ISSN 0005-1144ATKAFF 52(1), 5-11(2011)Ratko Magjarevic, Igor LackovicBiomédical Engineering - Past, Present, FutureMedicine and health care have changed dramatically in the past few decades and they depend on high technol-ogy for prevention, diagnosis and treatment of diseases, and for patient rehabilitation. Modem hiomedical researchand health care are provided by multidisciplinary teams in which biomédical engineers contribute to the advance-ment of knowledge equally as medical professions. Biomédical engineering represents one (out of two) the mostrapidly growing branches of industry in the developed world  (the other are sustainable and renewable energysources). The new knowledge gained by basic biomédical engineering research (at gene, molecular, cellular, organand system level) has high impact on the growth of new medical products and boosts industries, including small andmedium size enterprises (SMEs). SMEs are expected to bring to the market new products and services for healthcare delivery . Health is the major theme of the specific Programme on Cooperation under the European Sev-enth Framework Programme, with a total budget of €6.1 billion over the duration of FP7. The objective of healthresearch under FP7 is to improve the health of European citizens and stir up the competitiveness of health-relatedindustries and businesses, while addressing global health issues, life improving and develop life saving technolo-gies. Hospitals and other medical institutions have a commitment to take care of all kinds of high technologydevices including the hospital information systems, networks and their safety and security. Growing technologi-cal panicipation in health services enforces the support of technologically specialized personnel, trained clinicalengineers. Worldwide, the educational system has adopted the curricula of biomédical engineering and of clini-cal engineering. Professional organizations are building certification system for biomédical and clinical engineersand the continuous education (life long learning) structures. The development of biomédical engineering and itsaffirmation has mainly appeared in the last 50 years, first as a result of development in electronic industry whilelater it started developing at its own pace. In the first part of this paper, we address the development of biomédicalengineering in that period and present our views on the development of hiomedical engineering in the future. Thesecond part is devoted to the International Federation for Medical and Biological Engineering (IFMBE), the largestorganization of biomédical engineers in the world which celebrated its 50th anniversary in 2009. In the third part,we recall our memories to the founder of biomédical engineering in Croatia, prof. Ante áantic and his achievementsin biomédical engineering, and present the state of art of biomédical engineering research and education in Croatia.Key words: biomédical engineering, biomédical electronics, health care, clinical engineering, medical physics.International Federation for Medical and Biological Engineering (IFMBE), BME educationBiomedicinsko inzenjerstvo - proslost, sadasnjost, buducnost. Medicina i zdravstvena zaätita su se dra-maticno promijenile u posljednjih nekoliko desetljeca, i ovise o visokoj tehnologiji za prevenciju, dijagnostiku ilijeSenje bolesti, i za rehabilitaciju pacijenata. Moderna biomedicinska istrazivanja i zdravstvena zastita osigu-rava se multidisciplinarnim timovima u kojima biomedicinski inïenjeri doprinose unapredenju znanja jednako kaoi medicinski strucnjaci. Biomedicinsko inzenjerstvo predstavlja jedno (od dvije) najbrze rastuce grane industrijeu razvijenom svijetu  (druga grana su odrzivi i obnovljivi izvori energije). Nova znanja stecena temeljnim is-trazivanjima u biomedicinskom inzenjerstvu (na razini gêna, molekula, stanice, organa i na razini sustava) imajuvelik utjecaj na razvoj novih medicinskih proizvoda i jacanje industrije, ukljucujuci i mala i srednja poduzeca(MSP). Ocekuje se da mala i srednja poduzeca na tríiste donesu nove proizvode i usluge za zdravstvenu skrb [2J.Zdravlje je glavna tema specificnog programa o suradnji u okviru europskog sedmog okvirnog programa (FP7), sukupnim proracunom od 6,1 milijarde eura tijekom trajanja FP7. Cilj istrazivanja u podrucju zdravstva u okviruFP7 je poboljsati zdravlje europskih gradana i povecati konkurenciju u okviru zdravstvene djelatnosti i indus-trije, a istovremeno voditi racuna o globalnim zdravstvenim problemima, poboljäanju zivota i razvoju tehnologijaza spasavanje Zivota. Bolnice i druge medicinske ustanove imaju obvezu voditi brigu o svim vrstama uredajavisoke tehnologije, ukljucujuci bolnicke informaticke sustave, mreïe i te o njihovoj sigumosti. Povecanje udjelatehnologije u zdravstvu proizvelo je potrebu za tehnoloSki specijaliziranim osobljem, klinickim inZenjerima. Diljemsvijeta, obrazovni sustav je usvojio visoko§kolske programe biomedicinskog inZenjerstva i klinickog inZenjerstva.AUTOMATIKA 52(2011) 1, 5-11
