Listen to Body Sounds, Diagnose Diseases

VoqXTM, the sonic stethoscope developed by Sanolla, can diagnose a range of diseases and symptoms by deciphering sounds produced by the body, including those that cannot be heard by the human ear. It is now possible to upgrade the good old stethoscope, adapt it for the 21st century, and give it innovative and intelligent detection and diagnostic capabilities

The SonoX™ device for 3D mapping of the lungs
Tiko Product Design

Dr. Doron Adler's phone rang one Saturday evening in February. The CEO and founder of Sanolla was surprised. Incoming work-related calls are not common on the weekends. On the line was a representative of the Chief Scientist’s office at the Ministry of Science and Technology with an important message. "We believe that Sanolla technology is suitable for taking on the challenge of corona detection," he said. Shortly afterwards, Sanolla and the Chief Scientist were collaborating intensely to enable efficient, accurate, and quick corona testing. The technology is currently undergoing clinical trials at several medical centers in Israel, including Ichilov, Rambam, and Assaf Harofeh hospitals.

Hear all body activity

When Dr. Adler founded Sanolla, in 2016, Corona was still only a brand of beer. The goal of the company was to develop a technology capable of listening to body noises and sensations, and deducing from it whether the patient was suffering from any medical condition. "It's a bit like a security camera," Dr. Adler explains.  "It films also in the dark because it can see in dim conditions, unlike the human eye. Sanolla technology does the same with sounds instead of images: 50% of the sounds the body makes are inaudible to the ear. We record sounds produced by the mechanical activity of the body and amplify them, so that the physician can hear them or observe them on screen. Take the heart, for example. Everything that happens in it is a mechanical activity. When a person suffers from atherosclerosis, vortices are formed in the patient’s arteries. These can be picked up on ultrasound, but also heard with the help of VoqX™, our product capable of detecting the problem that these acoustic signals reflect.”

The Sanolla team
The Sanolla team Photo courtesy of Sanolla Ltd

"Another example is the lungs. Like the heart, they are also in perpetual motion. There is constant whistling of air passing through various barriers, which can be listened to. In general, we are able to hear all body activity, including movements that do not produce sound, like moving joints. In the future we may be able to hear worn out cartilage, and who knows what other indications that are reflected in acoustic signals. Did you know that a fetus produces a huge number of sounds below the human hearing range? You cannot hear them with a stethoscope, but  VoqX™ makes audible even the movement of the fetus inside the uterine fluid."

How do you interpret the sounds to identify disease?

"To achieve this ability, we first sampled body sounds of patients with known diagnoses. Processing the samples using advanced technologies, such as AI, we can map and understand which body sound is related to which disease. Today we work at many medical centers with verified patients in all categories. When somebody is admitted with pneumonia, we record the sounds of the patient’s body, and the system learns them. At the end of the process it knows with high certainty: ‘This is how a patient with pneumonia sounds.’"

Dr. Doron Adler
Dr. Doron Adler Dudi Moskovitz

Detecting a heart attack

The group that founded Sanolla includes seven executives and engineers who have been working together at various companies for about 20 years. In the past, they set up a company that was sold to Olympus. They continued working in it after the company was sold, until they had a sense of having exhausted the possibilities and felt a desire to embark on a new venture. This resulted in the establishment of Sanolla and the development of VoqX™, the AI based infrasound stethoscope. The development has been supported by the Israeli Innovation Authority, and it is based on smart technologies such as AI, deep learning, and big data.

Dr. Adler at the ATS conference, San Diego, USA
Dr. Adler at the ATS conference, San Diego, USA Liat Adler

"We realized that the technique of listening to body sounds needs a strong revamping," explains Dr. Adler regarding the rationale behind the establishment of the company. “Only a part of the sounds of the human body are audible to the human ear, and as physicians get older, their hearing deteriorates. We knew that richer voice information could be obtained than what is available today. It seemed absurd that such important clinical information exists, but is not used by the medical world, although it is so effective and can save invasive testing. No one except us is dealing with infrasound today, and the only ones who did research on it in the past are NASA. VoqX™ can test and diagnose a wide range of parameters: vital signs, heart rate and its electrical signals, blood oxygen level, respiratory cycle and its character, and even body temperature. The device can draw conclusions that before could be reached only after performing an ECG or blood tests. An ambulance crew can reach the home of a person who feels chest congestion, activate the device, and detect a heart attack with 90% certainty. Pneumonia can be detected with a 92% certainty without an X-ray. A physician with a standard stethoscope detects about 50% -60% of cases."

