Jan 12 2012

Tricorder X-Prize

I love the X-Prize concept, and I love the concept of a Star Trek style tricorder – so both in one is awesome squared.

At the Consumer Electronics show in Vega, Qualcomm announced their tricorder X-prize – $10 million dollars for the first group to produce a device that weighs less than 5 pounds and is capable of non-invasively sensing a variety of health metrics (like temperature and blood pressure) and diagnosing 15 diseases.

The details are not available yet, and the specific rules for this contest have not been formalized. I am particularly interested in what the requirements will be, for the sensors to be either remote, allow direct contact to the subject, or will it also allow any invasive techniques, like drawing blood or other fluid.

It seems that one key feature will be that all of the diagnostic modalities have to be contained in one small (5 pound limit) device, but that device can have as many components as necessary.

A few thoughts come to mind:

The X-Prize

Regarding the X-prize concept itself, I think this is a wonderful idea. It creates a dramatic competition for some technological breakthrough, like commercial spaceflight, a driverless car, and now the tricorder. Winners are likely to spend more getting to the finish line than the prize dollar amount, but they come away with more than cash – they have the prestige of winning (good for garnering investors) and the working prototype of some technological breakthrough.

I also like the publicity of the X-prize,  making science and engineering exciting and dramatic. This seems like it would be good for public interest in science and technology.

In terms of practical utility, there is a sweet-spot to the X-prize concept: prizes are best offered for technology that is on the cusp, or the basic components are already in existence, but there needs to be a concerted push for a specific application – putting all the pieces together. If the technology is not enough of an advance, then there is no point to the prize and some private corporation is likely to achieve the goal without the X-prize.

If, however, the goal is too far away, then the X-prize will likely be disappointing. I don’t think you can achieve a specific technological goal simply because you are working toward it and offering a prize. The potential has to be there. We might offer an X-prize for someone to design a space elevator, but until we have a material that can stand the stress the space elevator cable would be under, it’s mostly pointless. A technology has to be “ripe”.

Tricorder Technololgy

Is the tricorder ripe for invention? It depends on the parameters. If it has to be entirely non-invasive, and/or entirely remote, then maybe not. We are getting better at getting some health information non-invasively. For example, we can put a little device on your finger and with light waves alone it can tell how much oxygen is in your blood (pulse-oximetry). The skin is transparent enough to allow for this, which you can see for yourself by placing a flashlight behind your hand.

How many other blood parameters can we determine with this same approach? There is already research looking at using spectroscopy techniques to measure blood glucose levels (which would be a boon to diabetics). Spectroscopy, or a similar technique, is a good way to remotely sense chemicals and elements and if highly developed could be a major part of a tricorder – measuring blood parameters that now require a blood draw.

Temperature is easy, we can already measure that with infrared sensors. Blood pressure is more tricky – for that you need a pressure gauge somewhere. Currently pressure is measured with either a blood pressure cuff, or more invasively with an arterial line. Incorporating an automatic blood pressure cuff into the tricorder might strictly meet the criteria for the X-prize, but would be a decidedly low tech way of accomplishing this.

Brain waves and heart electrical activity can already be measured with surface electrodes. If this is acceptable then this should be easy to incorporate into a medical tricorder. Given the goal of the prize the procedure for each would need to be simplified. Right now you have to place electrodes in a specific pattern that requires some training, or at least detailed instructions.

Ultrasound devices are also non-invasive and portable, but tricky to perform and interpret.

We are still a long way away from a true Star Trek tricorder that simply bleeps and whines and gives all sorts of medical information. But we can duplicate, or are close to duplicating, many of its functions with physical contact or minimally invasive procedures.

Another part of the tricorder X-prize is not just gathering health metrics but putting it together with software that can spit out possible diagnoses or problems to be addressed, and make basic recommendations – like seek medical attention urgently, or relax and go to bed.

Practical Applications

The creators of the tricorder X-prize talk about putting medical information in the hands of the public.

“Qualcomm strives to provide a means to see choices, make decisions and get the right care faster and more conveniently. We believe this is a fundamental step in helping people become true ‘Health Consumers’ who can have as much say in assessing and accessing healthcare as they would any other service or product,” said Don Jones, Vice President of Wireless Health Strategy and Market Development at Qualcomm Labs. “Qualcomm believes the value of this X PRIZE is also in changing the cost structure and focus of healthcare. By having consumers take the initial actions to obtain health assessment data, the use and the quality of physicians’ time is improved.”

