Local Solution with Global Potential

1. Development of IT enabled Healthcare
Devices and Telemedicine
at Dhaka University
LOCAL SOLUTION WITH GLOBAL POTENTIAL
K Siddique-e Rabbani
Department of Biomedical Physics & Technology
Dhaka University
rabbani@du.ac.bd
www.bmpt.du.ac.bd
Keynote Presentation, bdNOG4, 11 November2015

2. Department of Biomedical Physics & Technology

3. 80% of global population, living in the
Third World still remain deprived.
Hardly a few % of them,
who are rich, get benefit of
modern healthcare technology at
huge costs
Motivation:
ECG & X-Ray invented
more than 100 years
back.
How many get the
benefits even today?

4. Our efforts towards indigenous design
and Innovation
Initially at department of
Physics
Now at
department of
Biomedical Physics & Technology
(established in 2008, initially offering PhD & Mphil only,
now offering Masters programmes in
Medical Physics (Radiation related)
and Biomedical Engineering

5. Possibly, the 1st IT enabled Medical Equipment
Developed in Bangladesh (1986-1988)
Computerised EMG/EP equipment
Expertise gained through the UK link
First nerve
conduction
service in
Bangladesh
(1988)
Cost: a
fraction of
that for
imported
ones

6. Recent development:
Intra-operative Neuro Monitor
To aid brain and Spinal cord surgery
Cost: a fraction of that for imported ones

7. made in Bangladesh
Computerised
ECG
Stand alone, or
Online for
Telemedicine
Made in
Bangladesh
Cost: a fraction of
that for imported
ones

8. Computerised ECG – stand alone/Online for
Telemedicine

9. Computerised ECG Output: Full 12 Lead, diagnostic,
pdf file- sent to doctor for report online, even on Smartphone
ECG Report
Patient Name : null Sex: Female
Age: 0 Wednesday 01 July 2015
Patient ID : 1
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
25 mm/sec 10 mm/mV
II
0s
1 s 4s2s 3s 2s 3s
1 s 4s0s
2s0s 4s
1 s 3s
5 mm/mV

10. Certificate
for ECG
equipment –
received
from DMCH
Through DG
Health of
Govt

11. Dynamic Pedograph
Dynamic foot pressure distribution
Helps prevent
ulcers, leading
to Gangrene
and foot/leg
amputation of
diabetic patients
Needed in large
numbers in the
low resource
countries

12. Dynamic Pedograph
Our System
Main unit goes into
a raised platform
Cost: a fraction of
that for imported
ones

13. Our System gives a black and
white picture from which we
obtain a colour contour
Video: 30 frames per second,

14. Displays pressure variation with time at 6
selected points

15. Making Customised Shoe Insoles:
Automation possible:
Pedograph à CNC machine, or Pedograph à 3D printer

16. Pedograph
Diabetic foot clinic in Baqai
Medical University, Karachi,
Pakistan
(they provided R&D costs)

17. Our installations of Pedograph
1. Diabetic foot clinic in Baqai Medical
University, Karachi, Pakistan + 2 other
installations
2. Ibrahim Foot Care Hospital, Dhaka,
Bangladesh
3. Leather Research Institute, BCSIR,
Bangladesh
4. NIROGI LANKA, Srilanka (Delivery: October
2015)

18. Semi-functional
Hand Prosthesis
Partially supported by:
• Farm Fresh (Akij Group) (initial phase)
• BEXIMCO (Current support)

19. A simple Prosthetic hand that can write & solder
Improvised using a hand of a ‘Mannequin’. Spring loaded thumb only.
Cost: about £20.
Movie

20. Cost Effective Myo-electric Prosthetic hand
Relaxed – thumb open Contracted – thumb closed
Microcontroller Controlled (IT enabled)
Presently: Only thumb movement
In future: wrist rotation

21. Focused Impedance Method – Our Innovation
Localised Lung function & Respiratory Rate
Special challenge: A baby or child should not CRY!!
0.0 0.5 1.0 1.5 2.
0
2.5 3.0
0 30 60 90 120 150 180
Frequency, Hz
Rate per min
Amplitude,arbitrary
scale
10 2
Time, Sec
Amplitude,arbitrary
scale

