Technology to bolster healthcare-MEDICAL ELECTRONICS SPECIAL ISSUE: May 2009 Issue

vo l u m e 4 | i s s u e 2 | FEBR UARY 2009

InterSystems named ‘Health IT Company of the Year’

ISSN 0973-8959

Brandon Medical Announces JV with Trivitron

A Monthly Magazine on Healthcare ICTs, Technologies & Applications vo l u m e 4 | is s u e 5 | M AY 2 0 0 9 | I N R 7 5 / U S D 10

Cover Story Technology to Bolster Healthcare Harsha Chawla Sr. Correspondent, eHEALTH Page 8

APPLICATION Wearable Medical Devices Dr. Sreekanth S. Raghavan Director, Paediatric Cardiology, Manipal Hospital, Bangalore Page 24

EXPERT CORNER Interventional Radiology Current Practices & Future Trends Prasanna Vadhana Kannan Research Analyst, Frost & Sullivan Page 26

in conversation Implanting a Success Ajay Pitre, Managing Director, Sushrut Surgicals & Adler Mediequip and Vice Chairman, CII Medical Equipment Division Page 28

Technology

to bolster healthcare

Medical electronics special issue

IN FOCUS CyberKnife – surgery ‘sans’ scalpel Dr. P.Mahadev, MD, DNB, DMRT, Apollo Speciality Cancer Hospital, Chennai PAGE 42

INDUSTRY SPEAK www. e h e a l t h o n l i n e . o r g

V Raja Praveen Ganapathy GE Healthcare Texas Instruments

Anjan Bose Philips Healthcare

A. Vijay Simha BPL Healthcare

Tarek Mo Mindray Medical

Rohit Mehta Avinash Trivedi L&T Medical Sony India

CONTENTS w w w . e h e a l t h o n l i n e . o r g | volume 4 | issue 5 | May 2009

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COVER STORY

EXPERT CORNER

Interventional Radiology - current practices & future trends

Technology to Bolster Healthcare Harsha Chawla, eHEALTH

Ms. Prasanna Vadhana Kannan, Research Analyst, Frost & Sullivan Technical Insights – Healthcare Team

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IN CONVERSATION WITH

Implanting a Success...

Ajay Pitre, Managing Director, Sushrut Surgicals & Adler Mediequip and Vice Chairman, CII Medical Equipment Division

30 30

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TECH TRENDS

Latest in haematology analyzers: Fluorescence Flow Cytometry

32 ‘Beams’ of Hope

INDUSTRY SPEAK

Dr. R V Ravi Kumar of Centre for Advanced Research and Development (CARD), Bangalore

Local Innovations, Global Opportunities V Raja, President & CEO (South Asia), GE Healthcare

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The ‘e’ Factor

Technology for lowering costs in medical devices

Praveen K Ganapathy, Director, Business Development, Texas Instruments India

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Sense, Simplicity, Success...

Anjan Bose, Head, Philips

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SPOTLIGHT

Milind Purandare, Associate Vice President, Solutions (Product Engineering Services), Patni Computers

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EVENT REVIEW

Strong Showing Expected at Asia’s Leading Media Event

At the ‘Point-of-Care’ Vijay Simha, COO & Vice-President, Healthcare Business Group, BPL

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EVENT REPORT

CII MEDITech Summit 2009 20

Global Quality @ Local Cost Tarek Mo, Head–India Operations, Mindray Medical India Pvt. Ltd.

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IN FOCUS

CyberKnife – surgery ‘sans’ scalpel 21

‘Imagineering’ a growth story Rohit Mehta, GM & Head, Medical Equipment & Systems, Larsen & Toubro

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Dr. P.Mahadev, MD, DNB, DMRT , Apollo Speciality Cancer Hospital, Chennai

‘Getting High’ - on High Definition Avinash J Trivedi, Head – Business Communication Products , Broadcast & Professional Product Division, Sony India Pvt. Ltd.

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APPLICATION

Wearable Medical Devices Electronic solutions for the flatter world Dr. Sreekanth S. Raghavan, Director, Paediatric Cardiology, Manipal Hospital, Bangalore

May 2009

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EDITORIAL Volume 4 | Issue 5 | May 2009

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‘Home Sick’ at home!

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Technology can drastically improve healthcare quality and outcomes. It can make the healthcare industry as efficient, as it did for other industries. However, advanced technologies often comes at prohibitive cost.

Acquiring medical products from foreign markets burgeons the burden of healthcare cost, whereas, manufacturing them locally requires a very congenial regulatory environment.

The way out is to not only manufacture equipments at home but do so in most costefficient manner that can make it easily affordable. And, for all this, we need a strong support from the government and solidarity among all stakeholders.

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India’s medical device industry is currently the fourth largest market in Asia. However, there was a time when the industry was far ahead than its competitors. India has the best of medical expertise, scientists and competent manufacturers, but lacks a regulatory system that can support it. It’s disappointing to see manufacturers who are recognised globally, still struggling in the myriad of our legal and regulatory system.

Take a look at Malaysia’s medical device industry. The Malaysian market for medical equipment and supplies is estimated at US$614 million in 2008, and recent trends suggest a positive outlook leading to 2013. Till some years back Malaysia was heavily reliant on imports, buying 90% of its medical equipments from abroad. However, the situation started changing in 2006 after the Malaysian government implemented the Voluntary Registration for Medical Devices Establishment (MeDVER) system. Today, the government is working hard to reduce trade obstacles to promote manufacturing of high-end medical equipments.

Also, there is a need for better connectivity between health care deliverers and the industry. Procuring the latest medical technology is not the end. In fact, it’s the beginning.

With time and vigorous use we find the best techniques to make the optimal use of technology for quality patient care. And, we need to share such best practices, so that it’s not restricted to limited people.

Lastly, we need to change our mindset that the best technologies can only be developed in the West. There are many new innovations taking place in isolated corners of India, but unfortunately there are few takers. Lately, some of the domestic and international medical device firms with their R&D in India are hiring local talents to develop high-tech products applications. May be we can hope to make India a hub of medical equipment manufacturing.

Say what?

Dr. Ravi Gupta Ravi.Gupta@ehealthonline.org Mayl 2009

COVER STORY

Technology

to Bolster Healthcare

While healthcare becomes ever more complex, technology is providing answers for some of the most challenging aspects of medicine. eHealth brings you a low down on medical technologies that are changing the way we provide clinical care.

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atest medical technologies are transforming health care like never before. Today, owing to the development of high-end equipments and instruments many complex surgical procedures are being performed with minimal incision such as endovascular surgery, interventional radiology or Laparoscopy. Beneficiaries are the hospitals, as it reduces the load on the hospital resources; and the patients who don’t have to stay put in the hospital for weeks.

health insurance and better financing are some of the factors which have led to better health care facilities in cities. However, at the same time, rapid changes in medical technology have also been a concern of healthcare systems even in rich countries. It also shows concern over inappropriate diffusion of medical technology as any new technology is only valuable to the extent that it leads to significant improvement of health outcomes and patient care.

The modern medical technology is making healthcare effective, speedy and portable. The latest in technology are lab-on-a-chip devices.

Though they aren’t been used in India at present but for the first time a Bangalore-based firm Bigtec Labs has developed a hand-held device for rapidly detecting Hepatitis B. On the other hand, a compact, portable teleelectrocardiogram (ECG) machine controlled by a mobile or a laptop which costs somewhere between Rs 7000-8000 was recently launched by Bhabha Atomic Research Centre. The machine would be of use to the elderly, people who travel frequently and especially to people living in remote areas where the primary heath centers are very far off. Many such innovations are going around in India and the world to control the higher incidence of chronic and lifestyle diseases.

“The Indian health care system has always suffered from an acute shortage of healthcare professionals.

A recent survey published in a leading business daily of India says that the number of students taking the medical entrance exam in India

Higher incomes, easy availability of

May 2009

Medical electronics has a role to play in every aspect of healthcare, be it prevention, therapy, surgery, pharmacology, hospitalisation, analysis, prosthetics or implants, but it’s the diagnostics which can transform the healthcare in India.

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has reduced considerably. In such a scenario, modern day medical devices are the solution. It has an exceeding potential to make health care available to a billion people. Medical electronics has a role to play in every aspect of healthcare, be it prevention, therapy, surgery, pharmacology, hospitalisation, analysis, prosthetics or implants, but it’s the diagnostics which can transform the healthcare in India. The reason being phenomenal increase in the incidence of lifestyle and genetic related diseases in the country and the growing elderly population without filial support. The need of the hour is low-cost portable diagnostic devices. An apt example is the Digital Infrared Thermal Imaging (DITI) or thermography which is being considered as a valuable adjunct to mammography and ultrasonography.

Thermal imaging is a 15-minute non-invasive test for not just the early detection of breast cancer but also to detect early abnormalities, and it’s also being seen as a simple, valuable and cost-effective technology. Such speedy diagnostics tests combined with telemedicine can truly benefit the people living in rural India,” says Dr Swapna Banerjee, professor of electronics and electrical communication engineering, IIT, Kharagpur.

The current scenario Health care has emerged as one of the largest service sectors in India. In

COVER STORY 2004, national health care spending (public & private) was about 5.2 per cent of the GDP and is estimated to be valued at US$ 34.9 billion. Health-care spending in India is expected to rise by 12 per cent per annum during 2005-09. Currently, the medical device industry is worth USD 3 billion in India, which is currently growing at a pace of 1215 per cent per annum and likely to touch USD 5 billion by the end of 2010.

There are several reasons which are causing the demand of medical equipments to soar. For instance, demand for quality health care because of higher incomes, availability of medical insurance, higher incidence of people suffering from lifestyle and genetic diseases and also growth in medical tourism. Today, the medical devices market is largely dominated by multinational players and most of them are expanding their portfolios.

Recently, two of the leading healthcare technology providers, Philips and GE announced their entry into the Indian home healthcare market. Both these companies have expanded their healthcare product portfolios by launching sleep therapy solutions and respiratory care solutions.

Undoubtedly, medical equipments play a huge role in every aspect of health care, however it is still an unorganised sector plagued with outof-date regulations in the absence of

Neuronavigators are used by neurosurgeons to navigate within the confines of the skull during surgery

a formal body like the Food and Drug Authority (FDA) in the USA. “In the age of chronic diseases like diabetes, heart disease, cancer and obesity-induced diseases which are common among all age groups, the need of high-tech applications is undeniable. Sophisticated devices and diagnostics not only assure patients’ security, accurate results and better health outcomes, but also save time and resources by shortening hospital stays as patients recover faster.

Contrarily, such high-end machinery are also viewed by medical observers as a reason for rising health care cost

Gamma Knife

as most of them are imported and the cost of procuring and maintaining them is extremely high,” says Dr Shakir Husain, honorary consultant and chief of services, Stroke Neurology & Interventional Neuroradiology, Sir Ganga Ram Hospital.

He further adds, “It is difficult to make the latest medical technologies available in the rural India and affordable to the common man until we bring down our dependence on imports and start manufacturing them at home. Currently, manufacturing initiatives in India are restricted to low-end equipments. Even if we consider importing high-end equipments, it wouldn’t drastically affect the overall cost if we manage to stop importing simple diagnostic devices, consumables, disposables and instruments. For instance, the cost of neuro intervention procedure of the brain like aneurysm goes up to lakhs of rupees. But you will be surprised to know that the money fleeced from the patient doesn’t go to the hospital coffers or to the doctor. Instead, the big chunk of the sum goes to the company (like Boston Scientific) which provides consumables like microcatheters. If we manufacture such consumables locally we can bring down the cost dramatically. On the doctors’ part they should encourage local manufacturers by buying their products, if the May 2009

COVER STORY

Affordable Healthcare For long sophisticated medical devices were linked with improved health outcomes, but today it’s been viewed also as a main cause of rising medical bills.

