The pitch presentation begins with an illustration of a family happily enjoying their Christmas dinner.
A blue ring appears around the head of a beatific paterfamilias, resplendent in his holiday sweater, smiling at his family from the head of the table. That blue-ringed, grey-bearded man, Ran Yang says, is Grandpa Joe. And Grandpa Joe is just moments away from going into cardiac arrest and not being able to breathe.
“And in order to save Grandpa Joe’s life, the paramedics have to perform a procedure called intubation,” Yang says. “Intubation is a medical procedure in which a breathing tube is placed into the patient’s trachea.”
She explained that intubation secures the airway, allowing external oxygen to be ventilated into Grandpa Joe’s lungs.
“However, the intubation procedure may fail often,” Yang added. “And failed intubation could cost lives.”
Yang is a lecturer in the Department of Physics at William & Mary. Associated with the department’s Engineering Physics and Design (EPAD) program, she is leading a team of students engineering and designing an instrument they’ve dubbed Britescope. It’s a new kind of laryngoscope — the instrument used for endotracheal intubation, or ETI.
Britescope has demonstrated its potential for market success, as well as for saving lives. The Virginia Innovation Partnership Corporation’s Commonwealth Commercialization Fund included Yang and Britescope in a recent round of funding to seed technology initiatives in the commonwealth.
“Virginia recognizes the importance of moving university-developed innovations into the commercial market, and supporting emerging startups as they develop and grow,” Virginia Governor Glenn Youngkin said in a release announcing the grants. “VPIC’s CCF program consistently provides critical funding support to university projects with strong commercialization potential, as well as to scalable technology-driven private startups.”
Yang explained the necessity that was the mother of Britescope’s invention: Human anatomy places the opening of the route to the lungs near to that of the route to the stomach. So, a common cause of intubation failure occurs when the emergency responders mistakenly intubate the patient’s esophagus rather than their trachea.
“Various laryngoscopes have existed for about 100 years,” Yang said. “And medical providers would just have to eyeball where the trachea is and hopefully the tube is placed in the right place.”
Training — and experience — help when it comes to successful endotracheal intubation (ETI). Yang presents data showing that emergency intubation success rates by emergency personnel in populated areas are almost twice as high than those in rural areas. But, rural or urban, intubation is often complicated by factors on the scene.
“It could be the patient’s anatomy makes it difficult to see the airway,” she said. “Or it could be there is facial trauma, so it’s harder to identify those key regions in the throat.”
Britescope is engineered to use artificial intelligence and other technology to make emergency intubation more resistant to failure. The instrument is equipped with a camera, but such a visual guide isn’t new to laryngoscopes, she said: Camera-bearing laryngoscopes have been around for around 20 years.
Britescope is different in a couple of ways. Yang said virtually all of the current camera-equipped scopes have a monitor built into the scope itself. The screen is necessarily small, and the image can be hard to see properly as the instrument is manipulated. By comparison, Britescope is connected to an iPad.
“We found that in the U.S., almost all the ambulances are equipped with iPads, for various reasons,” she said. “So instead of putting a very bulky screen on the top of the device, we’re wirelessly connecting our scope to an existing iPad.”
The second —and more important — advantage of Britescope lies in its use of artificial intelligence. Yang explained that it uses machine learning to identify key areas of the patient’s anatomy, as shown by the scope’s camera, steering the operator toward the trachea, and away from the esophagus.
Yang likens the progressive development of laryngoscope technology to the improvements in automotive back-up assistance. The old-school manual scopes have their parallel in rear view mirrors and looking over your shoulder. Then, in the early 2000s, cars started having rear-view cameras to help you park, she said — about the same time as laryngoscopes with cameras came into use. Yang says that Britescope is akin to the next stage of parking assistance technology.
“So, on the screen, you not only see the video feed, you also see how many inches you’re away from the curb, right?” she said. “It does not replace the driver. But it gives the driver a lot more confidence. And it shows guidelines so you don’t bump into anything.”
Britescope also has guidelines, Yang said. An AI-informed bounding box appears on the iPad screen, showing the “sweet spot” leading toward the trachea.
As the development of Britescope progressed, Yang began discussions with members of William & Mary’s tech transfer and entrepreneurship communities. She met with Jason McDevitt, the university’s director of technology transfer. She also consulted faculty associated with the Alan B. Miller Entrepreneurship Center at William & Mary’s Mason School of Business, initially with Rachel Frazier and later with Graham Henshaw and Stephanie Gelman, an executive partner at the Mason School.
“As a physicist-engineer, I have no idea about how the business world works. The Entrepreneurship Center is being really helpful. They told me: If you really want to save Grandpa Joe’s life,” Yang recalled, “then you have to bring the product to market.”
Taking Britescope to market prompted her to add a hyphen, so Yang began evolving from physicist-engineer into physicist-engineer-entrepreneur. In addition to consultation with the Mason School of Business faculty, she also enrolled in the Innovation Commercialization Assistance Program of the Virginia Small Business Development Center.
Yang developed a marketing presentation for Britescope, complete with a data-laden PowerPoint deck. The presentation leads off with the fictional tale of Grandpa Joe’s tragically truncated Christmas dinner, then Yang outlines both the need and the market for a better laryngoscope.
She presented data indicating there are 13 to 20 million emergency intubations performed each year in the U.S. Failure rate of the procedure is as high as 60 percent, depending on a variety of circumstances including training, patient anatomy and type of scope used. One constant is time: Yang’s presentation features data showing survival rates depend heavily on quick and successful intubation.
Britescope was invited to the Entrepreneurship Center’s rocket pitch events, winning second prize once and audience favorite (as determined by decibels recorded by a “clapometer”) another time. She used feedback and follow-up questions to fine-tune her pitch, working on her delivery with Michele King, a lecturer in the university’s Department of Theatre, Speech and Dance.
The tuning and honing began to pay off in May of 2022, when Yang first presented Britescope to representatives of the Virginia Innovation Partnership Corporation. In August, she had a second, more formal pitch/interview session with around a dozen VPIC people, resulting in the project being approved for seed money from the Commonwealth Commercialization Fund.
As 2023 begins, Yang continues work on Britescope. She is in regular contact with her mentors and is discussing commercialization and tech-transfer opportunities with Jason McDevitt. Yang is optimistic about taking Britescope beyond the “quick and dirty” prototype stage, while her pitch presentation winds up with a happy ending.
“With Britescope,” Yang says, “Grandpa Joe can join us on a bright Christmas morning.”
Joseph McClain, Research Writer