The invention relates generally to medical devices and more particularly to non-invasive medical devices, systems and methods for the detection of coronary artery disease.
Cardiovascular disease is the leading cause of death in both men and women in the United States, and is a major cause of death throughout the world. According to a 2006 American Heart Association (AHA) report, approximately 80 million people in the United States have heart disease and in 2005, 864,480 people lost their lives. This accounts for 35.3 percent of all deaths or one of every 2.8 deaths in the United States according to the AHA. Cardiovascular cost the health care system approximately $368.4 billion in 2004, accounting for nearly a third of the trillion dollars spent on health care in the United States each year, again according to the AHA. Patient care accounts for 90% of this cost.
The health care system would benefit tremendously by identification of those individuals at high risk for coronary related attacks. Current evidence shows that established cardiac risk factors, such as certain abnormal levels of blood pressure, blood glucose and cholesterol and a history of smoking, possess a limited ability to estimate cardiac risk. In symptomatic patients with suspected cardiovascular disease, there are a variety of tests available to establish diagnosis. It remains a difficult problem, however, as clinical history and additional information is needed to establish the diagnosis, estimate prognosis and guide appropriate treatment. Coronary angiography is considered the “gold standard” for diagnosis, but it is invasive and costly and is an appropriate initial diagnostic study in only a minority of patients.
Other tests include exercise treadmill test, stress echocardiogram, computed tomography, calcium heart scanning and angiography. Each of these tests is ordered by clinicians after a patient is suspected to have CAD. These tests vary in their accuracy with angiogram considered the gold-standard. Exercise ECG testing is the most commonly used test because it is simple and inexpensive. The patient must be able to exercise to at least 85 percent of the predicted maximal heart rate to rule out ischemic heart disease if the test is otherwise negative. Patients who cannot exercise, have baseline ECG abnormalities that could interfere with exercise ECG testing, or in whom the exercise ECG test suggests intermediate risk, a number of alternative noninvasive tests are available including echocardiography with exercise or pharmacologic, radionuclide myocardial perfusion imaging (rMPI), using either planar or photon emission computed tomographic as the imaging method, positron emission tomography (PET) or using coronary calcium scores.
Many of these tests are also invasive, time-consuming and expensive, requiring trained personnel and capital equipment. Therefore, there is a need for improved devices, systems and methods for the detection of coronary artery disease.
Embodiments relate to non-invasive medical devices, systems and methods for the detection of coronary artery disease. In an embodiment, a handheld coronary artery disease (CAD) detection device is used in a non-invasive manner to determine whether an internal coronary artery blockage is present. The CAD detection device can be used in conjunction with an identification element, such as scanning area identification pads or a patient scan sequence guide, to aid in the proper placement of the CAD detection device while scanning a patient and manage data collection and medical record matching. Advantages of embodiments include non-invasive test procedures; quick results; and cost-effectiveness.
In an embodiment, a system for use in the detection of coronary artery disease comprises a detection device including a detection device body, at least one sensor coupled to the detection device body, a memory, a controller configured to instruct the at least one sensor to sample data and store the sampled data in the memory, and a contact portion configured to contact a patient; and an identification element including at least one identification area corresponding to a data acquisition location on the patient, the at least one identification area configured to interface with the contact portion, wherein the system is configured to determine a presence of coronary artery disease based on the data sampled by the at least one sensor at the data acquisition location associated with the at least one identification area.
In another embodiment, a method of detecting coronary artery disease using a detection device and an identification element comprises engaging a contact portion of the detection device with at least one identification area of the identification element, the at least one identification area corresponding to a data acquisition location on the patient; engaging the contact portion with the corresponding data acquisition location on the patient; sampling data by at least one sensor of the detection device; and analyzing the sampled data to determine if coronary artery disease is present.
