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Development of IT enabled Healthcare Devices and Telemedicine
at Dhaka UniversityLOCAL SOLUTION WITH GLOBAL POTENTIAL
K Siddique-e RabbaniDepartment of Biomedical Physics & Technology
Dhaka [email protected]
www.bmpt.du.ac.bd
Keynote Presentation, bdNOG4, 11 November2015
Department of Biomedical Physics & Technology
80% of global population, living in the Third World still remain deprived.
Hardly a few % of them, who are rich, get benefit of modern healthcare technology at huge costs
Motivation:
ECG & X-Ray invented more than 100 years back. How many get the benefits even today?
Our efforts towards indigenous design and Innovation
Initially at department of Physics
Now atdepartment of
Biomedical Physics & Technology(established in 2008, initially offering PhD & Mphil only,
now offering Masters programmes in Medical Physics (Radiation related)
and Biomedical Engineering
Possibly, the 1st IT enabled Medical Equipment Developed in Bangladesh (1986-1988)Computerised EMG/EP equipmentExpertise gained through the UK link
First nerve conduction
service in Bangladesh
(1988)
Cost: a fraction of
that for imported
ones
Recent development:Intra-operative Neuro Monitor
To aid brain and Spinal cord surgery
Cost: a fraction of that for imported ones
made in Bangladesh
ComputerisedECG
Stand alone, or Online for
Telemedicine
Made in Bangladesh
Cost: a fraction of that for imported
ones
Computerised ECG – stand alone/Online for Telemedicine
Computerised ECG Output: Full 12 Lead, diagnostic, pdf file- sent to doctor for report online, even on Smartphone
ECG Report
PatientName: null Sex: FemaleAge: 0 Wednesday01July2015
PatientID: 1
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
25mm/sec 10mm/mV
II
0s 1 s 4s2s 3s 2s 3s1 s 4s0s
2s0s 4s1 s 3s
5mm/mV
Certificate for ECG equipment –received from DMCH
Through DG Health of Govt
Dynamic PedographDynamic foot pressure distribution
Helps prevent ulcers, leading to Gangrene and foot/leg
amputation of diabetic patients
Needed in large numbers in the low resource
countries
Dynamic PedographOur System
Main unit goes into a raised platform
Cost: a fraction of that for imported
ones
Our System gives a black and white picture from which we obtain a colour contour
Video: 30 frames per second,
Displays pressure variation with time at 6 selected points
Making Customised Shoe Insoles:
Automation possible:Pedograph à CNC machine, or Pedograph à 3D printer
PedographDiabetic foot clinic in BaqaiMedical University, Karachi, Pakistan
(they provided R&D costs)
Our installations of Pedograph1. Diabetic foot clinic in Baqai Medical
University, Karachi, Pakistan + 2 other installations
2. Ibrahim Foot Care Hospital, Dhaka, Bangladesh
3. Leather Research Institute, BCSIR, Bangladesh
4. NIROGI LANKA, Srilanka (Delivery: October 2015)
Semi-functional Hand Prosthesis
Partially supported by: • Farm Fresh (Akij Group) (initial phase)• BEXIMCO (Current support)
A simple Prosthetic hand that can write & solderImprovised using a hand of a ‘Mannequin’. Spring loaded thumb only.Cost: about £20.
Movie
Cost Effective Myo-electric Prosthetic hand
Relaxed – thumb open Contracted – thumb closed
Microcontroller Controlled (IT enabled)Presently: Only thumb movementIn future: wrist rotation
FocusedImpedanceMethod– OurInnovationLocalised Lungfunction&RespiratoryRateSpecialchallenge:AbabyorchildshouldnotCRY!!
