medical equipment and automation

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Publisher’s Note

Mar-Apr 2014 � Medical Equipment & Automation

Advancements are noted in all the fi elds of medical science. Th e fi eld of Radiosurgery is seen progressing with notable advances in robotic technology.

Th is issue deals with one such technology that helps in precisely targeting tumors, present anywhere in the body with pinpoint sub-millimeter accuracy. In the write-up on ‘Cyberknife – Revolutionary Robotic Radiosurgery System’, the author has emphasized on the features, advantages and how Cyberknife treatment is more benefi cial than the conventional treatment.

Computer navigation is a recent advancement in joint replacement surgery that enables the surgeon to create digital reproduction of the entire surgery. Computer navigation helps in clearly viewing the component position, range of motion, ligament tensioning, and overall limb alignment during every step of the operation. Various benefi ts and details of computer navigation procedure is highlighted in the piece of writing on ‘Computer Assisted in TKR Surgery’.

Oncology is another fi eld where there is immense ongoing research conducted. Th e article, ‘MRI Scan Detects Treatment of Bone Marrow Cancer’ deals with the innovation of one such revolutionary scanning technique. Th is scanning technique images the entire body of the patient disclosing the cancer aff ected areas in the bones and further directs the doctors in the choice of treatment. Th e scan demonstrates the response of the patient to cancer treatments. Th is special issue on Surgical and Oncology equipment further enlightens our readers regarding the advancements in the said fi eld.

Moreover, we feel pleasure to invite you at our MEA booth during Medicall Expo 2014 at Chennai during August 1-3, this year.

Please do send me your comments at [email protected]

Pravita IyerPublisher

With each passing day, there are numerous research done to invent newer techniques, approaches & devices which can help in early detection of medical conditions. It is seen that early detection helps in arresting progress of the disease and offering quick relief to the patient.

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ContentsDirector /Publisher Pravita Iyer Mahadevan Iyer

Editor Mahadevan Iyer [email protected]

Associate Editor Gopal Krishna Anand [email protected]

Sub-Editor Dr Varsha V Sharma Kshitija Kolhapure

Editorial Coordinator Nafisa S. Kaisar [email protected]

Advt. Department Karan Singh [email protected]

Design Rakesh Sutar

Subscription Department Hemant Yelave Nafisa Khan [email protected]

Administration Dattakumar Barge Bharati Solanki

Social Media Abbas Saifee

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Editor : Mahadevan Iyer

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Computer Assisted TKR Surgery

20

Dr Satish Puranik

As osteoar thritis progresses, the knee becomes more misaligned, stiff, and deformed. Restoring alignment is critical for the long-term success of a knee replacement. Precise position of the implants is another critically important element of the durable knee replacement.

Survival rate of Head & Neck Cancer patients

30

Dr Dhairyasheel N Savant

Head and neck cancer is the largest component of the overall cancer; with nearly 2,00,000 new cases being repor ted every year. In India around one third of the total cancer incidents are Head and neck cancers in contrast to only 4% and 8% in US and Europe respectively.

Bariatric Solution for curing diabetes off ers new hope

32

Surgical Automation & Robotics

22

Dr Balbir Singh and Prof Dr Lakshmi B

Automation is an emerging trend providing outstanding quality of care, combined with good treatment and service. Automation and use of robotics has let healthcare not only to advance exponentially in terms of dexterity, precision and comfor t but also proved to be time saving, simple and reliable.

Screening of IDA and Th alassemia using Automated Hematology Analyzerss

37

Divya Munshi

In the Indian context, the two most common etiologies for microcytic hypochromic anemia cases are iron deficiency anemia & beta thalassemia (a genetic hemoglobinopathy). As per the WHO estimate, 80% of children, 58% of pregnant women, 30% adults in India are suffering from IDA while 3.3% of Indian population is affected by beta thalassemia.

Dr Ramen Goel

For ty three-year-old S Nair had been diabetic for 15 years. His disease was uncontrollable and had turned him blind. Just when he had given up all hope, doctors suggested bariatric surgery to cure the condition. Just 12 days after the procedure, his insulin was back to normal and he was taken off all medication for diabetes.