Biomédical Engineering - Past, Present, Future R. Magjarevic, 1. LackovicProfesionalne organizacije su izgradile sustav potvrdivanja za biomedicinske i klinicke inienjere i za njihovo kon-tinuirano obrazovanje (cjelozivotno ucenje). Razvoj biomedicinskog inzenjerstva i njegova afirmacija je zapocelau posljednjih 50 godina, kao rezultat razvoja elektronicke industrije, a kasnije se biomedicinsko inienjerstvo nas-tavilo razvijati vlastitim tempom. U prvom dijelu ovog rada, govorimo o razvoju hiomedicinskog inienjerstvau pocetnom razdoblju i predstavljamo nase poglede na razvoj biomedicinskog inzenjerstva u buducnosti. Drugidio posvecen je Medunarodnoj federaciji za medicinsko i biolosko inzenjerstvo (IFMBE), najvecoj organizacijihiomedicinskih inienjera u svijetu koji je proslavila svoju 50. godisnjicu u 2009. godini. U trecem dijelu, pod-sjecamo se na utemeljitelja biomedicinskog inzenjerstva u Hrvatskoj, prof. Antu áantiéa i njegova dostignuca upodrucju biomedicinskog inienjerstva. Konacno, predstavljamo sadasnje stanje istrazivanja i ohrazovanja u po-drucju biomedicinskog inienjerstva u Hrvatskoj.Kljucne rijeci: biomedicinsko inzenjerstvo, biomedicinska elektronika, zdravstvena skrb, klinicko inzenjerstvo,medicinska fizika. International Federation for Medical and Biological Engineering (IFMBE),obrazovanje u podrucju biomedicinskog inzenjerstva1 INTRODUCTIONBiomédical Engineering (BME) is a field of engineeringoriginating from an interdisciplinary background of differ-ent engineering sciences and principles and study of biol-ogy, medicine, behavior and health. BME aims to improvehuman health and quality of life. Research in biomédicalengineering creates knowledge from molecular and cellu-lar level to the level of organs and the body as a system,resulting in new devices, materials, processes and soft-ware. New technologies are implemented in prevention,prediction, diagnostics and treatment of disease, patientcare and rehabilitation. In the same way as medicine, BMEhas developed numerous specializations. Those based onelectrical phenomena from the body and electrical or elec-tronic devices and systems which measure signals and pro-cess signals and information have their roots in biomédi-cal electronics: medical instrumentation, monitoring sys-tems, physiological signal and medical image acquisitionand processing, minimally invasive surgery, image guidedsurgery, robotics in therapy and rehabilitation, artificial or-gans and prosthetics, etc. Another large group of special-izations is present in biomechanics and biomaterials, bothenabling technologies for extremely sophisticated passiveand active implants. Research in the field of cellular engi-neering, tissue engineering and stem cell engineering willenable designing of artificial organs of biological originvery soon. Gene technology supported by bioinformaticsoffers enormous benefits for health care and disease pre-vention by modifying genes and transferring them to newhosts. Medical informatics today also includes connectingof the information sources through information and com-munication technologies making information available tomedical staff also from a long distance, no matter whetherthe information is acquired from the patient body or froman electronic archive. Clinical engineers are professionalswho support and advance patient care by applying engi-neering and management skills to healthcare technologyand they typically find their jobs within clinical settingswith primary aim in patient safety and quality insurance.Traditionally, biomédical engineers collaborate with medi-cal physicists who as a profession take care of radiotherapyplanning and protection of ionizing radiation.2 FROM THE EARLY DAYS TO THE PRESENTThe beginning of modern biomédical engineering as anew and emerging technology started shortly after the in-vention of the silicon transistor in the early fifties of the20th century. Miniaturisation of diagnostic and therapeu-tic devices, their