In another embodiment, a coronary artery disease detection device comprises a detection device body; a contact portion coupled to the detection device body and configured to contact a patient at one or more predetermined locations; at least one sensor coupled to the detection device body; a memory; a user interface operably coupled to the detection device body and configured to display the one or more predetermined locations; a controller configured to instruct the at least one sensor to sample data, confirm the sampled data for the one or more predetermined locations, and store the sampled data in the memory; and a power supply configured to power the at least one sensor, the memory, the controller, and the user interface.
The above summary of the invention is not intended to describe each illustrated embodiment or every implementation of the present invention. The figures and the detailed description that follow more particularly exemplify these embodiments.
The invention may be more completely understood in consideration of the following detailed description of various embodiments of the invention in connection with the accompanying drawings, in which:
While the invention is amenable to various modifications and alternative forms, specifics thereof have been shown by way of example in the drawings and will be described in detail. It should be understood, however, that the intention is not to limit the invention to the particular embodiments described but rather to include all modifications, equivalents, and alternatives.
Embodiments relate to non-invasive medical devices, systems and methods for the detection of coronary artery disease. In an embodiment, a handheld coronary artery disease (CAD) detection device is used in a non-invasive manner to determine whether an internal coronary artery blockage is present. The CAD detection device can be used in conjunction with an identification element, such scanning area identification pads or a patient scan sequence guide, to aid in the proper placement of the CAD detection device while scanning a patient. Advantages of embodiments include non-invasive test procedures; quick results; and cost-effectiveness.
Referring to
Body 102 is ergonomically sized and shaped to be easy and comfortable to grasp by a medical professional while scanning a patient. In embodiments, body 102 can be smooth or textured and firm or somewhat pliable to provide an enhanced gripping surface. Body 102 can also comprise one or more ports and/or contacts (not depicted) to provide for charging and/or exchanging data with CAD detection device 100 and external sources. In other embodiments, CAD detection device 100 comprises wireless capabilities, such as RFID, BLUETOOTH, WIFI or some other suitable wireless communication technique, such that ports and/or contacts are optional.
User interface 104 of CAD detection device 100 comprises a screen 108. Screen 108 can be touch sensitive, including multitouch sensitive, in embodiments. Screen 108 can also be mounted to function as a switch, such as by pushing, toggling, swiping, tapping or turning screen 108. For example, selectively applying downward pressure to screen 108 can function to power CAD detection device 100 on and off. In the embodiment depicted, user interface 104 also comprises power status indicators 110, such as LEDs on an upper portion of body 102. In another embodiment, power status indicators 110 can be incorporated into screen 108 or some other portions of CAD detection device 100. An audible on/off indicator can also be provided in embodiments.
User interface 104 also comprises a heart beat indicator 112, a timer 114 and a scanning area identifier 116 displayed on screen 108. A pressure indicator 118 provided on body 112 is also part of user interface 104.
Heart beat indicator 112 illuminates in one embodiment when a sufficient heart beat is detected while CAD detection device 100 is in use. The illumination of heart beat indicator 112 can be steady stated, such as on or off, or intermittent. In one embodiment, for example, heart beat indicator 112 flashes in time with a detected heart beat. Heart beat indicator can also be accompanied by an audible indicator of sufficient heart beat or in conjunction with a detected heard cadence.
Timer 114 comprises a plurality of hash marks in an embodiment to provide a visual indication of a scanning and/or recording time. Timer 114 can be programmed to start automatically upon detection of a sufficient heart beat, or timer 114 can be programmed to require manual starting and stopping. In other embodiments, timer 114 comprises a series of dots or other shapes, a solid line that progressively lights to mark time, a numerical counter, or some other configuration. Timer 114 can also comprise an audible indication of time scanned or time remaining.
Scanning area identifier 116 is an alpha-numeric indicator that corresponds to a series of scanning areas (discussed in more detail below) to prompt a user with respect to which area is to be scanned. In one embodiment, there are four scanning areas, and scanning area identifier 116 displays 1, 2, 3 and 4 accordingly. In other embodiments, letters, symbols, abbreviations, a series of marks or some other system corresponding with that used by the pads or portfolio discussed below is used, instead of or in addition to numbers.
