Transcript Biomedical Computing

THE END
OF DISABILITY
Eliza Strickland
IEEE Spectrum
June 2014
IS 376
December 2, 2014
TELEMEDICINE
With high-speed broadband communications, medical
professionals can provide assistance without being
physically present.
Medical implants use wireless
communications through body
area, personal area, local area,
and wide area networks.
A technician operates ophthalmic
equipment in rural India, and a
counselor follows up with patients
based on the diagnosis provided by a
doctor at the remote base hospital.
Robot surgery in remote communities, war
zones, and disaster-stricken areas.
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EXPERT SYSTEMS
Consulting with medical experts, software engineers develop a program that taps into
the expert knowledge to determine probabilities for certain symptoms and test results
yielding specific diagnoses and treatments.
1) Patient’s name:
** PT538
2) Age:
** 34 YEARS
3) Sex:
** MAEL
-MALE
4) Race:
** CAUCASIAN
Please supply one answer under each heading.
If your response is not understood, you will be
prompted by the standard questioning method.
Please enter the results of positive cultures
using the following table.
site culture
date
date
method of
number collected positive
collection
(urine, sputum only)
5)**DONE
Please enter the results of pending cultures
in the following table.
site culture
stain
date
method of
number examined positive
collection
(urine, sputum only)
6)** CSF 1234 30-Jan-77 YES
stain of morphology
smear
[type DONE if no organism was seen on the smear]
7)**DONE
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19) Does PT538 have any cutaneous lesions or rash on
physical examination?
** NO
20) Does PT538 have evidence of ocular nerve
dysfunction?
** NO
21) Is PT538 a compromised host (e.g. alcoholic, sicklecell-disease, immunosuppressed)?
** YES
22) Is PT538 immunosuppressed (e.g. corticosteroid
therapy, cytotoxic drug therapy, radiation therapy,
leukemia, lymphoma)?
** NO
23) For how many days has PT538 had abnormal
neurologic signs?
** 7.2 HOURS
24) For how many days has PT538 had neurologic
symptoms?
** 1 DAYS
25) Has PT538 had recent evidence of tender or
enlarged salivary glands?
** NO
26) Has PT538 been exposed to any contagious disease
recently (e.g. meningococcal disease, mumps)?
** NO
Please enter CSF findings in the following table
CSF Percent Protein CSF
Peripheral
WBC PMN
Glucose Glucose
27)** 100 99 280 5 UNKNOWN
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My therapy recommendations will be designed to treat
for organisms that either are very likely or, although
less likely, would have a significant effect on therapy
selection if they were present. It is important to cover
for the following probable infection(s) and associated
organism(s):
INFECTION-i1s MENINGITIS
+ <ITEM-l>E .COLI [from clinical evidence only]
+ <ITEM-2>P SEUDOMONAS-AERUGINOSA [from clinical
evidence only]
+ <ITEM-3>KLEBSIELLA-PNEUMONIAE [from clinical
evidence only]
+ <ITEM-4>D IPLOCOCCUS-PNEUMONIAE [from clinical
evidence only]
[REC-1] My preferred therapy recommendations as
follows:
In order to cover for Items <1 2 3 4>:
Give the following in combination:
1) AMPICILLIN
Dose: 3.5g (28.0 ml) q4h IV [calculated on basis of 50
mg/kg]
2) GENTAMICIN
Dose: 119mg (3.0 ml, 80mg/2ml ampule) q8h IV
[calculated on basis 1.7 mg/kg plus consider giving 5 mg
q24h Intrathecal
Comments: Monitor serum concentrations
Since high concentrations of penicillins can inactivate
Aminoglycosides, do not mix these two antibiotics in
the same IV bottle.
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MEDICAL DATABASES
While medical records are still primarily stored on paper, an increasing
percentage are stored electronically.
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• Huge IT Expense
• Huge Paper Storage Expense
• Ease of Data Retrieval
• Ease of Data Entry
• Simultaneous Access from
Multiple Locations
• Resistant to External
Tampering
• Medical Errors Due to
Software Glitches
• Medical Errors Due to
Illegible Writing
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PRIVACY CONCERNS
With the development of remote access to electronic medical
information, concerns have arisen about the privacy of one’s medical
records.
In 1996, Congress passed HIPAA, the Health Insurance Portability
and Accountability Act, which requires that special care be taken
with the following information available to health providers:
•
•
•
•
•
•
•
•
Names
Addresses (City, County, Street, Zip Code)
Dates (Birth, Death, Admission, Discharge)
Phone or Fax Numbers
Online Addresses (E-Mail, IP, URLs)
Numbers (Social Security, Account, License, Health Plan, Medical Record)
Biometric Identifiers (Fingerprints, Retina Scans, Voiceprints, Photos)
Individually Identifiable Health Information
HIPAA does not protect your medical data from:
• Insurance Companies (even if you pay for the procedures yourself)
• Marketing Firms (as long as it sounds like treatment, e.g., diabetes magazines)
• Law Enforcement (in some cases, without a warrant)
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PANDEMIC TRACKING
One strong motivation for converting to electronic health
records is the need to track pandemics like H5N1 (avian flu)
and SARS (severe acute respiratory syndrome).