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Contents

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Disclaimer: Chary Publications does not take responsibility for claims made by advertisers relating to ownership, patents, and use of trademarks, copyrights and such other rights. While all efforts have been made to ensure the accuracy of the information in this magazine, opinions expressed and images are those of the authors, and do not necessarily reflect the views/collection of the owner, publisher, editor or the editorial team. Chary Publications shall not be held responsible/ liable for any consequences; in the event, such claims are found - not to be true. All objections, disputes, differences, claims and proceedings are subject to Mumbai jurisdiction only.

Medical Equipment & Automation � Mar-Apr 2014

Departments� Publisher’s Note 02

� Editorial 06

� Newsline 08

� Feature 29, 45 & 55

� Hospital Update 70

� Event 73

� Product Review 74

� Advertiser’s Index 77

� Biography 78

� Medical Wizard 79

Interview

34

Dr Kamal Kiran Mukkavilli Nephrologist, Kamineni Hospitals

40

Dr Anil Potdar MD, DNB (CARD.), MNAMS, FACCParisoha Foundation Pvt Ltd

46

MRI Scan Detects Treatment of

Bone Marrow Cancer

48

Brand Recall in Healthcare

Dr Varsha Sharma Kapila

P Ashoka Varma

50

Diagnostic Radiation Th e ALARA Mantra

56

Free Light Chain (FLC) Analysis in Plasma Cell Dyscrasias

Dr Sharad Maheshwari

Dr Vijay S Bhat

62

Technology and Innovation to stay

game changers

64

CYBERKNIFE Revolutionary Robotic Radiosurgery System

Anjan Bose

Dr Ch. Mohana Vamsy

66

Osteoporosis How you can help

yourself!

68

Quality Medical Education

Dr Gerd Mueller

Dr Jayshree Mehta

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Editorial


Harm reduction can be assumed as abstinence from all forms of tobacco Nicotine, the addictive component of tobacco alters neural circuits to promote addiction,

and altered activity of these neurons may undermine eff orts to quit smoking. Th e rate of developing esophageal squamous cell carcinoma (ESCC) nearly doubles in those who both smoke and drink compared to those who only smoke or drink, according to new research published in Th e American Journal of Gastroenterology. According to National Cancer Institute, it is estimated, in 2014 there will be over 18,000 new cases of esophageal cancer in US, and over 15,000 deaths from disease.

Evidences indicate - avoidance of smoking, increased consumption of fruits and vegetables, physical activity, reduction of alcohol consumption - eff ect in reducing rate of cancer. In the realm of cancer management, measuring eff ectiveness of treatment on survival alone is not enough. Quality of life may get aff ected post surgery and treatment causes physical, emotional and psychological diffi culties for concerned individuals.

Standard care requires surgeons to remove the tumor and some neighboring tissue that may or may not include cancer cells. Oft en a second surgery is recommended to remove additional tissue - and checked for the presence of cancer. Cancer cells are diffi cult to see, even under high magnifi cation. Recently, high-tech glasses developed at Washington University School of Medicine in St. Louis may help surgeons visualize cancer cells, which glow blue when viewed through the eyewear.

Choice of treatment for cancer depends mostly on the type of primary cancer. For some cancers chemotherapy works better and for others radiotherapy. Th e global market for biological therapies for cancer is to reach $53.7 billion in 2014 and for Predictive Breast Cancer diagnostic and drug Technologies valued at $21.2 bn in 2011 is expected to reach $24 bn by 2016.

Approximately 12.5 million new cases of cancer are being diagnosed worldwide each year and considerable research is in progress for drug discovery for cancer. Most drugs used to treat lung, breast and pancreatic cancers also may promote drug-resistance and ultimately spur tumor growth. As drug resistance occurs, tumor cells acquire stem cell-like properties that give them the capacity to survive throughout the body and essentially ignore the drugs. Th e fi ndings were published during April, 2014 online issue of Nature Cell Biology. Over and all, drug discovery and delivery remains a challenge in management of cancer progression.

