How does MRI work?

Diagram
This week we had to draw a diagram for our paper which represented the way it worked, through the "machine analysis" viewpoint that Dr. Bogen asked us to use. Basically, we had to think of our "process" or "object" (in my case MRI) and describe it as a machine, with the building blocks being each component and what was transferred between them. Then we had to add the properties that govern each block, what was accumulated or balances, what quantities were affected, etc. for each block. Finally, we had to put it all together in diagram form and relate all of the processes to one another.


To me, the hardest part was trying to adapt my subject to the format Dr. Bogen asked us to use. It wasn't so hard to enumerate all the components and which ones were related, but it was very hard at some point to think of precisely what quantities were affected by the transfer, etc. I believe it was so because MRI doesn't lend itself so much to an interpretation in that format, the way that (for example) the machine diagram for flow of blood into left ventricle in diastole (Dr. Bogen's example) did. However, after a lot of research and a creative way of analyzing the MRI and finding out all the different properties and transferred data, I ended up with the following preliminary diagram for MRI (click on it to make it bigger):

I think that, as I'm writing my paper, this will be a good reference to structure my thesis around. Furthermore, because I HAD to make the diagram this way, I'll have more information about how to approach MRIs in a "machine analysis" (i.e. how does it work?) style and therefore my final work should - hopefully - be a lot better!

Research Paper

How does it work?
This month we'll have to complete a research paper on a biomedical topic from an engineering viewpoint. That is, how does something related to the biomedical field work? The only thing I needed to know to begin was what to discuss in my paper.
I was watching House on TV the other day with some friends and we were discussing how medical imaging techniques had changed so much over the course of a few decades, and how useful new machines were to diagnostics - the case in the episode was solved thanks to one in particular, the MRI. This is when I started wondering about magnetic resonance imaging, and found it a very interesting topic, so I decided to focus my paper on this subject. In essence, what I want to find out is:

• How does an MRI machine work?
  
• What are the physics/biological principles that make MRIs possible?
  
• How was it developed?
  
• How is it constructed and how does it operate?
  
• What are its applications?
  
• Are MRIs safe?
  
• What is the future of MRIs going to be?
  

It seems like a pretty interesting subject to discuss, so I'm looking forward to researching how it works and answering my questions!

Structures presentations

Talking about structure...
This week, we had to prepare a brief presentation for class, which I really enjoyed. I think that encouraging independent work in the sciences is one of the greatest challenges for teachers, because (unlike with music, arts and other recreational activities) scientific and engineering-related hobbies can often be expensive and trying, but you can really love them at the same time. Although it was hard to come up with a structure to analyze, I was happy with the final result and I believe I learned a lot from this individual project.
However, what I liked the most was the recitation this week, because we all saw what our classmates think like and how they might interpret things, which I believe can help you learn a lot about them. I also found the structures they chose to analyze very interesting, and enjoyed seeing their different perspectives and ideas on the same objects. Overall, I had a lot of fun!

All you need is LOVE

The LOVE sculpture
For this week's assignment, we had to analyze a "thing" on the Penn campus, and - as I discussed before - I choose the LOVE sculpture on Locust Walk. As I said in my earlier post, I choose it as my subject because it’s one of the staples of Penn’s campus and of the city where we live, Philadelphia.
This structure is a sculpture displaying the letters LO over VE, and was originally designed as the front of a Christmas card for the MoMA (Museum of Modern Art) by Robert Indiana. It is a three dimensional model of the word "love"in capital letters and is painted bright red on the front, back and sides and blue and green on the inside. I analyzed this sculpture over three (and a half) length scales:

The sculpture
this is how most of us see the statue, a big body displaying the message "love". On this scale it's roughly 2m (h) x 2m (w) x .5m (d); and is made of poly-chromed red, green and blue aluminum. So this length scale is around two meters). This statue can be compared to the patterns made by rubber inkstamps, as the typeset is reminiscent of that typically used for this purpose, looking as though someone had messed up the letter "o". It also reminded me of a box of chocolates, but mostly (because of the bright color) likening it to the human body it brought to mind the human heart. The statue is located in the center of campus, next to undergraduate admissions, close to the quad and Van Pelt library and right on Locust walk. Its in the middle of everything and is connected to all of campus through the "vascular system"of streets: it's the heart of penn that has the message love imprinted on it.