22. FIM for Breast Tumour
Characterisation (whether
malignant or benign)
Cancer Cells have different
impedance characteristics than
normal
Dual Frequency FIM
Difficulty: separation from normal
tissue around
Ht
Vt

23. Feature extraction using IT enabled analysis:
Red ones are malignant (through core biopsy)
-0.2
0
0.2
0.4
0.6
0.8
1
1.2
1.4
1.6
1.8
0 5 10 15
Future/Age(NumericalValue)
Feature Number
Age Divided Feature Plot
P1_Age28
P2_Age52
P3_Age17
P4_Age30
P5_Age40
P6_Age30
P7_Age17
P8_Age24
P9_Age18
P10_Age48
P11_Age32
CP12_Age42
CP13_Age40
CP14_Age55
CP15_Age52
Malignant
Benign
Patient age range:
17 -55 yrs
Unaffected side:
Imp: 1-4
Slope: 9, 11
Affected side:
Imp: 5-8
Slope: 10, 12
… seems to create some distinction

24. • Stomach emptying
• Stomach acid secretion
•Abdominal fat thickness measurement
• Bladder emptying
•Tumour ablation monitoring
............... many more
FIM : potential in Diagnosis and Physiological study

25. Others starting FIM study:
• Warwick University, UK
• Kyung Hee University, Korea
• University of Oslo, Norway
A Swiss R&D company showed interest in developing
the equipment for commercialisation, but we did not
want take patent, so did not work out

26. Pigeon Hole Impedance Imaging (PHI)
(our concept)

27. PHI
based on 4 electrode FIM. Measurement in every
square, gives a low resolution image
Z11 Z12 Z13
Z21 Z22 Z23
Z31 Z32 Z33
Z14
Z24
Z34
Z41 Z42 Z43 Z44
I1
I1
v1
I2 I2
v2

28. PHI simulated experimental results

29. PHI application
Z11 Z12 Z13
Z21 Z22 Z23
Z31 Z32 Z33
Z14
Z24
Z34
Z41 Z42 Z43 Z44

30. Telemedicine
for rural healthcare
where qualified doctors are not available

31. 31
Basic Telemedicine Network

32. Our developed items for Telemedicine
• Digital ECG, 12 lead, full diagnostic
• Digital Stethoscope
• Digital Microscope
• Digital X-Ray view-box
• Digital Colposcope (for cervical cancer
investigation)

33. Scheme at Rural/Semi-rural Healthcare Center End
Digital
Stethoscope
Digital X-ray
Viewer
Digital
Microscope
Digital
Colposcope
Digital ECG,
12 Lead
Typed data
entry through
PC keyboard
Sound input jack of PC
USB port of PC
USB port of PC
USB port of PC
USB port of PC
Local PC
Telemedicine
Software
Display
Report and
Prescription
Generation
Archiving and
Printing
INTERNET
Video Conferencing

34. ECG, 12 lead, with live internet transmission
For telemedicine

35. Computerised ECG Output: Full 12 Lead, diagnostic,
pdf file- sent to doctor for report online, even on Smartphone
ECG Report
Patient Name : null Sex: Female
Age: 0 Wednesday 01 July 2015
Patient ID : 1
I
II
III
aVR
aVL
aVF
V1
V2
V3
V4
V5
V6
25 mm/sec 10 mm/mV
II
0s
1 s 4s2s 3s 2s 3s
1 s 4s0s
2s0s 4s
1 s 3s
5 mm/mV

36. 36
Improvised
Digital Stethoscope
A microphone insert is
fixed at a cut end of the
rubber tube of a
commercial stethoscope
Delays through internet and
limitation of Frequency response
does not allow live transmission.
=> Store & Forward.

37. Improvised Digital Microscope
Software zoom
A good webcam attached to a Chinese
microscope.
We are trying alternative methods using
USB camera modules and improvised
optics.

