Future Technologies for Medical Applications

The modern age of surgery began at the end of the nineteenth century because medicine discovered the Industrial Age, with its wealth of revolutionary technologies such as anesthesia, asepsis, microscopy, and new materials. At the close of the twentieth century, the Information Age diffused into medicine, and a revolution of even greater magnitude occurred. To understand the change it is necessary to look outside of medicine to society as a whole and find the underlying principles, and then apply them within our discipline. The medical record is now becoming electronic and nearly all of our imaging has changed from film (atoms) to digital images (bits). Medical education is using computer-aided instructions, CD-ROM, and VR to simulate and supplement cadaver and animal models. With the new research in robotics, even our hand motions are being changed in to electronic signals and being sent from one place to another. The future of medicine is no longer blood and guts, but bits and bytes. A commonality of information enables us to tie together a whole new concept of how medicine could evolve, like an entire medical ecosystem, whereby discoveries in micro-sensors permits new imaging devices, which in turn enable new forms of image-based surgery. It is an upward spiral, one discovery providing a giant step forward toward the next technology and escalating the whole changing system logarithmically. This could help explain why we are all so overwhelmed by the rapidity of our changing profession. Yet the younger generation of physicians-to-be are not so uncomfortable with the rapidly changing technologies. One of their fundamental tools is the ability to understand the world in the form of three-dimensional (3-D) visualization. There is a speculative scenario that can be used as a framework to illuminate the integrating power of this concept. It is refe rred to as the ?>doorway to the future ?> and extrapolates to 20, 50 or perhaps 100 years into the future. As a patient visits her surgeon for a consult, she passes through the office door and, just as scanning is performed today by airport security, she has multiple imaging modalities scanning her (perhaps CT, MRI, ultrasound, and infrared). The data are all collected and then displayed as a 3-D image of her (looking like the Visible Human) but with not only correct anatomic structure but also all the biochemical and other data added to the correct organ systems. If an abnormality is seen, such as a colon mass, a virtual colonoscopy can be done on the image by flying through the colon with the same view as an actual colonoscopy. If a lesion is found, the image can be used for patient education, illustrating to the patient exactly what her specific problem is. At the time of surgery, an image can be imported onto the video monitor of laparoscopic colon resection, and with data fusion the two images displayed simultaneously as an intraoperative navigation tool (stereotactic navigation). At the postoperative follow up visit, the patient is scanned again, by comparing the postoperative with the preoperative datasets and using digital subtraction techniques, the difference between the two datasets is automatic outcomes analysis. Because the record is a dataset, it can be stored on a credit card (the U.S. military is using a prototype card called the MARC card) or kept on a Web server to be distributed worldwide over the Internet for consultation. The purpose of the this scenario is to provide an explanation of and rationale for why it is so important to understand how information can empower us, to show the looking glass through which the next-generation surgeon will be viewing the world. To bring the scenario out of the speculative and rhetorical and into the real world, the...