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SIR: 'OK, Google -- Scrub Up!'

Okay Google Scrub Up

March 25, 2019 -- Smart speakers like Amazon Alexa and Google Home already get plenty of questions about the weather, but the technology could soon make a meaningful contribution to patient outcomes during surgery, according to a Sunday presentation at the Society of Interventional Radiology (SIR) annual meeting in Austin, TX.

Researchers at the University of California, San Francisco (UCSF) have developed an application using a Google Home smart speaker that takes questions from interventional radiologists and surgeons about the correct size of a device for a particular procedure. It answers those questions with a recommendation from which the physician can make a final, informed decision.

"This research project is about asking the question: How can this powerful and fundamentally different technology be harnessed to offer value to our patients in the hospital?" said presenter Dr. Kevin Seals, a fellow in interventional radiology at UCSF. "To this end, we created a variety of tools, with this particular study focusing on the use of smart speakers for issues related to the sizing of medical devices, a common and fundamental challenge during procedures."

Bringing Google Into Surgery

Interventional radiologists and surgeons often face the challenge of how to take advantage of software and computers after they have donned their sterile scrubs for surgery.

"You put on those sterile surgical gloves and suddenly you lose one of your modern superpowers," Seals said. "You cannot touch a smartphone, use a tablet, or operate a computer. In some sense, you are robbed of modern technology."

At the same time, interventional radiologists have a multitude of devices available to them. Their options increase almost daily, as new interventional techniques and devices are developed. Needless to say, it is a daunting task for any interventional radiologist to keep pace with the technological advances and specifications of newer tools.

"Currently, when there is a question around sizing, the workflow involves having a member of the team dig through a dense manual for device specifications to retrieve the sizing information," Seals said. "That approach is cumbersome, inefficient, and takes time and attention away from direct patient care."

To overcome these constraints, the researchers developed a device-sizing application for use with the Google Home smart speaker. The application processes questions from a human voice and provides recommendations on the correct size of a medical device.

For example, a physician may need to know what size sheath should be applied to a particular type of stent for a patient's blood vessel. The smart speaker could quickly and accurately communicate the most appropriate size based on the specific circumstances of the surgery.

'Technological Magic'

"The technological magic that enables tools like this comes from advances in machine learning and natural language processing," Seals explained. "These tools can understand human language in a rapid, sophisticated way that was previously impossible."

The researchers implemented natural language processing using a program from Google called Dialogflow, which is designed to quickly process and understand a physician's question. An extensive literature review also was performed to compile the medical content and device-sizing information for 475 interventional radiology devices, including catheters, sheaths, stents, vascular plugs, and other accessories.

"As a result, we were able to build a helpful tool for interventional radiologists that can provide critical information almost instantaneously, all while the physician stays in a sterile surgical scrub," Seals said. "While this tool is powerful and useful, it represents an early step in what will likely be a transformative technology in healthcare, with smart speakers and voice analysis offering an enormous array of useful medical tools in the future."

In fact, Seals and colleagues have already created an application that allows physicians to assess device cost information during a procedure. It is a "topic that many interventional radiology physicians know all too little about," he contended. "If we can assess the cost of a particular piece of equipment in a millisecond, we may be more inclined to make economically thoughtful decisions."

Inventory And Privacy

The researchers also hope to develop a tool that could query a hospital's inventory to determine what equipment or supplies are readily available. For example, one could ask how many 6-mm stents are currently in stock. Right now, someone would have to leave the procedure, walk to an inventory storeroom, hunt down the article, and report back to the operating suite. Such a process is "superinefficient, and we can do better," Seals said.

There is still some fine-tuning to perfect the smart speaker technology for interventional radiology and healthcare in general. One issue is the need to ensure patients' privacy rights under HIPAA.

"That is clearly a significant challenge and something to think about very carefully," Seals said. "It is something that we have to execute perfectly before this [smart speaker technology] can be used practically in the clinical setting. In the future, there are clear pathways to take care of that, and given the value that it offers to our patients, we will find a way to get it done."

There has been considerable discussion about both Google and Amazon releasing a HIPAA-compliant smart speaker; both companies are interested in engaging physicians to work on these types of projects, he said. Other companies are also developing new smart speaker hardware with clinical use cases in mind.


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