Medical Technologies Overview and a Brief History

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Medical TechnologiesOverview and a Brief History
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Medical Technology is

• One component of the broader field of Health
  Technology which includes
• Health-care products, equipment, tools, and
  medicines that are used to prevent, diagnose,
  monitor, and treat various conditions or
  illnesses
• Engineers continuously strive to develop new
  technological devices that
• Improve quality of health care
• Provide a more accurate diagnosis
• Detect problems earlier
• Are non-invasive (no incision)
• Decrease the recovery time/rehabilitation period

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Health Technology

• In 1900 -average life expectancy for a human in
• the United States was 47 years
• In 2000 -average life expectancy was nearing
  77 years
• This increase of 30 years was a result of several
  factors including
• Creation of a safe water supply
• Wide assortment of medical advances in
• diagnosis
• pharmaceuticals
• medical devices
• various other forms of treatment

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A little bit of history

• In the early beginnings of humankind, disease was
  viewed with mystery
• Caused by negative interaction between
  environmental elements and body fluids
• Hippocrates (460-377 BC) and Claudius Galen
  (131-201 AD) described the four humours
• Measured deficiency or excess of body fluids with
  respect to the changing seasons
• First documented Western physicians to actively
  engage in the science of healing to increase the
  quality of life for their patients

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A little bit of history

• Medical technology slowly evolved in response to
  diseases with high mortality rates (Black plague
  Europe, 1348 and 1350)
• Medicine and medical technology has become the
  antidote for illness and disease that formerly
  destroyed entire societies

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The Evolution-Early Stages

• Patient descriptions of symptoms and personal
  observations
• Rarely a physical examination of body
• Theoretical and philosophical approach
• Medical students discouraged from touching
  patient while learning
• This started to change as physicians realized
  that medical texts first published in 11th
  century and the general practices of the time had
  many errors
• By the 18th century, manual techniques to
  diagnose patients became more accepted as a
  medical practice
• Use of cadavers and physical touch (public was
  very reluctant)

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The Evolution-Developing

• For the majority of the 19th century, general
  practitioners provided in-home patient care
• Decentralized and rural
• Most of the medical equipment that they used fit
  easily into the doctor's little black bag
• In 1895, German physicist Wilhelm C. Roentgen
  accidentally discovered a form of electromagnetic
  radiation that could pass through the body and
  leave an image of its bones or organs on a
  photographic plate. The birth of the X-ray
  sparked a revolution!

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The Evolution-More Recent

• By the 19th century, physicians used machines for
  diagnosis or therapeutics instead of instinct
• Hutchisons device for measuring vital capacity
  of the lungs was one of the first technologies to
  numerically measure an essential body function
• Herissons sphygmomanometer for blood pressure
  measurement was also an early device
• Slow change from the use of subjective evidence
  provided by the patient, to objective evidence
  obtained by mechanical and chemical technology
  devices

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The Evolution-Modern

• Diagnostic tools such as the electrocardiograph,
  CAT scan, and MRI followed, as did the
  development of artificial and transplanted organs
  and joints, as well as other surgical devices and
  techniques designed to keep the body functioning.
  
• These advancements and the discovery of
  antibiotics and other life-saving drugs
  contributed to increasing the life span of people
  throughout the developed worldon average nearly
  30 years longer than their ancestors a century
  ago.
• National Academy of Engineering, 2009

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A Timeline

• 1903

First Electrocardiograph Machine (ECG) -After
attaching electrodes to both arms and the left
leg of his patient, Dutch physician and
physiologist Willem Einthoven was able to record
the hearts wave patterns on a
photographic plate or paper by measuring
small changes in electric potential as the
heart contracts and relaxes

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A Timeline
First Modern Practical Respirator -Created using
an iron box and two vacuum cleaners -Dubbed the
iron lung, the finished productnearly the
length of a small carencloses the entire bodies
of its first users polio sufferers with chest
paralysis. -Pumps raise and lower the pressure
within the respirators chamber, exerting a
pull-push motion on the patients chests. Only
their heads protrude from the huge cylindrical
steel drum.
1927

