S7E4 Brain Injury in Focus: The Role of Imaging, Innovation and Early Intervention

So to kick things off then, what do we think are the biggest challenges in diagnosing brain injuries today?

Yeah, thank you, Ben.

I think, to be honest, probably the honest answer is I still think we're flying partially blind with this, and the reasons for that are biological and systemic in nature.

I think the first issue is an issue of heterogeneity, and that's a real core problem.

Because no two brain injuries are alike, effectively means the same mechanism of injury can produce a radically different presentation.

And that depends on the age of the patient, pre-existing medical conditions, and obviously the precise anatomical location of the damage to the brain, if you like.

Unfortunately, I don't think our diagnostic frameworks have been really built for that level of variability.

Obviously, we have the nice guidance with regards to head injuries and it's excellent and obviously works across a whole population spectrum.

But it's hard to produce guidance that works for everyone when there's that level of variability.

So that's core problem number one.

I think there is an imaging gap.

Obviously, the workhorse of the acute assessment for patients with potential brain or head injuries is the standard CT scan.

And any emergency department that you walk into in England will do numbers of these a day, lots and lots.

But unfortunately, whilst it is the most accessible and quickest method of imaging, it's reasonable to say that we think it misses a significant proportion of those harder to understand injuries.

So the diffuse axonal injuries, micro hemorrhages and any white matter damage that MRI would catch more easily.

often and more sensitively but the problem and it's not just with head injuries it's with other things such as back pain etc mri isn't really available acutely in most trusts outside of major trauma centers and obviously an mri is also a much more involved much more intensive imaging modality so agitated or unstable patients aren't always the most suitable so And this is mentioned in NICE guidance around MRI versus CT.

But I do think that there is a trade-off there.

But as a system, and from an NHS perspective in England especially, we don't have the resources to be MRIing the patients who perhaps we would, who would benefit from that.

And just out of interest, Craig, so if a patient is given a CT scan and potentially it misses something, with a brain injury, would that delay in time have an effect on the patient? Is time critical with a brain injury? So,

absolutely, absolutely.

we may come on to talking about AI, et cetera, but it's always time is brain and it's really important.

So some of the diffuse axonal injuries and the micro hemorrhages are less, not less important, but less significant early doors with regards to managing these brain injuries.

In relation to subdural hematomas, certainly extradural hematomas, the sooner we can diagnose them, the sooner we can get these injuries managed in an appropriate way.

If you're in a major trauma center, the likelihood is you have a neurosurgical center there.

either within your building or very, very close and closely associated.