Prof. A K Mahapatra Director, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow

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ndia needs a large number of hospitals and health-care professionals to provide quality health care at an affordable cost.

Medical treatment at newly-opened corporate hospitals is costly and out of the reach of the common man. On the other hand, government-run hospitals are over-crowded and often lack modern facilities and diagnostics. Most of our

product does the job equally well as the imported one. Primary health centres are the cornerstone of rural healthcare. If we can make low-cost and low-end diagnostics and general medicines available here, we can make a huge impact.”

requirements of medical devices are met through imports despite the presence of indigenous manufacturers. Not only that even simple medical devices such as defilbrilators, pacemakers, cardiac stent, heart valves and long arterial lines, which are used commonly, have to be imported. Consequently, we end up importing not only hi-tech equipments but also consumables-such asdialyser, oxygenator, heart valve, kits for diagnosis, ECG Electrode, long lines for cardiac monitor--which in leads to increased health-care costs.

In the field of neuro science, significant progress has been made in the last three decades which has made diagnostics speedy, accurate and easy with the availability of Multislice CT, MRI Scan, PET CT and SPECT.

Improvement of therapeutic modalities include image guidance, neuro navigation and minimally-accessed surgery in brain. Cochlear implant, Gamma knife and intra operative US are the latest additions. Today, we are doing all types of neuro-surgical procedures and tests which were only available in the West till some years back. However, we are still heavily dependent on foreign manufacturers for the import of 85 to 90 per cent of items for day to day use such as guide wires, micro catheter, coils, etc.

To make health-care affordable and reachable to the rural India, we need to create a congenial environment for indigenous manufactures to produce cost-effective high-quality equipments to lessen our dependence on imports. In India we still follow

expensive equipments are bought by hospitals. In both the cases patients’ bear the brunt either by compromising on safety or by paying high medical bills,” says Dr Hussain.

“Currently, most of the demand for medical equipments in India is met through imports. Imported equipments are preferred over indigenous manufactured equipments

Need for regulation and certification One of the reasons for rising health care expenses is increased spending on imported medical equipments, as indigenous manufacturing initiatives are restricted to low-end equipments. In the absence of a regulatory framework, obsolete or sub-standard technology is forced onto hospitals as buyers don’t always have the complete knowledge about equipments’ effectiveness. This not just compromises on patients’ safety but is a complete waste of money as after a period of time they are left unused. “Sometimes out of ignorance or hidden interests redundant or highly-

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Gamma Knife

COVER STORY

Indian Drug Cosmetics Act of 1940 for medical devices. A medical device is totally a different category and cannot be clubbed with pharmaceuticals because there is hardly any similarity between the two. For years now Indian government is trying to formulate a Medical Device Act but there are no signs yet of it being in place.

crores, whereas on the other hand the other company was selling the latest model of 64 Slice CT with accessories for Rs. 3.5 crores. It’s very common to see a difference in price quoted by the same company in different hospitals or to see two different companies selling the same product with different price tags. The reason being the original price of the imported medical device

is not known to the buyer, and the agents/company representative cash in on their ignorance. The second problem which a buyer faces in buying an imported device is that agents don’t provide timely and effective post-sale services, trained manpower are not available and the cost of spare parts is very high.

The sophisticated electronics which are imported from foreign markets are highly-priced. Therefore, price inequality becomes a major issue while buying them.

Sample this - Government had sanctioned Rs 20 crores for a brain suite to a medical institute but the price at which it was available was Rs 38 crores. In such a situation either the buyer has to negotiate for a lesser price or the government has to revise the allocated funds. In this case, negotiations with the company went on for six months and the final price was Rs. 19.85 crores. Similarly, for a 64 Slice CT, one company quoted Rs. 6

To promote the use of indigenous medical equipments, which can make health care affordable to the common man we need to create a level playing field. despite huge price differences as the government doesn’t certify their manufacturers as bona fide. So, to promote the use of cost-effective indigenous medical equipments, which can make health care affordable to the common man, and increase their acceptance in the international market, we need to create a level playing field. On a fair competitive ground local manufacturers can compete at par with multinational players. For all this to happen, we

PET Scanner

need a centralised regulatory body to form regulatory benchmarks and to ensure the effective execution of regulations uniformly in all parts of India,”says Rajiv Nath, co-ordinator, the Association of Indian Medical Device Industry (AIMED) and joint managing director, Hindustan Syringes & Medical Devices. AIMED is a newly formed association representing the interest of over 150 manufacturers of medical devices.

“We also need to recognise that the needs of the medical devices industry are different from pharmaceuticals, thus they cannot come under one authority. Another step that can protect and promote the domestic industry against the onslaught of imported goods, and motivate domestic players is to give a price differential of say 15 to 20 percent on a blanket basis, as is done in other countries like Malaysia,

Thailand. This will force MNCs, who are currently free traders in India without any manufacturing intent, to manufacture in India and thus reduce our dependence on imports.

A proper regulatory mechanism will ensure an incentive to manufacture high-tech devices, standardisation of equipments, fair pricing and will also control inappropriate diffusion of technology. The only way to motivate indigenous manufacturing initiatives is through the right infrastructure and conducive policies,” adds Mr Nath.

Last but not the least there is a need for better communication among the stakeholders: health care professionals, scientists, technologists, manufacturers, vendors and importers to discuss emerging technologies, techniques and trends in health care.

May 2009

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INDUSTRY SPEAK

Local Innovations, Global Opportunities V Raja, President & CEO (South Asia), GE Healthcare talks with eHEALTH about achievements and initiatives of his company in India, and challenges that are holding back the real success of domestic manufacturing in this country.

What is your R&D and manufacturing strategy in India? What advantages are derived out of it?

GE always viewed India as a place for strategic investment in R&D and manufacturing. Our ‘John F. Welch Technology Centre’ in Bangalore is credited with many pioneering innovation in healthcare and allied technologies. Almost 25% of our global healthcare engineering workforce is based out of this centre.

Components, accessories and finished products developed in India have provided superior quality at far lower cost than the Western world. Over the years, this has reposed tremendous faith for investing in this country. It is almost certain that this trend will continue over coming years.

What are the objectives and expectations of your partnerships with some state governments and non-profit organisations?

What are your offerings for rural markets and low-income economies?

We are working on a PPP model with some state governments, like Gujarat and Madhya Pradesh to make advanced technologies available for masses.

Unutilised physical space in government hospitals are used by our private service partners to install advanced MRI and CT machines from GE, without any financial obligation on the hospital.

Patients are charged at discounted rates (30-50% lower than market) preapproved by authorities. It makes sense for private providers as they get assured patient volume and opportunity for optimum asset utilisation. In addition, students at teaching hospitals get to train themselves on such advanced equipments.

In the non-profit sector, we are working with organisations like NICE Foundation, Vivus Clinics and Manipal Hospital Foundation for supplying mobile vans retrofitted with ECG, ultrasound, defibrillators and first-aid facilities, which are used for running rural health camps and for responding to emergency situations. However, whether such initiatives can develop a sustainable business model is yet to be seen.

Products like our Mac 400 portable ECG machine developed in India are

Which are your best performing prod-

What is your current portfolio of healthcare products and components produced in India?

We started off with manufacturing CT machines, and gradually went into Ultrasound, Colour Doppler, ECG, EEG, Foetal Monitors and Patient Monitors.

We are still expanding the basket with Phototherapy Systems, Baby Warmers and advanced X-ray machines.

In addition, we are producing a wide range of components and accessories for global markets. Last year, we supplied USD 250 million worth of critical components and accessories to GE’s worldwide healthcare business.

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testament to our effort in this direction.

We are also working on low-cost ultrasound. The objective is to provide adequate quality at a price point that fits the rural segment.

May 2009

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ucts in Indian market and which carries the most potential?

Our biggest footprint and market share is in the ultrasound segment.

This is closely followed by molecular imaging equipments like PET-CT and Gamma Cameras. Nuclear medicine is another important segment for us in India, however, currently we are only importing them. In coming years, we are expecting a large market share in maternal and infant care and home healthcare products.

What was your business growth over last couple of years? What was your total turnover in last year and what is your expectation for current fiscal?

We have had consistent double digit growth over last couple of years. In ’08, we grew by almost 20%. Last year, our turnover was nearly USD 500 million and in spite of the downturn, we are expecting somewhat healthy growth in the current year.

As the new Chairman of FICCI Medical Electronics Forum, what issues do you wish to advocate for the industry?

Broadly there will be three priority areas for us. Firstly, how to increase footprint of local manufacturers by encouraging and incentivising the industry. Secondly, how to facilitate technology transfers so that local manufacturers can keep themselves competitive in global markets. Last but not the least, how to create a firm regulatory environment to ensure quality and safety of products.

INDUSTRY SPEAK

The ‘e’ Factor...

Modern electronics is revolutionising healthcare like never before. While bringing superior diagnostic and therapeutic capabilities, electronic and semiconductor technologies are also making healthcare ever more efficient, accessible and affordable.

Praveen K Ganapathy, Director, Business Development, Texas Instruments India, shares with eHEALTH the most cutting-edge in medical electronics.

What are the advancements in the field of medical electronics over the last few decades?

There are multiple aspects of the medical profession/healthcare industry that is impacted by electronics and semiconductor industry. Mostly, they have resulted in improvement in quality of life and higher productivity. Preventive healthcare is benefited through advances in early detection techniques by studying molecular level changes. Acute disease care has improved through new diagnostic and therapeutic techniques. Advanced imaging technologies are providing better insight into disease conditions. Technology is also enabling home healthcare and telemedicine - extending medicare beyond hospitals.

What are the current R&D initiatives of TI in the field of medical electronics?

TI’s complete end equipment solutions leverage our product expertise in microcontrollers, high-speed amplifiers, high-resolution imaging DSPs for personal medical devices and medical imaging products. We have associated with School of Medical Science and Technology, IIT Kharagpur, to develop advanced semiconductor technologies for personal medical devices, implantable devices, medical imaging, wireless healthcare systems and bio-sensor technology. This forms part of a global initiative of TI to invest USD15 million to fund medical technology research focusing on improving quality, accessibility and affordability of healthcare.

The collaboration also reflects TI’s

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May 2009

commitment to engineering education and developing the next generation of innovators.

What are some of the latest medical products/technologies introduced by TI in the recent past?

In 2008, TI introduced a family of fully integrated analog front ends (AFEs) for portable to high-end ultrasound diagnostic equipments. TI‘s AFE58xx family allows the design of innovative ultrasound systems with superior image quality and reduced power consumption. The AFE5805, provides nearly 50% space savings, 20% less power and 40% less noise than existing integrated solutions. In 2008, TI also introduced the industrys’ lowest power, zero-drift instrumentation amplifier, INA333. The device improves accuracy and stability while extending battery life in a variety of precision, low-power applications such as portable medical data acquisition and handheld instruments. In April 2009, TI announced the availability of an embedded processor software toolkit that helps ultrasound manufacturers to easily develop ultrasound applications on the improved processing power of TI’s C64x+™ DSP platforms.

What are the initiatives of TI towards developing low-cost technologies?