lower power consumption, portability andintegration of firstly automatic functions and later buildinginto the devices some kind of intelligence enabled theirapplications in practically all branches of medicine. It isimpossible to enumerate all successful biomédical devicesand methods in a short article but a visit the Hall of Eameofthe American Institute for Medical and Biological Engi-neering (AIMBE) , enables one to recall a lot of devicesused in modem healthcare: from X-ray imaging devices,cardiac pacemakers , antibiotic production technology,artificial kidney from the early days, computerised tomog-raphy and magnetic resonance imaging devices and meth-ods, up to genomic sequencing & micro-arrays, positronemission tomography and image-guided surgery from thelast decades. Contribution of technology to medicine canbe noticed also through the choice of the laureates of theNobel Prize. The Nobel Prize in Physiology or Medicinein 2003 was awarded to Paul C. Lauterbur and Sir PeterMansfield for their discoveries concerning magnetic reso-nance imaging  and in 2009, Nobel Prize for physicsAUTOMATIKA 52(2011)1,5-11
Biomédical Engineering - Past, Present, Future R. Magjarevic, I. Lackovicwas awarded to Willard S. Boyle and George E. Smith, forthe invetition of the charge-coupled device (CCD), whichis used in most digital camera sensors and has a spreadmedical application for imaging the inside of the humanbody, in diagnostics and for microsurgery .The technology develops also due to the current, alteredneeds of the health care . Population projections in Eu-rope show dramatic growth of elderly population: thoseaged 65 years or over (17.2 % in 2009) will account formore than 30.0 % of the EUs population by 2060 . Theimpact of aging will cause increased social expenditure re-lated to healthcare, while the population will expect rea-sonably priced high quality care. Only technological ad-vances can enable the industry to meet these conditions.Today, healthcare industry intensifies efforts for solutionsof the long-term treatments for chronic diseases in the ag-ing patient population. One of the challenges is how toachieve healthcare services and healthcare quality.3 A GLIMPSE INTO THE FUTURE OF BMEFor research in biomédical engineering, there is no limitbecause humans are demanding and would like to extendthe quality of life and the life itself for many years. In thenext decades, one can expect that research will concentrateand bring to the market devices for restoring the functionsof tissue, by more sophisticated implantable electronic de-vices, e.g. implantable systems for heart resynchronisa-tion. In future, there will be patients with more than oneimplantable electronic device and these devices will haveto learn how to communicate and adjust their performancein order not to cause any harm due to joint action. The nextstep will probably be functional tissue engineering wheretissue will be grown from biological material - cells, placedinto the body into the right position, and then the functionof the newly implanted tissue will be restored. Of course,there is still a lot to be learned on how to produce biologi-cal materials which have properties close to, or the same ashutTian living tissue and can withstand the same forces andstrain. Image guided surgery will enable precise access tothe place of interest and positioning of the implant to theright position. At the same time, data transfer and informa-tion processing in medical applications will become moredemanding due to increased number of sensors for mea-surement or monitoring of physiological and biomechani-cal quantities, from the surface and/or from the inside ofthe body. Closed loops of sensors, e.g. glucose sensorsimplanted into the body and external actuators e.g. the in-sulin pump, mimic organs like the pancreas with the inten-tion to regulate the blood glucose level in the same way asa healthy human organ. In near future, people will learnhow to design more complex integrated biological struc-tures - the organs. Tremendous advancements have beenmade in the development of artificial eye and ear, bring-ing sight and hearing to blind and deaf. The newest retinaimplant has a sensor of only 3 by 3.1 mm in size, and con-sists of approximately 1,500 light-sensitive microphotodi-odes . Also, a cochlear implant does not cure deafness,but is a prosthetic substitute for hearing with limited qual-ity. There are two major fields of intensive research whichwill improve the current