Fully Automated Transcranial Doppler Ultrasound for Middle Cerebral Artery Insonation

Abstract

Background: Transcranial Doppler ultrasound (TCD) is utilized in the assessment of neurological conditions in clinical environments such as the intensive care unit and emergency department. However, obstacles for widespread use of TCD include a lack of trained registered vascular technologists (RVT) and operator variability. We present a study comparing RVT and a fully automated robotic TCD system (NovaGuide rTCD) for insonation of the middle cerebral artery (MCA).Methods: A trained RVT and rTCD sequentially collected bilateral MCA cerebral blood flow velocity (CBFV) from 86 healthy subjects. Mean CBFV (mCBFV) and the signal quality assessment (SQA) acquired manually by RVT and autonomously via rTCD were compared. Comparison metrics evaluated include mean accuracy ratio (MAR), and Bland-Altman mean-difference (MD) between rTCD and RVT with paired t-Test for significance. Bootstrapping was used in the accuracy ratio and mean-time to best signal computations to establish 95% confidence intervals.Results: The mCBFVs and SQAs found by rTCD compared to RVT had MAR of 99.7% (97.7-101.7%) and 102.7% (101.1-104.8%), respectively. The rTCD mean-time to best-quality signal was 0.87 min (0.71-1.05) (RVT was not timed). The mean-difference scores for mCBFV and SQA were MD=-0.43cm/s (<i>p</i>=0.053) and MD=-0.36 (<i>p</i>=0.61), respectively. The rTCD had a 3.5% no-window failure rate compared to RVT no-window rate of 4.1%.Conclusion: Comparison of bilateral TCD signals collected by rTCD and RVT demonstrated equivalence in mCBFV and signal quality, suggesting rTCD’s potential to expand utility of TCD in clinical settings that are resource-limited.