This month’s issue presents a sampling of advances in devices, materials, and robots, as reported in the media in the past six months or so. The examples illustrate that, among other things: 1. (surprise!) HIT ain’t there yet; 2. Technology is relentlessly pushing care downstream, to dentists’ offices and patients’ homes; 3. The European Union is very active in developing medical technologies; and 4. The Robots Are Definitely Still Coming.

Devices

Device Connectivity

Connecting medical devices to clinical information systems is “a mess” and “so confounding that many hospitals don’t even try,” Gary Baldwin wrote in HealthLeaders magazine. Instead, they opt for “good old pen and paper” to capture data from the plethora of monitors, pumps, and ventilators that festoon the ICU, where documenting data from devices can account for more than a third of nurses’ time.

Trinity Health system has more than 2,000 physiologic monitors and 9,750 IV pumps, from at least five different manufacturers, who must be “pushed kicking and screaming” into providing connectivity between the devices and the natural repository for their data — the electronic medical record. Trinity knows whereof it speaks, having worked for over a year with its primary clinical information systems vendor, Cerner, to develop a “universal interface” to all devices.

The technological challenge is not trivial, but may be less challenging than the roadblocks erected by vendors and hospital IT departments, which have been “willing accomplices” to recalcitrant vendors, one hospital executive said. “The IT department figures nurses will just type in the data.”

There is some hope: Kaiser Permanente is already insisting that device vendors commit to building interoperability with EMR systems, and IBM and the University of Florida have been working jointly on part of the problem for almost 18 months. Their solution is a combination of middleware and sensor hardware enabling blood-pressure and glucose monitors and other medical devices used at home to automatically send their data to care providers. Devices incorporating this technology could be on the market within a year.

There is also a wireless medical monitoring system that could begin sales to drug and medical device manufacturers during 2008. It will enable (for example) diabetic patients or their caregivers to monitor the patient’s blood-sugar level and insulin intake. The patient’s cell phone will capture data from home medical devices or prescription drug packages via a Bluetooth (short-range wireless) connection, then automatically transmit the data to a server to be cross-checked with the patient’s medical history and treatment program.

At the end of the day, device connectivity is about patient safety and quality of care. A continuous data stream leads to a more complete health history, which alone leads to better care in the ER, the hospital bed, the doctor’s office, and the home.

* * *

Wireless Power

In June 2007, MIT researchers successfully tested an experimental system to deliver power to devices without the need for wires. They made a 60W light bulb glow from a distance of 2m (7ft), even with obstructions such as wood, metal, and other electronic devices placed in between the energy transmitter and the bulb.

The system uses magnetic fields, which should not present any significant health risk to humans. The researchers are now working on shrinking the size of the system while extending its reach to longer distances.

Implanted Hearing Aid

It will be some time before that technology is ready for market, but the same basic principle is already being employed to recharge the battery of a totally implanted — therefore invisible and waterproof — hearing aid sold in Europe and in phase II clinical trials in the US. It detects sound with a microphone implanted underneath the skin behind the ear. The signal is processed and sent to a tiny piston that vibrates the small bones in the middle ear, at which point natural processes take over.

In earlier phase I clinical trials, 20 subjects with moderate to severe hearing loss were implanted in one ear. Objectively, the device did not measure up as well as other hearing aids most of the subjects had used, yet the subjects themselves felt the device improved their hearing and produced more natural sound.

The device costs US$19,000 in Europe, excluding the cost of the surgery, versus $6,000 for a high-end conventional aid.

Blood, Sweat, and Electricity

Even wireless recharging of implants will be unnecessary in a few years. A paper battery made mainly of cellulose and about the size of a postage stamp can be powered by blood and sweat. It works in temperatures up to 300 degrees Fahrenheit and down to 100 below zero. It can be printed, and “rolled, twisted, folded, or cut” into shapes and can easily be implanted to power pacemakers and other devices. It is, however, some years from commercial production. Perhaps it will be ready in time for . . .

The Cybertooth

Following successful trials in pigs, the EU-funded Intellidrug project is close to launching human clinical trials of its “cybertooth” — a crown-like device or implant that attaches to a tooth and is pre-programmed by a patient’s doctor to deliver a specified dosage of a drug at specified times. On schedule, a panel on the device opens and releases the programmed dosage into the back of the patient’s mouth, where it mixes with saliva and enters the bloodstream.