results, neural interfaces and neu-roscience. The need for neural interfaces fosters develop-ment of new biocompatible materials for neural prosthesis,especially among the nanomaterials and nanotechnology.For example, the main problem in clinical application of abionic eye is how to attach the outputs of the sensors to thevisual nerves and nanotubes appear as a possible techno-logical solution. In neuroscience, scientists are researchinghow the brain works and for processing and understand-ing the complexity of all the data acquired, engineeringknowledge is necessary. For better understanding of thedata in neuroscience, fusion of imaging modalities is nec-essary and for better diagnosis, medical experts still needbetter resolution of all image modalities.Environment in the biomédical engineering world isconstantly and rapidly changing, the knowledge is rapidlyincreasing and there is a constant need for increasing theresources and equipment necessary for the demanding re-search. International collaboration for biomédical engi-neers and other scientists and professionals in medicineand health care is a must and the pioneers of biomédicalelectronics realized it in 1959 and they founded the Inter-national Federation for Medical and Biological Engineer-ing [lOJ.4 50TH ANNIVERSARY OF THE IFMBEThe International Federation for Medical and BiologicalEngineering (IFMBE) is primarily a federation of nationaland transnational organizations that represent national in-terests in medical and biological engineering: building upbiomédical engineering and health research and profes-sional networks, exchange of knowledge, fostering inter-national mobility of researchers and students, making med-ical and engineering knowledge and health care availableto all. The objectives of the IFMBE are scientific, techno-logical, literary, and educational.The International Federation "was founded in 1959 inParis during the 2nd International Meeting of engineers,physicians and physicists who were mainly researchingin the field of Medical Electronics. At that time therewere few national biomédical engineering societies. Forthis reason researchers and professionals in the disciplinejoined the Federation as Associates. After a larger numberof national BME societies were founded, these societiesbecame affiliates of the Federation. In June 2011, the Fed-AUTOMATIKA 52(2011) 1,5-11
Biomédical Engineering - Past, Present, Future R. Magjarevic, I. Lackoviceration has an estimated number of 120,000 members in 62affiliated national or transnational BME organizations.The IEMBE has also achieved a close association withthe Intemational Organization of Medical Physics (IOMP). Since 1976, the two organisations have been jointlyorganizing intemational conferences every three years.The two intemational bodies have established the Inter-national Union for Physical and Engineering Sciences inMedicine (IUPESM)  and they act together on intema-tional scene in matters related to health and patients. IU-PESM is recognized by the Intemational Council of Sci-entific Unions (ICSU) , representing a global mem-bership that includes both national scientific bodies (121members) and intemational scientific unions (30 mem-bers). The membership of IUPESM In the ICSU givesvisibility and legitimacy to the profession of biomédicalengineers and medical physicists. The ICSU starts globalprojects such as the inter-union initiative on Science forHealth and Well Being which in different time periods dealwith specific topics, e.g. "Science and Technology in theCare of Patients and Persons with Disabilitie" or "The Im-pact of Technology on Hypercommunicable Disease Pro-cesses".During the last decade the IFMBE has promotedbiomédical engineering at scientific conferences and meet-ings, and among political decision makers, representativesof the health care systems and the medical device industry.Active cooperation of IEMBE with the World Health Orga-nization (WHO), where IEMBE acts as the only accreditednon-govemmental organization (NGO) from the field ofbiomédical engineering, enabled the Federation to presentseveral resolutions which are important for biomédical en-gineering as a profession and for technology in medicinein general . IFMBE is involved in a number of globalinitiatives that promote health like the World Alliance forPatient Safety. In the World Standards Cooperation, it rep-resents patients in matters of medical equipment and tech-nology safety and security.IFMBE is primarily a leamed society