The letter O
I chose to zero in on the letter O because of it peculiarity within the sculpture. It’s tilted towards the right, which might represent the imperfections of love. The scale of this magnification level is about a meter. This letter could be compared to a toroid (my fancy way of comparing it to a doughnut), because of their similar shape.

The material
This is the third level of magnification, and on this level al we see is the material the love statue is made of (poly-chromed aluminum). The material reminded me of tin cans, because it was cold to the touch and shiny.

The campus of brotherly love
One of the reasons I chose this sculpture was because of its relationship to Philly and Penn. Philadelphia means “city of brotherly LOVE” so I felt like this sculpture on locust walk represented the campus of brotherly love, encouraging friendship and respect among students.

The function of this structure is to provoke thought and promote a positive message: LOVE. It’s an accessible but complex message, and I believe that the artist succeeds in transmitting his message through all three length scales because of various reasons. In the first scale, the bright color and size of the sculpture really attract your attention and have you wonder why the statue would be there. Upon closer inspection, the slanted O draws your eye in and makes you keep it on your mind. And the material  of which it is made complies with its function by making it sturdy and durable in the Philadelphia weather. Therefore, it represents Philadelphia because of the etymological meaning of the cities’ name, causing you to really see and think, and not just look - like this assignment wanted us to do.

Searching for structure at Penn

What's my "thing"?
As soon as I read the assignment for this week's recitation, I knew I was going to have a hard time completing it. It wasn't because of the fact that I couldn't think of a structure to analyze (not that I had that many original ideas, anyway), but rather because I couldn't think of one I would love to analyze. As I was wandering around locust Walk, walking to and from class, making my way to the quad or going to the library, I realized there was one thing that I always noticed when I walked by: the LOVE statue.
At first, I thought it would be too hard to analyze the structure of something so abstract, and that it might be a cliché to use one of the staples of Penn's campus and Philadelphia as my object. I also pondered over the questions that we had to blog about, and I thought that it would be a big challenge to compare the statue to something else and to relate its form to its function. Despite the daunting prospects, I decided to take the plunge and see what would happen if I tried to describe the LOVE statue as a "thing" across three length scales, because - after all - isn't the whole point of this assignment to learn how to connect concrete and abstract things?
I'll be back soon with the final result, and I hope you enjoy it as much as I did!

Oh the wonders of technology...

Lowering health care costs thanks to technology

This last assignment was particularly hard for me. I don’t know what people may think, but ten ways to reduce health care costs are a LOT of creative ways to use technology to solve medical issues. This is why many of the top researchers in health technologies occupy years in their fields trying to come up with an answer to this question: how can technology help us reduce healthcare costs?

Efficient Technologies

The first thing we must consider when creating new technologies to reduce health care costs is if their cost is low enough to significantly help lowering the price of medical help. Many technologies have proven to be extremely helpful in curing many diseases, even those deemed untreatable a few years ago, but the high cost of manufacturing them and the high demand they have provokes a great rise in healthcare costs. Therefore, we must engineer solutions not only to solve problems, but also to do so in a cost and energy-efficient manner. This way we will be creating technologies that better the quality of medical treatments sustainably and inexpensively.

Reducing the need for healthcare

This may seem like a trivial point, but in theory if we were all healthy there would be no demand for medical care. This doesn’t mean that we must be naïve and assume that everyone will always be healthy and well-off in society through plain diet and exercise (although this is essential considering the rising percentages of obesity and diabetes in the US), but rather that preventive measures can go a long way. An article published in the New England Journal of Medicine actually calls for health promotion and disease prevention (since preventable diseases, according to the authors, account for “approximately 70 percent of the burden of illness and the associated costs”[1], which is backed by Healthy People 2000) arguing that “reducing the need and demand for medical services is a positive solution, one that will bring better health for the individual, and that will ultimately lower medical costs”[1].

A good way to implement this plan would be with online medical and support databases, to give people access to medical information to see how they can make a difference by improving their lifestyle and personal health.

Health Information Technology Databases

Along the same lines as the previous point, health record infrastructure is one of the biggest challenges modern medicine faces. According to one source “Today's health care system is widely fragmented and hugely inefficient. Patients may be treated at multiple locations by multiple doctors who keep multiple paper records and fill out multiple paper forms seeking reimbursement from multiple insurance carriers. These inefficiencies not only lead to higher costs, they also result in poorer quality health care”[2]. Therefore, they propose a system called “telehealth” which, could “remotely monitor patients, facilitate collaboration between medical professionals, exchange medical data and images, and instantaneously provide efficient emergency service to remote areas”[2]. This way, the cost and hassle of going to the hospital (especially for chronically or disabled patients) is extinguished because there is no urgent need to make the trip to the doctor’s office.

