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23 B C B U S I N E S S . C A S E P T E M B E R 2 0 24 A d a m B l a s b e r g IT'S ALL ABOUT SQUIGGLES on a page. Even if you have never lain on an exami- nation table while a technician stuck elec- trodes all over your chest—and then flicked on the switch!—you're likely familiar with the image of an electrocardiogram ( ECG): a page of graph paper covered in wavy lines. They're unintelligible, or seem that way to the untrained eye. For a cardiologist, however, those lines reveal the nature and path of the electrical impulses that activate the heart, showing everything from heart rate and rhythm to the size and nature of heart chambers. Experienced specialists, the ones who look at tens of thousands of scans a year, can also identify heart defects and past damage, the effect of heart drugs, even the performance of an implanted pace- maker. It's kind of magical. Five years ago, Peter Noseworthy, a Canadian physician- researcher working at the Mayo Clinic in Rochester, Min- nesota, started to wonder if he could supercharge the magic by review- ing all ECG results with artificial intel- ligence. Instead of relying on bleary- eyed humans star- ing at a practical maximum of about 50,000 scans a year, Noseworthy wrote an algorithm—really, just a very specific set of instructions— that could guide a computer to sample millions of images, to see what it could see. The Mayo sys- tem, including doz- ens of small clinics, as well as two other major campuses in Florida and Arizona, conducts more than 400,000 ECGs a year and has more than four million scans on file; it's a dataset that makes this kind of deep learning possible. The results, according to B.C. cardi- ologist Brett Heilbron, were "mind-blow- ingly good." Cross-trained with patient demographics, outcomes and cardiac imagery, Noseworthy's algorithm was able to detect a whole range of factors that even the most diligent humans can't see—everything from the age and gender of a subject to valve function, valve dis- ease, inherited cardiac conditions and more. And there are uses outside of car- diology, too: Noseworthy explained in a recent virtual UBC Medicine seminar that there is even an identifiable signal for cirrhosis (serious scarring of the liver). Adding to the promise, ECGs are easy, non-invasive and cheap, especially com- pared to alternative diagnostic tests. Echo- cardiograms, for example, require more expensive equipment and greater exper- tise from an ultrasound technician, and take almost an hour. Heilbron says each test costs the system around $1,000, and you can wait more than a year to get one. ECGs, on the other hand, take much less training to administer and are remarkably quick; the actual scan lasts for as little as 10 seconds and a full appointment can be concluded in under 15 minutes. Add in the price of disposables, the time of the cardi- ologist to read the scan—even the rent, heat and light in the lab—and you can still book one by tomorrow and get out for a small charge to the system of around $35. The problem is the chasm between conceiving of a medical innovation and implementing a transformative clinical practice. New diagnostics, like new drugs, need to be proven and approved by the Food and Drug A d m i n i s t r a t i o n ( FDA) in the U.S. and by Health Canada in this country— a process that is complicated, time c o n s u m i n g a n d expensive. B.C.'s medical system is also already over- whelmed. (Heilbron goes so far as to say "it's broken.") In a time when people are struggling to schedule, execute HEART PROBLEMS B.C. cardiologist Brett Heilbron thinks that new technological advances can help fix what he calls a bro- ken health-care system

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