The semiconductor industry will play a pivotal role in designing and developing portable and affordable medical devices that reduce healthcare costs. The connectivity enabled by semiconductor technology (wired or wireless) will drive applications, such

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as telemedicine, that will facilitate access to the required level of healthcare as needed. Semiconductors can help in revolutionising the medical electronics market. We have seen semiconductors change the paradigm in the area of communications. While it is still early days in this journey, the potential to make healthcare affordable through semiconductor technology is huge. Devices such as the AFE58xx family, INA333 and the C64x+™ DSP platforms from TI are steps towards that direction.

What is your view about the emerging market for healthcare equipments in India and Asia? What are the ongoing efforts at TI for addressing this market?

Most observers agree that India and Asia are key markets of the future for medical devices and equipments. Medical electronics represents the fastest growing industrial semiconductor opportunity for suppliers; home health, clinical and imaging end-equipment segments are requiring increased and more advanced component support, as technologies for medical applications continue to evolve. The focus need to continue on availability, accessibility and affordability of medical equipments. TI is helping shape electronics to revolutionize healthcare.

TI’s expertise across digital and analog technologies, and ability to address the wireless connectivity, digital imaging and power management requirements of applications, helps our customers put innovative medical electronic systems into the hands of more people.

INTEGRATED EMR Helps you eliminate paper charts Faster document processing Easy storage and retrieval of data Instant access to patient records Support for Charts and Schematics

EASY TO USE User friendly interface Simple mouse-click access Quick learning curve

CUSTOMIZABLE Designed for individual requirements Integration with existing applications Workflow based technology Selective modules

SECURE Access control passwords Encrypted data for confidentiality HIPAA compliant Audit on all transactions HL7 transactions

ADVANCED FEATURES Publish Charts/EMR Follow-ups Referral Management Voice Recognition Workflow Management Correspondence Manager SMS and Email Alerts Centralized/Distributed Implementation

INDUSTRY SPEAK

Sense, Simplicity, Success... eHealth caught up with Anjan Bose, Senior Director and Business Head, Philips Healthcare, to get his perspective on the needs of a fast-changing Indian medical device industry and about the growth plans of his company in India. Excerpts from the interview.

Can you detail upon the major advances in the medical devices industry in recent years?

The last two decades have seen a lot of technological advancements in almost every field of medicine.The development of high-tech medical devices has truly revolutionised the healthcare systems all over the world. Especially, areas like cardiology, neurology, ortho are hugely benefited by technology.

Introduction of transthoracic and transesophageal echocardiography, 3D echocardiography, advanced MRI ranging from 0.1 Tesla to 3 Tesla machines, C-arm X-rays are testament to some of these. Also, molecular imaging deserves a special mention in this regard. The great strides made in this domain is bringing paradigm shift in healthcare – moving from curative to preventive and early disease detection based advanced equipments like PET-CT are the result of stupendous progress made in this field.

Do you think technology is often overpurchased than what is optimally required? How would you react to such concerns?

I think susch arguments are facile. If we look at mobile phone market, we have both high-end as well as low-end phones. Both are in demand and are targeted for different user segments.

We need to have this, as requirements of customers differ. Similarly, there is relevance for a broad range of medical equipments catering to different needs.

Moreover, the quality of healthcare and their outcomes offered by advanced technologies is often beyond mere

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cost consideration. Having said that, low-cost medical technology innovation is surely desirable. Last year, Philips made two acquisitions in India, namely, Meditronics and Alpha X-Ray Technologies - both of which have adopted proven costinnovation models for manufacturing cost-effective quality products. I think the trick in this matter lies in making judicious investments to make ethical usage of technology.

What is the current ratio of medical equipments manufactured in India against those imported by Philips? How is Philips contributing to make India as a manufacturing hub?

It’s very difficult to give the exact ratio. However, I can say that Philips is a champion of indigenous manufacturing. That’s the reason why we have acquired two Indian companies last year and would like to strengthen our manufacturing base in India. We want to manufacture products for the domestic as well as international market to create goodwill of Indian medical device industry globally.

What measures do you suggest for costeffective manufacturing?

Use of efficient supply chain and inventory management, along with superior resource planning and quality control are crucial for achieving excellence and cost-effectiveness in manufacturing. The labour arbitrage advantage in our country, coupled with above best practices can give desired results.

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Which products are your top revenue earners and which possess potential for future?

Philips has been a consistent market leader in areas like Cardiac CathLab, Patient Monitoring, High-end MRI, Multi-slice Cardiac CT and a host of other segments. I think Indian healthcare system is in a state of flux and five years down the line, there would be tremendous growth of medical device industry than what it is today. Recently, Philips expanded its healthcare product portfolio by launching home healthcare products like sleep therapy solutions and respiratory care solutions. For such products to do well in the future we need to create awareness among patients. For instance, there have been many cases where sleep apnea patients have lost their lives in sleep. Philips wants to cater to demands of both bigger and smaller cities and also want to tap rural hospitals and emerging markets.

What are the regulatory barriers for Indian medical device industry?

I think regulatory consciousness in the Indian medical device industry is coming of age and I really feel proud that from being an underdeveloped industry, today it is developing exponentially. The government is trying to put in place a regulatory framework and there is a lot to be done. Instead of calling them barriers, I would say they are short-term challenges. In the current scenario, what we need the most is commitment from the industry and the government to work together.

INDUSTRY SPEAK

At the ‘Point-of-Care’...

Known as a pioneering organisation with capabilities of design, development and manufacturing of a wide range of diagnostic medical devices, BPL Healthcare has one of the most comprehensive service and delivery systems in the country and an undisputed leadership in pointof-care segment.

Vijay Simha, COO & Vice-President, Healthcare Business Group, BPL in talks with eHEALTH.

How have you seen the advancement in the field of medical electronics over last few decades? Which areas of healthcare have mostly been benefited through such technologies?

Seeing is believing seems to be the leitmotif of modern medical diagnosis.

Imaging seems to have taken center stage and visualisation tools using Gamma Radiation, X-Rays, Ultrasound and Magnetic Resonance probes have made disease identification and location more precise.

However, very little progress has been made on the diagnosis and treatment of systemic diseases that may manifest itself as a cancer or an autoimmune response. Using molecular probes, the area of molecular diagnostics will begin to mature as a routine diagnostic tool over the next decade. Example of this can be the case of outbreak of infectious viral diseases like the H1N1 strain, not only in developing countries but also in highly developed nations and its control.

What is the current portfolio of electronic equipments, devices and solutions offered by BPL Healthcare?

Which among them are currently your fast movers and majority revenue earners?

BPL focuses on diagnostic equipment that addresses the larger segment of the healthcare infrastructure; that is in the primary and secondary areas of practice. These tools help

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Medical device is a complex multidisciplinary field and regulatory authorities are falling over each other in order to bring in a framework. Our current infrastructure and investment in public health system leaves much to be desired, and its time that both awareness and priority be assigned to this area the medical practitioner obtain more precise and quick diagnosis of diseases. Sometimes, it’s a set of tools that need to work together to provide this effectiveness and efficiency. Our breadwinners are the point-of-care products.

What new initiatives and strategic advantages does BPL wish to derive out of its recent partnership with Welch Allyn? How do you foresee the

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partnership value-adding your top line and bottom line in short and long term?

Welch Allyn is a global major in the point of care devices area and BPL’s relationship stretches across these vast expanses of our geographies.

The synergy is seen in the value that the customer would derive from this association. Both our companies are highly customer centric organisations.

What was the percentage growth and total turnover of BPL Healthcare in the last financial year?

This information is yet to be released officially.

What incentives and regulatory support do you wish from the government for boosting medical technology industry and making advanced healthcare affordable in the country?

I think the government should first remove the disincentives that exist.

The ecosystem for development and manufacturing of medical devices is just not conducive for investors. Medical device is a complex multidisciplinary field and regulatory authorities are falling over each other in order to bring in a framework. Our current infrastructure and investment in public health system leaves much to be desired, and its time that both awareness and priority be assigned to this area. Disease screening and preventive healthcare programs could contribute largely to a healthy population.

INDUSTRY SPEAK

Global Quality @ Local Cost Established in 1991 in Shenzen, China, Mindray Medical has since emerged as one of the leading global manufacturer and supplier of highquality medical equipments and devices. The company remains committed to offer most competitively priced products without compromising on quality, reliability and performance. Having started its India operations from January 2007 Mindray has already established itself as a leading player in patient monitoring and life support, in-vitro diagnostics and medical imaging segments.

Tarek Mo, Head–India Operations, Mindray Medical India Pvt. Ltd. talks with eHEALTH about his plans for the domestic market and reflects on current issues concerning the industry as a whole.

“We aim to set up a long term and mutually beneficial relationship with valuable local partners, as we do in Chinese market. We cherish the partnership we have established so far and are looking forward to a more extensive and in-depth cooperation with local partners”

How have you seen the advancement in the field of medical electronics over last few decades? Which areas of healthcare have mostly been benefited through such technologies?

The biggest two breakthroughs were MRI and CT, both of which won Nobel prizes. The imaging areas have since benefited the most.

What is the portfolio of medical equipments and devices that you are

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currently offering in India?

Mindray is a leading developer, manufacturer and marketer of medical devices worldwide. Mindray offers a broad range of products across three primary segments - patient monitoring & life support, in-vitro diagnostic products and medical imaging systems.

All these instruments are marketed in India.

A number of medical equipment companies are setting up R&D and manufacturing base in India. Do you have similar plans in this country?

We own a world class R&D team with more than 1,500 engineers located in five research centers i.e. Shenzhen, Beijing and Nanjing in China, along with Mahwah and Seattle in U.S. Over 60% of them hold Masters or Doctorate degrees. At this stage, we do not intend to build a R&D center in India. However, going forward, India is no doubt an ideal place for us to outsource and engage researchers with good talent and experience in medical industry.

What has been your marketing and business strategy in India? Are you working through your own resources or through local distributor/reseller network?

We aim to set up a long term and

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mutually beneficial relationship with valuable local partners, as we do in Chinese market. We cherish the partnership we have established so far and are looking forward to a more extensive and in-depth cooperation with local partners. We strongly believe that an excellent and mature distribution network could help us better understand and penetrate the local market.

What are the existing regulatory hurdles and bottlenecks for medical device companies operating in India?

What will be your wish list from government authorities for boosting this industry?

India is a great emerging market. It is pretty attractive for many medical equipment companies. However, unqualified instruments without CE mark are also floating around due to absence of strict entry regulations.

Such situation is quite threatening for healthcare industry and people in general, and is not conducive for continuous growth and technology advancement of medical equipment companies. We wish more strict regulations be implemented by government authorities in order to weed out poor quality and low-grade products.

‘Imagineering’ a growth story Larsen & Toubro Limited (L&T)’s Medical Equipment & Systems strategic business unit, better known as ‘L&T Medical’ was established in 1987 as part of the company’s endeavour to expand into emerging areas of technology. Currently positioned as one of the leading suppliers of advanced patient monitoring and medical imaging products, L&T Medical is on a high growth trajectory.

Rohit Mehta, GM & Head, Medical Equipment & Systems, Larsen & Toubro in a candid interview with eHEALTH. Doppler, Syringe Pumps, Hospital Turnkey Projects, Telemedicine Solutions and Speciality Ambulances.

What has been the growth of Indian healthcare sector in recent years?

What is your R&D and manufacturing capacity base in India?

