Top Healthcare Conversations of 2008

Many of the great healthcare thinkers and bloggers wrapped up 2008 with end-of-year considerations of the important developments in their fields, and some looked ahead with predictions for 2009.

Dark Side of the Internet: Pro-Anorexia Sites

The free-wheeling information economy of the global Internet won’t always be there to save us. We’ll have to be sure we make the right health choices.

Tiny In Vivo Robots Roam the Abdomen

Minirobots_1A squad of lipstick-sized prototypes robots developed at the University of Nebraska are being deployed to test minimally invasive surgery techniques. Specialized devices for illumination, biopsy, clamping and cauterizing are planned, some of which could be mobile in the stomach or the abdominal cavity. Soldiers on the battlefield, astronauts in space and trauma victims on the roadside could benefit. See the developers’ web site for a remarkable video (in Real Network format) of a motorized robot roaming a patient’s abdomen.

Dr. Google Saves a Baby

Over 73 million Americans use the Internet to answer health questions, harrying their doctors with self-diagnoses and putting stress on the physician-patient relationship. Medical web sites, disease discussion forums and health blogs give the "Worried Well" an endless supply of symptoms and therapies to ponder.

DrgoogleBut sometimes, the Internet can save some pain, some suffering — and some billing. An article in the Google Blog reports on a premature baby admitted to an ER with very low hemoglobin levels. ER doctors told the parents that an immediate emergency blood transfusion was necessary, but Dad whipped out his Palm computer and Googled the Web. He found an on-line article in American Family Physician that a hemoglobin drop in premies was  "not uncommon." After a respectable period of further study, the docs agreed that the kid was fine. Dad wrote:

Google literally saved our newborn son from having to endure an extremely dangerous, and totally unnecessary, blood transfusion.

Maybe Googling should be added to the list of standard medical practices.

To Scan or Not to Scan: A $300 Question

In the wake of some high profile lung cancer news this month, an AP story today by Marilynn Marchione, "Smokers Flock to Hospitals for Cancer X-Ray," reports on the stampede of smokers who are signing up for CT scans that could potentially spot tumors long before they show up on a conventional x-ray. The deaths of ABC newsman Peter Jennings and Dallas star Barbara Bel Geddes, and the recent lung cancer diagnosis of Dana Reeve, wife of actor Christopher Reeve, have heightened U.S. cancer awareness.

As we wrote last month, advances in digital imaging techniques are producing stunning CT images that look more like living tissue and less like black-and-white x-rays. Marilynn’s article quotes individuals who have signed up for the $300 scans — not necessarily covered by insurance — in order to get "piece of mind" rather than the diagnosis of a current condition. The resolution of CT scans is so good that minor lumps and bumps may cause false positives for cancer, potentially resulting in unnecessary biopsies and surgeries.

While some eminent physicians have recommended early CT scans, the American Cancer Society, the federal government and  "a raft of cancer specialists" caution against the test until a huge new study proves that such early detection is worthwhile —  so that it would be covered by insurance. One hospital lung specialist even stopped her at-risk 82 year old mother from getting scanned. Maybe it means a possible false positive, but it seems to me that $300 is small price top pay for your mother’s piece of mind.

Healthwear: Wearable Medical Devices

Alex (Sandy) Pentland, a member of the Health IC Summit Advisory Board and the Toshiba Professor of Arts and Sciences, heads the MIT Media Laboratory’s Human Dynamics research group. He’s published a terrific article in the IEEE Computer Society’s flagship publication Computer titled "Healthwear: Medical Technology Becomes Wearable." Here’s the abstract from the Computer web site:

Until recently, researchers have had little success in extending
healthcare into the home environment, yet there clearly is a huge
demand for this service. Americans currently spend $27 billion on
healthcare outside the formal medical establishment, which they find
difficult, expensive, and painful to access. A dramatic shift in the
composition of the US population makes it absolutely necessary to
develop such distributed systems. To address these demands, a research
group at the MIT Media Lab has been developing healthwear, wearable
systems with sensors that can continuously monitor the user’s vital
signs, motor activity, social interactions, sleep patterns, and other
health indicators. The system’s software can use the data from these
sensors to build a personalized profile of the user’s physical
performance and nervous system activation throughout the entire
day—providing a truly personal medical record that could revolutionize
healthcare.