0.0 0.5 1.0 1.5 2.0
2.5 3.00 30 60 90 120 150 180
Frequency, HzRate per min
Am
plitu
de, a
rbitr
ary
scal
e
10 2Time, Sec
Am
plitu
de, a
rbitr
ary
scal
e
FIM for Breast TumourCharacterisation (whether malignant or benign)
Cancer Cells have different impedance characteristics than normal
Dual Frequency FIMDifficulty: separation from normal tissue around
Ht
Vt
Feature extraction using IT enabled analysis: Red ones are malignant (through core biopsy)
-0.2
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
0 5 10 15
Futu
re/A
ge (N
umer
ical
Val
ue)
Feature Number
Age Divided Feature Plot
P1_Age28
P2_Age52
P3_Age17
P4_Age30
P5_Age40
P6_Age30
P7_Age17
P8_Age24
P9_Age18
P10_Age48
P11_Age32
CP12_Age42
CP13_Age40
CP14_Age55
CP15_Age52
Malignant
Benign
Patient age range: 17 -55 yrs
Unaffected side:Imp: 1-4Slope: 9, 11
Affected side:Imp: 5-8Slope: 10, 12
… seems to create some distinction
• Stomach emptying• Stomach acid secretion
•Abdominal fat thickness measurement• Bladder emptying
•Tumour ablation monitoring
............... many more
FIM : potential in Diagnosis and Physiological study
Others starting FIM study:
• Warwick University, UK
• Kyung Hee University, Korea
• University of Oslo, Norway
A Swiss R&D company showed interest in developing the equipment for commercialisation, but we did not want take patent, so did not work out
Pigeon Hole Impedance Imaging (PHI)(our concept)
PHIbased on 4 electrode FIM. Measurement in every
square, gives a low resolution image
Z11 Z12 Z13
Z21 Z22 Z23
Z31 Z32 Z33
Z14
Z24
Z34
Z41 Z42 Z43 Z44
I1
I1
v1
I2 I2
v2
PHI simulated experimental results
PHI application
Z11 Z12 Z13
Z21 Z22 Z23
Z31 Z32 Z33
Z14
Z24
Z34
Z41 Z42 Z43 Z44
Telemedicinefor rural healthcare
where qualified doctors are not available
31Basic Telemedicine Network
Our developed items for Telemedicine
• Digital ECG, 12 lead, full diagnostic
• Digital Stethoscope
• Digital Microscope
• Digital X-Ray view-box
• Digital Colposcope (for cervical cancer
investigation)
Scheme at Rural/Semi-rural Healthcare Center End
Digital Stethoscope
Digital X-ray Viewer
Digital Microscope
Digital Colposcope
Digital ECG, 12 Lead
Typed data entry through PC keyboard
Sound input jack of PC
USB port of PC
USB port of PC
USB port of PC
USB port of PC
Local PC
Telemedicine Software
Display
Report and Prescription Generation
Archiving and Printing
INTERNET
Video Conferencing
ECG, 12 lead, with live internet transmissionFor telemedicine
Computerised ECG Output: Full 12 Lead, diagnostic, pdf file- sent to doctor for report online, even on Smartphone
ECG Report
PatientName: null Sex: FemaleAge: 0 Wednesday01July2015
PatientID: 1
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
25mm/sec 10mm/mV
II
0s 1 s 4s2s 3s 2s 3s1 s 4s0s
2s0s 4s1 s 3s
5mm/mV
36
Improvised Digital Stethoscope
A microphone insert is fixed at a cut end of the rubber tube of a commercial stethoscope
Delays through internet and limitation of Frequency response does not allow live transmission. => Store & Forward.
Improvised Digital MicroscopeSoftware zoom
A good webcam attached to a Chinese microscope.We are trying alternative methods using USB camera modules and improvised optics.
38
Digital X-Ray View Boxsoftware zoom
39
Digital Colposcopefor detection of Cervical Cancer
Improvised from a binocular
Software filtering done to get effects similar to that obtained using Red,
Green and Blue filters
40
Digital ColposcopeSoftware filter - optical
Software for TELEMEDICINE, Web based
Software for TELEMEDICINE:• Registration and ID to
health operator and doctor by admin
• Log in by remote operator • Log in by doctor• Patient registration, vital
information entry and uploading
• Doctor sees uploaded data• Patient consults doctor
through video consultation.