Currently, India is amongst the fastest emerging healthcare markets in the world. A large population, steady economic growth and increased awareness among people for health and wellness, along with factors like, an ageing population, opportunities in medical tourism, proliferation of health insurance and increased burden of lifestyle and chronic diseases are acting as robust catalysts for growth.

L&T Medical has pioneered indigenous R&D and manufacturing of Critical Care and Imaging equipments in India. Our Mysore Campus is country’s first ISO 9001 certified, state-of-the-art medical equipment facility with ISO 13485:2003, ISO 14001:2004 and OHSAS 18001 accreditations.

Our products are also certified under IEC 60601-1, CE(G-MED, France), CMDCAS (Underwriter Laboratories) for export to Canada.

We have also secured US FDA for several products.

How do you perceive the growth of medical technology industry in India?

How do you think technology will transform healthcare?

In India, the medical equipment and devices sector has witnessed a growth of 5.5-6.0% over last two years. However, the need of the hour is to achieve complete control of information from bed-to-bed, with or without central monitoring facility to review vital signs.

Which products and solutions are currently offered by L&T in India?

L&T Medical’s product segments encompass Patient Monitors, Surgical Diathermies, Anaesthesia Delivery Systems & Ventilators, Defibrillators & Cardiac Resuscitation Systems, ECG Machines, Ultrasound & Colour

What has been the marketing strategy for L&T medical products? Which are your major business drivers?

L&T Medical is among the leaders in terms of market share in Inida.

We also export to countries like US, Europe, Latin America, Middle-East, Malaysia to name a few. We plan to a focus on international markets by offering a complete range of critical healthcare products, including, multi-parameter patient monitors with enhanced communication and networking features.

Which areas hold the maximum future potential? What is your strategy to address such need?

Emergency Response (ER) and trauma management have opened up scope for project business in ambulatory care. Funding commitment through NRHM and available sanctions to State governments will fuel growth in this segment. In order to cater to growing market needs and expand the product basket, L&T is augmenting physical capacity of its Mysore Campus. This will enhance our production capacity for recently introduced range of advanced 55 Series multi-parameter monitors, namely - Star 55, Planet 55, Galaxy 55, Comet P, besides, Wireless Central Nursing Stations - Skyline 55 and new Ultrasound Color Doppler - Scintilla.

What are the drawbacks of our current regulatory and economic environment?

Imports account for majority of high-tech equipments and depreciation of Rupee has resulted in severe pressure on margins.

Stringent government policy on issuance of PNDT certificates have been affecting sales of ultrasound scanners. There is an urgent need to streamline this processes so that care givers get the ability to provide the best treatments. In the present economic crisis, loans are drying up, resulting in reduced business volume due to delays in order finalisation. Once liquidity improves and market confidence enhances, the business should see a significant upward growth..

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INDUSTRY SPEAK

‘Getting High’ - on High Definition Popularly known for its unprecedented leadership in consumer electronics segment, Sony also offers a wide range of products for high definition medical imaging, recording, storage, viewing and printing solutions.

The company expects a significant growth in demand for High Definition solutions for healthcare industry and plans to put in place concerted effort to reach the end users.

Avinash J Trivedi, Head – Business Communication Products , Broadcast & Professional Product Division, Sony India Pvt. Ltd. in conversation with eHEALTH. How have you seen the advancement in the field of medical electronics over last few decades? Which areas of healthcare have mostly been benefited through such technologies?

Electronic technology has certainly enhanced the effectiveness of medicines, and it continues to make an astonishing impact in the medical field. Medical electronics has given birth to an entire biomedical industry, which incorporates sophisticated diagnostic, treatment, and surgical systems that are very helpful for healthcare.

There are clear and defined areas in healthcare where electronics has made tremendous effect. Some of these areas are - Imaging Techniques, Tele Medicine, Drug Delivery, Implantable Devices and Applications and Electronic Instrumentation.

When did Sony start its medical division business in India? What is the range of medical devices and equipments currently being offered?

Our medical business initiative in India started about a decade back. We offer products for following range of medical applications • Image Capturing – CCD Video Cameras Image Recording – DVD and • HD based systems

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• •

Image Viewing – Medical Grade Monitors Image Printing – Colour Video Printers, B/W Video Graphic Printers, B/W Hybrid Graphic Printer, Digital Colour Printers, B/W Digital Graphic Printer, Digital Film Imager, DICOM Colour Printers etc.

What has been the marketing strategy for Sony medical products? Does your leadership in consumer electronics segment help in building technical and/ or marketing value-addition for medical products?

Sony as a brand is committed for quality, innovation and customer satisfaction, it holds well across all product categories.

We are planning to increase our reach to end users and focus on High Definition solution offerings.

What has been the growth in business and product offerings since the inception of Sony medical division in India? Which product segment do you foresee generating maximum demand in near future?

The days of electronic reporting and tele-diagnostics are nearer than we can anticipate. Seeing the momentum, we anticipate high growth prospects in High Definition systems, Data Recording systems and Cameras.

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“There are clear and defined areas in healthcare where electronics has made tremendous effect.

Some of these areas are - Imaging Techniques, Tele Medicine, Drug Delivery, Implantable Devices and Applications and Electronic Instrumentation.”

Are you manufacturing (or planning to manufacture) your medical products in India? What do you think should be the policy and regulatory measures of the government to encourage domestic manufacturing?

Taking the population and growing spending capacity into consideration, it is quite obvious that India is a very big market for healthcare. However, manufacturing our products locally in not under consideration as of now.

APPLICATION

Wearable Medical Devices

Electronic solutions for the flatter world Technology is becoming a critical factor in monitoring patients with speed and accuracy.

stems out of a longer life expectancy, better management options for chronic disease, the time constraints involved due to frequent monitoring and health care visits apart from the prohibitive hospital visit costs.

In a general scheme, medical devices are either implantable, wearable or non contact. Autonomous devices that are worn by a person and provide medical monitoring or support over a prolonged period of time qualify as wearable medical devices.

Dr. Sreekanth S. Raghavan Director, Paediatric Cardiology, Manipal Hospital, Bangalore

In our quest for a superior quality of living, wearable medical devices have enabled us to better care for our diseased and non diseased senior members of our society. Medical technology has advanced exponentially in the last decade, partly due to embedded chip technology with faster processing capabilities. The cost of health care has spiralled to uncontrollable levels that even the developed socialistic countries are finding it difficult to care for their aging and diseased population.

The need for a WeMed product

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The desirable characteristics for a WeMed would be that it is small, light, unobtrusive, and designed for operation by unskilled users. It should also provide real-time feedback, alerting mechanisms, medical decision support, and wireless access to information.

Technological advances have definitely provided the ecosystem for better health support and monitoring systems. However, adapting them to a wearable realm is the key.

High density packaging, micro electronics miniaturization, powerful signal processing and compact communication capabilities have widened the application horizon.

Indeed none of these would work without power and hence availability of low power consuming chips and better battery life has provided high reliability to these systems. The current

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expectations or guidance is at least a 4 year field life for the batteries.

Of course, one of the major concerns is the biocompatibility issues when more than one WeMed is utilized in a patient. The sensor technology has to provide not only reliable sensing of the required parameters but also accommodate, without interfering with other medical devices. So, one challenge when different devices are made and used for patient monitoring is to be able to seamlessly amalgamate the data obtained from the devices, and to collate and present to the physician in the most lucid way possible.

On the services front, it should be robust in delivering point-of-care service.

It must facilitate unconfined medical monitoring and support, and assist in remote management of medical conditions. It has high value in rehabilitating patients, the chronically ill, and the disabled by monitoring their health parameters, and can also assist in their daily functioning. It plays an important role in emergency management by alerting and activating the appropriate health care sequences. A smarter version of the future would be able to suggest automatic stabilizing solutions during emergencies.

At least in the current scenario, it has a major role in chronic disease

APPLICATION management involving the heart, brain, the kidneys and diseases that produce physical limitations. One interesting study published in the journal Lancet, looked at patients who were on a wearable hemodialysis device for chronic renal failure (1). There were 8 patients who did not have any major adverse reactions, but interestingly all of them confirmed that they would recommend it to other patients on chronic hemodialysis. This study reiterates the value of WeMeds in managing chronic disease conditions that dampen a good quality of life. Some of the recent efforts in cardiac disease management by monitoring heart rates and identifying abnormal heart rhythms have helped in preventing major cardiac events and in cardiac rehabilitation. Some of the R&D has focused into other potential areas such as Diabetes and patients on Insulin therapy, Stroke, Dementia and disorders with physical limitations.

The value of WeMeds in any home health and nursing care patients cannot be over emphasized. It provides

Some of the recent efforts in cardiac disease management by monitoring heart rates and identifying abnormal heart rhythms have helped in preventing major cardiac events and in cardiac rehabilitation. the much needed flexibility and accessibility for the elderly. Also, its utility in life style management situations is copious. They can guide and assist in weight management and also maintaining the necessary regimen for better performance in healthy individuals.

Gone are the days when patients have to spend enormous time travelling apart from wasting their limited resources in accessing good health care.

It is well within our era that advanced

technology and communications are being leveraged to better the health care in remote and inaccessible areas. The typical scenario would be connecting WeMeds with telemedicine consoles to transfer medical data to the expert physicians in urban centers of excellence. Some of the existing GPS, data processing and digital image compression technologies have brought these capabilities within our reach even in our lifetime.

With the economics of health care being the major driving force behind WeMed products, the bumptious older versions are giving way to more smarter, intuitive and sophisticated versions, forcing physicians to get comfortable with advanced communication systems, apart from the mundane medical diagnostic and therapeutic advancements. Indeed, the medical world is getting flatter. However, the ultimate success of a medical device is not in its technology but in its utility.

Ref:1.The Lancet; Dec 15, 2007; 370, pg 2005�

EXPERT CORNER

Interventional Radiology -

Current Practices & Future Trends The Concept Interventions:

Ms. Prasanna Vadhana Kannan Research Analyst, Frost & Sullivan Technical Insights – Healthcare Team

Interventional radiology has undergone tremendous advances owing to the development of new imaging technologies and interventional devices.

This has paved the way for applying IR to a vast number of medical conditions that are otherwise performed using invasive methods.

of

Image

guided

Interventional radiology, a sub-specialty of radiology, utilizes various imaging techniques such as CT, MRI to guide percutaneous minimally invasive procedures for both diagnosis and therapy.

Advances in IR have simplified most of the procedures while retaining safety and fewer traumas to patients. Besides angioplasty, drainage procedures, tumor ablations, and embolizations are now increasingly becoming image guided minimally invasive interventions with the refinement of technologies. Owing to minimized complications, morbidity, and cost of procedure, image guided ablation has emerged to be the primary treatment modality for cancer. The impact that the IR domain has had on traditional procedures is that it has enabled a novel confluence of minimally invasive diagnosis and therapy for cost-effective patient care. This successful evolution of IR procedures could be attributed to advances such as improved multidimensional (3D, four dimensional 4-D) imaging techniques, microcatheter technology, improved guidewires, small sized balloon catheters, vertebroplasty, drug eluting and flexible stents, removable vena cava filters. Additionally, the development of computer technologies, improved software for image processing and reconstruction, treatment planning and simulation are all expected to enable the diagnosis and treatment of diseases at much earlier and curable stages even before the symptoms begin to appear.

