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Trends in Medical Technology: “There are many debates on what demands hospitals will have in the future“
Professor Olaf Dössel during his lecture on the Medical Technology Innovation Forum 2010; © Regina Sablotny
COMPAMED.de met with Professor Olaf Dössel, Head of the Institute of Biomedical Engineering at the Karlsruhe Institute of Technology, during the Medical Technology Innovation Forum 2010 in Berlin and inquired about exciting innovations and why it sometimes takes so long from development to application for the patient.
COMPAMED.de: Professor Dössel, you introduced ten innovative areas of Medical Technology during your lecture. What criteria did you use to choose these highlights?
Olaf Dössel: The choices were of course influenced by what I am interested in. Yet there are also those topics that I believe are interesting from a more global perspective. In my choice of topics, I was also guided by questions that are currently fiercely debated in International conventions. There are many debates on what demands for instance hospitals will have in the future. Participating engineers and physicians are swapping information on this subject. I have tried to illustrate topics where I know: This trend in medical technology provides a benefit for the patient. For example, there is the retina implant, which is currently developed by associates at the NMI Reutlingen, the Retina Implant AG and the University of Tübingen. Or the Lab-on-a-Chip, which for instance is supposed to be used in cell diagnostics and cell therapy, to characterize and classify cells. Although there are initial products, future developments are meant to become more specific and even easier to use. In medical technology we also work a lot on enhancements of products that are already on the market. Examples of these are image-guided medical systems like X-rays, magnetic resonance tomography or ultrasound, which are continuously improved. One should mention phase contrast X-ray imaging as a particularly exciting example, with which the soft tissue contrast can be significantly improved. Brand-new methods like for instance imaging of bioelectrical sources in the heart are also being developed. Please allow me to briefly explain this: The rhythmic beating of the heart is controlled by small electrical currents, which the heart produces on its own. You probably know an ECG, where the corresponding electrical signals are measured on the surface of the body. Disruptions of these electrophysiological processes lead to dysrhythmia. We are now working on a completely new imaging medical method, where these electrical processes are mapped in the heart to make better diagnostics possible for a cardiologist.
COMPAMED.de: Do you normally approach physicians or do physicians approach you for instance to inquire about a technical solution to a problem?
Dössel: It alternates. Medical technology is a multidisciplinary area where experts like physicians, engineers, physicists or computer scientists collaborate. Sometimes the suggestion for a technical development is made by a physician and sometimes by an engineer. New things develop only in a team.
COMPAMED.de: Medical science is getting more and more equipment-oriented for physicians. Do you think that a doctor needs to trust his intuition more or is trust in equipment predominating? As in: This was the result of the exam, and now we will treat as follows …
Dössel: This is a very difficult question, which is far reaching. I am convinced that reproducible measured data plays an increasingly important role in concrete treatment decisions. The art of medicine is also developing more and more into guidelines, where the physician needs to say in the end: If the measured value X is larger than a specific critical value, then the guideline recommends the following. And this is then the correct action and no other! After all, a guideline is based on extensive clinical trials which comprised thousand of patients, and thus is superior to medical intuition. This does not change the fact though, that every patient needs a person of trust, who accompanies him in his disease. And I am not downplaying this component in any way. This is the important duty of a physician and it will still be the duty of a physician a hundred years from now. Yet you won’t be able to – and are not able to today – merely intuitively be able to say whether someone had a severe heart attack during the past fifteen minutes or not. In this case, every physician needs to rely on the measured data that is available to him. The better the measured data is, the more reliably he can decide, whether the patient had an infarction and with which method he might potentially be able to save the patient’s myocardial tissue.
What will the future bring? The researchers want to develop small robots that will be able to support the surgeon in his work; © panther-
COMPAMED.de: In your lecture you also mentioned robot-assisted endoscopy. How does it work?
Dössel: Endoscopy means to look into the body, for instance through natural orifices or through small incisions. The area of interest is then illuminated with light, so you are able to examine it. Generally, endoscopy has advanced a lot in the past 20 years. While you initially were only able to examine, now it is already routine to for instance also immediately perform a biopsy or even simultaneously start a treatment. I am thinking for example about a colonoscopy. But more developments will follow. At the moment, the physician only has simple hooks and loops at his disposal, but other technical instruments are conceivable. Soon for example it might be possible to stitch at the endoscopic tip with the help of a robot. Why would you not want to cut out a piece directly in the body, then connect the endings and join them back together? You need some sort of sewing machine for this. Or when applying adhesive to a wound – you require an instrument for this, which applies the adhesive and reconnects the corresponding ”parts“. This could happen with the aid of small mini robots for instance.
COMPAMED.de: Do you think that the physician profession is going to change due to the technical possibilities and that physicians will need an additional course of studies in engineering?
Dössel: No. Take the example of driving a car. You can be a very good driver without knowing how to build a car. Those are simply different skills. The physician is the expert driver and the engineer is the developer and builder. Of course a good driver will provide suggestions on how the car might be made even better. A doctor has such an extensive medical knowledge, which he has to acquire over many years. That’s why he cannot and need not in addition have to understand the technology behind a computer tomography scanner – that is what a Medical technology engineer is for.
COMPAMED.de: You already developed a lot of equipment. How long does it take until one of your developments gets to the patient?
Dössel: That really depends. There are rare instances where technical developments get to the patient after only two to three years. In many cases it will take ten years. This also depends on approval procedures, and also in what form reimbursement is to take place. All medical equipment that is used in the inpatient area, “only“ needs to pass one relatively simple procedure in Germany, where you need to prove that the equipment is technically safe and achieves the promised performance. However, you don’t have to provide proof that the new procedure is also a cost-effective solution in terms of the Social Code. For the outpatient area though there is an extensive test on clinical effectiveness and economic efficiency before reimbursement by compulsory health insurance funds is provided, and sometimes this takes many years.
COMPAMED.de: So an approval for an endoprosthesis takes longer than an approval for an imaging method?
Dössel: This is another point you are addressing here: Far more extensive testing procedures apply to developments that are meant to be inserted or implanted into a patient’s body. That’s already dictated by ethics alone. Here the procedure proceeds according to the following pattern: First you need to deliver proof in the laboratory by means of cell cultures that the system is useful and never harmful. Then the whole issue is tested on animals and in the end comes the clinical trial on human beings. This is why this path of approval indeed generally takes many years.
The interview was conducted by Simone Ernst and translated by Elena O’Meara.