Date of Award


Document Type


Degree Name

Master of Science (MS)


Industrial Engineering

Committee Chair/Advisor

Dr. Kapil Chalil Madathil

Committee Member

Dr. Sudeep Hegde

Committee Member

Dr. Shubham Agrawal


Stroke is a life-threatening condition that can cause permanent damage by stopping blood flow in the brain. Quick and precise intervention is imperative, as every second lost increases tissue deterioration and impacts patient outcomes. Several technological advancements such as Magnetic Resonance Imaging (MRI), have revolutionized stroke care by enabling more accurate and quicker diagnoses in hospitals. Portable head MRI scanners with lower magnetic fields are a recent innovation capable of providing neuroimaging at the point of care within hospital settings. Integrating such a device into ambulances could potentially enhance stroke care during transit, facilitating prompt diagnosis and prognosis. However, few studies have considered the human factors aspects for integrating MRI systems in ambulance-based settings. This research focused on identifying the barriers to integrating MRI systems into emergency medical ambulance services for early stroke diagnosis, targeting a reduction in door-to-needle time. The study employed a qualitative methodology, using a digital twin of the patient handling process developed and demonstrated to 18 participants (11 paramedics from Charleston County Emergency Medical Services and seven neurologists from the Medical University of South Carolina). Semi-structured interviews were conducted via video conferencing to collect feedback about the entire process. The Systems Engineering Initiative for Patient Safety (SEIPS 2.0) framework was used to identify the barrier themes. The recordings of each participant were transcribed and coded to determine the themes based on the work system categories such as person, tools and technology, task, physical environment, and organization. Person-related barriers included the specialized skills and training required for paramedics and neurologists in MRI operation and interpretation to overcome the physical and cognitive demands while performing the various tasks. Task barriers highlighted procedural challenges such as triage decisions, patient positioning, patient accessibility, airway management and emergency extraction in confined spaces. Tools and technology barriers arose from the size and complexity of MRI devices, vibrations affecting scan quality, maintenance and durability of the device, and integration with other equipment in the moving vehicle. Physical environment barriers involved the confined space inside ambulances and safety concerns related to MRI mounting and operation. Organizational barriers comprised training needs, standard operating procedures, policy development, and liability concerns. To mitigate these challenges, many potential solutions, such as comprehensive training programs, stretcher modifications, MRI device design optimization, and organizational policy changes were suggested. The research highlighted the need for a human-centered design approach in integrating MRI technology into ambulances. Future work could focus on expanding the research scope to include a broader range of stakeholders and geographic settings for generalizability. Further investigation is needed using actual equipment in simulated or real-world settings to validate the identified barriers. Developing needs statements around major barrier themes and exploring multiple concept directions, such as ambulance interior reconfiguration and MRI device redesign, are also recommended. This will also involve creating detailed prototypes and conducting validation testing focused on human factors and usability for patients and care providers. The study provides comprehensive insights into potential barriers, paving the way for developing MRI systems for ambulances, thereby improving the rapid diagnosis and treatment of stroke patients.

Available for download on Tuesday, December 31, 2024