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Telemedicina e e-Saúde 2009/2010
Telemedicine Technologies 1
Telemedicine Technologies
Telemedicina e e-Saúde
2009/10
Pedro Brandão
References
Sources are indicated by [RefSource] where the complete citation will be at the end
Insite citations will be From: CitationSource
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ROBOTICSTELE SURGERY
Technologies
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Robot example NAO
From Aldebarran group
oNAO
Some medical goals [MSHB]s
o Elders companion/helpers
o Children education
• “in San Raffaele Hospital [...] NAOs are used to train diabetic children to take the insulin injections”
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(not much on telemed...)
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History – Telesurgery Experimental Telesurgery 1990 by Satava, Green, and
Bowersox [VTFE]o Prototype experiment on bovine and swine
o Comparison to regular surgery• 192 ± 24 sec conventional
• 483 ± 118 sec telepresence surgery
• Same precision results
Clinical Demonstration in 2001 by Jacques Marescauxo telerobotic cholecystectomy on a patient in Strasbourg
o Controlled from New York City
o Distance: 4000 km
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From [ROBSUR]
History (cont) 1994 Computer Motion, Inc. produced Aesop 2000
o Automated Endoscopic System for Optimal Positioning
o surgical robot, laparoscopic camera
o Next was Zeus tele-operatedRobotic System
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AESOPComputer Motion
ZeusComputer Motion
History (cont)
Davinci System from Intuitive Surgical*
o Instruments are swapped by nurses
o Head control
o 3D display
o Small incisions
o High precision
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From Intuitive Surgical(1999)
*Merged with Computer Motion in 2000
Davinci System
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From Intuitive Surgical
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History (cont)
2005 Penelope robotic scrub technician
o responsible for dispensing and retrieving surgical instruments.
o By Robotic Surgical
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From [ROBSUR]
Source: Columbia Surgery
Prototypes – SILS in robot
Single Incision Laparoscopic Surgery
One small tube one incision
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Robotic prototype from Intuitive Surgical
SILS Port from CovidienFor “regular” laparoscopy
History (cont)
“February 2003 Dr. Anvari performed the world’s first hospital-to-hospital teleroboticsurgery over a telecommunications network”
Centre for Minimal Access Surgery (CMAS), from McMaster University, Canada
o “telementoring and telerobotics for the provision of training and clinical services within remote areas of Canada”
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From CMASCyberKnife System Non invasive x-radiation cancer treatment
Uses a linear accelerator
Automatic real time image-guidance
o No patient restrain
o Minimizes damage tohealthy tissues
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From [STRS]
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Robot capabilities
Manipulation
Movement
Vision
Everything is information
o Can be assessed
o Can be commandeered
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Usages – Operations Cardiac surgery
o arterial anastomoses of Coronary Artery Bypass Grafting (CABG);
o mitral valve replacement ;o atrial septal defect;
Urologyo radical prostatectomyo laparoscopic nephrectomyo Pyeloplastyo laparascopic cholecystectomy
Gynaecologyo Hysterectomyo fallopian tube (re)anastomosis
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From [ROBSUR,TEUS]
Usages - Education
Medical conferences:
o live video session of a robotic procedure
Save movements and use them as feedback for students;
Pre-operative testing
oUse a virtual patient to test/practice an operation procedure
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From [ROBSUR]
Advantages
Higher precision, dexterity
o Tremor reduction
Couple several instruments (camera included)
o Control
o (possibly) In a single incision
Small incisions (pencil diameter)
Smaller learning curve
Ergonomic position
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Others
NOTES: Natural Orifice TranslumenalEndoscopic Surgery
o Feasibility has been studied in animals
o Being evaluated in Humans
Cooperative Robots
oMore than one robot to help on the procedure
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From [COOPROB]
Davinci and lighting/imaging robot(from [COOPROB])
Nanorobots
Nano is 10-9
Targeted drug delivery
Target blood vessels
Cell/DNA repairs
Attack/Destroy specific cells
Diagnostics
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Nanorobot example
Chemical Sensors
Power supply
Actuators
Data transmission
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From [NBA]
Image from [NBA]
Nanorobot for brain aneurismComputer simulation
Robot dimensions2 µm in length0.5 µm in diameter
6 µm diameter red blood cell1012 nanorobots in the 5l blood vol.
