Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας Dagstuhl Seminar on Assisted Living Session IV: Hardware Challenges Position Statement: Adapting Biomedical Technology to support Home-Care Dr. rer. nat. Basile Spyropoulos Medical Instrumentation Technology Department, Faculty of Engineering, Technological Education Institute of Athens, Athens, Greece

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living2 Contemporary diagnostic procedures  Contemporary diagnostic procedures entail the use of Biomedical Technology, and consist of the collection of diagnostic information, and the evaluation and assessment of the individual patient.  The aspect of the collection of diagnostic information comprises of:  Clinical information obtained by the case history and by inspection, palpation, percussion, auscultation etc.  Signals related to bodily functions which are collected from in vivo diagnostic procedures (ECG, EEG, EMG etc).  Data acquired through in vitro diagnostic tests.  Images related to the morphology and the functions obtained from medical imaging procedures.  Information related to various past therapeutic interventions.  Data which are of administrative and of financial importance such as insurance, costs of medical treatment, cost of hospitalization etc.

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living3 The in vivo Diagnostic procedures  The in vivo Diagnostic procedures leading to the collection of electrical and non-electrical Biosignals, related to the bodily functions, tend to become a laptop, or even a smaller computer-centered system, equipped with sensors, preamplifiers, analog to digital converters etc.  They are usually connected through a Universal Serial Bus (USB) port, or linked wirelessly through Blue Tooth or other Radiofrequency technologies.  Not only research groups, but also various manufacturers offer already commercially available Diagnostic Workstations that combine:  ECG and Holter recordings  Spirometry, Pulse Oximetry, and Blood Pressure  Less often EEG and Evoked Potentials plug-in modules on a single computer.  This solution eliminates the expense of purchasing and maintaining multiple medical devices, and provides for the necessary mobility and portability to be employed in Home-care.

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living4 A custom developed system developed by our group Carotid sound acquisition (44.1kHz) and HR and RR (low-pass filter) determination The overall monitoring hardware block diagram B. Spyropoulos, M. Botsivaly, A. Tzavaras, K. Koutsourakis, E. Koulouris, D. Liargovas, K. Mertika, Development of a system supporting Patient Supervision and Treatment in contemporary Home–Care: Status Report, Stud Health Technol Inform 124 (2006)

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living5 Examples of other R&D and commercial systems

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living6 Home-based in vitro Diagnostics  Concerning home-based in vitro Diagnostics, Clinical Chemistry offers today a variety of products, covering the whole range of important parameters, like metabolites, enzymes, electrolytes etc.  A variety of Home Diagnostic Tests is offered over the counter in the USA, in Europe and elsewhere that lead to a home-based in vitro diagnostics laboratory that could prove very useful, if combined with Medical Advice and Supervision, during Home-Care or Care in various facilities looking after elderly people.

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living7 From Dry Chemistry Strips to the emerging Biochips  The development of the reagents from the Dry Chemistry Strips to the contemporary emerging Biochips has already changed the landscape of the Point of Care in vitro Diagnostics, several times during the last decades.  These miniaturized micro-electronic/micro-fluidic systems create justified expectations for a portable, multifarious, disposable, and cost-effective Lab on a Chip, supporting reliably, conveniently, and promptly medical decision making, during Home-Care, extending for instance, from the timely identification of the onset of an Acute Myocardial Infarction, to the evaluation of anti-Coagulants level of a post-operative or post-stroke patient at home

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living8 Lab on a chip advances Left: Self-assembled cellular micro-arrays patterned using DNA barcodes Right: Micro-fluidic logic gates and timers (Lab Chip, 2007, 7, )

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living9 Home Imaging  Concerning Home Imaging, although several mobile X-ray systems have been developed, most of them are not portable, and therefore, bedside imaging will remain the limited privilege of the ICU patients, and hard-core Radiology and Nuclear Medicine, will continue to be “status symbols” of the Hospital for the near future.  The exception is Ultrasonic Equipment and especially Echocardiography that uses ultrasound to show the structure and function of the heart and related blood vessels.  Portable, hand-carried ultrasound units, about the size of a laptop computer, have been developed for point-of-care cardiac assessment and documentation of the left ventricular function, chamber size, source of murmurs, wall thickness, valve structure, and the presence of pericardial effusion.  Recently developed portable ultrasound units have the capability for continuous or pulsed wave Doppler, and enhanced tissue imaging, for a broad potential patient group.

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living10 Point-of-Care Echocardiography

Τμήμα Τεχνολογίας Ιατρικών Οργάνων Εργαστήριο Βιοϊατρικής Τεχνολογίας November 14-17, 2007Dagstuhl Seminar on Assisted Living11 Concluding remarks  Home-Care gains access to contemporary multifarious technologies that provide for limited, however, reliable and adequate medical data, compared to the ones they could virtually be acquired in the Hospital.  The additional information concerning the patient’s living environment, combined with the diagnostic feeling, based on the General Practitioner’s length of practice, and on the uniformity and regularity of the phenomena he has encountered, lead usually to a successful diagnosis and treatment.  Our own research and development experience, the published reports of similar attempts, and finally, the evaluation of commercially available products, argue for the gradual build-up of continuously improved home- care hardware.  This fact will allow for, both, the life saving urgent intervention, and the successful supervision of a long term condition, thus, prolonging the length and improving the quality of the life of elderly and frail patients, at home.