Local Solution with Global Potential

Development of IT enabled Healthcare Devices and Telemedicine

at Dhaka UniversityLOCAL SOLUTION WITH GLOBAL POTENTIAL

K Siddique-e RabbaniDepartment of Biomedical Physics & Technology

Dhaka Universityrabbani@du.ac.bd

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