1. INTRODUCTION

Medical electronics is the convergence of electronics with the realm of medicine. Every time one visits their doctor or the hospital for medical care, one benefit from medical electronics that has become a part of healthcare. From measuring the blood pleasure using the tiny electronic gadget, getting a diagnostic scan done by the doctor, up to the major surgery at the hospital, there are semiconductor chips working hard to enable such medical advancements. Medical electronic gadgets like scanners, blood pressure monitors and ultrasound systems are essential for diagnostics and perform a critical function in determining the right treatment. The most complex surgeries use electronics for imaging and robotics.

Taking medical electronics to the next stage is wireless technology, which is now almost omnipresent with the spread of mobile phones in India. This enables medical care to go mobile as well with the integration of 3G wireless modules in diagnostic devices like cardiac monitors for heart patients and glucose meters for diabetic patients. These electronic devices allow real-time monitoring by the physicians and fast and timely corrective action. Individuals are empowered by their own health, make adjustments based on the data and get required medical assistance before the situation becomes serious. This is significant for patients requiring remote or home based care, like senior family members at their homes.

The medical electronics ecosystem comprises original equipment manufacturers (OEMs), system integrators, independent design houses for software and hardware development, semiconductor manufacturing houses, mechanical components manufacturing houses, etc.

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2. DRIVERS RAISING ITS DEMAND

Healthcare is one of the largest service sectors in India. High-end medical specialty electro-medical equipment accounts for 11% of the market demand , whereas X-ray apparatus account for 10%. Imaging and electronic treatment devices make up for about `13 billion and `10billion, respectively, of the medical devices market.

The main drivers for increase in the demand for medical electronics are:

1. Increase in the number of ailing people in India.2. Increase in the number of people with lifestyle disease.3. Rising cost of health care in emerging market like India.4. Rural healthcare initiatives.5. Increased adoption of miniaturization and portability in medical devices.6. Increase in the overall consciousness of health amongst people in recent

years.

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3. TECHNOLOGICAL ADVANCEMENTS

To understand the reach and impact medical electronics is having on the patient care, consider a few cases: Surgeons using 3-D body registration systems and high resolution imaging for cutting into visible areas, implanted insulin pumps with a closed loop feedback capable of automatic fine tuning of drug delivery and thus cutting down the need for diabetics to opt for regular self-tests, and implanted simulators and drug delivery devices that focus only on effected parts instead of oral delivery of psychiatric drugs, thus lessening to a great extent the risk of collateral damages and side effects.

With major inroads being made by IT and semiconductor technologies into the realm of healthcare, patient data storage and access has become safer and easier. Also, with patient consultation and diagnosis moving to the internet and health care facilities starting to use data servers to monitor and access complete patient information over a common network, hospitals are becoming increasingly DIGITALISED.

With digitalization possible, hospitals can now deploy an advanced set of clinical applications like nurse call, patient monitoring and collaborative care. These help doctors and other medical staff perform their duties with greater efficiency and prioritize information for clinicians and their patients. Hospitals are now developing an internal network for patient data storage which will eventually lead hospitals to turn ‘paperless’.

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4. USE OF ELECTRONICS IN MEDICINE

4.1. IMAGING TECHNIQUES

Imaging includes diagnostics measures for the clinical examination of human bodies. These include everything from X-rays to CT scanners, and from MRIs and ultrasound to nuclear medicines.

4.1.1. ULTRASOUND SONOGRAPHY

Ultrasound-based diagnostic medical imaging technique is used to visualize muscles, tendons, and many internal organs, to capture their size, structure and any pathological lesions with real time tomographic images. Ultrasound has been used by radiologists and sonographers to image the human body for at least 50 years and has become one of the most widely used diagnostic tools in modern medicine. The technology is relatively inexpensive and portable, especially when compared with other techniques, such as magnetic resonance imaging (MRI) and computed tomography (CT). Ultrasound is also used to visualize fetuses during routine and emergency prenatal care.

Figure 1 . Portable Ultrasound Diagnostic Scanner

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Figure 2 . Ultrasound machine

Ultrasound energy produces a mechanical pressure wave through soft tissue. This pressure wave may cause microscopic bubbles in living tissues and distortion of the cell membrane, influencing ion fluxes and intracellular activity. When ultrasound enters the body, it causes molecular friction and heats the tissues slightly. This effect is typically very minor as normal tissue perfusion dissipates most of the heat, but with high intensity, it can also cause small pockets of gas in body fluids or tissues to expand and contract/collapse in a phenomenon called cavitation; however this is not known to occur at diagnostic power levels used by modern diagnostic ultrasound units.

