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“FrontMatter.”

The Biomedical Engineering HandBook, Second Edition.

Ed. Joseph D. Bronzino

Boca Raton: CRC Press LLC, 2000

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Introduction and Preface

As we enter the new millennium, the prospects for the ﬁeld of Biomedical Engineering are bright.

Individuals interested in pursuing careers in this ﬁeld continue to increase and the fruits of medical

innovation continue to yield both monetary rewards and patient well being. These trends are reﬂected

in this second edition of the

. When compared to the ﬁrst edition

published in 1995, this new two-volume set includes new sections on “Transport Phenomena and

Biomimetic Systems” and “Ethical Issues Associated with Medical Technology”. In addition, over 60% of

the chapters has been completely revised, incorporating the latest developments in the ﬁeld. therefore,

this second edition is truly an updated version of the “state-of-the-ﬁeld of biomedical engineering”. As

such, it can serve as an excellent reference for individuals interested not only in a review of fundamental

physiology, but also in quickly being brought up to speed in certain areas of biomedical engineering

research. It can serve as an excellent textbook for students in areas where traditional textbooks have not

yet been developed, and serve as an excellent review of the major areas of activity in each biomedical

engineering subdiscipline, such as biomechanics biomaterials, clinical engineering, artiﬁcial intelligence,

etc., and ﬁnally it can serve as the “bible” for practicing biomedical engineering professionals by covering

such topics as a “Historical Perspective of Medical Technology, the Role of Professional Societies and the

Ethical Issues Associated with Medical Technology”.

Biomedical Engineering is no longer an emerging discipline; it has become an important vital inter-

disciplinary ﬁeld. Biomedical engineers are involved in many medical ventures. They are involved in the

design, development and utilization of materials, devices (such as pacemakers, lithotripsy, etc.) and

techniques (such as signal processing, artiﬁcial intelligence, etc.) for clinical research and use; and serve

as members of the health care delivery team (clinical engineering, medical informatics, rehabilitation

engineering, etc.) seeking new solutions for difﬁcult heath care problems confronting our society. To

meet the needs of this diverse body of biomedical engineers, this handbook provides a central core of

knowledge in those ﬁelds encompassed by the discipline of biomedical engineering as we enter the 21st

century. Before presenting this detailed information, however, it is important to provide a sense of the

evolution of the modern health care system and identify the diverse activities biomedical engineers

perform to assist in the diagnosis and treatment of patients.

Biomedical Engineering Handbook

Evolution of the Modern Health Care System

Before 1900, medicine had little to offer the average citizen, since its resources consisted mainly of the

physician, his education, and his “little black bag.” In general, physicians seemed to be in short supply,

but the shortage had rather different causes than the current crisis in the availability of health care

professionals. Although the costs of obtaining medical training were relatively low, the demand for

doctors’ services also was very small, since many of the services provided by the physician also could be

obtained from experienced amateurs in the community. The home was typically the site for treatment

and recuperation, and relatives and neighbors constituted an able and willing nursing staff. Babies were

delivered by midwives, and those illnesses not cured by home remedies were left to run their natural,

albeit frequently fatal, course. The contrast with contemporary health care practices, in which specialized

physicians and nurses located within the hospital provide critical diagnostic and treatment services, is

dramatic.

The changes that have occurred within medical science originated in the rapid developments that took

place in the applied sciences (chemistry, physics, engineering, microbiology, physiology, pharmacology,

etc.) at the turn of the century. This process of development was characterized by intense interdisciplinary

cross-fertilization, which provided an environment in which medical research was able to take giant

strides in developing techniques for the diagnosis and treatment of disease. For example, in 1903, Willem

Einthoven, the Dutch physiologist, devised the ﬁrst electrocardiograph to measure the electrical activity

of the heart. In applying discoveries in the physical sciences to the analysis of biologic process, he initiated

a new age in both cardiovascular medicine and electrical measurement techniques.

New discoveries in medical sciences followed one another like intermediates in a chain reaction.

However, the most signiﬁcant innovation for clinical medicine was the development of x-rays. These

“new kinds of rays,” as their discoverer W. K. Roentgen described them in 1895, opened the “inner man”

to medical inspection. Initially, x-rays were used to diagnose bone fractures and dislocations, and in the

process, x-ray machines became commonplace in most urban hospitals. Separate departments of radi-

ology were established, and their inﬂuence spread to other departments throughout the hospital. By the

1930s, x-ray visualization of practically all organ systems of the body had been made possible through

the use of barium salts and a wide variety of radiopaque materials.

X-ray technology gave physicians a powerful tool that, for the ﬁrst time, permitted accurate diagnosis

of a wide variety of diseases and injuries. Moreover, since x-ray machines were too cumbersome and

expensive for local doctors and clinics, they had to be placed in health care centers or hospitals. Once

there, x-ray technology essentially triggered the transformation of the hospital from a passive receptacle

for the sick to an active curative institution for all members of society.