Pressure indicator 118 comprises one or more LEDs, electroluminescent wire or some other suitable visual indicator in embodiments. Pressure indicator 118 provides feedback to a user regarding whether proper pressure is being applied to CAD detection device 100 when scanning in use.
Contact portion 106 comprises a contact 120 and a diaphragm 122. Contact 120 is configured to make contact with a pad and/or patient to collect data during a scan. Diaphragm 122 can have a variety of configurations and compositions in embodiments. In one embodiment, diaphragm 122 is flexible or semi-flexible to help CAD detection device 100 conform to a patient's anatomy and contact 120 to establish sufficient contact with a pad or patient. In embodiments, diaphragm 122 can comprise a gel or an impedance-matching material.
Referring to
In one embodiment, pads 132 are simple, self-adhesive sticker-like dermal patches for application to a patient's skin. Pads 132 can simplify an overall scanning procedure by making it unnecessary to shave or otherwise prep a patient's skin or body before scanning. In other embodiments, pads 132 can comprise a fluid or gel layer to aid in coupling with CAD detection device 100, a radio frequency identification (RFID) tag or other circuitry or electronics. Pads 132 can also be communicatively coupled with one another in embodiments, such as wired or wirelessly. Coupling pads 132 can enable intercommunications between circuitry in pads 132. For example, pad 1, which is typically though not always scanned first, can get a heart cadence and then communicate related information to pads 2, 3 and 4. In other embodiments, pads 132 can intercommunicate via CAD detection device 100 as it sequentially interfaces with each pad to scan a patient.
In another embodiment, and referring to
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In the embodiment depicted in
Therefore, active noise cancellation can be implemented in embodiments of CAD detection device 100 as described above. Passive noise cancellation can be implemented in combination with active noise cancellation, or on its own, in other embodiments. Materials such as, but not limited to, rubber, foam, sponge, glass fiber, ceramic fiber, mineral fiber, vinyl, tape, or sound-absorbing coatings and pastes or combinations thereof can be disposed proximate one or both of sensors 142a and 142b or otherwise suitably arranged on or within device 100 in order to passively reduce noise.
In preparation for or during patient scanning, when pressure is being applied to CAD detection device 100 against the patient, an appropriate amount of pressure exists within a range of too little pressure to too much pressure. If a user applies too little pressure, the sensed signal can be weak or intermittent or comprise no signal such that no waveform signature or shape indicative of turbulent blood flow can be determined. On the other hand, if a user applies too much pressure, the sensed signal can become maxed out, and similarly, no waveform signature or shape indicative of turbulent blood flow can be determined. Therefore, it is desired to apply a proper amount of pressure to CAD detection device 100 when in use.
In embodiments, one or both of sensors 142a and 142b can comprise pressure sensors or other sensors suitable for sensing the pressure applied by a user to detection device 100 in preparation for or during patient scanning. In embodiments, one or both of sensors 142a and 142b can comprise pressure sensors or other sensors suitable for sensing the pressure applied by a user to detection device 100 in combination with the ability to collect data related to the presence or absence of a turbulent pressure wave in a coronary artery. In other embodiments, an additional sensor or plurality of sensors is configured for sensing the pressure applied by a user to detection device 100 in preparation for or during patient scanning.
In embodiments, the pressure applied by a user is measured and compared against a minimum value representative of a typical amount of minimum pressure to establish a signal, and a maximum value representative of a typical amount of maximum pressure so as to not max out the measured signal. If the measured pressure exceeds the maximum value, an error message can be displayed to the user via user interface 104. Likewise, if the measured pressure is below the minimum value, an error message can be displayed to the user via user interface 104. Other threashold minimum and maximum values can also be used, depending on the patient, user, or other appropriate factors. Power supply 144 can comprise a battery in embodiments, such as a rechargeable battery or a replaceable battery. Rechargeable power supply 144 can be inductance-style, two-pin, charge by computer, and/or charge by AC wall outlet, or some other suitable charging configuration. Power supply 144 can also be configured to allow for multiple different charging schemes. For example, CAD detection device 100 can interface with a charging station by physical coupling or cable, and/or CAD detection device 100 can couple by USB or other cable to a computer, docking station, wall outlet or other source of power.