Communication between health providers
and local and state authorities is rather ad hoc
and primitive, often dependent on written
records and forms, telephone calls, and faxes.
A fully automated system, which monitors 911 calls,
pharmacy sales, school absenteeism, etc. has been
proposed as an effective way to track pandemics, but…
…the expense of converting to EHR and the potential
privacy concerns tend to deflate such efforts.
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ROBOTIC PROSTHETICS
Microelectronics and biosensors combine to place
intelligence in replacement body parts.
Fluid vibrations are used to detect
rough surfaces.
Perceived pressure varies with the
touched locations.
Small conductive devices detect
touched hot objects.
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BIONIC LIMBS
Standard artificial limbs only return about half of the energy supplied to them
by the user, resulting in awkward and uncomfortable gaits.
Newer bionic systems return 100% of the energy of a
biological limb while accommodating for real time terrain
changes, thus normalizing the individual's gait dynamics.
This lower-leg system translates approximately 250
data points per step through algorithms and circuit
boards that tell an actuator to retract or extend.
When the actuator retracts, it pulls the series
spring up, similar to the loading of a catapult.
At the end of step, the actuator retracts
further and the spring releases stored
energy, emulating the action of the calf
muscles and Achilles tendon.
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PACEMAKERS
A pacemaker is a device that is surgically implanted in the chest
in order to control abnormal heart rhythms (arrhythmia).
Single lead pacemakers connect the
generator and the lower right chamber
of the heart (the right ventricle).
Double lead pacemakers connect the
generator, the right ventricle, and the
upper right chamber of the heart (the
right atrium).
In 2008, researchers at the University
of Massachusetts Amherst were able
to wirelessly hack into a pacemaker,
reprogramming it to shut down and
to administer potentially fatal jolts of
electricity.
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Pacemakers are programmed in one of
two ways:
• Demand pacing – Heart rhythm is
monitored and electronic pulses are
transmitted only if the heart beats too
slow or misses a beat.
• Rate-responsive pacing – The heart
rate is sped up or slowed down
depending on current activity levels.
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MEDICAL IMAGING
Being able to see into a human body without invasive surgery
assists in medical diagnosis without the danger of infection.
Ultrasound
Like the sonar of bats,
ultrasound produces images
by transmitting sound and
then analyzing the returning
echo to determine the size,
shape, and consistency of
organs, tissues, and vessels.
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Computerized
Tomography
Magnetic Resonance
Imaging
CT scans produce a
volume of data about
bodily structures, based
upon their ability to block
a projected X-ray beam.
MRI scans align the
magnetization of some of the
body’s atoms with a powerful
magnetic field, applies radio
frequency fields to
systematically alter that
alignment, and then scans the
resulting magnetic field to
produce an image of that part
of the body.
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DEEP BRAIN STIMULATION
Deep Brain Stimulation (DBS) is under study for the treatment of
numerous brain diseases.
From psychiatric
disorders, such as
depression and
obsessivecompulsive
disorder, to
neurodegenerative
ailments, such as
Parkinson’s and
Alzheimer’s, …
… the insertion
of electrical
probes to
either
stimulate or
inhibit
neuronal
activity is
proving
effective in
reducing
symptoms.
The trick is
finding the
right target.
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THE BRAIN INITIATIVE
In 2013, President Obama announced the Brain Research through Advancing
Innovative Neurotechnologies (BRAIN) Initiative, a collaborative effort
between the NIH, the NSF, DARPA, and the FDA to explore how the human
brain encodes, stores, and retrieves vast quantities of information, and to shed
light on the complex links between brain function and behavior.
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PHOTOGRAPHING THOUGHTS
Using functional MRI scans of test subject brains while watching
movies, UC Berkeley scientists have been able to roughly
reconstruct images of what the test subjects are watching by
analyzing the brain activity itself.
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SURGERY SIMULATORS
Data from CT and MRI scans are used to produce a 3D virtual world of the
patient’s anatomy, and special gloves connected to motion sensors and haptic
feedback devices are used to teach a surgical trainee how to perform particular
surgeries without endangering actual patients.
Virtual Laparoscopic Liver Surgery
Virtual Eye Surgery
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Virtual Intestinal Surgery
Virtual Brain Surgery
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Virtual Endonasal Sinus Surgery
Virtual Open Heart Surgery
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DRUG IMPLANTS
Implantable drug-delivery
devices merge microfluidics with
flexible microelectromechanical
systems to replace pills, which,
due to their long travel through
the bloodstream, must sometimes
be prescribed at near-toxic levels.
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