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Medical equipment updates, news and reviews

Handheld ECG Devices

29 May, 2013 | Cardiology Equipment

Handheld ECG device - CardeaScreen

The handheld ECG device is an affordable and accessible diagnostic tool for identifying cardiac abnormal conditions by recording the electrical activity of the heart.

The CardeaScreen

In February 2013 Cardea Associates released its new Handheld ECG device, the CardeaScreen. This device was specifically designed for young athletes; being in-sync with the normal functioning of a young athlete’s heart from age 14 and up, and being suitable for use before participation in sports events.

Cardiac arrest is the leading cause for sudden death during sports activity, due to medical reasons. Often a preexisting heart condition is not known, and this is the first indicating symptom, being at this time already too late. Having an affordable and accessible device enables high schools and colleges to own an ECG and be able to examine their athletes thereby lowering the number of cardiac arrest cases.

An important feature of the CardeaScreen is the fact that being specifically designed for athletes, it produces many less false-positive-results by producing more accurate results than other handheld ECG devices. A false-positive-result may cause an athlete not to participate in an event and go through unnecessary examinations therefore its elimination is a time and money saver.

The FDA cleared CardeaScreen medical device transfers the information to a standard PC via Bluetooth and assists physicians in identifying in advance an abnormal condition.

The imPulse

An additional recent release in the handheld ECG monitor market is the imPulse, designed by Plessey. This is a new application for their non-contact semiconductor sensor technology. The device records ECG signals with direct skin contact by placing the thumbs on two sensor pads, with no need for a gel or any skin preparation.

The signals from the device are transmitted via Bluetooth to a smart phone. A special software application displays the information and can provide simple analysis of pulse rate and pulse variation. The device was first displayed in November 2012 in the Electronica exhibition in Munich.

Conclusion

Having an affordable and accessible ECG is invaluable. It can have lifesaving implications, especially for young athletes, who often are not aware of a cardiac precondition, and at their age, do not think of the possible dangers of strenuous physical activity in reference to the heart.

The Influence of the US Excise Tax on Veterinary Equipment Costs

22 May, 2013 | medical equipment, Veterinary equipment

Veterinarian examining golden retriever dog

Veterinarian examining golden retriever dog

On January 1, 2013 the 2.3% excise tax on the sale of medical devices went into effect, aiming to help fund the Affordable Care Act; providing health insurance coverage for all Americans living in the USA. This federal statute was meant to be imposed on any device “intended for humans” and was not supposed to effect veterinary equipment.

In practice, in cases where veterinarians purchase dual-use medical devices – those intended for humans but that are also used for treatment of animals – they are also exposed to the tax. This is especially applicable regarding devices purchased for treating small animals.

The tax was initially supposed to be paid by the manufacturer, importer or distributor, but in reality, it is often passed along to the purchaser, which in this case is the veterinarian, who in turn passes it along to the American pet owner.

In a survey that included 181 manufacturers, over 58% of North American medical equipment manufacturers admitted that they plan to pass along the tax, either partially or even completely, to the subsequent parties in the supply chain.

Dr. John Beltz of Wisconsin Veterinary Referral Center of Racine estimates that approximately 70% of the medical equipment that he purchases for his clinic is originally manufactured for humans, and is therefore affected by the tax.

The increase in medical device prices may influence veterinarians deliberating whether or not to buy a new device and, in turn, may result in them not purchasing the most advanced devices, to the detriment of the animals receiving their care. The impact will be the greatest on veterinarians starting a new practice and needing to buy a lot of new equipment.

Some veterinarians say out right that if costs for them increase, they will raise prices for the customers, while others are not so fast to raise their prices considering the economic situation. The result of the price increase in veterinary expenses could lead people to think twice before taking their pet to the vet or before adopting a new one, and this could be a considerable concern.

For veterinarians working mostly with large farm animals, such as cows and horses, there is very little dual-use medical equipment, therefore, they are much less affected by the new tax.