and its aim is toencourage BME research and application of knowledge forthe benefit of science and patients. It does not fund sci-entific research projects, but since 1962 it is publishingthe peer reviewed joumal Medical and Biological Engi-neering and Computing (MBEC), and the electronic ver-sion of the Joumal is available on-line. Though MBECis a "general" biomédical engineering joumal, the editorsfoster publishing of special thematic issues, e.g. on Mi-crobubbles , Shoulder Biomechanics  orNeurody-namic Insight into Eunctional Connectivity and Cognition. On yearly basis, the Joumal awards the best paperpublished in MBEC the Nightingale Prize [18, 19]. Since2006, the IFMBE Proceedings Series which covers publi-cation of papers from IFMBE sponsored conferences andsome of the IFMBE endorsed conferences is also availableat the web site.5 BIOMEDICAL ENGINEERING IN CROATIAThe pioneer of biomédical engineering in Croatia isProf. Ante Santic. He received his D.Sc. degree in1966 in electrical engineering from the University of Za-greb, Faculty of Electrical Engineering. In his thesis, heelaborated the application of the parametric amplifiers forrecording of bioelectric potentials, in particular the poten-tials of the brain (EEG) . He was the head of Elec-tronics Laboratory at the Institute of Electrical Engineeringin Zagreb, where he developed special electronic instru-mentation and medical instrumentation. The Institute be-came the leading manufacturer of electroencephalographsin Central Europe. In 1970, Santic joined the Univer-sity of Zagreb, Faculty of Electrical Engineering. Erom1971, he started teaching a course in Biomédical Elec-tronics and founded the Biomédical Electronics Labora-tory. In the following years, his research activities ex-panded to radio- and infrared biotelemetry, non-invasivemeasurements (blood pressure measurement), gait analy-sis and pulse plethysmography [21-23]. He published twotextbooks: "Electronic instrumentation" and "BiomédicalElectronics" . For his research. Prof. Santic was rec-ognized internationally and at the national level. He wasthe first European BME researcher to receive the IEEEEMBS Career Achievement Award in 2003 for his "fun-damental and pioneering contributions to the developmentand construction of EEG, EMG and ENG Instrumentationand for his leadership in creating biomédical engineeringcourses in Europe" [25, 26]. The EMBS Career Achieve-ment Award is presented annually to an individual who hasmade significant contributions through a distinguished ca-reer of twenty years or more in the field of Biomédical En-gineering, as an educator, researcher, developer or admin-istrator. As a visionary. Prof. Santic felt the growth of hismost beloved field of engineering and promoted biomédi-cal engineering in Croatia. He was the founding Presidentof the Croatian Medical and Biological Engineering Soci-ety (CROMBES) , founded in 1992, continuing as thesuccessor of the Croatian Section of the former YugoslavBME Society (founded in 1984).Today, CROMBES has over 100 members - scien-tists and experts involved in different scientific fieldsof biomédical engineering and medical physics. Since1993, the Society has been a full member of the Interna-tional Federation for Medical and Biological Engineering(IFMBE) and the European Federation for Medical Physics(EFOMP). Later the Society affiliated also to the Intema-tional Organisation for Medical Physics (IOMP) and theEuropean Alliance for Biomédical Engineering and Sci-ence (EAMBES).AUTOMATIKA 52(2011) 1, 5-1
Biomédical Engineering - Past, Present, Future R. Magjarevié, I. Lackovic6 BME RESEARCH IN CROATIAResearch activities in biomédical engineering in Croa-tia are carried out at the University of Zagreb, at the Fac-ulty of Electrical Engineering and Computing, Faculty ofMechanical Engineering and Naval Architecture, SchoolofMedieine, Faculty of Kinesiology and other institutionsin Zagreb and other cities.At the Faculty of Electrical Engineering and Comput-ing, there are several research groups in this field. Researchof the Electronic and Biomédical Instrumentation Group isdevoted to biosignal measurement and processing meth-ods , in particular of the heart , muscle [30-31]and the brain, as well as bioimpedance measurement meth-ods  and instrumentation including characterization ofbioeleetrodes . The research of computational mod-elling of electric  and thermal effects in tissue duringelectroporation-based treatments  is aimed to developdevices for