New Developments

Medicine of the future

"The robotic doctor and virtual patient. Chips in the hip and gamma knives. These advances in medicine that boggle the imagination have computers playing an intrinsic role"

 

            We have seen more advances in medical science in the last 50 years than ever before. Our worlds transformed in way that surpass the wildest imagination. Technology that exists today was unthinkable in the 1950s. Is it possible to even predict the technology 25 years hence? Where will the techno-human evolution lead us in the next millennium?

Open Your Body, Your Mind 

“The abdomen, the chest and the brain will forever be shut form the intrusion of the wise and humane surgeon,” said sir John Eric Erickson, British surgeon appointed to Queen Victoria in the Year 1873. 

            But, how wrong he was! Medical science has grown by leaps and bounds since then. Now, it is considered routine for doctors to conduct delicate surgery using lasers. Fiber-optic cables connected to video cameras permit them to see inside the body and operate through tiny holes in the skin without even cutting the skin. Open-heart surgery had caught the world’s imagination when it was first conducted. Today, a revolutionary new system is set to take on the medical world by storm.  

            Doctors have begun testing a robotic surgery procedure in the United States that could get heart surgery patients back to work within days instead of weeks. The new system combines robotics and computer imaging. It allows doctors to perform heart surgery by controlling miniature hands inside the chest cavity through one-centimeter incisions. The robotic hand is allowed seven degrees of freedom of movement at the wrist, Just like the human wrist, and is wonder fully ergonomic. Since incisions are minute compared to those made in traditional open-heart surgery, doctors expect patients to have a shorter recovery time and suffer significantly less pain. Surgeons control the robotic appendages with joysticks and watch their progress via a 3-D computer image. 

            It’s not unlike surgery; however in this case, the surgeon is always in absolute control of the machine as well as the operation. The advantage of this amazing technology is that in a matter of days the surgeon can learn the procedure.  

            It does seem that genetic engineering, biometric chips, incision-free and robotized surgery will become conventional in the years to come. 

 

Brain And Gamma Knife Radiation

In yet another development, surgeons  are using new imaging software to develop gamma radiation treatments that take the place of painful and risky cranial incisions for tumour removal and other brain treatments. 

            Doctors transfer the images taken by MRI over the hospital’s network to a treatment planning workstation, where scientists work out the computationally intensive math to come up with coordinates for the surgeons to target. 

            In the past, the processing might have taken hours or days, so the types of surgery that could be done were limited. More recently, with the newer computer software and real-time treatment planning doctors are being able to design treatments in minutes. 

            Surgeons can now view the lesion on the MRI and directly develop a treatment plan targeted at the lesion, preserving the surrounding normal brain structures. Doctors can treat brain tumors and other disorders with a pain free, outpatient operation using the so called gamma knife. 

            The treatment can last from several minutes to several hours depending on its complexity and number of individual targets. The gamma knife emits 212 beams of Cobalt-60 gamma rays. The surgeons and physicists program the machine so the radiation will hit one spot, within a fraction of a millimeter , anywhere inside the brain. 

            When traveling separately, the 212 beams travel through other parts of the brain without causing damage. When they converge at the desired spot, however, they deliver a high dose of radiation that achieves a clinical effect. The gamma knife causes no pain, allowing adult patients to comfortably stay awake during the procedure. 

            Traditional surgery is still preferred and necessary in some cases. But, now for many conditions such as arteriovenous malformations (AVM), gamma knives are becoming the first line choice. This is the surgery of the future. 

 

The Artificial Human And Artificial Surgeons 

While crash-test dummies have been used for years in auto collisions, a new type of dummy called medical test  dummy has found its way into hospitals and is being used for drug testing. 

            Even as robots assist experienced doctors in delicate surgery, doctors fresh from medical school find themselves training on a medical test dummy. It seems as if the human hand might not be necessarily perform delicate surgery in the future; and neither would the body part being operated be made of human tissue. Sounds absurd, but even as you read this, researchers at Penn University, USA are in the final stage of developing the first artificial patient. 

            This full sized computerized patient simulator can develop many physiological complexities and diseases. It is also programmed to react to 50 different drugs used by humans in just the same way. Any monitor that could potentially be hooked up to a real human can be hooked up to the mannequin. Since the dummy has a heart with a pulse that can be felt in the neck and arms, it produces the same electrical pulse output as humans do, which enable an ECG monitor to record the signals. 