There are currently efforts on both sides of the political map to repeal the tax, and the American Veterinary Medical Association is in the process of bringing the implications of the Affordable Care Act to the awareness of veterinarians.

Conclusion

It looks like unless there is a reform in the 2.3% excise tax, there may be two relatively straight forward solutions for the case of medical devices with dual-use, one being a funded tax deduction for devices that are proven to be used for animals, the other, much more fundamental approach to the entire issue, being a stricter enforcement of the statute, ensuring that it is indeed the manufacturers who pay the tax, as was originally intended. But perhaps this is a difficult one to implement. In any case, what can definitely be said is that health coverage for all is a vital element for an advanced healthy society and at the same time, pet owners and animals should not be the ones carrying the load.

4D CT Scanner

15 May, 2013 | CT Scanner

Doctor preparing patient for CT

The four dimensional computed tomography scanner (4D CT Scanner), is the next generation in medical imaging. It is faster and more accurate than traditional CT. With the 4D CT Scanner, in addition to obtaining a 3D image of the body, also the movement is recorded. The movement is registered throughout the breathing cycle, capturing the location of the internal organs along this time.

 The ability to monitor and time the movement of internal organs, throughout the breathing cycle, is especially important in treatment of cancers that are located near or on organs that move with breathing, as in the area of the chest and abdomen.

A complete scan of the body with the 4D CT Scanner takes about 30 seconds. The device spins in a corkscrew motion, taking images all the time. The output provides information on the body’s breathing, the corresponding tumor movement, and the effect of the surrounding organs on the position of the tumor.

New treatment capabilities due to the 4D CT Scanner

The new imaging capabilities, provided by the 4D CT Scanner, support development of more accurate treatments for tumors that move, such as what is called intensity-modulated radiation therapy (IMRT), which enable:

  1. Administrating the radiation treatment only when the tumor is in the correct position in the breathing cycle, and stopping when it is not.
  2. Targeting the tumor precisely in terms of both the timing and the angle.
  3. Avoiding the side effects of damage to surrounding organs and healthy tissue, such as radiation pneumonitis (damage to the lungs caused by radiation on healthy tissue just around the tumor).
  4. The use of higher levels of radiation, which are more effective than low levels, as the danger to surrounding healthy tissue is reduced or eliminated.

 Conclusion

 The fourth dimension in imaging has brought with it new capabilities for cancer treatment. It is enabling targeted radiation of the tumor with less damage to surrounding healthy organs and tissue. This brings new hope especially for patients suffering from the most common cause of death due to cancer in the world, lung cancer.

 

Use of EEG Patterns to Track Consciousness Levels When Under Propofol Anesthesia

8 May, 2013 | EEG

Brain waves

Brain waves

A study conducted at Massachusetts General Hospital used Electroencephalography (EEG) patterns to identify a patient’s consciousness level when under general propofol anesthesia. Highly structured EEG patterns enabled identifying when the patient was sedated, unconscious and regaining consciousness.

This is the first time that specific patterns indicating the state of consciousness were identified. Currently the monitoring of anesthesia patients focuses on the vital signs and the dose is based on the concentration of the drug in the blood or lungs. This is despite the fact that the drug’s primary effect is actually on the brain and central nervous system.

EEG raw signals and frequency components can provide specific information on the state of the brain, but most EEG units reduce the signal to a single number, which does not enable identifying the physiological processes that actually create the pattern.

The experiment

In the study, ten healthy volunteers were placed under general propofol anesthesia. The propofol dosage was gradually increased to a target level over a period of an hour and then was gradually decreased during a second hour. This is in contrast to the clinical use of propofol, where the unconscious level is induced within less than a minute, making the tracking that was possible in the study, impossible.

During the experiment, certain sounds were operated every four seconds, to which the participants responded. When they stopped responding it indicated sedation, and when this persisted it indicated loss of consciousness. This enabled identifying characteristics in the EEG patterns that could be tagged as sedation, loss of consciousness, deep unconsciousness and return to consciousness.