Controller 146 controls the operation of CAD detection device 100. During scanning, controller 146 can control GUI 104, the timer and the general operation of CAD detection device 100. Controller 146, via GUI 104 and/or an audible indicator, can also prompt a user to carry out various tasks, such as to apply CAD detection device 100 to one or more of the pads 130, tags 139 or patient areas, to move on to the next pad 130, tag 139 or patient area, to rescan a particular pad 130, tag 139 or area, to reposition a pad 139 or device 100 if data of sufficient quality is not detected, to recharge CAD detection device 100 and other functions. As previously mentioned, CAD detection device 100 comprises a timer, such as part of controller 146, for each scan to ensure that sufficient data is collected at each scan site. In one embodiment, this timer can automatically start as soon as data of a sufficient quality is detected by sensor 142a, though other procedures can be used in other embodiments.
Controller 146 can be subservient to and/or operate in conjunction with an external controller coupled by wire or wirelessly in embodiments. In embodiments, controller 146 can carry out processing of collected data, for example to determine a presence of coronary artery disease based on data sampled by at least one of sensors 142a and 142b at the patient data acquisition locations associated with the idenficiation areas of pads 130 or guide 138, though in other embodiments data processing is carried out external to CAD detection device 100. Controller 146 operates in cooperation with memory 148, which stores collected data until it is transferred to an external device or manually or automatically deleted and can be of any suitable type. Controller 146 also can correlate data sampled by sensors 142a and/or 142b with a data acquisition location using the identification element, such as pad set 130 or sequence guide 138, in embodiments.
Communication circuitry 150 is configured to transfer data to and from CAD detection device 100. For example, after scan data is collected for a particular patient and stored in memory 148, the raw scan data can be packaged and transferred wired or wirelessly to a remote device 170 for processing and determination of whether CAD may be present, such as is depicted in
Scan results are determined by processing and analyzing the raw data for indications of turbulent blood flow, which can cause pressure changes on the patient's thorax detectable by a pressure sensor and/or audible flow that can be detected by an acoustic sensor. In one embodiment, the data is processed and analyzed to determine whether a waveform signature or shape indicative of turbulent blood flow as the result of a blockage is present in a particular frequency range. Other criteria can be used in other embodiments. More information can be found in co-owned U.S. Pat. No. 7,520,860 and pending U.S. patent application Ser. No. 12/962,812, which are incorporated herein by reference in their entireties.
Referring to
Referring to
This method can be modified in embodiments to add or remove steps. For example, in an embodiment, both guide 138 and pads 132 can be used, such as for training or for some other purpose, though for efficiency and ease of use only one or the other is used in other embodiments. Further, alternative ways of linking scan data with a particular patient or file can be used, such as manual entry, patient identifier entry via device 100, or some other way appreciated by those skilled in the art.
Embodiments also provide for effective and graceful error handling. For example, if CAD detection device 100 has internal, operational, or user errors, “CADence Error” or another appropriate error message can be displayed on screen 108. In embodiments, the error message can contain a number or set of numbers that refer to particular components within CAD detection device 100. For example, “CADence Error 1” an refer to a sensor 142 failure. “CADence Error 2” can refer to a sensor 142 failure and a memory 148 failure. Optionally, a fail or error sound can be output in combination with the error message. Any number of error message values can be output on screen 108 that can be subsequently interpreted by a user in order to troubleshoot CAD detection device 100. For example, a key or listing of error codes can be provided in hard copy or online such that a user can look up the code to determine how to resolve the error.
