Remote Monitoring of Internal Bleeding Based on Magnetic Induction and Cellular Phone Technology: A Potential Application in Poor Regions in México Monitoreo Remoto de Hemorragias Internas Basado en Inducción Magnética y Tecnología de Telefonía Celular: Una Potencial Aplicación en Regiones Pobres de México César A González1, Gaddi Blumrosen2 y Boris Rubinsky3 1University of the Mexican Army/EMGS-Multidisciplinary Research Laboratory, DF, México. National Polytechnic Institute /Superior School of Medicine-Section of Research and Graduate, DF, México. e-mail: [email protected] 2Center for Bioengineering in the Service of Humanity and Society. School of Computer Science and Engineering, Hebrew University of Jerusalem, Jerusalem, Israel. e-mail: [email protected] 3Department of Bioengineering and Mechanical Engineering, University of California at Berkeley, Berkeley, CA 94720, USA. e-mail: [email protected] Article received on January 26, 2009; accepted on 12 January, 2010 Abstract. The goal of this study is to introduce the Mexico in mind, this concept could become valuable theoretical foundation of a new concept in medical worldwide. technology that is centered on the cellular phone. The Keywords: Phase Shift, Magnetic Induction, Spectroscopy, concept was conceived with the needs of medically Cell Phone, Internal Bleeding. underserved regions of Mexico in mind. The application introduced here deals with undetected intraperitoneal Resumen. El objetivo de este estudio es introducir el bleeding that is responsible for the death of one of four fundamento teórico de un nuevo concepto en tecnología women who die at childbirths and that of 20% of accident médica basado en telefonía celular. El concepto fue trauma deaths; even brain trauma. The concept is made concebido teniendo en mente las necesidades médicas de possible by the wide availability of cellular phone las regiones marginadas de México y confronta el technology in Mexico, even in the poorest of regions, problema clínico que representan las hemorragias internas where other infrastructure is missing. The biophysical no detectadas a tiempo, tal problema es responsable de la principles of the technology are based on the observation muerte de una de cada cuatro mujeres que mueren that electromagnetic properties of tissue change with durante el trabajo de parto así como del 20% de muertes disease and internal bleeding. We introduce a new por accidentes traumáticos; incluyendo trauma paradigm of medical diagnostic in which inexpensive craneoencefálico. El concepto planteado es posible debido electromagnetic coils at the patient site are used to take a la amplia disponibilidad de tecnología de telefonía bulk data from a magnetic field that is generated through celular en México, la cual incluye a las regiones más pobres the tissue or organ of interest. Instead of processing the en donde se carece de otro tipo de infraestructura básica. data with a computer at the remote site the raw data is El principio biofísico de la tecnología está basado en la send via a cellular phone to a central facility that processes observación de los cambios en las propiedades the raw data for the entire country or region. The electromagnéticas de tejido enfermo y hemorragias diagnostic is returned in real time to the cellular phone at internas. Introducimos un nuevo paradigma de the patient site, thereby substantially reducing the cost of diagnóstico médico en el que bobinas electromagnéticas the devices and with good quality of the diagnostics. de bajo costo son empleadas en el sitio del paciente para Components and functionality required to support the adquirir datos volumétricos de un campo magnético que remote monitoring concept by magnetic fields and cell es generado a través del tejido u órgano de interés. En phone technology are presented. The study includes lugar de procesar los datos con una computadora en el criteria for data processing at the remote site and gives a sitio remoto, los datos crudos son enviados vía un teléfono linear optimal solution to the problem. More advanced celular a una estación central que procesa los datos crudos data processing methods and calibration of the system will para toda una región o inclusive el país entero. El be developed in future. While designed with the needs of diagnóstico se envía en tiempo real al teléfono celular en el Computación y Sistemas Vol. 14 No. 2, 2010, pp 187-195 ISSN 1405-5546 188 Wilfrido Gómez Flores et. al. lugar del paciente, reduciendo sustancialmente el costo de imaging devices become available they are often of los dispositivos e incrementando la calidad de los an inadequate type, non-functional, or handled diagnósticos. Se presentan los componentes y incorrectly [1]. Around 95% of medical technology in funcionalidad requerida para soportar el concepto de developing countries is imported and over 50% of monitoreo a distancia mediante campos magnéticos y tecnología de telefonía celular. El estudio incluye criterios equipment is not being used, because of lack of para el procesamiento de datos en el sitio remoto y maintenance or spare parts, because it is too