Now a days software beam forming with the help of digital signal processing (DSPs) for ultra sound imaging provides flexibility and reduces hardware cost of high end equipments. A software implementation of ultrasound imaging requires to use multiple processors.

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4.1.2 CT SCANNER

Computed tomography (CT) is a medical imaging method employing tomography created by computer processing. Digital geometry processing is used to generate a three-dimensional image of the inside of an object from a large series of two-dimensional X-ray images taken around a single axis of rotation.

Figure 3 . CT Scan

A large donut-shaped x-ray machine takes x-ray images at many different angles around the body. These images are processed by a computer to produce cross-sectional pictures of the body. In each of these pictures the body is seen as an x-ray "slice" of the body, which is recorded on a film. This recorded image is called a tomogram. "Computerized Axial Tomography" refers to the recorded tomogram "sections" at different levels of the body.

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Figure 4 . CT Scanner

A key trend in the CT segment is the shift towards combination scanners, which are primarily hybrid scanners comprising positron-emission tomographs (PET) and CT imaging capabilities. New technologies can fuse MRI and CT images to predict the pattern of illnesses. They are now helpful for pre-natal foetal examination. Improved resolution of image is another advancement.

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4.1.3 MRI SCANNER

It is primarily a noninvasive medical imaging technique used in radiology to visualize detailed internal structure and limited function of the body. MRI provides much greater contrast between the different soft tissues of the body than computed tomography (CT) does, making it especially useful in neurological (brain), musculoskeletal, cardiovascular, and oncological (cancer) imaging.

Figure 5 . Full Body MRI Scan

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MRI uses a powerful magnetic field to align the nuclear magnetization of (usually) hydrogen atoms in water in the body. Radio frequency (RF) fields are used to systematically alter the alignment of this magnetization. This causes the hydrogen nuclei to produce a rotating magnetic field detectable by the scanner. This signal can be manipulated by additional magnetic fields to build up enough information to construct an image of the body.

Figure 6 . MRI Scanner

MRI is used to distinguish pathologic tissue (such as a brain tumor) from normal tissue. One advantage of an MRI scan is that it is believed to be harmless to the patient. It uses strong magnetic fields and non-ionizing radiation in the radio frequency range, unlike CT scans and traditional X-rays, which both use ionizing radiation. MRI provides comparable resolution with far better contrast resolution.

Today’s MRI equipment offer increased patient comfort and enhanced diagnostic information. Techniques to speed up examination, such as parallel imaging technology, are implemented to speed up MRI scanning, thereby enabling shorter breath-hold times, higher resolution and shorter stay time for the patient within magnet for any examination.

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4.2 PATIENT MONITORING AND MANAGEMENT SYSTEM

These help measure parameters that are integral to the physiological functioning of the body; for example, EEGs and ECGs. They are also used to monitor and maintain saturated pressure of oxygen and other such parameters; for example, respiratory chambers and the like recently used in the treatment of H1N1 virus.

Figure 7 . EEG

Segments like ECG and neurophysiologic monitoring systems have developed rapidly and continue to advance due to higher adoption rates.

Wireless lower-acuity monitors that are the size of a cell phone can be used with wireless local-area network (WLAN) to transmit the vital signs of emergency room patients who might be ambulatory or moved to other areas of a hospital.

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4.3 DEVICES AND IMPLANTS

The total demand for cardiac implants will continue to rise largely due to the widening use of cardiac resynchronization therapy (CRT) devices in the treatment of congestive heart failure (CHF). CRTs are more effective than alternative drug therapies in restoring the blood pumping capabilities of CHF patients along with reducing their risk of disease complications. Ultra low power electronics find application in this area. Use of RF technology to control the electrical stimulation for neurological stimulators is one trend.

Figure 8 . 1S CRT Device

In defibrillators, use of devices with biphasic technology and low energy defibrillation is the emerging trend.

Figure 9 . BIVPM

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4.4 TELEMEDICINE

Telemedicine and e-healthcare have immense potential for growth in a country like India where a major portion of population resides in rural India with very little or no access to quality healthcare advice and treatment. Additionally, with an increase in lifestyle related diseases like diabetes and cardiac diseases, it becomes obvious that we need easily accessible technology and a common platform that connects billions of patients spread across the country to medical experts in time.