Gopal Krishna Anand

Managing Cancer, Treatment and Th erapies

Global market for biological therapies

for cancer is to reach

$53.7 billion

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22 Mar-Apr 2014 � Medical Equipment & Automation

Surgery

SurgicalSurgical

&&AutomationAutomation

RoboticsRobotics

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23Medical Equipment & Automation � Mar-Apr 2014

Surgery

Automated laboratory and medical systems help clinicians make accurate diagnoses and provide

effective treatment. They help medical researchers find new lifesaving cures and help hospitals and clinics provide efficient care. Healthcare providers do a better job and patients receive better care when these systems are faster, more precise and more reliable. With higher-performing, more reliable equipment, the whole healthcare system works better, benefitting everyone from patients and caregivers to hospitals and clinics – and the machine builders who serve them.

Now the hospitals have the technology and engineering knowledge to solve the toughest motion challenges. Modern day robotics offers the widest standard product selection, with the ability to rapidly modify products for an exact fit to meet the requirement of specific applications. Present day machines can be simplified by

utilizing direct-drive technology, removing transmission components for greater accuracy, repeatability, reliability and a lower total cost of ownership. In addition, they can help to integrate motion systems along with optics, fluidics and pneumatics for higher performance and precision.

Surgical AutomationMinimally invasive surgery is

the way of the future. Improving on the technologies of conventional laparoscopy and arthroscopy, surgical robots are providing surgeons with greater visibility, dexterity, precision and comfort than ever before. Today’s surgical robots decrease operative trauma, improve patient outcomes and shorten lengths of stay in prostate, cardiac, gynecological and many other types of surgery. And their growth potential is unlimited as new surgical applications are developed and as hospitals add new capabilities to better compete for patients.

Automation is an emerging trend providing outstanding quality of care, combined with good treatment and service. Automation and use of robotics has let healthcare not only to advance exponentially in terms of dexterity, precision and comfort but also proved to be time saving, simple and reliable. Use of robotics can prevent patient from undergoing lengthy and painful procedures by way of minimally invasive surgery. Robotic surgery can provide highest level of accuracy while retaining the expertise of a surgeon.



Surgery

The Most Demanding Motion Environment: Operating Room

Precise control of multi-axis motion, with coordination across all surgical controls, cameras and instruments, is the key to surgical robotics. This requires the highest-quality servomotors, drives and motion controllers working together seamlessly over a high-bandwidth motion network. But it’s not just about quality. It takes a complete motion solution, integrating components that are designed to work together within the most demanding application requirements and space constraints.Right Tools and Skills

Industry prefers most advanced servomotors in configurations and torque ranges to meet virtually any specification. Compact frameless and cartridge motors provide

direct rotary motion for the stiffest, most exact motion in the smallest possible space – without the need for complicated and bulky transmission components. Additionally, the integrated drives, controls, development tools and expertise is needed to bring an optimized motion solution from the drawing board to the operating room.A Tireless Assistant

Quality should always be the number-one concern in the healthcare setting. Repair and maintenance time is time that could be spent treating patients, instead of rescheduling their appointments. Through the Danaher Business System, kaizen-based quality assurance and continuous improvement programs have made providers the recognized leader in high-end motion. And with global supply,

engineering and support network, the components and expertise to keep robots performing are always near at hand. So the robot is always on the job.

Surgical SimulationSimulation is another big

concept in modern medicine. Simulation is particularly attractive in the field of surgery because it avoids the use of patients for skills practice and ensures that trainees have had some practice before treating humans. Surgical simulation may or may not involve the use of computers.

One of the barriers to development of virtual reality surgical simulation has been the large amount of computing capacity that has been required to remove delays in signal processing, but this is being addressed by systems that break down the tasks by concentrating on chains of behavior. Designers of surgical simulators attempt to balance visual fidelity, real-time response and computing power, and cost.What Currently happens in Surgical Training?