• Real time (almost) stethoscope
• Real time (almost) respiration monitor
• Real time (almost) ECG • Uploading of images of
Ultrasound, X-ray, previous prescriptions A Prescription - preliminary and final
• All records archived for future reference
<www.bmpt.du.ac.bd/telemedicine>
Prescription generation
With database for medicines, advices, etc.
Acknowledgements1. Farm Fresh brand of Akij group, Bangladesh2. ISP of Uppsala University, Bangladesh3. Access to Information programme of Govt of
Bangladesh (partners: UNDP, USAID)4. Information Society Innovation Fund (ISIF)-Asia5. All post graduate students at the department who
contributed to this project
Challenges We want to add Images – Ultrasound Ø 640x480 monochrome adequateØ Still images , about 100KB, store
and forward acceptableØ Video images, needs 480Kbps for
25 FPSØ Reducing frame rate to 5FPS in
some cases, 120Kbps may be adequate
Ø Difficult under present situationØ We are planning to go for store
and forward of Video
Challenges We want to add Images – Ultrasound Ø 640x480 monochrome adequateØ Still images , about 100KB, store
and forward acceptableØ Video images, needs 480Kbps for
25 FPSØ Reducing frame rate to 5FPS in
some cases, 120Kbps may be adequate
Ø Difficult under present situationØ We are planning to go for store
and forward of Video
Dial-up using telephone line : 2.4 Kbps to 56 kbps
DSL – Digital Subscriber Line : 16 Kbps to 9 Mbps
Broadband Internet Connection, Cable : 200 Kbps to 20 Mbps
Fibre optical link : 1 Mbps to 40 Mbps
Internet over Satellite : 492 Kbps to 512 Kbps
Mobile broadband, 2G : 10 Kbps to 240Kbps
Mobile broadband, 3G : 100 Kbps to 16 Mbps
Mobile broadband, 4G : 5 Mbps to 1000 Mbps
How can you help us in taking these services to remote regions?
How can we deliver the
benefits of modern healthcare technology to whole
humanity?
University(BMPT)
CTE BiBEAT
Users, Small entrepreneurs
Users, Small entrepreneurs
User
s, Sm
all en
trepr
eneu
rs
Users, Small entrepreneurs
1. BMPT-Dhaka University
2. Centre for Technology Equalisation (CTE)[under Relevant Science & Technology Society, Bangladesh (RSTS)]
3. BiBEAT Ltd. – Company, Limited by Guarantee (under article 29), No shareholders, Paid-up capital: Zero, Nobody takes the profit
Model for Dissemination
We have to break away from the existing accepted norm of getting equipment from
the rich countries.
for global benefit,
We are not patenting our products!!Teach technology, manufacture and entrepreneurship to Third World scientists and engineers, ask them to produce the equipment in their own country and sell
Technology innovators should become entrepreneurs
Businessmen cannot do this job
(wrong concept prevalent now)
All our products are manufactured & sold by BIBEAT Ltd. – a non shareholding company
for public good à nobody takes profit
(except technologies like safe drinking water for which technology is disseminated at no cost)
Acknowledgements1. Ministry of Sc & Tech, Govt of Bangladesh2. Ministry of Education, Govt of Bangladesh3. Asiatic Society of Bangladesh4. British ODA (now DFID) 5. University Grants Commission, Bangladesh6. Neurology Foundation, Bangladesh7. Trauma Centre, Bangladesh8. Farm Fresh brand of Akij group, Bangladesh9. ISP of Uppsala University, Bangladesh10. Access to Information programme of Govt of
Bangladesh (partners: UNDP, USAID)11. Information Society Innovation Fund (ISIF)-Asia
Our committed and youthful team at the Department of Biomedical Physics & Technology
Dhaka University (Includes foreign students)
Thank You