Interesting patterns were observed during the experiment; a pattern observed during transitions in consciousness was named trough-max, and one observed during the highest dosage of propofol was named peak-max. The trough-max was especially observed right before returning to consciousness and the peak-max was observed in the deepest unconsciousness levels.

The implications of the study

 The implications of this study mean that EEG systems, which show the raw detailed signals, could be used in the operating room to know when the patient is unconscious and when the patient is regaining consciousness.

Patrick Purdon, PhD, an instructor in anesthesia at the Harvard Medical School, said:  ”We are working on new monitoring technologies to develop EEG monitors that will display the peak-max and trough-max patterns, helping us ensure when patients are unconscious and predict when they might be regaining consciousness. We also are working to characterize similar EEG patterns for other anesthetic agents and to develop a program to train anesthesiologists how to interpret the EEG in terms of the neurophysiology and mechanisms for different drugs.”

Emery N. Brown, MD, PhD MGH anesthetist said: “This work helps establish the basic and clinical science needed to set standards for use of the EEG to track the brain states of patients under general anesthesia. Reading the EEG will allow anesthesia caregivers to adjust dosage more precisely and thereby help reduce the incidence of cognitive dysfunction and delirium following anesthesia as well as making unintended regaining of awareness while under anesthesia a phenomenon of the past.”

Conclusion

With new discoveries on brain waves under anesthesia using EEG patterns, more precise doses of propofol can be administered and the patient’s consciousness levels can be monitored much more precisely. This paves the way to tailored EEG monitors that specifically indicate trough-max and peak-max, and perhaps additional states and transitions in brain waves which may be discovered over time.

fMRI and EEG Dream Catchers

1 May, 2013 | EEG, MRI

Native American dream catcher

Native American dream catcher

In a recent research conducted at the ATR Computational Neuroscience Laboratories in Kyoto, Japan, functional magnetic resonance imaging (fMRI) and Electroencephalography (EEG) systems were used to decipher dream images during the hypnagogic sleep stage; the stage experienced during the transition to and from sleep.

The experiment focused on three subjects who were asked to fall asleep in an MRI for three hour sessions, over a period of ten days. The brain activity was monitored using an fMRI and the subjects were awoken every time the EEG detected the presence of a hallucination. Each subject was awoken at least 200 times and was asked each time to describe what he had visually seen before awakening. The subjects were awoken approximately every 6 to 7 minutes and a visual image was described for over 75% of the times they awoke.

The visual images that were verbally reported were transferred to WordNet –a lexical database for English that groups “nouns, verbs, adjectives and adverbs… into sets of cognitive synonyms” referred to as synsets, “each expressing a distinct concept.” Words that appeared at least ten times for a specific subject were grouped and about twenty general categories were created for each subject.

Subsequently, designated software designed for the experiment was “taught” to associate the category with the brain pattern, and images that correspond to the categories were downloaded from the internet. After this ‘teaching’ process, a second dreaming round was conducted, and this time using the fMRI the computer tried to predict what the person was dreaming, while the person was asleep. The results showed a 60% correlation between what the person reported and the image that the computer displayed.

Robert Stickgold, a neuroscientist at Harvard Medical School, said that “this is probably the first real demonstration of the brain basis of dream content.”

The images during the hypnagogic stage are actually “hypnagogic hallucinations” rather than the classic dreams in REM sleep, they have “a different underlying physiology,” said  Allan Hobson, a psychiatrist at Harvard Medical School.

This experiment provides a robust basis to understanding that what we see in dreams is real, in the sense that we do not make them up. It is the first objective step into a world that hitherto had been the most private domain of the human being – our thoughts.

 

Ambulance and Football – What’s the Connection?

24 April, 2013 | Emergency Equipment

Ambulance on football field

Ambulance on football field

So, you may ask yourself ‘what is the connection between football and an ambulance?’ and the answer would be Pappis Cisse, Newcastle United’s striker. The 27 year old Senegalese football player used to drive an ambulance in his hometown Sedhiou, when he was 15 years old.