Total of 0.2g
ACQUISITIONTechnologies
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Microscope for the Phone
Aydogan Ozcan aims for mobile microscope
o LUCAS (Lensless Ultra-wide-field Cell Monitoring Array platform based on Shadow imaging)
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From Physorg
From MIT Tech Review
Mobile Devices
Sending high definition images to mobile devices (Smarphones)
o Prototypes using Waaves compression program to send the images using GSM
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From MSDN Blog by Octavian Purcarea. Images also.
ECG on the run
Blackberry application to receive ECG reports
Use/development of eUNO R 10 technology
oWith Maestros Mediline Systems
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From HealthAge
Intel Health Guide PHS6000
Two way video calls
Specific devices connectivityo blood pressure monitors, glucose meters, pulse
oximeters, peak flow, weight scales
o Wired: 4 USB 2.0 ports;
o Wireless: Bluetooth* v2.0, Class 1
o RJ 45 connector (broadband access)
Multimedia content
History
Reminders
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Portable ultrasound – Vscan (GE)
PC software to act as a gateway between Vscan, customers’ PC tools and GE hotline service.
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From GE Vscan brochure
From Vscan
Vscan Specifications Clinical Applications
o Cardiaco Abdomeno Urinary bladdero Obstetrics and gynecologyo Pediatrico Selected peripheral vascular applicationso Thoracic/pleural fluid and motion detection
Imagingo Black and white mode for displaying anatomy in real-timeo Colour-coded overlay for real-time blood flow imagingo Field-of-view for black and white imaging: up to 75 degrees with
maximum depth of 25 cmo The colour flow sector represents blood flow within an angle of 30
degrees
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From GE Vscan datasheet
APPLICATIONSTechnologies
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Dr. SMS
Kerala region in India
User sends a text with:
oNeeded facilities
o Pin-code identifying the centre (location) where the facility should be situated
User receives:
o details of nearest centers with the requirement
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From Dr SMS
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Tele Psychiatry
Dept of Mental Health in South Carolina (USA)o “develop a telepsychiatry network for all South
Carolina (SC) hospitals operating emergency departments (ED)”
o “The objective of the grant is to make psychiatric consultation available in all SC EDs at all times.”
Portugal = 92 090 Km2
South Carolina = 80 780 Km2
Development
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Telerehabilitation for speech Patients with
o Aphasia, dysarthria, apraxia of speech, cognitive-linguistic disorders.
Resulting from:o stroke, traumatic brain injury, Parkinson’s disease,
multiple sclerosis
Consultations are based in audio-visual interactionsoUse of video-conference or telephone
Swallowing treatmento Assessed (experimental) using real time video-
fluoroscopy
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From [REHAB]
Telerehabilitation – PhysicalPatients with
o muscular-skeletal problems, stroke-induced paralysis, cognitive deficits.
Consultations use Virtual Reality environmentso “teaching by example”, “video-game like”, “exposure
therapy”
Advantages o Ability to multiplex treatmento “more fun” patient motivationo Access to detailed patient “performance” datao Easy reuse of software and hardware
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From [REHABVR]
VR Rehab examples
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The VR-based orthopedic rehabilitation using a haptic glove during a pegboard exercise. © IEEE 2000
Virtual scene used in desensitizingVietnam veterans © Virtually Better 2000
Teaching by example, © Lawrence Erlbaum 2002
Refs from [REHABVR]
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Uses of video-conference
Tele-psychiatry
Tele-paediatrics
Tele-dermatology
Acute care
Remote consultation of stroke patients
Telemergency (UMississipi)
Family-Link (UCDavis)
Etc...