The device can contain up to several weeks of doses of most drugs and administer more than one type of medicine. It transmits to a remote receiver information on when it is about to go empty and needs to be replaced.

* * *

Toward the Tricorder

The film technology used to digitize and animate the Gollum character from the Lord of the Rings movie is available in a Star Trek tricorder-like device to accurately and noninvasively gauge and record the width and depth of wounds. Caregivers can more easily monitor the healing process and minimize patient discomfort. The device eliminates the need for probes to test wound depth, saves time, and eliminates the over-use of ointments or antibiotics.

Also rapidly acquiring tricorder dimensions and capabilities is the battery-operated portable ultrasound machine, whose market is growing rapidly, especially in rural hospitals and developing countries. They don’t (yet) replace standard console-sized units, but are gaining ground among doctors in emergency medicine, anesthesiology, and other specialties outside the traditional areas of radiology, cardiology, and prenatal care. GE Healthcare saw a 74 percent increase in its portable ultrasound business from 2005 to 2006.

The newer portable units weigh as little as three pounds and can produce images comparable to those of the higher-end console units. They cost between $15,000 to around $90,000 depending on manufacturer (GE and Sonosite together have most of the market) and features.

* * *

Enose for Asthma

An “electronic nose” or Enose can diagnose asthma simply by analyzing a patient’s breath. It measures the amount and type of volatile organic compounds in exhaled breath for markers of lung disease or other respiratory ailments. In a study involving 20 healthy volunteers and 20 asthmatics — split evenly between those who had mild and severe forms of the disease — the Enose detected asthma with 95 percent accuracy (but was only 65 percent accurate in differentiating between mild and severe asthma.)

If these results are validated in future studies, the noninvasive, quick, cheap, and easy-to-use Enose could become the diagnostic method of choice for asthma and potentially other diseases.

* * *

Cell Microscopy

A nanoscale quantum-cascade laser developed at Harvard overcomes the constraint of a physical property of light called the diffraction limit and thereby makes possible microscopes with at least 100 times greater resolution than possible hitherto, which will facilitate ultrahigh (about 100 nanometers) resolution microscopy of cellular events, such as changes in individual proteins on the surfaces of cells, in real time.

MIT has also created a microscope that can record detailed, three-dimensional video of living cells in their native state with no staining or other preparation at all. It can, for example, capture chromosomes spooling during cell division or a cervical cancer cell shriveling up when treated with acetic acid. (MIT has collaborated with Harvard on this project, but it is not clear if it involves the quantum-cascade laser.)

* * *

Cancer Lab on a Chip

A microfluidic “lab on a chip” under development at the University of Texas detects oral-cancer cell biomarkers in less than 10 minutes and is simple and cheap enough for use in the dentist’s office — a sore in a patient’s mouth could be scraped and tested for signs of cancer while the patient is in the chair. The device could be adapted to test for other cancers, including cervical cancer. It works well on cancer cells grown in the lab and is currently being tested on biopsies from oral-cancer patients.

Traditional methods for detecting cancer-cell biomarkers are expensive, require trained technicians and the sort of sophisticated equipment only a hospital can supply, and take ten times longer.

* * *

Brain-linked Prosthetics Advance

Nearly a dozen people are benefiting from a technique called “targeted muscle reinnervation” (TMR), which enables their prosthetic arms to respond directly to their brain signals. As a result, they can open and close their artificial hands and bend and straighten their artificial elbows almost naturally, just by thinking. The technique involves connecting the “residual” nerves (that formerly carried commands from the brain to the natural arm) to chest muscles so that the signals can be used to move the artificial limb. The technology is being refined to facilitate the different hand grasp patterns needed to pick up and hold a baseball, pen, or tool.

According to a BBC News report, the first two patients to try the technology were not only able to fold clothes, eat bananas, and do the washing up, but also to differentiate between sensation felt by their chests and sensation felt by their bionic hands. In some cases they were able to pinpoint exactly where on the hand a sensation was being felt.

Materials

Potential New Ortho Implant Material

Human osteoblasts (bone-forming cells) have been found to grow twice as fast on anodized titanium with a covering of embedded carbon nanotubes than on pure or anodized titanium. The new material thus has great potential for use in orthopedic implants, including perhaps ones that could sense and report bone growth, eliminating the need for X-rays and bone scans to monitor implantees, and even detect infection then elute antibiotics or other drugs in response.

