Trends in medical technology

Advances in medical technology have played a major role in saving and improving the lives of millions of patients since time immemorial. Technology has played a vital role in augmenting clinical capabilities for diagnosis and treatment of all diseases. Medical equipment and devices are necessary tools in the hands of clinicians to supplement their skills and acumen for disease identification and management. Developments in computing technology have been pivotal for application of Robotics and Artificial Intelligence in medicine and healthcare.

Minimally invasive surgery (MIS). As we know it today, MIS was first practiced about three decades ago after development of the miniature solid state or chip camera. Rigid endoscopes were first used for laparoscopic surgery and these were extended to other specialties like orthopedics (using arthroscope) and neurosurgery (using neuro endoscope). MIS greatly evolved over the next few decades with progressive development of the imaging chain, particularly 3 chip, HD, 3D, CMOS and 4K cameras. The advantages of MIS have been small incisions, less pain, faster recovery and lower hospital stay.

Robotics in surgery. Despite the advantages of MIS, limitations existed to access regions close to critical organs and to overcome these, robotic surgical systems were developed to achieve greater precision and accuracy. Leading global supplier is Intuitive Surgical and at Apollo Group Hospitals six of their units are being used for about a decade. Primary applications have been in urology, gynecology, oncology, general surgery. As accurate hip and knee replacement surgeries are also quite critical for balance and stability, several vendors like Stryker, Zimmer, and Smith & Nephew have developed robotic systems for these applications. Development of image guided surgical navigation systems have greatly helped in the development of orthopedic and spine robotic systems. Considering that accuracy and precision are critical for spine surgeries, Globus Medical and Medtronic have developed navigation assisted robotic spine surgical systems to perform several spinal procedures. The systems have capability of real time monitoring of accuracy and active navigation tracking throughout the procedures.

Robotics in cardiology. For carrying out percutaneous interventional procedures, cardiologists and their patients have always been exposed to radiation from the cathlab in addition to mechanical fatigue at the table. To overcome these shortcomings, corindus developed the corpath GRX robotic assisted system for carrying out interventional work with more precision in stent placements and less radiation levels in the interventional suite. The cardiologist can carry out the procedures from the console room using joystick controls.

Robotics in rehabilitation. A Swiss based company, Hocoma, has since two decades developed robotic assisted rehabilitation equipment to help improve mobility for a wide range of patients. They have dedicated products to cater to pediatric and geriatric patients, for upper or lower limb rehabilitation, gait and balance training and so on.

Robotics in radiation. Radiation treatment has been given to treat cancer patients for more than a century. robotic technology has been applied in the cyberknife radiosurgical system about two decades ago to treat tumors throughout the body for the first time with utmost precision and accuracy in 1 to 5 sessions. This system also has capability to treat moving tumors like lung, liver etc. with minimal radiation exposure to normal tissue surrounding the tumor. In addition to clinical robotic applications, this technology has also been utilized for disinfection of critical areas like ICU, OT, wards using UVC radiation by companies like Mediland and Diversey. This is especially very useful and safe during the current pandemic times.

Apollo Hospitals have continuously inducted the latest technologies developed abroad in Group Hospitals in India for benefit of patients here. All the above technologies are currently in use at Apollo Hospitals. Today’s high speed internet technologies have also enabled specialty surgeons to perform robotic surgeries on patients by using controls located remotely.

Era of AI in healthcare. The applications of AI in medicine is vast and growing by the day. AI enables the use of complex algorithms to analyze and interpret voluminous patient data and assist clinicians in decision making more efficiently for early and accurate diagnosis.

Researchers have proved that COVID-19 could be detected with more than 90 percent accuracy from chest CT scans of asymptomatic patients and this could be distinguished from other viral infections with high specificity. Patient CT images can be analyzed and AI tools can predict the incidence of lung cancer with high accuracy at a very early stage of the disease.

It is customary to screen women for breast cancer using digital mammography systems. But for women with dense breasts, there are challenges with sensitivity using this technique and AI tools have been developed to overcome this and detect tumors at an early stage.

Similarly, using MR image data and with machine learning and AI tools, assessment and characterization of abnormal breast tissue is possible with greater accuracy non-invasively and without any radiation exposure.

Typically, coronary calcium scoring is a biomarker for predicting cardiovascular events and requires dedicated cardiac CT studies with and without contrast. But now, using AI tools, coronary calcium scoring is possible with standard non-contrast low dose chest CT scans thus avoiding extensive testing to detect high risk patients.
Incidence of diabetes has been growing worldwide and as a consequence many of these patients are also affected by diabetic retinopathy. AI tools are now available to analyze images from a fundus camera and automatically predict this condition at early onset to save the patients’ eye sight.

In order to determine blood flow disorders in the brain, neurovascular imaging of the brain is performed in an interventional suite. A transcranial Doppler ultrasound system is used to measure blood flow velocities. These ultrasound images can be combined with AI tools to assess the brain’s blood vessels and predict onset of stroke and other brain disorders caused by blood flow issues without any extensive invasive studies.

AI tools are being used by smart watches to provide ECG traces and also blood pressure information so that any cardiac event can be notified to the wearer and improve their quality of life. AI applications in digital pathology have helped histopathologists provide their reports more accurately and quickly. As DP images can be stored in common access locations, this is particularly useful for hospitals in remote towns without their own histopathologists. These new developments are like the proverbial tip of the iceberg, many startup companies are able to develop very useful AI tools for application in routine healthcare as well. Even software giants like Google, IBM, Microsoft and Intel have invested millions of dollars for AI research and this era is seeing acquisition of many startups for greater progress in achieving quicker and more accurate solutions in healthcare.

Increasing use of AI is a boon for many developing nations plagued with scarce number of doctors as virtual assistants will be able to bridge the divide. While AI research is yielding welcome results for better healthcare, regulatory compliances need to be suitably aligned as well.

Digital healthcare. Restrictions imposed on general population as well as public transport facilities due to the pandemic has paved the way for newer technologies to be adapted to provide continuum care. Patients are now able to dial in for live video virtual appointments with their consultants of choice from the comforts of their home. Google Meet, Microsoft Team, Zoom etc. are easily accessible to facilitate the same.

Apollo Hospitals have also launched 24×7 app which can be used by patients round the clock to consult remotely with doctors for any clinical advice. Both central government and state governments have adopted digital healthcare delivery system to reach out to the masses in the current pandemic scenario successfully in India.
It is seen that what was once conceived as science fiction many years ago is becoming a reality today due to newer trends in technology.