How is the examination conducted?

"It is similar to using a standard stethoscope, and it lasts a few seconds. The system examines the patient at several body points, collects the data, and processes them with the aid of AI technology. In a few seconds, it produces a diagnosis regarding heart rate and respiratory cycle, and provides an assessment regarding the existence of disease. This is how the device tests for corona as well."

Short and accurate test

Corona testing has made Sanolla a particularly busy company. As the capabilities of VoqX™ became clear, many interested parties began to call, from strategic partners to one of the largest brewers in the world, interested in a device that can identify corona patients at the entrance to the bar. In a feasibility study conducted by the EU on the device, all four testers gave it the maximum score: 15 out of 15. From here it was a short way to inquiries from large manufacturing plants interested in producing the VoqX™.

The PyXy™ device for home use
The PyXy™ device for home use Product Design, Koby Kor BusinessFollowsDesign

"The EU is looking for a tool that allows testing higher numbers of potential corona patients," says Dr. Adler. "This is what most of our work revolves around today: the ability to test a mass of people in the most accurate way. We keep collecting data on acoustic signals from corona patients to expand and refine the sound pool, and we are working hard on artificial intelligence, with the objective of perfecting the technology. The product is currently undergoing the regulatory process of EU approval, and it is expected to receive approval before 2021. It will soon eliminate the swabs and the invasive, highly unpleasant test that produces a result only after a few days. The corona test will be a short listening test, after which it will be possible to know whether the subject carries the virus or not."

Does the Corona test work in the same way as the other tests performed by VoqX™?

"Yes. The device listens to sounds, processes them, and within seconds assesses whether the person has corona, and what the severity of the disease is. One of the challenges the virus posed to us is distinguishing between regular pneumonia and pneumonia due to corona. It turns out that in a corona patient the inflammation is not in the lung itself, but in the area that surrounds it. The lung is not quiet, and the sounds it produces are different and clear. We initially tested eight verified corona patients at a facility. The system identified seven as suffering of corona and the eighth as suffering from pneumonia. It was 87.5% successful. Today the system correctly identifies over 90% of subjects based on over 2,000 recordings of corona patients that we have collected. We are expanding the collection of sounds to Europe, and will soon expand beyond it as well, to enrich our data. Eventually, the product will be able to identify patients with asthma, chronic obstructive pulmonary disease, and heart failure. Today, these can be detected only by a physician, in an examination at the clinic or emergency room. We will be able to identify them at home."

The VoqX™ device, a smart stethoscope for physicians
The VoqX™ device, a smart stethoscope for physicians Tiko Product Design

The home version

Home use is another objective marked by Sanolla. Now that  VoqX™ is about to be launched, the company can focus on the home version of the product — a device called  PyXy™. "Today, homes include at most a thermometer and a blood pressure monitor. Suddenly, a small device will be available that can perform about 100 tests at home," says Dr. Adler. "Currently there is no product that brings such a variety of capabilities within the range of home testing, all in a device the size of a smartphone." PyXy™ will be able to detect a heart attack and call an ambulance by itself, or alternatively issue a message to the person being tested: 'You don’t have a heart attack, you are in the middle of a panic attack.' The device can send a text message to the physician, indicating that the patient, after self-examination at home, was found to be in need of immediate medical attention.”

"In Europe they also count on PyXy™. The European plan is to equip with it medical teams that arrive at patients’ homes and need to perform tests to make decisions. It will have a strong presence in nursing homes as well. We expect developments by Sanolla to serve physicians and patients alike, inside and outside the home. Our vision is that our sound diagnostic products will start in the emergency room, proceed to intensive care, and reach the physician’s clinic, the nursing home, and eventually every home."