* * *

Talking Paper

Swedish researchers have constructed an interactive paper billboard with pressure-sensitive conductive inks and printed speakers. Upon touch, the billboard emits recorded sound. For example, if you touch an area of the billboard containing a picture of a beach, you might hear a brief description of the beach.

A cigarette pack made of the paper could deliver a spoken warning of the health risks of smoking, every time the smoker picks up the pack. It might also be used on drug containers, to tell the patient the appropriate dosage information.

The paper is still too expensive for broad markets, however.

* * *

Smart Clothes

The EU-funded Biotex project aims to develop intelligent textiles containing embedded sensors to monitor body fluids. The textiles would be used to make everyday apparel. A prototype multi-sensor test patch able to measure the acidity, salinity, and perspiration rate of sweat was being readied for trials as of mid-2007. Future versions will monitor vital signs, wound healing, and abnormalities in metabolism.

Robotics

We have not had much to say on robotics for some time. Perhaps that is because roboticists have been too busy tackling the many fundamental problems that arose following earlier waves of hype, but the results are starting to emerge.

Toyota Accelerates Robots Program

Toyota has added a robot violinist to its robotic orchestral lineup, hitherto consisting of a lonely trumpet soloist. Toyota’s game is not music, however; it is to assist Japan’s aging populace. The robot’s violin virtuosity merely serves to demonstrate that robots with human-like manual dexterity could be put to work in the home, in the factory, and in nursing and medical care. Toyota plans to have one on the market “by the early 2010s.”

Walking Like a Human

Toyota’s robots still walk like robots, however, whereas Runbot, a bipedal robot developed in a four-year-old EU cooperative project, can walk almost as naturally as a fast-walking human. It literally thinks on its feet — as do we, most of the time. Our brain may determine our walking speed and direction and handle obstacles and uneven terrain, but “local circuits” in the legs do most of the routine work.

Runbot is controlled by local “neural loops” — circuits — that analyze data from sensors and accelerometers on the joints and feet and adjust the gait accordingly. Like a toddler, Runbot learns from its falls, and gets better over time at walking on varying terrain without stumbling.

Robot With Cerebellum

Add a human-like brain to Toyota’s human-like dexterity and Runbot’s human-like gait, and now you’re talking humanoid. In May, an EU-sponsored Spanish, French, German, British, and Israeli team will be at the halfway point of a two-year, €6.5 million project called Sensopac to create robots that will move and interact with humans in a more natural way than is possible with current robotics technology.

The Spanish component is designing an artificial cerebellum — the part of the brain that controls motor functions – for implant into a robot made by the German component. A new artificial skin, realistic both in appearance and in sensitivity to touch, is also being developed for the robot.

Like Toyota, the EU sees such robots as home helpers for disabled people.

Robotic Wheelchair for Infants

Robotic help of a different kind may soon be available for disabled infants. From age five or six, children and adults with mobility constraints – such as Down Syndrome, cerebral palsy, and autism patients — have options of assistive technology such as power wheelchairs, but infants do not, and the lack is costly given the known criticality of brain development during infancy and the contribution mobility makes to that development. A University of Delaware researcher involved in resolving the problem said: “When a baby doesn’t crawl or walk, everything also changes. Immobility changes the infant, and the family.”

The Delaware solution is a sensor-studded robot baby carrier that can detect obstacles and either allow infants to bump into them or take control from the infant and drive around the obstacle itself. Infants as young as seven months were able to master the first prototype robot’s simple joystick controls. The next prototype will provide additional control to a supervising adult. Ultimately, the researchers aim to build a product “light enough for moms to stow in a car trunk, and robust enough for babies to use in the home, yard and playground, and maybe even the beach.”

* * *

neuroArm

Canada’s C$27 million “neuroArm” surgical robot, in development for several years, is now undergoing clinical testing. It enables precision brain surgery. The device’s haptic handles enable the surgeon to feel the pressure and texture of the tissue touched by the end effectors, and even slight tremors in the surgeon’s hands are dampened. Besides the obvious benefit of less risk to the patient, it also means that neurosurgeons, whose hands tend to become shakier with age, can stay in practice longer. The robot is expected to make difficult surgeries easier, and impossible surgeries possible.