In an embodiment, CAD detection device 100 comprises self-administering error resolution routines such that user instructions to troubleshoot or resolve device 100 errors or operational errors are displayed to the user, for example, via screen 108. For example, in the sensor 142 failure discussed above, instead of “CADence Error 1” displayed via screen 108, internal logic determines the nature of the error and the steps to best resolve the error. Screen 108 then instead displays “Replace Sensor 1” or other similar message, the device 100 having determined that the sensor error is one that cannot be resolved except by replacement of the faulty sensor.
Error handling can be implemented during operation of CAD detection device 100. For example, if a user is applying too much pressure on the patient with CAD detection device 100 during a scan, as determined by the value measured by one or both of sensors 142a and 142b compared to a set maximum value as described above, screen 108 can display a message to “Reduce Hand Pressure” or similar language or indication. In embodiments, pressure indicator 118 can display an appropriate indication, alone or in combination with screen 108. Optionally, a fail or error sound can be output in combination with the pressure message.
If no heart signal is detected during a scan at any particular scan site, as described with respect to the patient scan initation at 218, rescanning can be attempted and/or the next scanning area can be tried. In an embodiment, referring to
Signal interruption can occur when background noise or physical disturbance is too great such that it interrupts the acquiring signal and scan. In embodiments, this can occur until the background noise level is reduced such that the acquiring signal and scan can be sufficiently determined. In such an operation error, screen 108 can display “Too Much Noise” or similar error message or indication. Further, a fail or error sound can be output in combination with the error message. In embodiments, prior to or after such a message display, the user can touch or otherwise interact with screen 108 as described above to cancel the current signal acquisition attempt. In embodiments, signal acquisition can be retried once the background noise level is reduced.
During interaction with patient scan sequence guide 138, in embodiments, CAD detection device 100 can indicate user operation errors or sequence guide 138 errors. For example, if the user places device 100 in the wrong sequence of scanning area tags 139 in guide 138, screen 108 can display “Wrong Site” or other appropriate error message. A fail or error sound can be output in combination with the site error message.
On occasion, sequence guide 138 can itself be defective, by failure of RFID scanning area tags 139 integrated in guide 138, or other guide 138 component failure. For example, assuming an RFID initiation pad 140 failure, when CAD detection device 100 is turned on and placed on initiation pad 140 to pair device 100 with the patient number of tag 141, device 100 can signal the pad 140 failure. In an embodiment, screen 108 can display “Pair Error” or other appropriate error message or indication. In an embodiment, the user can attempt another initiation with initiation pad 140. In other embodiments, the user can use a new guide 138 book.
If a particular guide 138 interaction point is defective, for example, the second scanning area tag 139, device 100 can signal the tag 139 failure. In an embodiment, screen 108 can display “Site B Error” or other appropriate error message or indication. Similar site errors can be displayed for the other scanning area tags 139, respectively. A fail or error sound can be output in combination with the pair error message or site error message.
Referring to
On occasion, the link between device 100 and syncing device can be intermittent or have no connection. From 230, in the case where CAD detection device 100 cannot upload with the syncing device and an upload error is detected, CAD detection device 100 can display “Upload Error” or other appropriate error message or indication at 232. A fail or error sound can be output in combination with the upload error message. In an embodiment, from 232, another attempt to sync scan data at 220 can be made, as depicted in
In an embodiment, if sync tag 139 fails, CAD detection device 100 can display “Sync Error” or other appropriate error message similar to the “Pair Error” or site error or indication discussed above. A fail or error sound can be output in combination with the sync error message.
In embodiments, the text or indications displayed on screen 108 or any part of the user interface 104 as discussed above are given only by way of example and are not intended to limit the scope of the invention. As such, the text or indications can vary such that similar language or indications can be used.