Figure 10 . Telemedicine

4.5 EMBEDDED TECHNOLOGY AND SOFTWARE

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The function of embedded system in medical technology is never ending. For example, new embedded systems are being developed where pills are taken that are ready with smart processors to repair organs or process information about cell formation or irregularities in cell operation.

Figure 11 . Capsule Endoscopy

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Figure 12 . Antenna Pill

Rizwan Bashirullah, a University of Florida assistant professor, holds a pill capsule designed to signal when a patient has swallowed it in this photo taken March 19, 2010. The pill is needed because many patients fail to take their medication, exacerbating medical problems, causing unneeded hospitalizations and leading to an estimated 217,000 deaths annually. Consisting of an antenna made with nontoxic silver nanoparticles and a tiny microchip about the size of a period, the pill works by communicating from inside the body with a stand-alone device worn by the patient.

Seeking a way to confirm that patients have taken their medication, University of Florida engineering researchers have added a tiny microchip and digestible antenna to a standard pill capsule. The prototype is intended to pave the way for mass-produced pills that, when ingested, automatically alert doctors, loved ones or scientists working with patients in clinical drug trials.

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“It is a way to monitor whether your patient is taking their medication in a timely manner,” said Rizwan Bashirullah. Such a pill is needed because many patients forget, refuse or bungle the job of taking their medication. This causes or exacerbates medical problems, spurs hospitalizations or expensive medical procedures and undercuts clinical trials of new drugs.

“The idea is to use technology to do this in a more seamless, much less expensive way,” Bashirullah said.

Figure13. Componenets of the PillCam syatem

Pillcam is essentially a miniaturized combination camera and transmitter, incorporating a camera imaging chip, a radio-frequency (RF) transmitter, a battery, and a miniature flashing light-emitting diode (LED), all in an 11 x 26-mm capsule. In practice, the patient swallows the capsule, which takes pictures as it passes through the patient's digestive tract. The device transmits image signals to an external receiver worn by the patient. Once the capsule is excreted, the patient brings the external receiver to the physician's office where the images are downloaded for evaluation and diagnosis.

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5. CHIPS BRINGING ABOUT REVOLUTION

The need today is to have products that offer ultra-low-power consumption , driven by the need for extended battery life, and are highly efficient and high-precision with a fast response time. All this has been possible with ICs. ICs have a significant impact on the end usage. These can help with miniaturization and low power consumption. New generation processors can improve the user experience.

In portable medical equipment, the core components must meet tight requirements like low operating voltage, low operating current, low stand by current, small packaging options, on/off power management, low noise, high-efficiency step-up and multiple battery topologies. ICs are being designed to meet these standards as required.

Electronic design automation (EDA) software is used by semiconductor companies to design chips for medical electronics applications like scanners, portable medical meters and medical imaging solutions. These chips are required to have very high reliability and precision. For mobile devices, it is critical that the power consumption is minimized to increase battery life.

Figure 14. PCB Layout Program

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A Company named SECOND SIGHT was developed to create a retinal prosthesis to provide sight to patients blinded from outer retinal degenerations. The device consists of a tiny camera and transmitter mounted in eyeglasses, an implanted receiver, and an electrode-studded array that is secured to the retina with a microteck the width of a human hair. A wireless microprocessor and battery pack worn on the belt powers the entire device.

The camera on the glasses captures an image and sends the information to the video processor, which converts the image to an electronic signal and sends it to the transmitter on the sunglasses. The implanted receiver wirelessly receives this data and sends the signals through a tiny cable to the electrode array, stimulating it to emit electrical pulses. The pulses induce responses in the retina that travel through the optic nerve to the brain, which perceives patterns of light and dark spots corresponding to the electrodes stimulated. Patients learn to interpret the visual patterns produced into meaningful images.

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6. OPPORTUNITIES GALORE

In an emerging market like India, there is a lot of potential for growth and demand for medical electronics (of which semiconductors are a essential part). The increasing awareness of health care has created a rapidly growing need for innovative medical solutions like portable affordable ultrasound equipment for use in doctors’ equipment, ambulances, mobile triage solutions and remote regions. Responding to these demands, Indian electronics OEMs are developing a number of portable devices like digital thermometers, blood pressure monitors, insulin pumps, heart rate monitors and digital hearing aids in addition to hospital equipment like CT and MRI scanners, X-ray machines and ultrasound scanners.