Surgical training consists of developing cognitive, clinical, and technical skills, the latter being traditionally acquired through mentoring. Fewer mentoring opportunities have led to the use of models, cadavers, and animals to replicate surgical situations and, more recently, to development of surgical skills centers or laboratories. However, the effectiveness of skills laboratories in teaching basic surgical skills (eg, instrument handling, knot tying, and suturing) is not yet proven.Is Simulation an Effective Method of Training?

Attempt is to gauge the



Surgery

instructional effectiveness of surgical simulation (that repeated use improves performance), as well as construct validity (that the simulator measures the skill it is designed to measure). Validity studies of surgical simulation (mostly computer simulation) have shown mixed results for construct validity while other important aspects of validity (such as predictive validity) and reliability are frequently not tested. The ultimate validation is for simulation training to show a positive influence on patient outcomes.

Simulation can not only be used for surgical training, but also to assess surgeons. For example, the U.K. General Medical Council is using it to assess poorly performing surgeons referred to the Council.Costs of Surgical Training

While the costs of simulation systems can be high, ranging from about U.S. $5000 for most laparoscopic simulators to up to U.S. $200,000 for highly sophisticated anesthesia simulators,traditional Halstedian training is not without cost either.

Bridges and Diamond calculated that the cost of training a surgical resident in the operating room for 4 years was nearly U.S. $50,000.

Robotic SurgeryRobotic surgery is also known

as Robot-assisted surgery; Robotic-assisted laparoscopic surgery; Laparoscopic surgery with robotic assistance.

Robotic surgery is a method to perform surgery using very small tools attached to a robotic arm. The surgeon controls the robotic arm with a computer. Here the patient is given general anesthesia so that he is asleep and pain-free. The surgeon sits at a computer station and directs the movements of a robot. Small surgical tools are attached to the robot’s arms. • The surgeon makes small cuts

to insert the instruments into the body.

• A thin tube with a camera attached to the end of it (endoscope) allows the surgeon to view enlarged 3-D images of body as the surgery is taking place.

• The robot matches the doctor’s hand movements to perform the procedure using the tiny instruments.

Why the spike in robotic usage?Back in 2000, there were only

1,000 robotic surgeries world-wide. That number surged to 360,000 in 2011 and 450,000 last year. Analytics say the practice is on the rise because of its strong



Surgerybenefits. For the patient, there’s usually less blood loss, a shorter hospital stay and less reliance on postoperative pain medication. There’s also the cosmetic benefit of no big scars, As in laparoscopic surgery, the instruments enter the body through small incisions. For surgeons, the procedures can be less tiring. They don’t have to bend over an operating table—they can sit in front of a screen with a magnified, full-color 3-D view of the surgical field. For maneuvering in very tight spaces, like the back of the throat, the enhanced screen image makes it much easier to see what actually is being done.Benefits of Robotic Surgery

Robotic surgery is similar to laparoscopic surgery. It can be performed through smaller cuts than open surgery. The small, precise movements that are possible with this type of surgery give it some advantages over standard endoscopic techniques. The surgeon can make small, precise movements using this method. This can allow the surgeon to do a procedure through a small cut that once could be done only with open surgery. Once the robotic arm is placed in the abdomen, it is easier for the surgeon to use the surgical tools than with laparoscopic surgery through an endoscope. The surgeon can also see the area where the surgery is performed more easily. This method lets the surgeon move in a more comfortable way, as well.

Robotic surgery can take longer to perform. This is due to the amount of time needed to set up the robot. Also, many hospitals may not have access to this method. Robotic surgery may be used for a number of different procedures, including:

Coronary artery bypass, Cutting away cancer tissue from sensitive parts of the body such as blood vessels, nerves, or important body organs, Gallbladder removal, Hip replacement, Hysterectomy,

Kidney removal, Kidney transplant, Mitral valve repair, Pyeloplasty, Pyloroplasty, Radical prostatectomy, and Tubal ligation.Risks and Recovery in Robotic Surgery

Like any other surgery the risks includes one pertaining

to anesthesia like reactions to medications and problems breathing and risks pertaining to actual surgery like bleeding and infection.Robotic surgery has as many risks as open and

laparoscopic surgery. However, the risks are different.