The full article is available for purchase on-line.

Molecular Imaging: SNM’s Image of the Year

2005_image_of_the_year_1Following yesterday’s imaging theme, a 3D image (at left, click to enlarge) that fuses 3D molecular and nuclear imaging was named the 2005 Image of the Year at the
Society of Nuclear Medicine’s 52nd Annual Meeting in Toronto last month. According to SNM:

The 2005 Image of the Year is "an exquisite structural
image," notes Henry N. Wagner Jr., SNM past president and historian and
professor of environmental health sciences at Johns Hopkins University The orange area indicates the uptake of F-18 FDG in a
primary cancer lesion and a mediastinal lymph node. The image is
provided by the Molecular Imaging Program at Stanford (MIPS), Stanford
University Division of Nuclear Medicine, Quon A and Gambhir SS.

Molecular imaging is a hot topic we’ll be covering at the Health IC Summit in January. It’s the medical incarnation of augmented reality, the use of overlays to give more information about the world we see, coverging x-ray, infographics, position information, video and virtual reality to give us superhuman vision.

(Thanks to Medgadget.)

CT Update: Higher Res, Higher Speed, Stunning Pictures

SomatomvascularCompared to old-fashioned monochrome x-rays, the latest Computed Tomography (CT) scanners combine innovations in digital imaging with high performance 3D and 4D volumetric computing to give diagnosticians a stunningly detailed look at our innards. Siemens Somatom Sensation 64 with z-Sharp technology, for example, delivers higher resolution 64-slice images at faster speeds by splitting the scan beam, speeding up the scan rate and exploiting high speed dual processor computer hardware to handle the stream. The resulting image (at left, click to enlarge), assembled from slices of digitized data, offers a colorized 3D view of the patient’s internal layout. Cardiac applications add the fourth dimension of time to show heart beats on the doctor’s workstation.

Siemens posts videos of doctors from various specialties demonstrating their use of volumetric data in practice. Today, CT systems are very expensive, complicated and touchy, but chip-driven, software-intensive digital imaging always gets cheaper and better over time.

OsiriX: Converging Macintosh, iPod, Open Source and Medical Images

OsirisRadiologists are viewing and manipulating MRI, CT, PET and other digital medical images on the latest generation Apple Macintosh computers, and they’re storing files and even viewing some images on the pocket-sized iPod Photo multimedia player, displacing expensive workstations, complicated file servers and proprietary software with store-bought consumer electronics gear.

Dr. Osman Ratib and colleagues at UCLA have re-written their previous generation Mac- and Unix-based Osiris system to take advantage of the Open Source graphics environment of the Mac’s System X operating system. The new product — OsiriX — displays medical-standard DICOM (.dcm) files and can be  downloaded free-of-charge from the web.

As the web site describes it:

OsiriX has been specifically designed for navigation and visualization of multimodality and multidimensional images: 2D Viewer, 3D Viewer, 4D Viewer (3D series with temporal dimension, for example: Cardiac-CT) and 5D Viewer (3D series with temporal and functional dimensions, for example: Cardiac-PET-CT). The 3D Viewer offers all modern rendering modes: Multiplanar reconstruction (MPR), Surface Rendering, Volume Rendering and Maximum Intensity Projection (MIP). All these modes support 4D data and are able to produce image fusion between two different series (for example: PET-CT).

OsiriX demonstrates the convergence of some important information technology and healthcare developments:

  • IpodsvideoOpen consumer electronics architectures
  • Open Source software and utilities
  • Streamlined development environments
  • Internet filesharing
  • Medical digital imaging standards
  • On-line medical consultation and collaboration

An article on the Apple Developer Connection tells the full story, and the Osiris web site offers some stunning screen shots of DICOM images on the Mac. One of the coolest shows a kid displaying a PET CT reconstruction through the iPod’s video interface onto a Sony Trinitron TV (above, right).