National Academy of Engineering, 2009
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A Timeline
1930s
Artificial Pacemaker Invented -Invented by Albert
S. Hyman, a practitioner cardiologist in New York
City, to resuscitate patients whose hearts have
stopped -Working with his brother he constructs
a hand-cranked apparatus with a spring motor that
turns a magnet to supply an electrical impulse.
-His invention never receives acceptance
from the medical community

National Academy of Engineering, 2009
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A Timeline
1933
Kouwenhoven Electric Shock Defibrillator
-Working on rats and dogs, William B.
Kouwenhoven and Orthello Langworthy discover that
while a low-voltage shock can cause ventricular
fibrillation, or arrhythmia, a second surge of
electricity, or countershock, can restore the
hearts normal rhythm and contraction -Kouwenhov
ens research in electric shock and his study of
the effects of electricity on the heart lead to
the development of the closed-chest electric
defibrillator and the technique of external
cardiac massage today known as cardiopulmonary
resuscitation, or CPR

National Academy of Engineering, 2009
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A Timeline
First Kidney Dialysis Machine -Willem J. Kolff
successfully treats a dying patient with an
"artificial kidney" -Made of wooden drums,
cellophane tubing, and laundry tubs and is able
to draw the womans blood, clean it of
impurities, and pump it back into her
body -Kolffs invention is the product of many
years work, and the patient was his first
long-term success after 15 failures. In the
course of his work with the artificial kidney,
Kolff notices that blue, oxygen-poor blood
passing through the artificial kidney becomes
red, or oxygen-rich, leading to later work on a
membrane oxygenator
1945

National Academy of Engineering, 2009
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A Timeline
1948
First Corneal Contact Lens Developed -Kevin
Touhy receives a patent for a plastic contact
lens designed to cover only the eye's cornea
(instead of across all of the visible ocular
surface, 1636) -Two years later George
Butterfield introduces a lens that is molded to
fit the cornea's contours rather than lie flat
atop it

National Academy of Engineering, 2009
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A Timeline
1950s
First Artificial Hip Replacement -English surgeon
John Charnley applies engineering principles to
orthopedics and develops the first artificial hip
replacement procedure, or arthroplasty -In 1962
he devises a low-friction, high-density polythene
suitable for artificial hip joints and pioneers
the use of methyl methacrylate cement for holding
the metal prosthesis, or implant, to the shaft of
the femur -Charnley's principles are then adopted
for other joint replacements, including the knee
and shoulder

National Academy of Engineering, 2009
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A Timeline
1951
Artificial Heart Valve Developed -Charles
Hufnagel develops an artificial heart valve and
performs the first artificial valve implantation
surgery in a human patient -The valve--a
methacrylate ball in a methacrylate aortic-size
tube does not replace the leaky valve, but acts
as an auxiliary -Albert Starr, working with
electrical engineer Lowell Edwards, designs a
silicone ball inside a cage. The Starr-Edwards
heart valve is born and is still in use today.

National Academy of Engineering, 2009
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A Timeline
1952
First Successful Cardiac Pacemaker -Paul M. Zoll
develops the first successful cardiac
pacemaker -The bulky device, worn externally on
the patients belt, plugs into an electric wall
socket and stimulates the heart through two metal
electrodes placed on the patients bare chest

National Academy of Engineering, 2009
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A Timeline
1953
First Successful Open-heart Bypass Surgery -John
H. Gibbon performs the first successful
open-heart bypass surgery on an 18-year-old whose
heart and lung functions are supported by a
heart-lung machine developed by Gibbon -The
device is the culmination of two decades of
research and experimentation and heralds a new
era in surgery and medicine -Today coronary
bypass surgery is one of the most common
operations performed

National Academy of Engineering, 2009
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A Timeline
1954
First Human Kidney Transplant -Led by Joseph E.
Murray, physicians remove a healthy kidney from
the donor and implant it in his identical twin
brother, who is dying of renal disease -Since
the donor and recipient are perfectly matched,
the operation proves that in the absence of the
bodys rejection response, which is stimulated by
foreign tissue, human organ transplants can
succeed

National Academy of Engineering, 2009
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A Timeline
1960
First Totally Internal Pacemaker -Buffalo, New
York, electrical engineer Wilson Greatbatch
develops the first totally internal pacemaker
using two commercial silicon transistors
-Surgeon William Chardack implants the
device into 10 fatally ill patients. The
first lives for 18 months, another for 30
years