Like all new technology, it is very difficult to imagine what specific niche it will fill until it actually gets into the hands of end-users. Microwaves were designed to be a cooking tool. It turns out they are a terrible cooking tool, but a wonderful heating tool. The internet itself went through a bubble where many applications were tried and failed, and a few home runs survived (like E-bay). Personal hand-held computers are going through a phase of trial and error – which applications are indispensable, and which are fads that will turn out to not be that useful? The Segway did not change the face of personal transportation, but is really useful for mall and airport security.

The vision described above of how a tricorder might be used seems to me to be in the preliminary naive phase of thinking about new technology. It also lacks a medical perspective. What I think they get right is that it will be useful to have many easy to use diagnostic modalities in one portable device. This kind of thing probably won’t be used in hospitals, but in remote areas, in poor areas without access to hospitals, perhaps in the military on the front lines, and in similar situations it may be very useful.

Also, the individual components of the tricorder may provide useful breakthroughs – like non-invasive instant blood analysis. I can see having such a device on every hospital floor, that nurses or technicians wheel around gathering a variety of health parameters, and reducing the need for blood draws. Abnormal or critical values can be followed up with more direct blood analysis, but the routine daily blood monitoring draw can be reduced or even eliminated.

Similarly, having an automated electroencephalogram (EEG) that can easily be performed with minimal instructions and no training would move that diagnostic test (at least is some cases) from a scheduled laboratory test to a quick office test.

The question of the consumer using a medical tricorder for self-monitoring or diagnosis is tricky. I am sure this will happen when the technology allows for it. You can already get automatic blood pressure monitors, for example. Which such tests will be useful remains to be seen, however. I would not take the naive view that all information is useful and positive. There is such a thing in medicine of too much information.

Frequently monitoring parameters that are likely to be normal will probably reveal fluctuations that should be ignored but are likely to be scary to the average person, especially the neurotic type person who is likely to frequently monitor their health parameters. This can lead to unnecessary utilization of health care resources, and even to unnecessary follow up tests and procedures.

A lot of research has shown that it’s best to ignore background fluctuations in asymptomatic individuals, and not to monitor parameters unless there is a specific evidence-based reason to do so. Unnecessary monitoring often leads to net negative health outcomes.

Perhaps this can be dealt with in the software, but screening procedures are designed to be highly sensitive and not very specific – to overcall possible problems so they can be followed up with more specific tests.

Conclusion

The tricorder X-prize is an exciting addition to the X-prize concept, and I hope that it yields fruit. This is a complicated prize, however, and it will be tricky to operationally define the goals and criteria. Everyone acknowledges that we are nowhere near a true Dr. McCoy style tricorder, but what will be an acceptable substitute?

It is likely that research into developing such a device would yield specific components that would be very useful to medicine, although such research is already ongoing.

Having one small portable device also has possible applications, but it remains to be seen what they would be in practice.

I hope the designers of this prize don’t allow for someone to simply put together existing technology into a small device and claim the prize. You could theoretically have a small computer-driven device that combines EEG, EKG, pulse oximetry, blood pressure, respiratory rate, and temperature measurement, with a basic diagnostic algorithm (which also already exists), and claim victory. An iPhone is more than powerful enough for this, and each of the individual components listed can be quite small.

I-phones also already have cameras in them which could be used to visually analyze skin, facial symmetry, perhaps even pupils and other features – the trick here would be all in the analysis software.

By picking all the low-hanging fruit, a “tricorder” could be made from existing technology. I hope they consider this and hold the prize out far enough (in the sweet spot) to require some true innovation to capture the prize.

Share

6 responses so far

6 Responses to “Tricorder X-Prize”

  1. ChrisHon 12 Jan 2012 at 12:40 pm

    Dr. Novella:

    You could theoretically have a small computer-driven device that combines EEG, EKG, pulse oximetry, blood pressure, respiratory rate, and temperature measurement, with a basic diagnostic algorithm (which also already exist), and claim victory.

    Our experience with EEG and EKG is that there has to be pads placed in some general areas. The month long Holter was fairly simple, but I remember washing the EEG muck out of a little kid’s hair.

    Recently the young man had some issues with his heart rate and I could not get the home blood pressure monitor to even work (it would pressure up, count down, not give a reading and start up a again). Then his speech became disorganized and 911 was called. Turned out to be a complex migraine.

    My wish is for a tricorder is that it work reliably, and perhaps tell the difference between a complex migraine and a stroke (though that is really dreaming, though it is fortunate we live so close to both the fire station and hospital).

  2. Steven Novellaon 12 Jan 2012 at 1:07 pm

    For EEG we sometimes (at least we used to before we had round the clock emergent EEG services) do what is called a “hairline montage” where we connect electrodes along the forehead, and not where there is hair. It gives a poor EEG but good for a quick look (is this guy having a seizure).

