BME 100 - Intro. To Biomed Engg.© 2008 James Andrew Smith, PhDwww.ee.ryerson.ca/~jasmith

What is Biomedical Engineering?

Overview of the Next Hour

• History related to Biomedical Engineering• The Modern System• Biomedical Engineering: Specifics• Societies, Organisations and Resources

Early Roots of Healing

• Health is a universal concern• Instincts & experience dominate

• Multi-generational traditions• No systematic, scientific process

• Supernatural concerns common• How different from today?

• Examples in the Americas• Trephine - bone / skull drilling

• Aztecs’ gold & bronze devices (1200 - 1400 CE)• Scurvy - Lack of Vitamin C

• Iroquois & Jacques Cartier (1535 - 1536 CE)• Annedda tree (white cedar) & white pine needles

• Coca leaves in Peru (Andean culture)• Mild stimulate, suppresses hunger, pain & fatigue

Ancient Greece & Egypt

• 3000 BCE - 323 BCE• “Rx” from Egyptian symbol for

“protection & recovery”• Egyptian Diagnostic & Surgical

Scrolls (1500 & 1700 BCE)• Medicine as a profession (1000 BCE)

• “Healthy body, healthy mind” paradigm• Hippocrates: disease as a natural

process• Hippocratic Oath

• Erasistratus (300 BCE)• Spirit flows through nerves to muscles

Hippocrates

Ancient Rome

• Roman Empire (27 BCE - 476 CE)• Absorbed Greek traditions in Medicine• Battlefield “first aid” & “base hospitals”• Clean drinking water and food• Galen the Physician

• Books on anatomy (w/o dissection)• Selected case histories

• “Hospital” : Latin “hospes”

Ancient India

• Science and Philosophy are intertwined• Ayurveda system (5000 BCE)

• Charaka Samhita Sutra• Book on internal medicine by Charaka (300 BCE)• Rational approach to disease• Uses objective methods for clinical examination

• 3500 - 1800 BCE: Queen Vispala (Rig Veda poem)• Leg amputated in battle• Returned to battle with iron leg

A physician who fails to enter the body of a patient withthe lamp of knowledge and understanding can never treatdiseases. He should first study all the factors, includingenvironment, which influence a patient's disease, andthen prescribe treatment. It is more important to preventthe occurrence of disease than to seek a cure.

Ancient China

• The Divine Farmer myth• Pharmacology and agriculture

• Drug culture• Healing, fortification and stimulation• Wuwei Tombs (100 CE)

• 30 remedies, drug preparations, acupuncture & moxibustion points• Example: Remedy for Scabies

• Attempts at systematic enquiry• Zhang Ji (140-200 CE): classification of illness progress

• Traditional Chinese Medicine: 40% of today’s practices

1. Finely pestle four heads of monkshood and one and a halfsheng (1 sheng = ~ 2cm3) of water chestnuts.

2. Mix into one and a half dou (~ 2 L.) of the urine of a maleyouth and … boil thoroughly.

3. Add in one sheng of grain and stir.4. Spread the medicine over it.

Islamic Golden Age

• 800 - 1200 CE• Universities, Libraries and Hospitals established• Trade routes with other civilisations

• China - Middle East trade of ceramics and dyes• Abu Al-Jazari (1136 - 1206)

• Arabic scholar & engineer• “The Book of Knowledge of Ingenious Mechanical Devices”

• Water-raising machine• Piston pump• Elephant clock• Programmable humanoid robots

Civilisations in Decline:Loss of Knowledge

• Library at Alexandria, Roman Egypt• Hypatia, Chief Librarian murdered (~400 CE)• Irrelevance of knowledge to public

• Medieval / Dark Ages, Europe• Roman Empire collapses• Churches take over medicine

• Chinese Ming Dynasty• Maritime expansion stopped in 1433• Traditions (e.g. acupuncture) in decline

Hypatia

Renaissance & Reformation

• European “Rebirth” (~1400 - 1700 CE)• Desire for “true” secrets of nature

• Re-examination of Greek & Arabic knowledge• Church loses grip

• Martin Luther (Germany) & Henry VIII (Britain)• New Sources of Knowledge

• Leonardo da Vinci, Galileo, Michelangelo• Jan Swammerdam: isol. muscle volume constant!

• Medical advances remain in “ivory towers”• Blood-letting & noxious ointments still common

Renaissance Engineering:Examples of Prosthetics

Middle Ages: Cauterization & hot oil oftenused to prevent hemorrhage afteramputation

Philip II of Spain & Wheelchair

Ambroise Paré

1508: Gotz von Berlichingen• Iron hand with moveable joints

1510-1590: Ambroise Paré, French Armysurgeon

• Father of modern orthopedics• Reintroduced ligatures after amputation• First articulated knee joint prosthesis• “Le Petit Lorain” mechanical hand with

catches and springs

1595: Spain’s Philipp II• First wheelchair user

First Hospitals in the Americas

1503 - Santo Domingo, Dominican Republic1524 - Hospital de Jesús Nazareno, Mexico City1639 - Hôtel-Dieu de Québec, Canada1751 - Philadelphia, Pennsylvania

Europe: 18th and 19th Centuries

• Hospitals for commoners• Patient death rate: 25% (Hotel Dru, Paris, 1788)• Attendant death rate: 6-12%

• Advances in battlefield medicine (French & Prussian)• Nursing advances (Florence Nightingale)

• Focus turns to patients• Hospital deaths due to conditions, not disease

• 1816: Laennec invents stethoscope• 1869: First wheelchair patent• 1870s: Pasteur & Koch establish germ theory of

disease• Cholera, Rabies and Anthrax vaccines follow

Europe & Americas: 20th Century

1895: Roentegen discovers x-rays1903: Einthoven invents Electrocardiograph1906: Hopkins links Scurvy & Vitamin C1919: Otto Bock streamlines prosthetics industry1921: Banting & Best invent insulin1947: Bardeen, Shockley & Brattain: Transistor1950s: Thermoplastics invented1953: Watson & Crick: DNA molecule structure1965: Pantridge installs first portable defibrillator1996: First cloned mammal

Canada’s Medical System

• Socialized Medicine• 1946: T. Douglas & Saskatchewan Hospitalization Act• Today: 30% privately paid (eyes, teeth, etc.)