Another interesting piece of writing concerning HIT Databases talked about “e-prescribing” and the approval of electronic health records, as well as the solution that HIT would provide “as the hardware and software that process information pertinent to storing, retrieving, sharing, and use of healthcare knowledge. This knowledge is then used for more effective communication among healthcare professionals, and for better decision-making. This includes maintaining health records online, so doctors can more easily access information when the need arises”[3].

Providing clean water

One of the most basic and overlooked ways to help better the general population’s health is to provide access to clean water. Although this is taken for granted in the United States, many nations across the globe still don’t have access to clean drinking water, which can greatly increase our life expectancy. Research by the World Health Organization shows that, with the adequate water distribution infrastructure, "an important share of the total burden of disease worldwide—around 10%—could be prevented by improvements related to drinking-water, sanitation, hygiene and water resource management”[4]. This would be a substantial change for the roughly 2.6 billion people[5] who don’t have access to this basic human need, greatly impacting global human health.

Outsourcing medical tests

With the digitization of information, outsourcing medical tests might prove to be a great solution to decrease the overall price of health care. According to one website “A number of hospitals in the US and UK are outsourcing laboratory and diagnostic tests to India as it costs about 70 to 80 per cent less to conduct them here. At the moment, this is generally limited to highly-specialized tests but experts say outsourcing of laboratory testing and diagnostic services is set to become big business in India”[6]. Another article further promoted outsourcing as a way of being competitive in the medical industry, encouraging companies to outsource the manufacture of entire medical devices[7].

Lack of competition in the high-tech medical realm

One of the biggest problems in high-tech medicine is the degree of specialization that each company must have in its specific field. This means that many corporations don’t have any competition in their area of medical technology and can therefore state their price for new devices and treatments, as there is no alternative. Take for example, the University of Maryland owns a da Vinci robot, which doctors use to perform remote minimally invasive surgery feet away from the operating table. This piece of equipment is worth roughly "$1.5 million, and every time it is used in the operating room, some $2,000 worth of parts must be replaced (for safety reasons). It takes a surgeon 12 to 18 months to learn how to use the machine, and a da Vinci operation usually takes longer than a hands-on procedure. Consequently, a University of Maryland study estimates that the robot adds about $8,000 to the price of bypass surgery"[15] . But the company who developed it (Intuitive Surgical) is the only one that produces these robots that allow quick recovery, minimally invasive surgery and access to many tight spots (useful for example in prostate surgery) commercially. Therefore there are no incentives for this firm to try to produce the machine more inexpensively, as it makes a much higher profit selling its products with enormous prices. If there was a big push towards science and research, more businesses in this field would arise that might develop similar products at more affordable prices, thus creating a healthy competition that would help lower and regulate the prices of medical technology.

Getting personal and user-friendly

This point was extremely reinforced in the “Grand Engineering Challenges” and "Healthy People 2010" reports as one of the most important goals to achieve in order to make healthcare affordable. Although it might seem unintuitive, personalizing healthcare could in fact prove to be worthwhile in the long run. Having more specific medications, tests and background information could break the “one-size-fits-all” medical perspective that exists nowadays and model a system where we begin tailoring each patient’s necessities to optimize the treatment of illnesses. Another way to encourage this would be to have user-friendly medical technology, that allows simple and clear access to medical information; thus, eliminating the obscurity of medicine and allowing people to make informed and wise choices.

Ingenious ways of using current technology

This would be one of the greatest ways to reduce healthcare costs: adapting existing technologies (and developing new ones) to accessible and affordable equipment. One company has been working on digestible chips that allow doctors to remotely monitor patients and control medication dosages, taking advantage of an already-existing wireless infrastructure and conventional laptop computers[8]. However, these chips are very expensive and still in their experimental stages, which is why insurance companies still don’t cover their use and only people on very high budgets can afford them.

Another interesting research project is being undertaken at UC Berkeley, where a group of researchers have invented a “cellscope”, a device that allows high-resolution imaging using powerful LEDs and off-the-shelf cell-phones. This invention could potentially replace regular microscopes in developing countries and remote locations thanks to its high-resolution images and affordability[9].