Semiconductors are set to play a pivotal role in designing and developing portable and affordable medical devices. The connectivity enabled by semiconductor technology (wired or wireless) will drive such applications as telemedicine, facilitating access to the required level of healthcare.

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7. MAJOR ONGOING PROJECTS IN MEDICAL ELECTRONICS IN INDIA

Deployment of indigenously developed 6 MeV medical linac for cancer treatment – Jai Vigyan Phase – II - By SAMEER Mumbai

Design and Development of Electronic Portal Imaging Device (EPID) for radiation Therapy By CSIO, Chandigarh and TSG, Integration, New Delhi.

Establishment of facility for batch fabrication of Linear Accelerator (LINAC) tube and Linear Accelerator machines.-By SAMEER, Mumbai

Design & Development of dual photon energy and multiple electron energy integrated oncology system.- By SAMEER Mumbai

Development of High Speed Interpoint Braille Embosser- By WML, Kolkata and CMERI, Durgapur

Design & Development of Cost-Effective Bio-Signals Controlled Prosthetic Hand – By Tezpur University

Development of Medical Image Analyser for Cervical Cancer (Cervi SCAN)- By CDAC, Thiruvananthapuram, IIT, Kharagpur and RCC, Thiruvananthapuram

Virtual Reality based minimally Invasive Surgical Simulator (VR-MISS) with Haptics Feedback-By IIT, Chennai and CMC, Vellore

Development of a Web-enabled e-Healthcare System for Neonatal Patient Care Services (eNPCS)- By IIT Kharagpur, SSKM Hospital Kolkata and WECS Kolkata

Web Enabled Medical Information Access Using Handheld Devices in a Wireless Environment for Telemedicine Applications-. By IIT, Kharagpur and WECS, Kolkata

Development of Telemedicine at Remote CHC/PHC in Tripura. By WECS, Kolkata

National Resource centre for Telemedicine & Medical Informatics. By SGPGI, Lucknow

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8. RESULT OF RESEARCHES IN INDIA

MEDICAL LINAC FOR CANCER TREATMENT

6MeV medical LINAC has been installed in Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra and RCC, Adyar, Chennai. These machines are being used for treatment of cancer patients.

PRODUCTS FOR VISUALLY IMPAIRED

The following products have been developed for visually impaired and are being used by a number of blind schools in the country

Braille keyboard with audio support Twenty character refreshable tactile reader and a modified perkins brailler. Text to Braille conversion software in major Indian languages

TELEMEDICINE

The following technologies have been developed in the area of Telemedicine:

Telemedicine software systems Mercury & Sanjivani by C-DAC and Telemedik by IIT Kharagpur have been developed and are in use. The technology has also been employed to set up a number of telemedicine networks connecting remote health centres with specialty hospitals.

Under telemedicine pilot projects, telemedicine centres have been set up in Tripura, Punjab, Himachal Pradesh, West Bengal, Kerala and Tamil Nadu.   

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9. CONCLUSION

The future seems to be in how the devices integrate themselves in a hospital ecosystem and their ability to communicate with other systems. Equipment having the ability to transmit data through telemedicine are now available.

Vivek Tyagi, country sales manager, Freescale semiconductor India, believes that semiconductor technology will play a critical role in the development of new technologies that assist in patient monitoring, diagnostics, therapy and imaging.

Neeraj Verma, country manager-sales, India and ANZ, Xilnx, has the opinion that the growth in ageing population has augmented the need for such medical equipments as biometrics, blood-pressure monitoring, blood analysis and telemedicine. It is due to this that Indian OEMs are developing portable devices like digital thermometers, blood pressure monitors, insulin pumps, heart rate monitors and digital hearing aids, in addition to hospital equipment like CT and MRI scanners.

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10. REFERENCES

1. Electronics for you magazine (august 2010 edition)2. http://www.2-sight.com/

3. http://news.ufl.edu/2010/03/31/antenna-pill-2/

4. http://www.mit.gov.in/

5. http://en.wikipedia.org/wiki/Magnetic_resonance_imaging

6. http://en.wikipedia.org/wiki/CT_scanner

7. http://en.wikipedia.org/wiki/Ultrasound

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