Dr. Shubhajit Roy Chowdhury: Biomedical Systems

Biomedical Systems:
From Non invasive diagnosis to Point of Care Testing
Dr. Shubhajit Roy Chowdhury,
School of Computing and Electrical Engineering,

IIT Mandi, India
Email: [email protected]
Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Story of Abha – a scan too late
12 yr old girl on vacation.
Fell down while climbing a rock.
Unconscious
 She already had irreversible

brain damage.
 If the scan could have been
Had to travel for 5 hrs for a scan done earlier a simple surgery could
have saved her
50
Abha is not alone
38
25
Neurology. 2012 Nov 20;79(21):2146-7
13
0
USA JAPAN ITALY INDIA SOUTH
KOREA
India has only 1 MRI scanner/million population

- One of the lowest in world
 Emerging epidemic of neurological disability
 affecting over 3.5 million people annually
 11,000 every day
 7 people/minute

It is a Global issue
Even emergency department

doctors miss 40-50% of
neurological emergencies
Misdiagnosis of neurological emergencies are common

What is lacking?
Medical diagnosis at the point of care……….

Diagnosis: What it is?
Diagnosis is the identification of the nature
and cause of anything.
Diagnosis is used to determine the cause and

effect relationships.

Fundamental elements of Diagnostics
Identification
Logic Analysis

What is Medical Diagnosis?
Identification of the nature and cause of disease by
investigation of its signs and symptoms
Medical terminology:
Clinical diagnosis Laboratory diagnosis

X-ray diagnosis Electrocardiographic diagnosis

Steps of Diagnosis
History taking --- Interview
Symptoms --- patient‘s complaints
Tests
Clinical thinking

Symptoms
Subjective sensation that patient describes
Physiological & Pathological &

functional morphological
Fever Cough Rash Mass

AN EXAMPLE

Clinical Studies
In average
75% 55% 35%

Success
Three subtypes of the
disease
A B C
A B C
100% 60% 65%
40% 40% 85%
10% 90% 5%
100%
90% 91.7%
B
85%

Therapeutic success improved
because of the refined diagnosis
91.7%
75%
Without developing any new

therapies
A higher resolution of dividing a
disease into subtypes improves
therapeutic success rates

How do we obtain a higher resolution
of diagnosis that is clinically relevant?
Patient history/profile
Stepwise Analysis
Logical thinking
Further tests based on initial clinical findings
Hence a plethora of tests are needed for diagnosis. What can be the right
approach?.......

Invasive versus Non-invasive diagnosis
Invasive diagnosis – some part of body need to be
punctured, some suture made
e.g. Biopsy
Blood tests
Problem: 1. Pain involved in the patients
2. Expert needed in sample collection
Non invasive diagnosis
• No suture, no puncture
• No pain involved
• Expert needed?

Diagnosis - Looking back
Hippocrates
•Born on the island of Cos,
Greece (c. 460-377 BC)
•The Father of medicine

Hippocratic oath
希波克拉底宣言
•Hippocratic corpus（文集）:
a collection of 70 works

Hippocratic oath

Contribution of ancient doctors---Western
Galen
• c.130-c.200
• His work in
anatomy/physiology is notable
• Identified artery and vein
• Added greatly to knowledge of the
brain, spinal cord and pulse

Laennec RTH
•A French physician
•Invented Auscultation and stethoscope

Laennec RTH
1816

Contribution of Western Physician
17th~19th century
Leenwenhock Microscopy (end of 17th century)
Fahrenheit Thermometer (1724)
Ludwig Hematomanometer (1847)
Welcher Hematinometer (1854)
20th century
X-ray film EKG
Endoscopy CT PET

Ultrasonic imaging

MRI

Problems with state of the art approaches
High Cost
Sometimes difficult to implement at village /
block level especially in the developing countries
Even if it is implemented, do patients visit the
health care centre regularly for
scanning/monitoring?

THE INDIAN SCENARIO:
IN INDIA OUR LINE OF RESEARCH HAS BEEN INSPIRED BY THE

FOLLOWING FACTS :
700 millions of Indians live in 636,000 villages
2% of doctors live in villages
66% of rural Indians do not have access to critical medicine
31% of the population travel more than 30 kms seeking health care
in rural India
22 million population pushed below poverty line annually due to
healthcare expenditure alone
40% of hospitalization expenditure funded by borrowed money or
sold assets
Preventable and curable diseases dominate the morbidity pattern

The alternate way of thinking………
Instead of patients reaching out to diagnostic

centers, can diagnosis reach patients?......