Snapshot of Emerging IR Trends: Interventional radiology has undergone tremendous advances owing to the development of new imaging technologies and interventional devices. This has paved the way

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for applying IR to a vast number of medical conditions that are otherwise performed using invasive methods. A myriad of existing opportunities that are attracting physician and patient interest for interventional radiology applications include promising cancer therapies, fibroid therapy and uterine interventions, vascular and spinal interventions, and notable pharmacological therapies. Useful insights about emerging developments in IR are provided below:  Angiography: IR procedures such as computed tomographic angiography (CTA) and magnetic resonance angiography (MRA) have almost replaced conventional angiography for most of the vascular diagnostic procedures. Unlike catheter angiography, noninvasive CTA and MRA are less risky to patients and facilitate rapid diagnosis.  Tumor ablation: Cancer therapy remains to be one of the fastest growing IR applications. Certain specific types of percutaneous tumor ablation including chemoablation, radiation therapy that uses radiofrequency waves, lasers, microwave, and high-intensity focused ultrasound along with cryotherapy, all  of which induce cell death by coagulative necrosis has now become very common.  Vascular interventions: Noninvasive IT techniques are believed to play a vital  role in peripheral vascular interventions, intravascular brachytherapy, cutting  balloon angioplasty, cryoplasty, and implantation of drug eluting stents.  Percutaneous biopsy: Advances such as CT fluoroscopy, portable ultrasound, and MR-guided biopsies enable the procedure to be performed with relative safety on an outpatient basis.  Drainage procedures: Image guid-

EXPERT CORNER

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ance has assisted the performance of percutaneous nephrostomy during which the placement of a drainage catheter into the renal collecting system is done. Another equally promising area of image guidance application would be in biliary intervention.

Gastrointestinal Interventions: IR procedures such as stent placements and balloon dilations through fluoroscopic guidance have become routine techniques for interventions in the obstructed duodenum, esophagus, and the colon. One of the emerging trends observed in this sector is the miniaturization of introductory devices and the availability of flexible and retrievable metallic stents.

Embolizations: Recently, interventional radiology has been successfully applied for arterial embolizations to treat conditions such as GI bleeding, trauma of pelvis, and abdomen. A few other important applications of IR embolization include the treatment of post-partum hemorrhage and embolization of hypervascular tumors prior to surgery. These mentioned advances have been made possible with micro catheter technology improvements and enhanced embolic materials.

Thromboembolism: Patients requiring treatment for this condition are often subjected to systemic anticoagulation, which does not suits all patients and is associated with some treatment complications. Image guided placement of retrievable inferior vena cava (IVC) filters is emerging as an adjunct or as an effective prophylactic treatment for high-risk patients.

Spine interventions: Excessive pain due to vertebral compression fracture, which is refractory to medical treatment, could now be treated with a promising IR procedure called vertebroplasty that is an Xray fluoroscopy guided intraosseous injection of bone cements. Some noteworthy applications of X-ray and CT-guide interventions include percutaneous steroid injections into facet joints for back pain reduction, pain killer injections

into selective nerve routes, and percutaneous nucleotomy along with nucleoplasty.  Varicose veins ablation: Minimally invasive IR procedures for treating varicose veins ablation have emerged and these include sclerotherapy and endovenous thermal ablation using RF waves and lasers.

Percutaneous thermal ablation using ultrasound guidance has become the most common IR procedure to treat varicose veins since the whole procedure requires less than an hour.

Unique Role of Medical Robotics: A few years back, image guided biopsies were the predominant interventional procedures performed, however now the number of percutaneous procedures aided through image guidance tools like cannulae and probes has increased manifold. In addition to providing robotic assistance in all IR procedures, robots may also serve as potential alternatives to human operators who are at higher risk of unwarranted radiation exposure during brachytherapy. Robots could also be integrated with multimodality imaging systems and can be deployed for optical or mechanical position tracking, and for active guidance for path planning and treatment execution. In order for the medical robots to enter the clinical practice widely, they must evolve to be highly intelligent devices capable of independent functioning needing only minimal operator training. They must also be user-friendly, require less set-up timing, and speed up the current interventional procedures rapidly, and most importantly be costeffective. Medical robots such as MrBot and Acubot, and a few others are already being developed by a team of researchers in the west for image guidance applications. Medical robotics is at present a relatively young field that could in the long run be securing huge places in minimally invasive procedures.

Strategic Recommendations for IR Adoption: 1.

Need for collaboration between academia and corporate sectors: Image guided interventional procedures

2.

3.

are evolving from being single image guided procedures to being multimodality image guided interventions. The emerging practice is to derive completely useful clinical information from fused images of multivariate imaging techniques that have different resolutions and also images taken at different times during the courses of the disease.

But to execute this practice successfully, there is a need for expediting the development and standardization of image processing techniques and software required for the same.

Capitalize on enabling technologies for providing effective training to radiologists: IGI procedures are undergoing rapid development and new techniques and instrumentation are being added to the IR protocols. For the interventionalists to stay abreast of technology, a formal training and acquisition of the required skills to perform these IGI procedures with maximum level of safety to patients is required. But as there is a decline of invasive diagnostic procedures with the advent of improved imaging techniques, radiologists are not finding enough opportunities for real-time training with patients. Also, apprentice training on real patients lengthen procedure times and requires close monitoring by experts all of which increase the final cost of the procedure. Hence it is becoming critical for radiologist training programs to make use of nonpatientbased training and learning.

Integration of Healthcare-IT with IR procedures: The integration of PACS and other HC IT solutions will enable effective clinical implementation of IGI. At present, technology and device development for IGI and development of IGI enabling HC-IT solutions are under way in an independent manner. Vendors should come forward to design solutions for integrating the two together in order to make them completely functional systems that can meet end- user demands.

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In Conversation

Implanting

a Success...

Sushrut Surgicals and its group company Adler Mediequip, are widely known for their colossal contribution and market leadership in orthopaedic implants and devices in India and abroad.

Ajay Pitre, Managing Director, Sushrut Surgicals & Adler Mediequip and Vice Chairman, CII Medical Equipment Division shares his thought with eHEALTH about the achievements of his company, vision for the future and his wish-list for the government to catalyse the growth of domestic medical device industry in India.

Q. Sushrut is known as a pioneer in ortho implants and surgical equipment tools, and a market leader in spine and reconstructive surgery segment. When and how did it embark on this journey?

What had been the core competence and winning philosophy of the company?

A. Sushrut Surgicals began operations in 1973 and today it is recognised as one of India’s oldest and most trusted companies in the field of orthopaedic implants and instrumentation. The group company, Adler Mediequip, was set up in 1993 with the objective of building on Sushrut’s experience in orthopaedic device business and bringing worldclass orthopaedic medical devices to India. At present, Adler Mediequip is the exclusive manufacturing arm for the group’s operations, with Sushrut Surgicals being the marketing arm.

Adler is the first Indian orthopaedic device manufacturer to secure ISO 9002:1994 (in ’99); the first to receive ISO 9001:2000 (in ’02); the first to obtain the coveted CE certification (in ’03) and also the first in this field to be certified

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ISO 13485:2003 compliant (in ’06).

Recently, Adler Mediequip achieved the unique distinction of being the first Indian company to receive the Drug Manufacturing Licence from the Office of Drug Controller General of India, for its complete range of orthopaedic implants.

Q. What is the current portfolio of medical products and devices that Sushrut is offering? Which among are most cutting-edge in terms of technology and innovation?

A. Our current portfolio of devices can be divided into three broad clinical areas viz. ‘traumatology’, ‘spinal surgery’ and ‘reconstructive orthopaedic surgery’. In each of these areas, the group has a comprehensive range of implantable devices and complementary instrumentation. The group offers a number of solutions that are innovative and represent cutting edge technologies in clinical care.

One of the most innovative is a mini external fixator system – ‘UMEX’, developed in cooperation with a group

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of leading orthopaedic surgeons from Mumbai. This system enabled a revolutionary simpler method of correcting deformities in children, such as, club foot and club hand and has also enabled pioneering applications in area of post-burns deformity correction.

In the area of spinal surgery, the ‘OneLock’ spine system, a system of spinal screws and other associated devices used for spinal fusion/stabilisation surgery, represents cutting edge technology in terms of device performance.

In the area of reconstructive orthopaedic surgery, the group is currently engaged in making a strong contribution to the field of limb salvage surgery with the development of the ‘ResTOR’ modular resection system in association with Tata Memorial Hospital in Mumbai.

Q. What is your existing R&D capacity and manufacturing facility in India?

What is your level of annual investment (in percentage of turnover) on R&D? A. We realised quite early that our

In Conversation future lies in presenting ourselves with qualitative innovations that matter in a global scenario. Hence, we have been continuously reinvesting in development of solutions. Although, the development effort started in an ad hoc manner, currently, we have a group dedicated to R&D. Their direct and continuous interaction with surgeons helps in creating and validating many of our research and development. .

Q. What has been your marketing strategy in India? Kindly elaborate on your initiatives around surgeon education and CME programs?

A. Our marketing strategy in India has focused on building high quality relationships with Indian orthopaedic community at large and with senior professors and teachers in the field. We believe that these interactions continuously nurture ongoing improvement based on continuous feedback. This network of relationships also enabled the group to continuously evolve in terms of product design and portfolio that meets the need of Indian orthopaedic community.

Sushrut’s commitment to surgeon education has taken the form of a dedicated infrastructure in the form of the ‘Sushrut Learning Center’, located in Sushrut House, at Hinjewadi, Pune. This centre has been created with state-of-the-art learning infrastructure in form of a professionally designed auditorium, latest in multimedia and audio visual technologies, a dedicated hands-on workshop area and video conferencing facilities.

Q. What are the existing challenges for medical device and equipment industry in India? What will be your wish list from government authorities for boosting this industry?

A. I will split the answer in two sections - viz. regulations and its effects on domestic medical device industry and lack of understanding of the government about issues affecting this industry.

Till October 2005, medical device industry in India was totally unregulated. The poorly constituted Gazette Notification of October

2005 (as a knee-jerk reaction to a public interest litigation case in Mumbai) notified ten categories of implantable devices as ‘drugs’ and brought them under the purview of Drugs and Cosmetics Act and Rules. However, it was completely unsuitable due to differences in the manner in which drugs and devices are intended to perform in the human body, and thereby, different risks they present. Later on, interactions between industry bodies like CII and FICCI and the implementing regulatory office (Drugs Controller General of India) brought forth various issues involved in this and increased general understanding of the subject.

However, the knowledge developed through such interactions has neither percolated to regional hierarchy of regulators nor to relatively less knowledgeable sections of the domestic industry.

As opposed to importers who need to tackle issues only at the regulators head office (HQ of DGCI), the domestic industry needs to compulsorily have the first point of contact at the regional level, as per current procedures implementing the Drugs Act. To tackle problems at the regional level, the domestic industry has to interact with the State Government as well as the Central Government representatives causing enormous hardships and substantial delays.

To put into perspective, there are close to 600 import registration/licences granted till date, as against less than 50 domestic industry manufacturing licenses. Moreover, majority of domestic manufacturing licenses have gone to a handful of progressive companies with global ambitions. Many domestic players have not even applied due to lack of clarity and their inappropriate understanding of regulations.

As a case in point, our own orthopaedic device industry has been reverse discriminated against finished products, which are completely duty free importablable for nearly a decade. Vital implantable raw materials that can only be sourced internationally need to be

imported paying the highest duty rates + CVD amounting to 25 to 30% (lowest in this decade). Since finished products are exempted from Excise, we are actually paying higher than peak duty and therefore are being penalised for manufacturing in India.

