guide management, and yet a few steps further away from demonstrating an improvement in clinical outcome and then a step or two to demonstrate a cost:benefit advantage over current managment.
They are targeting acute stroke as their clinical indication for use. There are two types of stroke, a bleed (haemorrhagic) and a blockage in an artery (ischaemic).
The treatments for each are quite different. Specifically, to treat ischaemic strokes drugs that thin the blood are given which will make a haemorrhagic stroke worse, potentially with a fatal outcome. In some instances a clot busting drug can be given (like for heart attacks). This is not a low risk proposition even if given for ischaemic strokes. If given for the wrong type of stroke ie a haemorrhage stroke, one can safely assume the patient will die. However, clot using drugs are nowadays used less and less as acute ischaemic strokes are currently managed with something clot retrieval. Here a catheter is inserted into the blood vessels in the brain and the offending blood sucked out, thus restoring blood and oxygen flow and limiting the damage to the brain.
Their most recent study on data sets at the PA hospital in Brizzy, shows the ability to differentiate between a haemorrhagic and ischaemic stroke of 93.3%. Which doesnt sound bad, but means that if we were to use this product in its current set up we could kill up to 6.5% of patients for, as yet, no demonstrated advantage (were clot busting drugs used, or huge resource overuse if clot retrieval used). There is a long way to go for this use case, just to prove equivalence in accuracy. You would then need to demonstrate that the time saved by using a bedside scan as opposed to putting the patient through a conventional scanning technique which is all of 20m away in most hospitals, translates into a meaningful improvement in mortality and morbidity (death and deficit) - I have no confidence that this could be achieved.
That is the use case for this scanner within the emergency department.
It may have a better use case in the pre-hospital setting. The theory being that potential stroke patient can be identified at the scene and then transported to an acute stroke unit facility that can offer clot retrieval. Currently, patients that have symptoms of a an acute stroke are transferred to stroke units. It doesnt matter if they could be an ischaemic or haemorrhagic stroke. Given that 87% are ischaemic strokes, the number of haemorrhagic strokes transported unnecessarily to a clot retrieval facility is low. Applying the converse situation, what happens to the ischaemic stroke patient that is not transported to the correct facility ? They have a potentially far worse outcome that was entirely preventable under the old system. Medico-legal pay-outs related to this scenario would be punitive.
Like any other investment thesis, I would start with "what problem does this solve" and "how well does it do it".
Currently my feeling is "I dont know" and "not very well".
Now, it may be that with further training of the data sets this scanner becomes very accurate. Even then, the cost of trials to demonstrate its safety and efficacy will be prohibitive. The medical approval process is incredibly slow and expensive and has a very poor success rate.