• Legislation• Provincial self-governing Colleges of Physicians and Surgeons

• Problems• Wait times: "This is a country in which dogs can get a hip

replacement in under a week and in which humans can waittwo to three years.” (Dr. Brian Day (CMA))

• Personnel shortage:• 2.2 doctors / 1000 people; 10 nurses / 1000 people

• Cost: $170 billion; 11% of GDP; $5,000 / person (2008)

21st Century

Where are we going?

What is Biomedical Engineering?

• Target: Biological Systems• Methods: Engineering

1. Understand2. Modify3. Control

• It’s applied!• Not pure science

• It’s systematic!• Not tinkering!

What Biomedical Device is he excited about?

What is Biomedical Engineering?• Signal analysis

• Brain (EEG), muscles (EMG), eyes (EOG)• Respiration• Mass spectrometry

• Systems analysis• Neuromuscular control• Oculomotor control• Vestibular control

• Biomechanics• Orthopedic and auditory mechanics

• Biomaterials• Artificial cells & organ engineering

• Medical imaging and image processing• Bioinformatics• Computers in medical education

The World of Biomedical Engg.

Biomechanics

Medical Analysis

Biosensors

Clinical Engineering

Bioinformatics

Rehabilitation Engineering

Physiological Modeling

Nanotechnology

Bioinstrumentation

Neural Engineering

Tissue Engineering

Biomaterials

Medical Imaging

Prosthetics & Artificial Organs

Clinical Engineers in Hospital

Clinical Engineer

Patients

Doctors

Other Health Professionals

Nurses

HospitalEnvironmentVendors

LeasingAgencies

Third PartyPayers

HospitalAdministration

RegulationAgencies

ClinicalResearch

Safety, MaintenancePower, Cabling

Accepted Practice

Requirements

Costs

Costs

Budget

Policy

R&D Trials

AcceptedMedicalPractice

Roles of Biomedical Engineers

1. Clinical Engineer• Hospital

2. Biomedical Designer• Industry

3. Research Scientist• Universities & Research Labs

DesignerClinical EngineerResearch Scientist

Industrial Engineering Process

Identification of pathology or ablation• What function is missing / deficient?

Identification of affordable technology• What motors and sensors? At what cost?

Determine level of functional replacement• What is possible?• Keep it simple & effective!

Risk evaluation• Never underestimate what can go wrong!• Failures always occur. What is the acceptable risk level?

Prototype device, test & start againTest on larger population setInternational certificationManufacture & distribute deviceLong process: Sometimes 15+ years!

• Otto-Bock C-leg development began in the 1980s; releasedin 1999

Start

End

Manufacture

Prototype

Test

Failures & Controversies

• Improperly tested drugs• Thalidomide & Acutane

• Genetic modifications & ownership• Harvard Mouse

• Electrocutions• Improper device usage and maintenance

• Tissue Sources• Stem Cells• Animal testing

• Disabled athletes in Olympics

Successes

• Portable blood testing for diabetes• Rapid, in-clinic AIDS testing• Pacemakers• Dialysis Machines• Prosthetic arms & legs

• Hip & Knee replacements• Disease eradication

• Antibiotics & Vaccines• Polio, Small Pox

• Nuclear Medicine• Diagnostic Tools

• X-rays, Ultrasound• Iron Lung (Polio)

Fetal Ultrasound

Canadian University Programs

• Undergraduate• Ryerson University (that’s you!)

• Graduate• Dalhousie University (Halifax)• University of Toronto (Toronto)• University of Saskatchewan (Saskatoon)• University of Western Ontario (London)• McGill University (Montréal)

Ryerson Biomedical Engineering

• Standard EE: Circuits, MicroProcessors, Electric Machines• Materials (BME 323)• Biology (BLG 143)• Bioinformatics (BME 501)• Anatomy (BLG 700)• Fluid Mechanics (BME 516)• Instrumentation (BME 674)• Control Systems (BME 639)• Biostatistics (MTH 614)• Options: Rehab., Tissue Engg., Signal Analysis, …• More Options: MEMS, Modeling, Human-Comp Interfaces …

Professional Societies

• IEEE Engineering in Medicine & Biology Society• IEEE is the largest professional organization• www.embs.org

• Biomedical Engineering Society• www.bmes.org

• The Canadian Medical and Biological EngineeringSociety• www.cmbes.org

• American Institute for Medical and BiologicalEngineering• www.aimbe.org

Publications

• IEEE Transactions on Biomedical Engineering• IEEE Engineering in Medicine and Biology• Annals of Biomedical Engineering• Biotechnology and Bioengineering• Biological Cybernetics• Journal of Biomechanics• The Lancet• Scientific American• Science Online• … and lots more!

Resources

• Important Biomedical Canadians:• http://www.cdnmedhall.org/laureates/

• Canadian Physicians:• http://www.collectionscanada.gc.ca/physicians/

• Wikipedia:• http://en.wikipedia.org/wiki/Health_care_in_Canada

• BME website• www.ee.ryerson.ca/~jasmith/courses/bme100