Thus, it seems that Indian government has raised substantial tariff and non tariff barriers against domestic manufacturing Industry. We can only hope that the government will take corrective measures for ensuring equitable treatment.

My specific recommendations for the government would be as follows: 1. Recognise medical device as an independent and important industry for meeting cost effective healthcare needs across demographics.

2. Correct inappropriate regulations and grant adequate transition time.

3. Strictly enforce regulation without compromise on quality.

4. Remove duty anomalies faced by domestic manufacturers. Exempt them from import duties on raw materials, components or capital goods (technology).

5. Create grants/subsidised funding for domestic manufacturers for modernisation and technology adoption.

6. Encourage and fund innovation to create cost effective solutions.

Q. What has been the overall growth of medical device industry in India (in CAGR terms) in recent times? What are the future expectations?

A. The overall medical device industry has been growing by 12 – 15% CAGR in certain segments. In segments where there are latent unmet needs, it is likely to grow even as high as 25% CAGR. This growth rate will be largely driven by capacity and capability creation which can be considered as key drivers. Of course, economic progress as well as growth in health insurance coverage would be other factors responsible to expand the healthcare industry and hence add.

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TECH TRENDS

Latest in Haematology Analyzers:

Fluorescence Flow Cytometry Haematology has evolved into an interesting subject due to the advanced technology. Also, over the past few years; the market penetration of haematology analyzers has increased significantly in laboratories across the country. The latest technology in haematology analyzers is Fluorescence Flow Cytometry (FCM).

of cell counters as traditional flow cytometry instrumentation requires the use of highly specific antigenantibody reactions; often requiring pre-incubation and use of expensive reagents. In addition, gating of cell scattergram is complex which is manually performed by skilled operator, complexities of the reagents used, requirements of manual pipetting and not all applications are automated.

Haematology analyzers with FCM use Florescence dye to stain all sampled cells, which increases specificity and allows extension of clinical applications beyond the realm of traditional cell counting, without the complexity and cost of antigen/antibody reactions.

The term “cytometry” is defined as a measurement of physicochemical properties of cells and other biological particles. Flow cytometry offers measurements of cells and other particles flowing in thin streams.

Generally, it detects optical information from cells or other particles flowing in a thin stream under irradiation of a laser beam. Such optical information sources include scattered light and fluorescence depending on the measurement objective.

Recently, ingenious Fluorescence Flow Cytometry (FCM) Technology platform is introduced in mid-size haematology analyzers, which was successfully introduced with top-ofthe-end haematology analyzers. These analyzers with FCM offer excellent capabilities of best differentiation of

Since the late 1990s, cell counter manufacturers have been looking at flow cytometry techniques as a way of increasing the capabilities

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normal cells and pathological cells; and interference is managed better that before and that also without compromising throughput and reliability.

The major benefit of FCM to its users is improved detection of pathological cells like Immature Granulocyte Count, High Fluorescence Lymphocyte Count, Abnormal Lymphocyte Detection etc. The other advantage is improved quality of 5 part differential of WBC with 48 to 72 hours stability after blood collection and that also for High linear ranges (no dilution necessary). It has a stable and long life detector system requiring no calibration.

As depicted in the image of Optical System of haematology analyzers with FCM, it detects each cell from three angles.  Forward Scattered Light (Information on Cell volume)  Side Scattered Light (Information on Internal Cell structure)  Side Fluorescence Light (Information

TECH TRENDS

immature cells. With use of artificial intelligence based complex computer algorithm this differentiation is plotted as easy to interpret scattergram by the haematology analyzers.

on RNA/DNA content) Fluorescence Light detects DNA/ RNA information of cells along with information about Cell activity such as Duplication activity of the nucleus (High RNA) & Cytoplasm activity (Protein synthesis etc) This information is useful for very good differentiation of mature and

Hence, FCM enables Haematology analyzers to differentiate not only mature WBCs, but also mature and immature WBCs. By staining the cells, analytical sensitivity of cell counter is enhanced and signal-to-noise ratio is increased. Reportable ranges are extended and interferences are reduced.

FCM enabled Haematology analyzers are now able give more detailed IP messages and suspect messages like Neutropenia, Neutrophilia, Lymphopenia, Lymphocytosis, Monocytosis, Eosinophilia, Basophilia, Leukocytopenia, Leukocytosis, NRBC Present, Blasts, Immature Granulocytes, Abnormal Lymphoblasts, lymphocytes, NRBC, RBC Lyse Resistance,

Atypical Lymphocytes, Anisocytosis, Microcytosis, Macrocytosis, Hypochromia, Anemia, Erythrocytosis and Reticulocytosis They are also able to analyze special parameters like Fluorescence Platelet (PLT-FL), immature Granulocytes (IG), Nucleated Red Blood Cell (NRBC), Hematopoietic Progenitor Cells (HPC), Reticulocyte, Immature Reticulocyte Fraction (IRF), Reticulocyte Haemoglobin (RET-He), Immature Platelet Fraction (IPF), etc. Analysis of these parameters give insight into bone marrow erythropoietic activity, timing for apheresis in peripheral blood stem cell transplantation, clinical information of peripheral platelet destruction and marrow failure in thrombocytopenic patients.

(Article contributed by Transasia Bio-Medicals Ltd. E-mail : transasia@transasia.co.in Website : www.transasia.co.in)

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TECH TRENDS

‘Beams’ of Hope CYTOTRON has been proven to be an effective solution for tissue regeneration in patients suffering osteoarthritis or having joint injuries, and also promises to be a viable option for treating cancer in future. Based on Rotational Field Quantum Nuclear Magnetic Resonance (RFQMR) technology, this highly advanced treatment shows phenomenal improvement in patient’s quality of life, without leaving any major side-effect as associated with traditional radiotherapies.

Dr. R V Ravi Kumar of Centre for Advanced Research and Development (CARD), Bangalore, who holds the worldwide patent for CYTOTRON talks with eHEALTH about this technology and its application.

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t is established that trans-membrane potential (TMP) is one of the known cellular signaling pathways. TMP pathways also regulate synthesis of various proteins at the appropriate time in the living cells. Many illnesses – like cancer, heart disease, degenerative disorders like cartilage loss and different kind of inflammation – are also linked to disturbances in the protein transcription process. It was postulated in 1993 that if appropriate method can be developed to alter the TMP in a controlled manner, most of

these disorders that are protein linked can be tackled.

Rotational Field Quantum Nuclear Magnetic Resonance (RFQMR) is a technology that is made to deliver highly complex quantum Nuclear Magnetic Resonance beams in the subradio and radio frequency spectrum (using CYTOTRONTM, developed by Centre for Advanced Research and Development (CARD), the Research Wing of Scalene Cybernetics Limited), with a near field delivery using

Actual view of Cytotron at CARD, Bangalore

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specialised antenna (K- μ Ferrite type; Near Field; gain; 10dB), that when appropriately controlled can alter the TMP to the specific requirement like stimulation of HSP 70 group of protein in cartilage regeneration or P53 and it’s silent partner P73 protein in case of Neoplastic Disorders (Malignant Tumors). The delivered instantaneous mode magnetic and RF modulation is highly cell specific (based on proton density, permittivity and depth of penetration), to modulate the cell membrane potential in vivo, such that specific protein required for tissue regeneration or degeneration is initiated.

In Chondrogenesis (Cartilage cells) the RFQMR beams are precisely controlled and focused onto tissues therein generating streaming voltage potentials, this flow in the joint causes forced movement of hydrogen protons in the extra cellular matrix (ECM) due to alteration in nuclear spin in the hydrogen atoms and subsequent resonance. This causes a decrease in the TMP of the chondrocytes stimulating the production of the required protein for initiation of mitosis by dedifferentiation and redifferentiation.

TECH TRENDS How can you describe the CYTOTRON machine and the way it works?

CYTOTRON is a very large machine that carries about 864 emission guns (older versions with 288 guns) each of which produces high instantaneous magnetic field and radio frequency.

It also consists of a special near field antenna and parabolic reflectors to deliver these signals. These guns emit packets or quantum of programmed signals in time and space that are focused on the target of interest using laser guides. The antenna delivers these emitted strings of packets, which contain the dosimetry required for a specific medical condition. The beams are then rotated in 360 degrees around the target.

The patient is made to lie down on a traveling bed, the bed travels into the bore of the CYTOTRON, the laser guides come on and the technician focuses the guns as per a pre-prepared template. The secondary dosimetry that is prepared by a trained doctor is initiated from the control room and the CYTOTRON starts its job. After completing the assigned dose of radiation, the device automatically stops and the patient is taken out of the bore.

Apart from Osteoarthritis and joint injury can CYTOTRON be used for curing other noncommunicable diseases? What is the progress so far for treating cancer patients?

Theoretically yes, but practically there are some challenges. Firstly, till now, not much is understood about protein synthesis and TMP pathways for most diseases. In areas it is understood, it is a long drawn process to create precise algorithms and delivery systems, simulate the outcome and then conduct clinical trials before it can be used to cure diseases. For instance, it took more than 15 years to treat the first patient for osteoarthritis, and similarly for cancer. There is need for a lot of research in this area.

Currently, freshly diagnosed cancer patients are not treated with CYTOTRON as the phase II trial has to be completed and proper protocols

has to be put in place before it is used for general public. However, it is still experimental in treatment of Cancer as a primary therapy, or in combination with existing modalities. It is also experimental in the treatment of Neurological disorders and other noncommunicable diseases.

quality of life, for whatever period they lived. All our research outcomes are audited by International third party audit and not the mere analysis of the project investigators.

What is the success rate of CYTOTRON treatment in Osteoarthritis and Cancer?

None of the implants are a contraindication as long as they are MR compatible, that is, you are permitted to take an MRI scan by your radiologist. Pacemakers are absolutely contraindicated, even if it is MR compatible. Pacemakers or any other radiosensitive implanted devices should not be allowed within 15 meters of the CYTOTRON machine.

First of all, it depends on how you define ‘success rate’. Success can be viewed from both subjective and objective side. Subjective side is how the patient feels and his general quality of life after the treatment and the objective side is the actual physical measurements that determine the end point of our research. In case of osteoarthritis, the subjective success is about 85% and the objective success is about 98%; this

means 85% of the 202 patients treated during the phase II clinical trials were pain free, with increased movement of their treated joints and could walk longer distance, climb stairs and drive.

The objective success rate is 98%, as we could achieve our end-point for up to 98% of the patients treated.

In case of terminal cancer patients, the success rate means a little different from others. Terminal cancer patients have a few weeks or months to live. So, in research involving terminal cancer patients, a one-year survival rate is taken. Out of the treated terminal cancer patients, the one year survival rate was 52% (including patients who died of heart attacks kidney failure etc.,) while 92% of the patients had improved

Can a patient with cardiac stents, orthopedic implants or pacemakers be treated with CYTOTRON?

Are there any adverse health effects of CYTOTRON-based treatments?

All forms of radiations are harmful, some are more and some are less. High frequency radiations are considered very harmful as they cause ionization of biological structure. However, RFQMRbased CYTOTRON emits only low frequency radiations that cannot damage biological tissues. However, if delivered uncontrolled, they are reported to cause minor physiological effects like depression or pain or some metabolic abnormalities. That is why we take enough precautions and checks in operations of this machine.

Only certified technicians and doctors trained by us are eligible to use it on patients.

Is CYTOTRON commercially available in India? What could be the price of the machine?

CYTOTRON will be commercially available from April ‘09 onwards.