proporciona una solución lineal óptima del problema. sophisticated or in disrepair, or because of lack of Métodos más avanzados de procesamiento de los datos, trained personal [1]. On the other hand, basic así como una calibración del sistema aún representan medical imaging is taken for granted in industrialized trabajos a futuro. Si bien el concepto aquí presentado fue countries, leading to insufficient aid and support diseñado con las necesidades de México en mente, este being channeled to medical imaging in the podría convertirse valioso en todo el mundo. Palabras clave: Corrimiento de fase, Inducción Magnética, developing world [3]. The goal of our research is to Espectroscopía, Teléfono Celular, Hemorragía Interna. develop new medical technologies that will address and solve these issues. Some of the major health issues related to lack 1 Introduction of diagnostic devices are in connection with detection of internal bleeding. Internal bleeding is This study was undertaken as a way to find a the cause of one of four maternal deaths during solution to the difficult situation of health care in poor childbirth, worldwide. Death may occur within two parts of the world in general and poor parts of hours after childbirth if the bleeding is not detected Mexico in particular. According to the World Health in time [5]. Obviously, early detection of internal Organization (WHO): “…. the majority of the world’s bleeding could save the lives of one of four women population is suffering from poverty and is denied who die at childbirth. Internal bleeding is also the adequate, safe and reliable access to solutions that cause of about 20% of the fatalities from trauma. health technologies can offer.” [1]. Health Trauma from accidents is the third most common technologies are the backbone of health services in cause of death in all age groups and the leading rich and poor countries, alike [2]. However, cause of death in the first three decades of life [6]. “…access to health technologies is ……. one of the Early intraperitoneal bleeding cannot be detected by most distinct differences between rich and poor vital signs (rate pulse or blood pressure) and it countries – far more so than access to technologies becomes evident only after a critical amount of blood associated with basic medical education” [2]. has found its way into the abdominal cavity. Death Diagnostic imaging and medical devices and from abdominal hemorrhage is a common cause of equipment are two trust topics of what the WHO preventable death in trauma patients. considers essential health technologies [1]. Medical imaging with magnetic resonance “Diagnostic imaging is a prerequisite for the imaging, X-ray and sometimes ultrasound could appropriate and successful treatment of at least a detect the occurrence of internal bleeding. quarter of all patients worldwide.” [3]. However, it is However, as indicated above, these technologies estimated that some two-thirds of the world’s are prohibitedly expensive in poor areas of the world population have no access to medical imaging [1]. and not available to poor regions of the world. “There is a depressing lack of equipment, Furthermore, medical imaging detects the inadequate types of equipment, non-functioning occurrence of internal bleeding by producing a equipment and incorrect handling of equipment” [1]. complete image of the interior of the body. It “Scaling up health services in a country implies that occurred to us that detection of the occurrence of essential diagnostic imaging services are available internal bleeding may not require a complete image nationwide. However, countries face major of the body and the use of the prohibitedly challenges in achieving this goal. This includes expensive medical imaging systems. It would be weak national systems, rudimentary procurement sufficient if inexpensive means for detection of and supply procedures, great disparity between occurrence of internal bleeding would become urban and rural areas, a lack of human resources, affordable and available everywhere. If the variable quality of laboratory performance and detection of internal bleeding is made early enough equipment that is either inappropriate or ill- the patient could be transferred for treatment at maintained.” [4]. Furthermore, even when medical central hospitals, since often hours pass from Computación y Sistemas Vol. 14 No. 2, 2010, pp 187-195 ISSN 1405-5546 Remote Monitoring of Internal Bleeding Based on Magnetic Induction and Cellular Phone Technology… 189 the changes in spectroscopic phase shift in the bulk incipience of undetected internal bleeding to death. of tissue [18] and [22]. We followed the theoretical Our solution to this problem draws from the work with a study with theoretical and in vitro knowledge that accumulation of fluid and changes in experimental parts on detecting edema and the water content of the tissue can be detected with hematoma in the bulk of brain tissue with phase shift bioelectric measurements on [7], [8]. Electrical spectroscopy [20]. Recently we reported our first in Impedance Tomography (EIT) was suggested as a vivo study.