Engineering better healthcare
14 July 2021
Engineering and its contribution to healthcare are immense. Yet, it is a field that often finds itself in the shadow of its more glamorous contemporaries in the world of medicine.
In an operating theatre, the lion's share of the core functions that enable surgeries to take place is reliant on engineering, from the design of the area to the instruments used. Keyhole surgery, for instance, allows operations to be conducted in a minimally invasive method. Much of this is enabled by microscopic cameras with sophisticated lighting systems that enable doctors to operate via tiny incisions, significantly reducing a patient's recovery period.
Such has been the pace of progress that has been driven by the field of engineering that much of what had already existed in healthcare is easily forgotten. The common fallacy is to associate advancement in healthcare solely to the rise of the present digital age, which has been propelled by technology. Inventions by engineers for medical imaging helped make possible ultrasound, computed tomography scans (CT scans), and magnetic resonance imaging (MRI) almost 50 years back, while the x-ray scan has been around for more than a hundred years.
“There are many ways engineering can contribute to the development of healthcare, and computational modelling is one of them. The advent of high-performance computing has helped engineers arrive at practical solutions to sophisticated and complex problems related to healthcare and medicine,” said Dr Ooi Ean Hin from the School of Engineering, Monash University Malaysia, a sentiment that is echoed by his colleague Dr Chiew Yeong Shiong. Dr Ooi and Dr Chiew currently head the Biomedical Engineering Modelling and Simulation (BEMS) group, where they collaborate with various medical institutions to research different ways to improve specific medical treatments.
Dr Ooi, who leads the Computational Modelling team of BEMS, collaborates with interventional radiologists from the National Cancer Institute to develop computational models that can predict the change in tissue temperature during radiofrequency ablation (RFA) treatment of liver cancer. During this heat-based therapy, it is important that the targeted tissue temperature is raised sufficiently high to induce cell death. However, because the heating process occurs inside the body, it is very difficult to monitor real-time changes in the tissue temperature. If the rise in temperature is insufficient, then not all the cancerous cells will be destroyed.
According to Dr Ooi, the ability to computationally predict the change in tissue temperature during an RFA procedure can help interventional radiologists plan better the treatment protocol to improve the treatment success rates.
“Cancer treatment is gearing towards customised and personalised treatments, and it is encouraging to see that engineering is playing a crucial role in this,” he added.
Dr Ooi has also collaborated with the Department of Ophthalmology, Faculty of Medicine, University Malaya, on developing computational models to identify understand how blockages occur in fluid (aqueous humour) flow inside the eyes and their implication on ocular drug delivery via topical eye drops.
When these blockages occur in the fluid flow of the eyes, they result in an increase in intraocular pressure (IOP). Heightened IOP is commonly associated with glaucoma, an eye condition that damages the optic nerves and can eventually lead to blindness.
"The mathematical model could help doctors learn about risk factors and causes of glaucoma, emphasising the concern that segmental outflow can lead to non-active regions becoming severely under-treated in the case of glaucoma treatment," added Dr Ooi.
Recently, with the support of Sunway Medical Centre, Dr Ooi and his team addressed the concern on whether it is safe for a patient with pneumocephalus to embark on air travel. Pneumocephalus is a rare medical condition defined by the presence of air inside the human head. By replicating the environment of an aircraft cabin in the laboratory, they recommended safe limits for the air volume and intracranial pressure for safe air travel among pneumocephalus patients. Their study provided useful laboratory data that can assist neurosurgeons when advising if post-neurosurgical patients can safely fly.
On the other hand, Dr Chiew, who leads the Data Analytics team of BEMS, focuses on model-based biomedical engineering research. He is currently taking these models to help improve hospital intensive care, especially mechanical ventilation treatment (MV) in the hospital. Critically ill or respiratory failure patients are admitted to the hospital for mechanical ventilation for life support. These patients are very ill and can have a high mortality rate of up to 60 per cent, and equally, the treatment cost per patient per day is significant.
Dr Chiew and his team of collaborators have developed mathematical models to describe a respiratory failure patient’s lung condition so that clinicians can have a better understanding of the patient’s conditions without the need for invasive measuring tools. These models are then integrated into monitoring and decision-making systems. They are being tested in the hospital to help clinicians to improve mechanical ventilation treatment.
Both Dr Ooi and Dr Chiew agree that developing computational models for healthcare can facilitate better disease diagnosis and treatment. They also referred to various other areas in healthcare where engineers have contributed and will continue to do so in the future.
For instance, engineering marvels have given those who are orthopedically handicapped a new lease of life. The availability of artificial joints such as prostheses has ensured patients affected do not lose mobility. The invention of these artificial body parts has been driven significantly by research by engineers. Market research estimates the global artificial limbs market to generate around US$2.7 billion by 2025.
Perhaps the greatest illustration of engineers' enduring contribution to healthcare is evident during the Covid-19 pandemic. Engineers utilised 3D printing to address shortages of face shields during the early stages of the pandemic. Complex simulations have also been carried out to understand the droplet trajectory after being expelled orally. The mass production of Covid-19 vaccines is also a huge engineering challenge.
Biomedical engineering is an emerging field of study that will cater to the future job market. The exponential rise of technology and the role of engineers in using it to develop healthcare solutions holds much hope for many in the medical field. The US Bureau of Labor Statistics has projected the employment prospects for biomedical engineers to grow by four per cent between 2018 and 2028.
Dr Ooi also pointed to how robots and artificial intelligence are increasingly being used in surgeries, recording fewer mistakes than when human beings carry out an operation. "Practically every aspect of surgery has taken on the characteristics of some technology. Engineers have been and will continue designing life-saving medical equipment. It is succinct to say that engineering is involved in all aspects of healthcare." he added.