For economic reasons, the centralization of health care services became essential because of many

other important technological innovations appearing on the medical scene. However, hospitals remained

institutions to dread, and it was not until the introduction of sulfanilamide in the mid-1930s and penicillin

in the early 1940s that the main danger of hospitalization, i.e., cross-infection among patients, was

signiﬁcantly reduced. With these new drugs in their arsenals, surgeons were able to perform their

operations without prohibitive morbidity and mortality due to infection. Furthermore, even though the

different blood groups and their incompatibility were discovered in 1900 and sodium citrate was used

in 1913 to prevent clotting, full development of blood banks was not practical until the 1930s, when

technology provided adequate refrigeration. Until that time, “fresh” donors were bled and the blood

transfused while it was still warm.

Once these surgical suites were established, the employment of speciﬁcally designed pieces of medical

technology assisted in further advancing the development of complex surgical procedures. For example,

the Drinker respirator was introduced in 1927 and the ﬁrst heart-lung bypass in 1939. By the 1940s,

medical procedures heavily dependent on medical technology, such as cardiac catheterization and angio-

graphy (the use of a cannula threaded through an arm vein and into the heart with the injection of

radiopaque dye for the x-ray visualization of lung and heart vessels and valves), were developed. As a

result, accurate diagnosis of congenital and acquired heart disease (mainly valve disorders due to rheu-

matic fever) became possible, and a new era of cardiac and vascular surgery was established.

Following World War II, technological advances were spurred on by efforts to develop superior weapon

systems and establish habitats in space and on the ocean ﬂoor. As a by-product of these efforts, the

development of medical devices accelerated and the medical profession beneﬁted greatly from this rapid

surge of “technological ﬁnds.” Consider the following examples:

1. Advances in solid-state electronics made it possible to map the subtle behavior of the fundamental

unit of the central nervous system — the neuron — as well as to monitor various physiologic

parameters, such as the electrocardiogram, of patients in intensive care units.

2. New prosthetic devices became a goal of engineers involved in providing the disabled with tools

to improve their quality of life.

3. Nuclear medicine — an outgrowth of the atomic age — emerged as a powerful and effective

approach in detecting and treating speciﬁc physiologic abnormalities.

4. Diagnostic ultrasound based on sonar technology became so widely accepted that ultrasonic

studies are now part of the routine diagnostic workup in many medical specialties.

5. “Spare parts” surgery also became commonplace. Technologists were encouraged to provide car-

diac assist devices, such as artiﬁcial heart valves and artiﬁcial blood vessels, and the artiﬁcial heart

program was launched to develop a replacement for a defective or diseased human heart.

6. Advances in materials have made the development of disposable medical devices, such as needles

and thermometers, as well as implantable drug delivery systems, a reality.

7. Computers similar to those developed to control the ﬂight plans of the

capsule were used

to store, process, and cross-check medical records, to monitor patient status in intensive care units,

and to provide sophisticated statistical diagnoses of potential diseases correlated with speciﬁc sets

of patient symptoms.

8. Development of the ﬁrst computer-based medical instrument, the computerized axial tomography

scanner, revolutionized clinical approaches to noninvasive diagnostic imaging procedures, which

now include magnetic resonance imaging and positron emission tomography as well.

Apollo

The impact of these discoveries and many others has been profound. The health care system consisting

primarily of the “horse and buggy” physician is gone forever, replaced by a technologically sophisticated

clinical staff operating primarily in “modern” hospitals designed to accommodate the new medical

technology. This evolutionary process continues, with advances in biotechnology and tissue engineering

altering the very nature of the health care delivery system itself.

The Field of Biomedical Engineering

Today, many of the problems confronting health professionals are of extreme interest to engineers because

they involve the design and practical application of medical devices and systems — processes that are

fundamental to engineering practice. These medically related design problems can range from very

complex large-scale constructs, such as the design and implementation of automated clinical laboratories,

multiphasic screening facilities (i.e., centers that permit many clinical tests to be conducted), and hospital

information systems, to the creation of relatively small and “simple” devices, such as recording electrodes

and biosensors, that may be used to monitor the activity of speciﬁc physiologic processes in either a

research or clinical setting. They encompass the many complexities of remote monitoring and telemetry,

including the requirements of emergency vehicles, operating rooms, and intensive care units. The Amer-

ican health care system, therefore, encompasses many problems that represent challenges to certain

members of the engineering profession called

biomedical engineers.

Biomedical Engineering: A Deﬁnition

Although what is included in the ﬁeld of biomedical engineering is considered by many to be quite clear,

there are some disagreements about its deﬁnition. For example, consider the terms

biomedical engineering,

bioengineering,

and

clinical

(or

medical

)

engineering

which have been deﬁned in Pacela’s

Bioengineering

Education Directory

[Quest Publishing Co., 1990]. While Pacela deﬁnes

bioengineering

as the broad

umbrella term used to describe this entire ﬁeld,

is usually deﬁned as a basic research–ori-

ented activity closely related to biotechnology and genetic engineering, i.e., the modiﬁcation of animal

or plant cells, or parts of cells, to improve plants or animals or to develop new microorganisms for

beneﬁcial ends. In the food industry, for example, this has meant the improvement of strains of yeast

for fermentation. In agriculture, bioengineers may be concerned with the improvement of crop yields

by treatment of plants with organisms to reduce frost damage. It is clear that bioengineers of the future

bioengineering

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