ENGINEERING AND MEDICINE

1. ENGINEERING AND MEDICINE BY Mark H. Bechtel, M.D.

2. My Story • No inclination into medicine originally • Mother and wife are nurses, Wife also CRNA • 1st hand experience with hospitalization • Wanted Change • Career Counseling • Decided on Medicine in 1993 • Prerequisites by 1994 and started Med School.

3. Introduction • Moscow High School • BSEE, University of Idaho 1989 • Internships at Varian and Chevron during EE training. • Test Engineering at IBM, 1989-1991 • VLSI Design at AHA, 1991-1994 • MD at University of Washington 1994-1998 • Internship in Spokane, Washington 1999 • Radiology Residency at University of Wisconsin, 1999-2003 • General Radiologist in Brainerd, MN 2003-2004 • Musculoskeletal Fellowship at Penn State Hershey, 2004 • General Radiologist, MSK Specialist, Yankton, SD, 2005-2006 • General Radiologist, MSK Specialist, Moscow, ID, 2006-present

4. Main Points • Engineers as Physicians • Engineers as Information System Experts • Biomedical Engineering • Electrical Design in Medicine

5. Physician Engineers • Engineering is an excellent base for medicine • High percentage of radiologists are engineers • Engineering teaches a method of thinking that is not taught in other undergrad degrees

6. Medical School • 4 Years • Easier conceptually than engineering • More time than engineering • Engineering: if understand the concept then studying is over. • Medicine: Doesn’t matter if understand the concept. Human body is dynamic and the patient is still sick. Learning is constant and there is no definite endpoint. • Much more memorization

7. Internship • Most Physicians have internships • One year general training • Interview and selection process

8. Residency • Three to Six years • Radiology (4 years)

9. Fellowship • Further specialization • 1-2 years for radiology • …

10. Engineers as Information System Specialist • Radiology is highly Technology Dependent • PACS systems • Large storage system • Single CT can have 2000 images at 500Kbyte each • Need to interface with different equipment • Need to be able to send entire studies many miles away • NightHawk

11. Biomedical Engineering • Designing equipment for medical use • Ie: Insulin pump and detector • Pacemaker/defibrillator • Digital Subtraction Angiography • Stents • Intravascular work

12. Pacemaker • Earl Bakken

13. Pacemaker • Bakken’s orignal schematic

14. Pacemaker • Newer Devices

15. Pacemaker • Chest Xray

16. Pacemaker • Conduction system

17. Ultrasound Images

18. Magnetic Resonance Imaging

19. MRI Images • Enhancement characteristics

20. MRI Images • Diffusion Tensor Imaging

21. MRI Images • MRA

22. MRI Images • Fat saturation

23. MRI Images • Spectroscopy

24. MRI Images • Cardiac Imaging

25. MRI Images • K-Space

26. MRI Physics

27. CT • See other lecture

28. Conclusion • Engineering is an excellent base for medicine as a researcher, designer, information specialist, or as a physician.

29. Multidetector CT Mark Bechtel, M.D.

30. Education • Medical School: University of Washington • Radiology Residency: University of Wisconsin • Musculoskeletal Fellowship: Penn State University, Milton S. Hershey Medical Center

31. Chronological Developments in Multisclice CT • 1971 CT invented by Godfrey Hounsfeld of EMI and independently by Allan Cormack of Tufts University, Massachusetts. • 1974-1976 First Commercial CT scanners (for head CT only) • 1976 Whole body CT now available. • 1980 CT now widely available. • 1989 Introduction of Helical CT by Siemens, Germany • 1991 Launch of Dual Slice CT by Elscint, Haifa, Israel • 1999 Launch of 4 Slice Scanners • 2002 Launch of 16 Slice Scanners • 2003 Prototype 32 Slicers developed • 2003 Prototype 256 Slicers developed (Toshiba) 4D CT • 2003 Research in Flat Panet Detectors • 2003 Research in Faster scanning (<0.4 s rotation time) • 2003 Research in Cone Beam CT Multislice CT : A Quantum Leap in Whole Body ImagingIK indrajit, mn shreeram, jd d’souzaInd J Radiol Imag 2004 14:2:209-216

32. 16 Slice is new standard • 32 and 64 slice models for cardiac scanning • New method of use is 3D evaluation versus axial imaging

33. Evaluation of a Mandibular Lesion • Left mandibular lesion was scanned in the axial and coronal planes. • Sagittal, oblique Sagittal and 3D images were reformated.

34. Mandibular Mass/Abscess

35. Mandibular Mass/Abscess 3D

36. Mandibular Mass/Abscess 3D

37. Comparison of Reconstructions • Comparing lumbar spine reconstructions from usual abdominal CT data sets from a single slice CT scanner and from a 16 slice multidetector CT.

38. Comparison of L-Spine Recons

39. 3D Reconstruction of Bones and Fractures • Multiplanar reconstructions are possible • Allows better visualization of orientation of certain types of fractures. • Experienced readers often prefer 2D reconstructions

40. 3D Hind/Mid Foot

41. Clavicle Fracture missed on plain film

42. Clavicle Fracture missed on plain film

43. Clavicle Fracture missed on plain film

44. Clavicle Fracture missed on plain film

45. CTA of the Lower Extremities • Fast scanning abilities allows scanning of the lower extremities for vascular disease. • Makes conventional diagnostic angiography almost obsolete. • Can be used for surgical planning.

50. Mesenteric CTA