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From UCDavis
©Technical Innovation
Neuro feedback/monitoringEnables Electro EncefaloGram reading Software for training/feedback, managed
remotely by doctor Skin potential/impedance, temperaturePhotic, vibratory and auditory feedback
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From BrainMaster Discovery Brochure
Triage – example Aid-Network
Objective: replace the paper based triage systems
Uses
o Bio-sensors
oMesh networks
To enhance the normal disaster 1st responder architecture
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Aid-N – Components miTag
o heart-rate and pulse oximetero Led with triage level/priorityo LCD with HR, O2 sat
PDAo Real time info of patients
Central control (miView)o Real time view of every patient triaged
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From Aid-N
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Aid-N – Architecture
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From [AIDN]
Aid-N (cont)
Forms a Mesh Network
oUses 802.15.4
o Can have repeaters
Long term wear carrier
oUse in hospitals
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Remember? Dermatology consult
Use of special cameras for acquisition
Triage, diagnosis
Wounds, skin cancer.
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©Technical Innovation
Dermatology: other
Web sites for discussion of diagnosis
oUpload of images
o Telederm.org
o Dermatlas (image database)
o Virtual Grand Grounds in Dermatology
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Example of sharing knowledge to increase it
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Remember: Tele Consultation
From Medical Centre Kansas University
Uses:o Digital stethoscope
o Otoscope Camera
o Dermascope
o Intra-oral camera
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END OFTELEMEDICINE TECH
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Referências – Robots – II [ROBSUR] Richard M. Satava, “Robotics in Colorectal
Surgery: Telemonitoring and Telerobotics”, Surgery Clinic N Am 86 (2006)
[MSEH] Octavian Purcarea, “Nao the friendly robot”, MS EMEA Health Blog
[RSB] Brown University, Robotic surgery, Student Project Report on, 2005o Video of a surgery available
[VTFE] Jon C. Bowersox, Ajit Shah, et al, “Vascular applications of telepresence surgery: Initial feasibility studies in swine”, Presented at the Forty-ninth Annual Meeting of the Society for Vascular Surgery 1996
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Referências – Robots – II [TEUS] Pamela Whitten and Beverly Sypher, “Evolution of
Telemedicine from an Applied Communication Perspective in the United States”, Telemedicine and e-Health Vol 12, N 5, 2006
[COOPROB] Lehman A, Berg K, Dumpert J, et al. “Surgery with cooperative robots. Computer Aided Surgery” Official Journal Of The International Society For Computer Aided Surgery, March 2008;13(2).
[STRS] Coste‐Manière È, Olender D, Kilby W, Schulz R. “Robotic whole body stereotactic radiosurgery: clinical advantages of the Cyberknife® integrated system”. International Journal of Medical Robotics and Computer Assisted Surgery, January 2005;1(2):28-39.
[NBA] Adriano Cavalcanti, Bijan Shirinzadeh, Toshio Fukuda, Seiichi Ikeda, “Nanorobot for Brain Aneurysm”, IJRR International Journal of Robotics Research, Special Issue, Sage, Vol. 28, no. 4, pp. 558-570, April 2009.
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References – Applications [REHAB] Deborah G Theodoros
“Telerehabilitation for service delivery in speech-language pathology”, Journal of Telemedicine and Telecare 2008; 14
[REHABVR] G. C. Burdea, “Virtual Rehabilitation -Benefits and Challenges”, Methods of Information in Medicine 2003 (Vol. 42)
[AIDN] Tia Gao, et al ““The Advanced Health and Disaster Aid Network: A Light-Weight Wireless Medical System for Triage”, IEEE Transactions on Biomedical Circuits and Systems, September 2007
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Acronyms – Robots
CABG – Coronary Artery Bypass Grafting
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