CYTOTRON has been licensed exclusively to Scalene Cybernetics Limited to manufacture and market it internationally. CYTOTRON is also the registered Trade Mark of Scalene Cybernetics Limited. The whole body machine with 864 guns would cost around 2.5 crore (25 million) Indian rupees.

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SPOTLIGHT

Technology for lowering costs in medical devices Progress in medical sciences including significant sophisticated diagnostic equipment, tools and medical devices has addled the developed world with rapidly rising healthcare costs.

With a global revenue of $200 billion, the medical device industry is under mounting pressure to curtail these sky rocketing costs while increasing the life expectancy and quality of life.

While on the face of it the situation seems beyond repair, help is coming from unlikely quarters namely, the global outsourcing industry.

Technology enabled healthcare and outsourcing - the antidote Milind Purandare, Associate Vice President, Solutions (Product Engineering Services), Patni Computers

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onsider this - the US currently spends close to 15% of its GDP on healthcare and this figure is expected to rise to 25% over the next 20 years. United Kingdom spends close to 8.3% of its GDP on healthcare and is under considerable pressure to reduce its healthcare costs.

This is clearly indicative of the fact that medical costs are soaring while the system reels under the pressure of increasing demand caused by aging baby-boomers and a sedentary lifestyle. The challenge therefore is two-fold; an urgent need to reduce costs while increasing productivity.

Hence the focal point for both these challenges are modern day medical devices such as CT, MR Scan machines, implanted pacemakers and ICDs and home dialysis machines While helping speed up the diagnosis and treatment processes, these devices add to overall healthcare costs.

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In the light of a growing concern over healthcare spends, medical observers are looking at the potential of technology and innovation to rescue the medical devices budget crisis. To be able to play an effective role in cost reduction, the medical device industry will need to devise new approaches and create devices aimed at driving down the costs of providing care. Cost reducing innovations are expected to be primarily in the areas of electronic health information capture / storage / access, integration between medical devices and electronic medical records, improved point of care devices with wireless networking, homecare monitoring, therapy devices for proactive diagnosis and remote interventions. With the aid of newer technologies, physicians and other healthcare providers can examine, treat and monitor patients remotely without compromising on standards of care. In addition, applications in areas such as tele-diagnosis, tele-surgery and teleconsultation are expected to reduce costs of patient movement and disease management.

That said, the question that one is

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faced with at this juncture is who will take the initiative and whose ownership it is to make this cost-effective remote management possible.

While traditional medical device companies are not likely to take this up, they can partner with IT services companies to pioneer low-cost innovations. In the recent past, IT companies have been involved in a multitude of such projects.

Believe it or not India today has a rapidly growing experience base in developing innovative solutions in healthcare.

This has been largely driven by the engineering services offered to leading global medical device companies making high ended products like diagnostic imaging modalities such as CT scan, MRI and ultrasound machines. Also serviced are companies making highly critical products such as pacemakers and implanted defibrillators.

Making Outsourcing Work As is evident, several medical device development processes are outsourced to cost-effective and domain-intensive locations like India. As the healthcare outsourcing model continues to mature, companies are realizing that outsourcing other key areas of product design and development can impart large productivity gains that translate into competitive advantages. Medical device manufacturers are now seeking partners that can provide full service outsourcing, completing all phases of device development, from market research through prototype build and equipment design.

EVENT PREVIEW

Strong Showing Expected at Asia’s Leading Media Event Asia’s leading infocomm and media event to meet exhibitor participation targets even in difficult business climate.

CommunicAsia 2009 and BroadcastAsia 2009 are expected to feature about 2,000 exhibiting companies from 65 countries and regions from across the globe, demonstrating the strong demand by companies to expand their footprint in Asia’s emerging markets and the importance of the annual exhibitions as networking and sourcing platforms for the global infocomm and media industries. The shows will be on from 16 - 19 June 2009 at the Singapore Expo.

The infocomm industry’s strength is still evident despite the unpredictable conditions in the global economy.

Infocomm sectors in many Asian countries are out-performing the rest of the economy, none more evident than in India. India’s mobile users grew by 15.4 million1 in January this year, recording its biggest monthly growth in history. With only 34.5 percent of the population owning a telephone, the market potential is immense. A more striking statistic is the nine percent penetration in rural areas, representing, according to the government, the “next accelerator” for mobile growth.

“The global gloom has accentuated the gleaming potential in Asia and increased the urgency in which international companies are moving into the continent,” said Stephen Tan, Chief Executive, Singapore Exhibition Services.

“CommunicAsia and BroadcastAsia’s established reputation

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and repeated ability to attract trade professionals from across the Asia Pacific region makes the shows the first choice for exhibiting companies, especially in the current environment of tighter budgets,”he added. Visitors can look forward to exciting displays from market leaders like Blackberry, Google, Harris, Huawei, LG, Navteq, Samsung, Yahoo! and ZTE. First-time exhibitor at CommunicAsia, Aricent, further affirms the show’s importance for companies. “CommunicAsia is a key event for Aricent. Catering to convergent technologies and applications at a global level, Communicasia reflects the unprecedented change in the communication landscape. As a premiere event, Communicasia provides an ideal environment to showcase cutting-edge products and services,” said Raj K. Bajaj, Regional Director, APAC, Aricent.

“The prominence of attendees also offers a great opportunity for us to network with peers and customers. We are very happy to participate in the show and we are confident of achieving the desired brand awareness and visibility for our offerings.”

As companies are turning to cutting-edge technologies to meet the challenges posed by today’s tough economic climate, CommunicAsia2009 will focus on the latest Hot Technologies for applications, solutions and hardware. These key technologies,

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which are already starting to have a huge impact on the way we live, work and play, include IPTV, Mobile Entertainment, WiMAX, Navigation & LBS, Satellite, Femtocell, iGov, Wireless Technologies, Green IT, and Mobile Internet.

In response to the buzzing media industry development in Asia, BroadcastAsia2009 will again feature key technologies that draw huge interest and demand from the market. These include Broadcastto-Handheld/Mobile TV, Digital Media Asset Management, HighDefinition Technology, IPTV, Mobile Broadcasting and Professional Audio Technology.

Featured for the first time at BroadcastAsia2009 is Digital Signage, which reflects the growing global demands of the retail, hospitality and entertainment industries for a dynamic medium to captivate their audiences. A form of electronic display that is installed in public spaces, Digital Signage is set to replace the conventional printed posters with state-of-the-art digital display panels.

CommunicAsia, BroadcastAsia, CG Overdrive, as well as various intergovernment meetings, are part of the Infocomm Media Business Exchange (imbX). It brings together business leaders, companies and industry professionals to showcase their latest innovations, network, exchange ideas and tap new markets.

NEWS REVIEW

Schiller India Launches MRI Monitor–MAGLIFE C Plus Schiller India, a leading Swiss Joint Venture Company in the field of Medical Diagnostics, have recently launched their MRI compatible monitor, MAGLIFE C Plus which offers complete and safe solution for monitoring high risk patients, undergoing MRI examination or MRI surgery. The MAGLIFE C Plus has been successfully installed in some leading hospitals in India such as, Kokilaben Dhirubhai Ambani Hospital, Mumbai and AIIMS, New Delhi. The MAGLIFE C plus integrates all the standard as well as optional parameters into a single unit, thereby permitting full control of the monitor from a single point. It also allows the buyer to select only required parameters for upgrades thereby optimising the purchase costs.

MAQUET introduces advanced MAGNUS Operating Table Maquet recently launched the advanced MAGNUS operating table system. From preparation to transport and diagnostics, up to the surgery and post-operative care, MAGNUS has been developed as a comprehensive system that optimally caters to the full spectrum of surgery - particularly those involving minimally invasive interventions and logistics. The operation table system can also dynamically adapt to ongoing changes in surgical techniques. With a service life of an average of some 20 years, the MAGNUS has been designed to integrate the very latest technical optimisations and to allow for modular expansion of the system whenever and wherever required.

Motorola Launches New Series of Mobile Computers in India Motorola’s Enterprise Mobility Business recently unveiled the new FR series of mobile computers which initially includes the rugged and compact FR68 and FR6000 models. The series, providing operability in a range of local languages, is designed to increase productivity wherever and whenever work needs to be done in small, medium or large enterprises across verticals such as retail, healthcare, logistics, transportation, utilities, manufacturing or public safety. With them, companies can achieve higher levels of resource optimization and operational efficiency and give mobile workforces the ability to work on business essential enterprise resource platforms as well as access and process business critical data on the go.

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InterSystems named ‘Health IT Company of the Year’ by Frost and Sullivan InterSystems Corporation has recently announced that it has been awarded ‘Healthcare IT Company of the Year’ in the prestigious 2009 Frost & Sullivan Asia Pacific Excellence in Healthcare Awards, following successful implementations in China, India, Thailand, Japan, Taiwan, Indonesia, Malaysia, Australia, New Zealand and Singapore. In awarding InterSystems, Frost & Sullivan judged that the company offers high quality products and services and is growing rapidly in the Asia Pacific region. This growth is driven by strong market demand for InterSystems TrakCare™, an advanced Web-based healthcare information system that rapidly delivers the benefits of an Electronic Patient Record. TrakCare offers unparalleled flexibility that makes it a strong choice for meeting the unique needs of international markets like Asia.

iSoft bags new projects around the world Even in the face of an ongoing global slowdown and economic recession, iSoft - an IBA Health company has been doing exceedingly well. After tendering a revenue growth of 168% in its half year ending December 31st, ‘08, the company announced a string of new projects from around the world over last couple of months, amounting to nearly USD 11 million. Two of the bigger projects, came from Spain and England, worth USD 3.85 million and USD 3.54 million respectively. While a Spanish regional government has chosen iSoft for implementing clinical and patient management system for their 28 hospitals over next two years, the Heatherwood and Wexham Park Hospitals under NHS Trust will deploy iSOFT’s iPatient Manager (i.PM) PAS and a technical refresh of an existing iSOFT clinical solution, iClinical Manager (i.CM) over next five years. In Germany, the company has been contracted by private healthcare group Damp Holding AG, for deploying an integrated RIS & PACS at a cost of USD 2.22 million. Al-Khadra Hospital in Tripoli, Libya will implement iSoft’s eHIS and LabCentre solution in its 580-bedded multi-specialty facility for USD 1 million.

Relatively small ticket projects in Latin American states of Mexico and Honduras also added to the overall booty with a combined revenue of USD 0.35 million.

NEWS REVIEW

Barco’s new clinical review displays to be installed at Stanford Hospital and Clinics Medical imaging specialist Barco has been selected by Stanford Hospital and Clinics, part of Stanford University Medical Center, to supply 58 of its recently launched MDRC 2120 clinical review displays. Installation of the 2 MegaPixel displays is ongoing with 40 currently deployed.

Thanks to the new displays, referring physicians at Stanford will be able to utilize this dependable and DICOM compliant review solution throughout the enterprise. The Barco MDRC-2120 is a brand-new clinical review display featuring a 20-inch screen, 1600 by 1200 native resolution, backlight stabilization, rotating mount and a multi-lingual on-screen display. Equipped with professional LCD-technology and a built-in DICOM Look-Up Table, the MDRC presents medical images with more accurate grayscales, better contrast and a wider viewing angle than conventional computer monitors. Hence, the displays are a perfect match for the Stanford Hospital and Clinics’ advanced network of PACS workstations.