As surgical cuts are smaller than traditional open surgery recovery is smoother with faster recovery, less pain and bleeding, less risk of infection, shorter hospital stay and smaller scars. �

Dr Balbir Singh

Prof Lakshmi B

Dr Balbir Singh is serving as Assistant Professor (UGC-NET qualified) in Health Studies Area, Centre for Human Development at Administrative Staff College of India. He is Bachelor in Medicine, has PG Diploma in Preventive & Promotive Health Care and MBA in Health Care Management from Apollo Institute of Health Care Management. He is a certified Project Management Professional from IIT, Delhi. Sample of his trainings and CME’s include programmes from Harvard Medical School, Johns Hopkins Center for Public Health, The University of Edinburgh, Stanford University, Asian School of Cyber Laws, NIOS and IGNOU.

Prof Dr Lakshmi B is Dean of Management Programs, Director of Centre for Human Development, and Chairperson of Health Studies Area at the Administrative Staff College of India (ASCI). She is BA, MA, MPhil. and PhD. She has Postdoctoral Master’s in Hospital Administration (MHA) from Sydney. She is a Fellow of Australian Institute of Management (FAIM). In the international arena, Prof. Lakshmi conducted MDPs for the Commonwealth and multinational sponsored programs for the South Pacific Islanders in Papau New Guinea.


Feature


The history of World Cancer Day dates back to 1933 when Union for International Cancer

Control (UICC) first observed the significance of this day at Geneva, Switzerland. It was an initiative of UICC to unite the entire world in order to reduce the global cancer burden, to promote greater equity, and to integrate cancer control into the world health and development agenda. World Cancer Day is celebrated annually on 4th of February all over the globe and aims to save millions of preventable deaths each year by raising awareness and educating about cancer, and pressing governments and individuals across the world to take action against the disease. In 2014 it has been focused on Target 5 of the World Cancer Declaration: Reduce stigma and dispel myths about cancer, under the tagline “Debunk the myths”. According to UICC its importance lies in preventing the inevitable global cancer epidemic by raising awareness against the deadly disease.

Currently, 7.6 million people die from cancer worldwide every year, out of which, 4 million people die prematurely (aged 30 to 69 years). Therefore the need of the hour is to raise awareness about the disease and to develop practical strategies to address cancer. By the year

2025, premature cancer deaths are projected to increase to 6 million per year. The estimate of 1.5 million lives which are at threat due to cancer could be saved per year if strategies are adapted to achieve the World Health Organization’s (WHO) ‘25 by 25’ target to reduce premature deaths due to non-communicable diseases (NCDs) by 25% by 2025.

Cancer Control in India

World Cancer Day is an important date where organizations and individuals are encouraged to project the day for a concerted ‘advocacy push’, calling on governments to live up to the new and ambitious commitments in the emerging NCD framework, and ensure that cancer interventions, prevention, early detection, treatment and palliation, are adequately addressed in the global health platform. There is now a need for a worldwide commitment which would aid advancements in policy and encourage implementation of comprehensive National Cancer Control Plans.

India is one of the few developing countries that have a National Cancer Control Program organized by the Ministry of Health and Family Welfare. Its primary objectives include prevention of tobacco related cancers and other prevalent forms like cancer

of uterine cervix, mouth and breast as well as extension and strengthening of therapeutic services including pain relief on a national scale through regional cancer centers and medical colleges (including dental colleges). The current program envisages- Recognition of new Regional Cancer Centers (RCCs); Strengthening of existing RCCs; Development of oncology wings in medical colleges; District Cancer Control Program; Decentralized NGO Scheme which together would aid the concerted network of cancer control.

Cancer Research in India

Cancer control program is perfectly complemented with current trends in cancer research in India which aims to unravel the diverse molecular and biological changes underlying cancer development and progression. The research on cancer is more oriented towards understanding the tumour micro environment, mechanisms that restrain tumorigenesis and translating novel findings towards cancer diagnosis, prognosis and therapies. The new era science is more concerned with personalized treatment strategies with targeted agents that are directed specifically to the molecular abnormalities that are driving specific tumours: PIB.

World Cancer Day

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