Medical Technologies Overview and a Brief History

1. Medical TechnologiesOverview and a Brief History

2. 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 treatvarious 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

3. 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

4. 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**

6. 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

7. 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)

8. 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!

9. The Evolution-More Recent • By the 19th century, physicians used machines for diagnosis or therapeutics instead of instinct • Hutchison’s device for measuring vital capacity of the lungs was one of the first technologies to numerically measure an essential body function • Herisson’s 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

10. 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 world—on average nearly 30 years longer than their ancestors a century ago. National Academy of Engineering, 2009

11. A Timeline… 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 heart’s wave patterns on a photographic plate or paper by measuring small changes in electric potential as the heart contracts and relaxes 1903

12. A Timeline… First Modern Practical Respirator -Created using an iron box and two vacuum cleaners -Dubbed the “iron lung”, the finished product—nearly the length of a small car—encloses the entire bodies of its first users: polio sufferers with chest paralysis. -Pumps raise and lower the pressure within the respirator’s 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

13. 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

14. A Timeline… 1933 Kouwenhoven Electric Shock “Defibrillator” -Working on rats and dogs, William B. Kouwenhoven and OrthelloLangworthy discover that while a low-voltage shock can cause ventricular fibrillation, or arrhythmia, a second surge of electricity, or countershock, can restore the heart’s normal rhythm and contraction -Kouwenhoven’s 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

15. 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 woman’s blood, clean it of impurities, and pump it back into her body -Kolff’s 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

19. 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

20. 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

22. 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

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

26. 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

28. 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 body’s rejection response, which is stimulated by foreign tissue, human organ transplants can succeed National Academy of Engineering, 2009

29. 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

30. A Timeline… 1963 Laser Treatments to Prevent Blindness -Francis L’Esperance 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

31. 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

33. 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 eye’s cornea than do hard plastic lenses National Academy of Engineering, 2009

34. 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

36. 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

37. A Timeline… 1980s Controlled Drug Delivery Technology Developed -Robert Langer develops the foundation of today’s 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

39. 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

41. 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

42. A Timeline… 1985 Implantable Cardioverter Defibrillator (ICD) Approved -The FDA approves Michel Mirowski’s 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

44. A Timeline… 1987 Deep-brain Electrical Stimulation System -France’s Alim-Louis Benabid a neurosurgeon implants a deep-brain electrical stimulation system into a patient with advanced Parkinson’s 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

45. 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 cow’s eye -Nine years later the first computerized laser—Lasik—designed to correct the refractive error myopia, is approved for use in the United States

46. 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

47. 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

48. 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

49. 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

50. 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.