New research for treatment of diseases

This is how today's common vaccines started hundreds of years ago. We must invest wisely in promising experimental treatments such as stem cell research or genetic therapy, which could provide solutions to many illnesses in the future, and play an important role in disease prevention. Although it might be expensive at the beginning, in the years to come the benefits of these experimental therapies might be extremely high.

Any other ideas?

Please feel free to comment if you have any feedback or interesting ideas – I’d love to hear them!

The slinky effect

Although during inauguration the Obama administration pledged, “we will restore science to its rightful place, and wield technology's wonders to raise health care's quality and lower its cost”[10] many people are skeptical about whether technology will in fact lower the cost of health care. It’s obvious that technological advances have greatly helped in advancing medicine, but they may also be responsible for the skyrocketing prices of health care in the US. According to the National Coalition on Health Care, the expenditure on national health “is expected to reach $2.5 trillion in 2009, accounting for 17.6 percent of the gross domestic product (GDP). By 2018, national health care expenditures are expected to reach $4.4 trillion—more than double 2007 spending”[11] and the problem is that the GDP is not growing at the same rate (“average annual growth in national health spending is projected to be 6.2 percent—2.1 percentage points faster than average annual growth in gross domestic product (GDP)”[12]). Many blame technology for this rise in the national expenditure on health care, which nonetheless has enabled a much higher quality in medical services.

In fact, it seems as though it is not the quantity of health care but the value and efficiency of medical help that matters. Many nations across the world spend much less on healthcare (in percentage of GDP) and yet have higher life expectancies and lower infant mortality rates. For example, life expectancy in the US is roughly 78.1 years with about 17% of the GDP being spent on health-care, while Japan spends less than half of this percentage and has an average life expectancy at birth of 82.1 years[13].

One article reasoned, “because the spread of new technologies is relatively unrestrained in the United States, many of these technologies are used to a greater extent than in other nations, and the United States thereby incurs higher health care costs”. However I believe there are ways to prevent this. Quoting Scientific American “Providing the best and most affordable care will depend on finding and using the technology that makes the most sense”[14] at the risk of increasing the cost if we do not do so. It is the only solution to the pressing issue of rising health care costs.

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[1]James F. Fries, C. Everett Koop, Carson E. Beadle, Paul P. Cooper, Mary Jane England, Roger F. Greaves, Jacque J. Sokolov, Daniel Wright, for The Health Project; Reducing Health Care Costs by Reducing the Need and Demand for 

Consortium, July 29th 1993

[2] Jonathan Rintels; An Action Plan for America: Using Technology and innovation to 3 Address our Nation’s Critical Challenges; A report for the next administration; January 2009

[3] Chuck Kosmider; How Information Technology Can Reduce the cost of Health Care; 2009

[4]  Annette Prüss-Üstün, Robert Bos, Fiona Gore, Jamie Bartram for the World Health Organization; Safer water, Better Health; 2008

[5] World Health Organization; Health through safe drinking water and basic sanitation; 2009

[6] PTI News; Lab Tests and Diagnostics – The Next Wave of Outsourcing; 2009

[7]  Fink P, Skeen J; Outsourcing to win; December 2007

[8] Adrienne Carlson; Will Medical Technology Help Reduce Healthcare Costs?; August 8th 2009

[9] Sarah Yang, Media Relations; UC Berkeley researchers bring fluorescent imaging to mobile phones for low-cost screening in the field; July 21st 2009

[10] President Barack Obama, Inaugural Address, January 20th2009 http://www.nchc.org/facts/cost.shtml

[11] National Coalition on Health Care, Health Insurance Costs, July 2009, http://www.nchc.org/facts/cost.shtml

[12] Siska, A, et al, Health Spending Projections Through 2018: Recession Effects Add Uncertainty to The Outlook Health Affairs, March/April 2009; 28(2): w346-w357.

[13] Organisation for Economic Co-Operation and Development, OECD Health Data 2009: Statistics and Indicators for 30 Countries, July 2009

[14] Katherine Harmon, Is Obama right that technology can lower health care costs?, January 20th 2009, http://www.scientificamerican.com/blog/60-second-science/post.cfm?id=is-obama-right-that-technology-can-2009-01-20

[15] Michael Saha; Behind Rising Health-Care Costs, BusinessWeek; July 14th 2008


Other sources:
Healthy People 2010
Grand Challenges of Engineering