    Imagine if you could do something similar with a single strip place along the forehead, self sticking, no goo, and easily removed. The technology would have to be developed to get and interpret sufficient information from this limited array of electrodes.

  3. howdinion 12 Jan 2012 at 2:30 pm

    Are you sure that was the CES show in Vega, and no Rigel 7?

  4. ChrisHon 12 Jan 2012 at 4:49 pm

    Dr. Novella:

    The technology would have to be developed to get and interpret sufficient information from this limited array of electrodes.

    Much like what is done for a Holter monitor EKG, where the electrodes are down to about three versus the larger number done in a cardiologist’s office (which include some on the leg and arm).

    The month long Holter monitor had enough memory for three recordings, which then meant going to a phone, calling a toll free number, talking to a technician and then have it transmit (like a fax) the readings though the phone receiver. Modifying a smart phone to take the readings and then automatically transmitting over the cellphone or wifi network would be a great improvement.

    Though, there would still be limitations. Even though my son was diagnosed with “only” a complex migraine, the discharge instructions stated that we should still call 911 if he had the same symptoms. Using my University of Public Library* education I am guessing that the physical measurements (EEG, EKG, pulse, etc) would not distinguish between a stroke and migraine.

    * There was no Internet nor Google when my son was born, and then had seizures, and finally a speech disorder. So I checked out every book I could understand from the library, which were few and far between. And some were downright rotten, like any written by Glenn Doman, plus the book that postulated that boys with high voices and girls with low voices suffered from sexual confusion (which made my son’s speech therapist laugh!).

  5. Captain Quirkon 12 Jan 2012 at 10:39 pm

    All I really want out of this is a way to do routine blood checks without venipuncture. I always faint during venipuncture, and then convulse while unconscious. It’s somewhat protracted (when I was younger I simply had a tonic stiffening of muscled or slight convulsions, but it’s gotten worse), to the point where even when the needle goes in while I’m lying down I’ll fainted and have convulse, waking up with my arm straight in the air and clenched into a fist, then have BP around 60 / 38 while they wheel me to another room and I’m so faint my head is hanging limply backwards and I slide back so the nurses think I had just lost consciousness again, and continue being dizzy on the verge of fainting for the next hour or two.

    I highly, highly doubt that need for blood draws will be eliminated in my lifetime, but I’d rather avoid routine blood draws. IM injections, fingertip-pricking, and the sight of blood have never bothered me, just that one thing.

  6. SimonWon 19 Jan 2012 at 1:24 am

    Someone already put ultrasound sensor on an iPhone which is more than capable of diagnosing 5 disorders, and if you are pregnant, so I too immediately though “what are the rules”. Whilst automatic interpretation is tricky, I suspect it is probably not as hard as some people imagine given the vast computing power in modern smart phones, just there has been little incentive to do it as the technology has been relatively expensive, and a lot of the time it is done on people who have wounds, or who need sensitive handling for whatever reason (sometimes the best place to put the probe can be rather personal), where a professional is available and can move the sensor and interpret the result.

    When I was a naive young physicist I assumed NMR technology would create a larger “tricorder”, since you can determine a lot from these types of signal (and assuming nothing magnetic is attached or embedded or near) without any significant known safety implications, but even if it gets developed further it really isn’t going to work in a handheld device as far as I can tell.

    I’ll hazard a prediction, that the tricorder available before we die will be a smart phone add-on.

    Maybe the “eyes” have it for non-contact device, glaucoma, cholesterol, macular degeneration, other issues with the retina, liver/renal failure. I suspect you could pick up all of these, at least to select interesting cases for review, with a light and cameras (particularly if sensitive to various frequencies to spot refraction changes or temperature changes). You might even get a lot of these with a current smart phone with cheap webcam with light on (I know they have cameras in but probably not suitable to control the light – still worth a try).

    If they want disorders with high confidence that might rule out some approaches. For example easy to detect disorders of the retina with a suitable camera, not always easy to say with confidence the precise cause, not sure this would make the device less useful if the person wasn’t aware of the problem or severity.

    There needs to be clarification on disease or symptom, and also if you can exclude based on tests. For example Graves’ disease is perhaps diagnosable with a camera on the eye (when Thyroid Eye disease is present), but can’t be excluded that way (some people don’t get visible eye problems), also raises the question of whether blatantly obvious disorders count in the 5, blatantly obvious being a movable feast depending on your knowledge, and a popular game with medical students I understand.

Trackback URI | Comments RSS

Leave a Reply

You must be logged in to post a comment.