 The town where Pappis Cisse grew up had a very poorly equipped hospital. At age 15, Cisse would drive patients four to five hours away from where they lived, to a hospital in Dakar, where they could receive proper treatment. Unfortunately, many patients could not handle the journey; many died on the way and many women miscarried.

These experiences kindled in Pappis Cisse a personal mission, to help his hometown hospital be better equipped so that the local population could receive better care. Inspired by Cisse’s fundraising efforts, Joe Jones, a Newcastle fan, set up Friends of Sedhiou charity in October 2012, and Newcastle United’s official betting partner, Bet Butler, declared it his official charity for 2012-2013.

As the Sedhiou hospital is still very badly equipped, has very few medically qualified personnel and suffers regular electrical power outs, seriously ill patients still have to make the long and arduous way from Sedhiou to Dakar. Pappis Cisse, with the help of Friends of Sedhiou and Bet Bulter, aims to raise £13,000 in order to purchase an ambulance that would be dedicated to providing patients with the conditions that would enable them to survive the journey.

As of today, Friends of Sedhiou are working hard to raise the money for the ambulance. On Sunday April 7, 2013, Miss Newcastle, Rachelle Graham, skydived 10,000 feet from an airplane in order to help with the fundraiser.  The ambulance is expected to be purchased in June 2013.

The Future of Multimodal Imaging – Hybrid MEG-MRI

17 April, 2013 | MRI

Doctors viewing imaging results

Doctors viewing imaging results

Current developments in multimodal imaging are stemming from the merging of two imaging devices into one, thereby combining the benefits that each device has to offer.   One such example is a hybrid created from the combination of an Magnetoencephalography (MEG)  with Magnetic Resonance Imaging (MRI). The results are showing that sometimes one and one are more than two.

 Development of Hybrid MEG-MRI

When multimodal imaging begun, the data was provided sequentially. Nowadays, with hybrid systems that are already in clinical use, such as PET-MRI and PET-CT, the imaging from two or more devices is done at the same time.

 The hybrid MEG-MRI is still under development. In order to create one device out of these two systems it is necessary to combine them physically and integrate the measurement outputs that each of them produces. The MRI and MEG each provide different types of data; the MRI provides visual structural imaging information while the MEG provides non-visual real-time information on neuronal activity. MRI can also measure functionality, in what is called functional MRI (fMRI), as the tissue properties imaged by the MRI can change over time, but this is problematic and not completely reliable.

The combination of the MEG spatiotemporal information with the MRI structural data produces a 3D image of the brain electrical activity that is displayed tomographically. A good analogy for this combination would be to think of the MRI as sight and the MEG as hearing, combining the two senses gives us a much more comprehensive representation of the reality around us.

Challenge in Merging the MEG with the MRI

The main challenge in the merge of the MEG and MRI is that they each have different magnetic field strengths. However, there appears to be a solution to this discrepancy; experiments held at Berkeley University and Los Alamos National Laboratory have shown that ultra-low-field MRI can produce clinically relevant information. Furthermore, ultra-low-field MRI does not have the possible distortions of the standard high-field MRI and due to the unique relaxation time characteristic of low magnetic fields, new information is shown that previously was not accessible.

Advantages of the Hybrid MEG-MRI

When the MRI and MEG are combined, the information that was previously obtained in two examinations can be obtained in one session, saving time and money. In addition, the data produced is more accurate and reliable regarding the location of the electrical activity in the brain.

The hybrid MEG-MRI is safe, quiet and inexpensive. Because of the low magnetic field it may be possible to examine patients with a pacemaker, and because of the physical structure it is friendlier for obese patients who cannot fit into the standard MRI.

Conclusion

One of the development paths for multimodal imaging is hybrid systems, thereby significantly enhancing the data that was previously obtained from each system individually. Moreover, the process of adapting each system for the merge is acting as a stimulus for discovery of new possibilities within the system in itself, as can be seen with the ultra-low-field MRI. MEG-MRI provides a more reliable method to obtain structure and functional information simultaneously, and may in the future be the solution when this type of information is required.