Point of care diagnosis – A solution…….
Point of care testing – What is it?

tests designed to be used at or near the site where
the patient is located, that do not require
permanent dedicated space, and that are
performed outside the physical facilities of the
clinical laboratories
(College of American Pathologists)

The drivers
Rapid testing of pathophysiological parameters
Home monitoring of parameters
Arterial blood gas testing in the ICU
Many POCT programs and physician office
laboratories intentionally limit their menus to
waived tests only
Attractiveness and potential of waived testing
market to industry

POCT: Common Use
Glucose
Blood gas analysis / electrolytes
Activated clotting time for high dose
heparin monitoring
Urine dipsticks for pregnancy
Occult blood
Hemoglobin
Blood pressure
Body temperature

Plethysmography – A point of care testing technique
PG is a term for a set of noninvasive techniques
for measuring volume changes in parts of the
body (even the whole body)
Commonly measured volume changes are:
those caused by breathing (lung and chest expansion)
those caused by blood being forced into vessels (such
as arteries,veins and capillaries)
those caused in the heart as it pumps

Common uses of the PPG
The Finger PPG
I0
Vout

I
Time - s
This signal is very similar to the peripheral blood pressure waveform

How does the PPG work?
15% of blood by weight is hemoglobin inside the Red
blood cells (RBC or Erythrocytes)
The total Hb (THb) can have one of the following forms
reduced or non-oxygenated Hb (HbR)
Oxyhemoglobin (HbO2) 99% of
Carboxyhemoglobin (HbCO) THb
Methemoglobin (metHb)
How do these various forms interact with light?

The PPG equipment
PPG signal without filtering
PPG signal after filtering

Journal of Medical Systems (2015)

Applications
Heart Rate
Respiratory rate
SpO2
Hb-HbO2
Electrolytes (Na+, K+, etc)
Glucose
Urea
Creatinine

POCT for Limb using MRI

Questions that come to my mind:
• Do we need 1.5T magnet for limb MRI?
• If we can play around at a lower intensity of
magnetic field what about the wobbling
frequency?
• Can we thereby get dispensed with a
superconducting magnet?
• Shall we be able to generate an RF pulse that
can resonate at that wobbling frequency?
• What is the requirement of voxel/pixel density?

A Global technology gap
There is no technology for brain that can ?

reach point of care

The Global Crisis
Time
A POCT device to capture Cerebrovascular
Reactivity
IEEE JTEHM 2015

Results
1. The anodal stimulation
induced a significant increase
in oxyhemoglobin (HbO(2))
concentration compared to
rest.
2. The Stroke and TBI patients

will have different changes in
HbO2 in response to anodal
tDCS.
Dr. Shubhajit Roy SCEE, IIT MANDI

Chowdhury
Classification of stroke and non-stroke patients

NIRS-EEG joint imaging for neurovascular
state estimation

The future of POCT
Microbiology – outbreaks, epidemics

Endocrine testing to guide surgical therapy –
ACTH, Gastrine, Parathyroid hormone,etc
Sepsis marker
Stroke marker

Roads to go……..
The state of the art POCT devices allows to monitor only some
simple pathophysiological parameters. We may go a bit further and
have some morphological findings of visceral organs. What about
monitoring at tissues or cell level?
Can we have answer to cancer?
Detecting a disease in time saves nine………

49
The ultimate question:
Will POCT replace Clinical Laboratories?

THINK…………

About Biomedical System Course
Course Code: EE516
Is it about Biology?
-----No
Is it about Bio-allergy?
-----No
It is study of Systems Engineering as applied to Biomedicine
Dr. Shubhajit Roy Chowdhury

SCEE, IIT MANDI
Books
1. J. Enderle, S. Blanchard, J. Bronzino, “Introduction to Biomedical Engineering”

Elsevier Academic Press, 2009.
2. J.G. Webster, “Medical Instrumentation: Application and Design”, John Wiley

and Sons, 2003.

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Biomedical Systems:

From Non invasive diagnosis to Point of Care Testing

Dr. Shubhajit Roy Chowdhury,

School of Computing and Electrical Engineering,

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

 She already had irreversible

India has only 1 MRI scanner/million population

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Even emergency department

Misdiagnosis of neurological emergencies are common

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Diagnosis is used to determine the cause and

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Clinical diagnosis Laboratory diagnosis

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Physiological & Pathological &

Fever Cough Rash Mass

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

75% 55% 35%

100% 60% 65%

40% 40% 85%

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Without developing any new

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

•The Father of medicine

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

IN INDIA OUR LINE OF RESEARCH HAS BEEN INSPIRED BY THE

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Instead of patients reaching out to diagnostic

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Point of care testing – What is it?

(College of American Pathologists)

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

This signal is very similar to the peripheral blood pressure waveform

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

PPG signal without filtering

PPG signal after filtering

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI

Dr. Shubhajit Roy Chowdhury SCEE, IIT MANDI