            The human mannequin’s chest heaves as lungs consume oxygen and produce carbon dioxide. Through the speakers, you could listen to the lung sounds. The dummy not only helps medical practitioners in their studies, but also could reduce the use of animals in drug testing trails. 

            Freshers who have never seen the real side effects of a slow heart rate, would prescribe medication to speed it up; however, this may not be good for the patient. But with training, the physician can accept a drop in heart rate, knowing it will come back in a minute or two. 

            The dummy is equipped with a barcode reader, so you can input more than 50 different drugs. It will recognize the drugs, and weigh the amount of fluid administered; it is programmed with math models that will calculate blood pressure, respiration, and so on.

 

Electronics and Insulin 

Electronics has spawned technologies that have transformed the world in the past five decades. It is fast blending with the science of life. Future trends will see man and machine in a perfect mélange of intrinsic and extrinsic qualities of both worlds. 

            New microchip technology has led to the creation of an advanced, implantable insulin pump that may eventually free diabetics from troublesome daily insulin injections. Algorithms have been recently developed which are small enough to fit on a tiny silicon chip that can monitor and control blood-sugar levels. 

            This microchip could be embedded in a surgically implanted insulin pump that could release insulin as needed and be refilled monthly. The system closely controls blood sugar levels in type I or insulin-dependent diabetics by continuously predicting the patient’s need for insulin. The algorithm would analyze glucose readings from a sensor and instruct the mechanical pump to deliver the appropriate dose of insulin to the patient. 

            The device is likely to be placed near the left hip, close to the portal vein, where the pacers normally releases insulin into the blood stream. The surgery  to implant the pump would be a complex procedure but beyond that the device would be designed for easy maintenance. Refills of the pump’s insulin reservoir would probably require a monthly outpatient injection. 

            Future devices based on powerful microchips could play a major role in the development and support of the human being, which could result in the formation of a cyborg or a bionic man.

 

Cancer and Technology 

A new computer-assisted process could help radiologists minimize the margin of error in mammogram screenings. The technology is designed to complement standard mammography film into a digital signal that can be analyzed by a computer. 

            With “pointers” on a video screen, the computer alerts radiologists to small clusters of micro calcifications and tiny clusters of cell that could  be the early stages of cancer. Preliminary tests based on a study of 104 mammograms have found that the computer can find some cancers that doctors might have otherwise missed. But researchers caution that future studies are still needed to determine the accuracy of the tool. 

            Clinical trials of the Image Checker demonstrated that for every 100,000 breast cancer currently detected, use of the tool could result in the early detection of an additional 12,800 cancers each year.

 

Database of CT scans 

Engineers have developed software and a central database that would allow doctors to make comprehensive image comparisons of medical cases within seconds. Content based image retrieval would allow doctors to compare the results of high-resolution CT scans to diagnoses and treatments of similar cases world wide. 

            It’s like a keyword search, where a query when posed does a search through the database. Only here its done with CT-scan images. Here’s how it works: A physician uses a mouse to identify up to five diseased regions on a patient’s image, then submits the picture in the form of a database query. 

            The software applies a series of image-processing algorithms to characterize the region and compares it with other images in the database. The physician receives four pictures from the database, which can be enlarged, isolated, enhanced, and cross-sectioned. Doctors would also have access to the treatment histories of the database cases to aid in making a diagnosis. 

            Currently the database contains only scans of  human lungs, but researchers hope to eventually include MRIs of the knee, liver and brain. 

            The system is designed to help doctors who are unfamiliar with certain diseases make more informed diagnoses. Normally, radiologists must sift through large books of compiled CT scans in order to compare cases. But the new retrieval system allows computers to analyze images in ways that once required the seasoned eyes of skilled radiologists.

 

Conclusion 

Meanwhile, the continuing technological explosion will bring the eradication of many diseases. It will also usher in an era of lifelong learning, broad access to information resources and maybe even virtual vacations on earth and space. 

            What we will witness in our lifetime could be the evolution of a new breed of medical treatment. The new generation who are in medical school or in the research domain will play an important role in shaping the world of tomorrow. And advancing towards it will be every bit as exciting and full of surprises as the last five decades have been for the medical community.



Copyright © 2002 Dr. Subrahmanyam Karuturi