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A Timeline
1963
Laser Treatments to Prevent Blindness -Francis
LEsperance works with a ruby laser
photo-coagulator to treat diabetic retinopathy, a
complication of diabetes and a leading cause of
blindness in the United States -In 1965 he begins
working to design an argon laser for eye surgery
(the blue-green light of the argon laser is more
readily absorbed by blood vessels than the red
light of the ruby laser) -In early 1968, after
further refinements and careful experiments, the
argon-ion laser is used to treat patients with
diabetic retinopathy

National Academy of Engineering, 2009
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A Timeline
1970s

Arthroscope Introduced -Advances in fiber-optics
technology give surgeons a view into joints and
other surgical sites through an arthroscope, an
instrument the diameter of a pencil, containing a
small lens and light system, with a video camera
at the outer end -Used initially as a diagnostic
tool prior to open surgery, arthroscopic surgery,
with its minimal incisions and generally shorter
recovery time, is soon widely used to treat a
variety of joint problems
National Academy of Engineering, 2009
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A Timeline
1971
First Soft Contact Lens -Bausch Lomb licenses
Softlens, the first soft contact lens approved by
the FDA -The new product is the result of years
of research by Czech scientists Otto Wichterle
and Drahoslav Lim and is based on their earlier
invention of a "hydrophilic" gel, a polymer
material that is compatible with living tissue
and therefore suitable for eye implants -Soft
contacts allow more oxygen to reach the eyes
cornea than do hard plastic lenses

National Academy of Engineering, 2009
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A Timeline
1972
CAT or CT scan is introduced -Computerized axial
tomography, popularly known as CAT or CT scan, is
introduced as the most important development in
medical filming since the X ray some 75 years
earlier -With the help of a computer, the device
combines many x-ray images to generate
cross-sectional views as well as
three-dimensional images of internal organs and
structures -Used to guide the placement of
instruments or treatments, CAT eventually becomes
the primary tool for diagnosing brain and spinal
disorders

National Academy of Engineering, 2009
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A Timeline
1978
First Cochlear Implant Surgery -Graeme Clarke in
Australia carries out the first cochlear implant
surgery -Advances in integrated circuit
technology enable him to design a multiple
electrode receiver-stimulator unit about the size
of a quarter

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A Timeline
1980s
Controlled Drug Delivery Technology Developed
-Robert Langer develops the foundation of
todays controlled drug delivery
technology -Using pellets of degradable and
non-degradable polymers he fashions a porous
structure that allows slow diffusion of large
molecules -Such structures are turned into
dime-size chemotherapy wafers to treat brain
cancer after surgery. When placed at the site
where a tumor has been removed, the wafer slowly
releases powerful drugs to kill any remaining
cancer cells. By confining the drug to the tumor
site, the wafer minimizes toxic effects on other
organs

National Academy of Engineering, 2009
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A Timeline
1981
MRI (magnetic resonance imaging) Scanner
Introduced -The first commercial MRI (magnetic
resonance imaging) scanner arrives on the medical
market -Using high-speed computers, magnetic
resonance imaging (MRI) is adapted for medical
purposes, offering better discrimination of soft
tissue than x-ray CAT and is now widely used for
noninvasive imaging throughout the body

National Academy of Engineering, 2009
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A Timeline
1982
First Permanent Artificial Heart Implant -The
first permanent artificial heart, a silicone and
rubber device is received by a Seattle
dentist -The dentist survives for 112 days
with his pneumatically driven heart (operated
with compressed air)

National Academy of Engineering, 2009
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A Timeline
1985
Implantable Cardioverter Defibrillator (ICD)
Approved -The FDA approves Michel Mirowskis
implantable cardioverter defibrillator (ICD), an
electronic device to monitor and correct abnormal
heart rhythms, and specifies that patients must
have survived two cardiac arrests to qualify for
ICD implantation -It weighs 9 ounces and is
roughly the size of a deck of cards

National Academy of Engineering, 2009
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A Timeline
1987
Deep-brain Electrical Stimulation
System -Frances Alim-Louis Benabid a
neurosurgeon implants a deep-brain electrical
stimulation system into a patient with advanced
Parkinsons disease -The experimental treatment
is also used for dystonia, a debilitating
disorder that causes involuntary and painful
muscle contractions and spasms, and is given
when oral medications fail