38. 38
Digital
X-Ray View Box
software zoom

39. 39
Digital Colposcope
for detection of Cervical Cancer
Improvised from a
binocular
Software filtering done to get effects
similar to that obtained using Red,
Green and Blue filters

40. 40
Digital Colposcope
Software filter - optical

41. Software for TELEMEDICINE,
Web based

42. Software for
TELEMEDICINE:
• Registration and ID to
health operator and doctor
by admin
• Log in by remote operator
• Log in by doctor
• Patient registration, vital
information entry and
uploading
• Doctor sees uploaded data
• Patient consults doctor
through video consultation.
• Real time (almost)
stethoscope
• Real time (almost)
respiration monitor
• Real time (almost) ECG
• Uploading of images of
Ultrasound, X-ray, previous
prescriptions A Prescription
- preliminary and final
• All records archived for
future reference
<www.bmpt.du.ac.bd/telemedicine>

43. Prescription generation
With database
for medicines,
advices, etc.

44. Acknowledgements
1. Farm Fresh brand of Akij group, Bangladesh
2. ISP of Uppsala University, Bangladesh
3. Access to Information programme of Govt of
Bangladesh (partners: UNDP, USAID)
4. Information Society Innovation Fund (ISIF)-Asia
5. All post graduate students at the department who
contributed to this project

45. Challenges
We want to add Images – Ultrasound
Ø 640x480 monochrome adequate
Ø Still images , about 100KB, store
and forward acceptable
Ø Video images, needs 480Kbps for
25 FPS
Ø Reducing frame rate to 5FPS in
some cases, 120Kbps may be
adequate
Ø Difficult under present situation
Ø We are planning to go for store
and forward of Video

46. Challenges
We want to add Images – Ultrasound
Ø 640x480 monochrome adequate
Ø Still images , about 100KB, store
and forward acceptable
Ø Video images, needs 480Kbps for
25 FPS
Ø Reducing frame rate to 5FPS in
some cases, 120Kbps may be
adequate
Ø Difficult under present situation
Ø We are planning to go for store
and forward of Video

47. Dial-up using telephone line : 2.4 Kbps to 56 kbps
DSL – Digital Subscriber Line : 16 Kbps to 9 Mbps
Broadband Internet Connection, Cable : 200 Kbps to 20 Mbps
Fibre optical link : 1 Mbps to 40 Mbps
Internet over Satellite : 492 Kbps to 512 Kbps
Mobile broadband, 2G : 10 Kbps to 240Kbps
Mobile broadband, 3G : 100 Kbps to 16 Mbps
Mobile broadband, 4G : 5 Mbps to 1000 Mbps
How can you help us in taking these services to remote regions?

48. How can we deliver the
benefits of modern healthcare
technology to whole
humanity?

49. University
(BMPT)
CTE BiBEAT
Users, Small entrepreneurs
Users, Small entrepreneurs
Users,Smallentrepreneurs
Users,Smallentrepreneurs
1. BMPT-Dhaka University
2. Centre for Technology
Equalisation (CTE)
[under Relevant Science &
Technology Society, Bangladesh
(RSTS)]
3. BiBEAT Ltd. – Company, Limited by
Guarantee (under article 29), No
shareholders, Paid-up capital: Zero,
Nobody takes the profit
Model for Dissemination

50. We have to break away from the existing
accepted norm of getting equipment from
the rich countries.
for global benefit,
We are not patenting our products!!
Teach technology, manufacture and entrepreneurship
to Third World scientists and engineers, ask them to
produce the equipment in their own country and sell

51. Technology innovators should
become entrepreneurs
Businessmen cannot do this job
(wrong concept prevalent now)

52. All our products are manufactured & sold by
BIBEAT Ltd. – a non shareholding company
for public good à nobody takes profit
(except technologies like safe drinking water for which
technology is disseminated at no cost)

53. Acknowledgements
1. Ministry of Sc & Tech, Govt of Bangladesh
2. Ministry of Education, Govt of Bangladesh
3. Asiatic Society of Bangladesh
4. British ODA (now DFID)
5. University Grants Commission, Bangladesh
6. Neurology Foundation, Bangladesh
7. Trauma Centre, Bangladesh
8. Farm Fresh brand of Akij group, Bangladesh
9. ISP of Uppsala University, Bangladesh
10. Access to Information programme of Govt of
Bangladesh (partners: UNDP, USAID)
11. Information Society Innovation Fund (ISIF)-Asia

54. Our committed and youthful team at the
Department of Biomedical Physics & Technology
Dhaka University (Includes foreign students)

55. Thank
You