minimally invasive therapeutic procedures incancer treatment and for heart therapy. Networked sensorsystems for physiological parameters monitoring and pro-cessing of extracted information in order to build up per-sonalised intelligent mobile health systems for health caresupport represent a new field of research and development. Research in the Sensors and Electronic Instrumenta-tion Group includes a number of biomédical topics such asmathematical modeling for extraction of 3-D content fromimages  and methods, algorithms, and software pack-ages that best implement these models, camera (self) cali-bration, 3D structured light scanning, image feature extrac-tion, marker tracking, surface registration, computer visiontheory and methods for human motion analysis.Image Processing Group conducts research in theoryand applications for intelligent image processing, patternrecognition and computer vision methods with applica-tions in medical image analysis and biomédical imaging[38-39]. The main research problems include image fea-ture extraction, image segmentation, image registration,and motion analysis. Research has been conducted forreal-time intravascular catheter tracking from X-ray im-age sequences and 3-D reconstruction of catheter tip, andin cardiac applications, methods for atlas-based imageanalysis of aortic outfiow velocity profile from ultrasoundDoppler images have been developed. Methods for 3D CTimage analysis of abdominal aortic aneurysm have beeninvestigated, as well as segmentation methods for nuclearmedicine image analysis, and methodology for quantita-tive analysis of intracerebral brain hemorrhage from CTimages .The Acoustics and Sonography Group develops sensors,devices and methods for medical application of ultrasound.They have developed an ultrasonic neurosurgical deviceand several methods for measuring acoustic power in lowfrequency ultrasound applications [41-42].At the Faculty of Mechanical Engineering and NavalArchitecture, a strong research group in biomechanics wasfounded under the leadership of Prof. Osman Muftic whodesigned the Croatian endoprosthesis of hip joint .7 BME EDUCATION IN CROATIAEducation in the field of biomédical engineering startedin Croatia in the early 1970s, as a part of biomédical elec-tronics teaching at the University of Zagreb, Faculty ofElectrical Engineering. Courses in biomédical engineeringare offered by two Croatian universities: at the Universityof Zagreb, at several constituent units, and at the Univer-sity of Split, BME courses are offered at the Faculty ofElectrical Engineering, Mechanical Engineering and NavalArchitecture. There is an action to establish a biomédicalengineering programme at master level at the Universityof Zagreb supported by the international Tempus project"Curricula Reformation and Harmonization in the field ofBiomédical Engineering" in which 23 European higher ed-ucation or research institutions including University of Za-greb are participating .8 CONCLUSIONBiomédical engineering is a young field of engineeringand science and it is small compared to the traditional en-gineering fields, like electrical or mechanical engineering.However, due to the needs of the society and enthusiasmsof young generations of BME students, the number of BMengineers working in research and development is rapidlygrowing. Most of the BM industry expands and labourmarket for BM engineers is expected to grow by 72% till2018. Currently the fastest developing industries are ac-tive implants, medical imaging and mobile health services.New opportunities open in neural engineering, in interfac-ing the devices and the tissue, changing the cells and build-ing artificial organs from artificial and biological materials,organisation of large dataseis from biology, etc. BME re-search is so complex that hardly any research institutioncan cover all knowledge and skills necessary for success-ful outcome of the research goals alone. After 50 yearsof well institutionalized development of biomédical engi-neering at international level, and a little bit shorter devel-opment in Croatia, the Croatian engineers and scientists inthe field contribute to the growing knowledge in the fieldof biomédical engineering.REEERENCES[ 1 ] S Shellenbarger, "What Will Be the Hot Jobs of 2018?", TheWall Street Journal, May 26, 2010, http://online.wsj.com/article/SB10001424052748704026204575266342935418962.html, (accessed June 2011)AUTOMATIKA 52(2011) 1,5-11
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