Brandon Medical Announces JV with Trivitron Healthcare

TAKE Solutions adds Cadila Pharmaceuticals to their growing list of clients

Trivitron has recently partnered with Brandon Medical, UK to manufacture advanced, shadow-less OT lights in India. Through this tie-up, Brandon Medical will set up production facility at Trivitron’s Medical Technology Park in Chennai. Brandon Medical is one of the leading manufacturers of OT lights, having product range across OT lamps, mobile operating lamps, minor surgical/ examination lamps, surgeons control panels and emergency power systems. The company has expertise in surgical lighting design with a reputation for innovation and design through incorporating the innovative HD-LED technology.

Cadila Pharmaceuticals recently selected TAKE Solutions for their PharmaReady eCTD, SPL and PPM software for regulatory submissions management. Considered to be a major win, the project came in less than twelve months since TAKE Solutions launched the product in India. Speaking on this occassion, Ramesh L, VP-Sales, Life Sciences APAC, said, “Cadila is a valuable addition to our growing list of Indian customers. The association with a brand like Cadila proves the reliability of our products for top notch companies.

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Dr Paul Chang Managing Director – Asia Pacific Joint Commission International (JCI), Singapore Vishal Bali CEO Wockhardt Hospitals Group, India Prof. Aw Tar Choon Senior Consultant – Laboratory Changi General Hospital, Singapore Norlia Musa Principal Consultant SIRIM, Malaysia

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EVENT REPORT

CII MEDITech Summit 2009 April 10, Hyatt Regency, Mumbai Technology will play a significant role in healthcare industry across the globe... and even more so in India, where it is still at a nascent stage.

The recently organised ‘CII MEDI Tech Summit 2009’ threw light on this crucial aspect that promises to transform healthcare industry by leveraging technology to improve standards of care.

Delivering the special address of this summit, Dr. Laxman Prasad, Advisor– Technology Development, Department of Science & Technology, Government of India emphasized the current healthcare situation in the country and brought forth the underlying need for active public-private partnership. “Our case is peculiar, in the sense that, 26% population is still below poverty line and many don’t even have the basic amenities of life. With this scenario, we must move ahead together to enhance the entire healthcare industry. For each rupee spent by the government, we propose the industry to spend 1.5 rupees to develop and strengthen this line.”

Echoing his sentiments, Sangita Reddy, Executive Director–Operations, Apollo Group of Hospitals, said, “We are determined to use this powerful medium and leverage technology for

effective healthcare. It is a subject that is not only being talked about by patients or their relatives alone, but has also become a debate inside most boardrooms. It is the key to the future of our country.” Anand Rangachary, Managing Director, Frost & Sulivan–South Asia and Middle East seconded this opinion. Thinking more in terms of targeting the mass instead of just the class, he said, “Innovation has to come in terms of technology and its availability. Creating awareness in remotest areas is another must.”

A Vaidheesh, Chairman–CII MEDI Tech Summit 2009 & Managing Director Johnson & Johnson Medical, India observed, “Though India is catching up rapidly and has been improving on healthcare, countries like Japan and China are way ahead in this. According to a report, healthcare is a USD 35 billion industry in India and is expected to reach over USD 75 billion by 2012 and further to USD 150 billion in another five years thereafter. Currently, it is just around 5% of India’s GDP.” Since technology is now weaved in our daily life, leveraging and focusing it to healthcare industry has become even more significant. Conveying this thought, Mr Vaidheesh expressed the

CEO’s Interactive Roundtable:”Charting A Roadmap To Leverage Technology For Transforming Standards of Care”: (Seated L-R): Anand Rangachary, Frost & Sullivan, Anjan Bose, Philips Healthcare India, Sangita Reddy, Apollo Group of Hospitals, A. Vaidheesh, J&J Medical India, Mini Menon, UTV News Ltd., Ajay Pitre, Sushrut Surgicals Pvt. Ltd., Samuel Mathew Kalarickal, Apollo Hospitals, Adarsh Chaudhary, Sir Ganga Ram Hospital and Vikram Jit Singh Chhatwal, Reliance Health Ventures Ltd.

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purpose of the summit with an ideal remark. “If you follow the normal way, it’s going to take a long time to reach the desired level. However, the need today is for disruptive innovations to leap frog to the next level. Interplay of various components in this system including complex financial systems and how will they play a significant role in today’s world, is the key to get there faster,” he said.

Looking at the future on how to leverage technology for transforming standards of care, and replying to Dr Laxman Prasad’s comments, Mr Vaidheesh rounded up the summit on a high note, saying, “I welcome the government’s stand. It is very insightful.

It is good to know that so much work is being done by the Government of India in science and technology and I welcome its move.”

Later in the event, CEOs from various institutions came together for a highly interactive roundtable to chart out a roadmap for growth and find best possible ways to implement such strategies in most efficient and effective manner. Along with Mr. Vaidheesh and Sangita Reddy, others who graced the brainstorming session included - Ajay Pitre, Vice Chairman, CII Medical Equipment Division and Managing Director, Sushrut Surgicals Pvt. Ltd.; Anjan Bose, Senior Director & Business Head–Philips Healthcare India; Anand Rangachary, Managing Director, Frost & Sullivan–South Asia and Middle East, Dr Samuel Mathew Kalarickal, Director–Cardiac Catheterisation Laboratories, Apollo Hospital Enterprises Ltd. and Dr Vikram Jit Singh Chhatwal, CEO, Reliance Health Ventures Ltd. It was almost unanimously agreed by the participants that it is necessary to reach the grass root level and chart out a course to zero-in on right medical care through innovative technologies and solutions. eHEALTH Bureau.

IN FOCUS

CyberKnife – surgery ‘sans’ scalpel The CyberKnife Robotic Radiosurgery System is a non-invasive alternative to surgery for treating both cancerous and noncancerous tumors anywhere in the human body, including, the prostate, lung, brain, spine, liver, pancreas and kidney.

This treatment, which delivers high doses of radiation to tumors with extreme accuracy, offers new hope for patients who have inoperable or surgically complex tumors, or who may be looking for a non-surgical option. Till date, more than 60,000 patients have been treated and more than 150 systems are installed worldwide. CyberKnife has revolutionized the way radiotherapy is delivered and its applications are increasing day by day.

Can you think of surgery without a scalpel? Today it is possible... thanks to a high tech tool that treats tumors without needing to undergo any physical surgery.

The Apollo Speciality Cancer Hospital in Chennai recently launched its ‘CyberKnife Center’, making it the first such centre of Asia-pacific region to offer this treatment.

Dr. P.Mahadev, MD, DNB, DMRT Apollo Speciality Cancer Hospital, Chennai

CyberKnife combines advanced robotics and missile-guidance technology to pinpoint the position of tumors and deliver highly focused beams of radiation without damaging surrounding tissues.

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The word ‘knife’ conjures up an image of an invasive procedure with a scalpel at the hands of a doctor. In reality, the CyberKnife is an outpatient, totally non-invasive, painless, bloodless procedure and does not involve a knife at all. This highly advanced radiotherapy machine can literally achieve what a knife can do in the expert hand of an experienced surgeon.

At first sight the CyberKnife looks like a space age robot seen in sci-fi movies or in children’s toy shops. It is actually a compact linear accelerator mounted on a robotic arm. The CyberKnife works by delivering multiple beams of high dose radiation from a wide variety of angles. X-ray cameras monitor the patient’s breathing and re-position the radiotherapy beam in order to minimize damage to healthy tissue. Such level of accuracy enables treatment of tumors that are located in difficult or dangerous-to-treat positions inside the body, such as those near those near spinal cord.

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CyberKnife is the world’s first and only whole body radiosurgery system that can treat tumors anywhere in the body with sub millimeter accuracy.

The CyberKnife uses extremely precise beams of radiation, combined with data from three-dimensional scans, to target tumors and lesions all over the body. It can eradicate malignant and benign tumors that were previously thought non-treatable by conventional surgical and radiation methods.

In essence, with its high precision and accuracy, a CyberKnife procedure can provide surgery-like results, without surgery. It’s a painless outpatient procedure without the risk and complications associated with traditional surgery.

CyberKnife combines advanced robotics and missile-guidance technology to pinpoint the position of tumors and deliver highly focused beams of radiation without damaging surrounding tissues.

A computer program evaluates the unique shape and location of the tumor to decide the orientation of each of the 1,200 or more beams of radiation that will target the tumor.

An x-ray source located on the CyberKnife’s robotic arm delivers concentrated beams of radiation to the tumor from multiple positions and angles. Individual beams are not

IN FOCUS

Once the treatment plan has been developed, the patient is ready to undergo the CyberKnife procedure.

After arriving at the CyberKnife Center, patients are comfortably positioned on the treatment table. Following this, the CyberKnife System’s computercontrolled robot slowly starts moving around the patient to various locations from which it will deliver radiation to the tumor.

CyberKnife System strong enough to damage any healthy surrounding tissue by themselves. The beams are targeted to intersect at the tumor, where their combined strength is intense.

The very flexible range of motion offered by the robotic arm allows the CyberKnife to reach tumors that are not reachable by other means.

The CyberKnife continually checks and corrects for any patient movement during the treatment, ensuring superior accuracy. Some of the technologies used are the Synchrony respiratory tracking, X-sight spine, and X-sight Lung. With this accuracy, the CyberKnife can use higher doses of radiation to attack tumors. One of the major advantages with this technology is that now even moving targets like those in the lung, liver, pancreas and prostate can be treated accurately with Radiosurgery.

to generate a treatment plan. The plan is used to match the desired radiation dose to the identified tumor location while limiting radiation exposure to the surrounding healthy tissues.

Each treatment session will last between 30 to 90 minutes, depending on the type of tumor being treated.

If treatment is being delivered in stages, patients will need to return for additional treatments over several days (typically no more than five), as determined by the doctor. Patients may experience some minimal side effects, but those often go away within the first week or two after treatment.

What is Stereotactic Radiosurgery?

Radiosurgery refers to the use of a high-energy beam of radiation. Stereotactic refers to the three-dimensional targeting system used to deliver the beam to the precise location desired. Radiosurgery can be performed in a single session or with divided doses, when it is known as fractionated radiosurgery. Previously, stereotactic radiosurgery was primarily confined to the head and neck, because the patient must be kept completely still during the delivery of the radiation in order to prevent damage to surrounding tissue. The motion of the patient’s head and neck was restricted by a stereotactic frame that holds them in place. It was difficult to immobilize other body regions in this way. However, with advanced technology used in CyberKnife system, the stereotactic frame is totally done away with and hence radiosurgery now can be done for lesions anywhere in the body.

Treatment Process CyberKnife treatments involve a team approach in which several specialists like Radiation oncologists, Neurosurgeons and medical physicists participate. Prior to the procedure, the patient is imaged using a high-resolution CT scan to determine the size, shape and location of the tumor.

Following scanning, the image data is digitally transferred to the CyberKnife System’s workstation, where the treatment planning begins. A qualified clinician then uses the CyberKnife software

(Left to Right): Dr.Janos Stumpf, Director Medical Services & Director Research in Radiation Oncology, Apollo Speciality Hospital, Chennai; Dr. Prathap C Reddy, Chairman, Apollo Group of Hospitals, Dr. Ganapathy Krishnan, Consultant Neurosurgeon, Apollo Hospitals

May 2009

43

More than 2 million people in UK regularly buy their drugs online.

Rural areas in India have only20% of total hospital beds available in the country.

IT budget of UK-NHS is worth US$ 30 billion.

Market for medical equipments in India is worth US$ 1.029 billion.

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