National Academy of Engineering, 2009
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A Timeline
1987
First Laser Surgery on a Human Cornea -New York
City ophthalmologist Steven Trokel performs the
first laser surgery on a human cornea, after
perfecting his technique on a cows eye -Nine
years later the first computerized
laserLasikdesigned to correct the refractive
error myopia, is approved for use in the United
States

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A Timeline
1990
Human Genome Project -Researchers begin the Human
Genome Project, with the goal of identifying all
of the approximately 30,000 genes in human DNA
and determining the sequences of the three
billion chemical base pairs that make up human
DNA -The project catalyzes the multibillion-dollar
U.S. biotechnology industry and fosters the
development of new medical applications,
including finding genes associated with genetic
conditions such as familial breast cancer and
inherited colon cancer -A working draft of the
genome is announced in June 2000

National Academy of Engineering, 2009
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The Evolution

• Medical technology stimulated the growth of
  medical specialists
• In 1930, only 1/4 practitioners was a medical
  specialist
• By 1980, more than 4/5 practitioners were
  specialists
• Specialization was a result of
• 1. Patient populations concentrated in urban
  centers
• 2. Economic incentives for doctors to relocate
• 3. General practitioners (GP) wanted to escape
  irregular hours
• 4. Specialization seemed to hold more prestige
• 5. GPs could no longer keep up with the amount of
  knowledge required to make accurate diagnostic
  and treatment assessments (increases in
  technology)
• 6. Machinery and equipment used in medicine
  became complex and required specialized technical
  expertise and support

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The Evolution

• With more specialists, came a need for more
  cooperative arrangements since no single
  physician possessed all of the special knowledge
  required
• Increase in the number of physicians associated
  with private medical groups
• Introduction of hospitals
• Medical services became cooperative practice
  arrangements
• Decreasing level of local medical services in
  many rural areas
• Medical technology and specialization increased
  the amount of data required to diagnose and treat
• Development of the medical record to organize and
  store data
• Need for medical technicians and data specialists
  
• By 1969, 80 of those employed as medical
  professionals were non-physicians

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The Evolution

• The exponential growth in medical technology and
  data created the need for more technicians of all
  kinds to test and manage data
• Education was needed for medical technicians for
  increased proficiency in the use of technology
• Patients also needed education to be better
  informed about the confusing decisions regarding
  the tests and procedures being performed for
  their health and well-being

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Something to think about

• Most of us have encountered some kind of medical
  technology in our lives. Even if we have not
  experienced it ourselves,
  someone we know probably has.
• If you have ever broken a bone, you have probably
  had an X-ray taken. If someone in your family has
  had kidney problems, he or she might have had to
  go on dialysis. Perhaps you know someone who has
  been through organ transplant surgery, heart
  surgery, or fertility treatment.
• There are many kinds of technology that help
  medical professionals diagnose and treat health
  problems.

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Wait a minuteconsider this!

• Medical technology has embedded itself in our
  culture and has been a positive and powerful
  force in the improvement of life for millions of
  people.
• However, for every yin there is a yang, and with
  all things that are positive, there is also a
  negative component that must not be ignored.
• Most Americans are familiar with the benefits of
  technology, specifically medical technologies
  the media reports on these benefits every day.
  However, it is not often that physicians and
  patients have the opportunity to discuss what has
  been given up, lost or sacrificed as a result of
  using these same technologies.

R. L. Sanders Medical Technology A Critical
Perspective . The Internet Journal of Medical
Technology. 2004 Volume 2 Number 1
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Think/Pair/Share

1. Write a list of medical technologies that you, or
   people you know, have experienced.
2. Describe each technology and what it does in as
   much detail as possible. If possible, describe
   how you or the person you know felt during the
   procedure.
3. Did you/they have positive or negative feelings
   about the technology?

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Think/Pair/Share

• Share your list of medical technologies with a
  partner.
• Discuss your feelings about the technologies. Do
  any of them have ethical implications?
• Have the technologies made a difference to human
  life-span and quality of life? Explain.
• From your perspective, which are the top 5 most
  significant technologies? Provide reasoning for
  your choices.
• Blogging Response 2 Due Friday, October 18th
• What are the top 3 most significant technologies?
  Provide
• reasoning for your choices.