In an embodiment, a system for use in the detection of coronary artery disease comprises a detection device including a detection device body, at least one sensor coupled to the detection device body, a memory, a controller configured to instruct the at least one sensor to sample data and store the sampled data in the memory, and a contact portion configured to contact a patient; and an identification element including at least one identification area corresponding to a data acquisition location on the patient, the at least one identification area configured to interface with the contact portion, wherein the system is configured to determine a presence of coronary artery disease based on the data sampled by the at least one sensor at the data acquisition location associated with the at least one identification area.
In another embodiment, a method of detecting coronary artery disease using a detection device and an identification element comprises engaging a contact portion of the detection device with at least one identification area of the identification element, the at least one identification area corresponding to a data acquisition location on the patient; engaging the contact portion with the corresponding data acquisition location on the patient; sampling data by at least one sensor of the detection device; and analyzing the sampled data to determine if coronary artery disease is present.
In another embodiment, a coronary artery disease detection device comprises a detection device body; a contact portion coupled to the detection device body and configured to contact a patient at one or more predetermined locations; at least one sensor coupled to the detection device body; a memory; a user interface operably coupled to the detection device body and configured to display the one or more predetermined locations; a controller configured to instruct the at least one sensor to sample data, confirm the sampled data for the one or more predetermined locations, and store the sampled data in the memory; and a power supply configured to power the at least one sensor, the memory, the controller, and the user interface.
Embodiments thereby provide efficient, cost-effective and non-invasive CAD detection devices, systems and methods. Embodiments can be used in a variety of healthcare settings, such as for routine physicals; pre-surgical screenings; in clinics, hospitals, urgent care, minute-clinic and remote or rural care settings; for insurance application screening; and in virtually any other setting and for a variety of purposes as appreciated by those having skill in the art.
Various embodiments of systems, devices and methods have been described herein. These embodiments are given only by way of example and are not intended to limit the scope of the invention. It should be appreciated, moreover, that the various features of the embodiments that have been described may be combined in various ways to produce numerous additional embodiments. Moreover, while various materials, dimensions, shapes, locations, configurations etc. have been described for use with disclosed embodiments, others besides those disclosed may be utilized without exceeding the scope of the invention.
Persons of ordinary skill in the relevant arts will recognize that the invention may comprise fewer features than illustrated in any individual embodiment described above. The embodiments described herein are not meant to be an exhaustive presentation of the ways in which the various features of the invention may be combined. Accordingly, the embodiments are not mutually exclusive combinations of features; rather, the invention can comprise a combination of different individual features selected from different individual embodiments, as understood by persons of ordinary skill in the art.
Any incorporation by reference of documents above is limited such that no subject matter is incorporated that is contrary to the explicit disclosure herein. Any incorporation by reference of documents above is further limited such that no claims included in the documents are incorporated by reference herein. Any incorporation by reference of documents above is yet further limited such that any definitions provided in the documents are not incorporated by reference herein unless expressly included herein.
The present application claims the benefit of and priority to U.S. Provisional Patent Application No. 61/522,075 entitled “DEVICES, SYSTEMS AND METHODS FOR THE DETECTION OF CORONARY ARTERY DISEASE” and filed Aug. 10, 2011; U.S. Provisional Patent Application No. 61/619,181 entitled “DEVICES, SYSTEMS AND METHODS FOR THE DETECTION OF CORONARY ARTERY DISEASE” and filed Apr. 12, 2012; and U.S. Provisional Patent Application No. 61/652,651 entitled “DEVICES, SYSTEMS AND METHODS FOR THE DETECTION OF CORONARY ARTERY DISEASE” and filed May 29, 2012, the contents of which are incorporated herein by reference in their entireties.
Filing Document | Filing Date | Country | Kind | 371c Date |
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PCT/US2012/050122 | 8/9/2012 | WO | 00 | 2/10/2014 |
Number | Date | Country | |
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61522075 | Aug 2011 | US | |
61619181 | Apr 2012 | US | |
61652651 | May 2012 | US |