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January 2015
The Medical Technology Innovation Magazine Issue #5
LOST IN MEDICAL WEARABLES

The blood sugar pioneers, new ECG wearables, securing the data
MEDICA 2014S
VIDEO COVERAGE
The Year of mobile and Hyper realism
OUT-OF-THE-LAB MIND READING

Emotiv.cos Interview
TABLE OF CONTENTS
EDITORS NOTE
THE CUTTING EDGE
Managing the consequences of the wearable invasion
Our selection of trendsetting news, from Siemenss new 1.5 T Amira MRI
to Embraces epilepsy wearable and biodegradable suture anchors
13
THE MEDICAL AVANT-GARDE
16
SPECIAL FEATURE:
LOST IN MEDICAL WEARABLES
33
VIDEOS: MEDICA 2014 TRADESHOW
40
HISTORY
41
Out-of-the-lab EEG is getting real with products like Emotivs EPOC headset.
We interviewed the start-up to talk about the medical applications of the device
Blood glucose, ECG, gait assessment, wearables are everywhere, while raising
questions about interoperability or security
Mobile healthcare developments or hyper realistic imaging, find out more about
the upcoming medical innovations in our Medica 2014s video coverage
The Susruta Samhita: a written guide on 4th century BC aesthetic surgery
PRACTICAL INFORMATION
Upcoming events and company index
Hamilton Medical on MedicalExpo.com
TEAM/CONTRIBUTORS
DIRECTORS
Corentin Thiercelin / Vincent Grard
ANNE GULLAND
EDITOR IN CHIEF
Anne Gulland is a UK-based freelance

journalist who has been writing about
health and medicine for 20 years. She
has contributed to the British Medical
Journal (BMJ), the Guardian and
Nursing Times. She writes about
global health for the BMJ as well as
regularly contributes to its obituary
section. She has also undertaken
research for a BBC television program,
Bizarre ER, about unusual illnesses
and accidents.
Ludovic Nachury
STAFF WRITERS
Brian Matthews / Erin Tallman / Natacha Truong

CREATIVE STAFF
Geoffrey Boulay / Aude Ferriere / Karine Ganora

CONTRIBUTORS
Racquel N.Cooper / Anne Gulland / Guy Ramsay

MEDICALEXPO EXPERTS
Yannick Bamouan / Fabien Costabello / Luca Cerasani /

Raafat Cheaytani / Gilles Ngamenye / Etienne Piccio
ADVERTISING
Candida Bingemer / Jean-Franois Castellani /

Jasmin Chavanne / Lucas Constant / Alexandra Jaulin /
Francesca Mechelli / Emilio Migliarese
MARKETING DIRECTOR
Isabelle Point-Falek
CONTACTS
editor-me@medicalexpo.com
sales-me@medicalexpo.com
GUY RAMSAY
Guy Ramsay is a South African medical
writer and is currently a PhD candidate
at the cole des Hautes tudes en
Sciences Sociales, Paris. His research
focuses on generational responses to
representations and performances of
desire in contemporary France. He
started his career as a biochemist
but found he preferred writing about
medical research than doing it himself.
He has a masters from the University
of Amsterdam and has written for a
variety of magazines about medicine,
nutrition and sexual health.
RACQUEL N. COOPER
Racquel N. Cooper is an English
freelance medical copywriter and
translator based on the outskirts of
Paris. She obtained her PhD in
Molecular and Cellular Biology of
Development from the Universit
Paris VII, Denis Diderot. Her curiosity
for science and passion for the
written word have morphed her into
a diligent writer with over 10 years of
experience in scientific and medical
communications.
MedicalExpo e-magazine
EDITOR'S NOTE
Managing the consequences of the wearable invasion
Wearable devices are nearly everywhere. According to a GlobalWebIndex study, 7% of US consumers
own a smart wristband, the most common form of fitness and health wearable. According to a Juniper
Research study, the number of wearables is expected to triple by 2018, with the Far East and China
becoming the key markets. At Medica 2014, worlds biggest medical device trade show, a booming
number of exhibitors were displaying wearables.
The wearable wave is breaking all around us. This issues special feature will help you keep from drowning.
If you want a look at the future of medical wearables, read our articles on blood sugar and ECG devices.
Wearables have evolved rapidly in these two fields; their successes and limitations hint at whats next.
In our article about interactions with hospitals, we also cover two key topics: how easily can a wearable
interoperate with other medical systems and how can it provide only relevant information to avoid
inundating doctors with data? We also interviewed a cybersecurity specialist to talk about protecting the
most private kind of datahealth data.
Data management, security, interoperability, certifications, etc.these are familiar issues for physicians,
ones they are expected to resolve. What is brand new is the hitherto unknown doctor-patient relation
it creates. By wearing and continuously accessing their device data, patients will certainly feel entitled to
claim possession of their medical data. Wearable is not only about the device, but also about who wears
and owns the information.
In this issue, you will also find out more about innovations which have attracted recent attention. We
interviewed Kim Du from Emotiv, the company in charge of the EPOC headset, a fascinating out-ofthe-lab EEG device. At Medica 2014, we got the opportunity to talk about lab diagnosis on a chip
and panoramic endoscopy, or 4K imaging. Indeed, 4K endoscopy is one of the most eagerly-awaited
technologies of 2015. As such, its a development you will read about in one of our upcoming issues.
Ludovic Nachury
Data management, security, interoperability,

certifications, these are well-known issues
for physicians
elitechgroup.com on MedicalExpo
The Cutting Edge INNOVATIONS & TRENDS
THE BIONIC EYE LOOKS OVER THE WORLD

Second Sight's Argus II Retinal Prosthesis System is reaching new milestones in the US and
in Europe. Following Italy (where its first commercial implant was done in 2011) and Germany,
France has agreed to reimburse the Second Sights device. In the US, a patient suffering from
retinitis pigmentosa became the seventh patient to benefit from the Argus II.
Courtesy of Duke Medicine
The so-called bionic eye relies on a sensor implanted in the eye, able to catch light signals
coming from a camera mounted on dedicated eyeglasses. In a press release related to this
operation, Duke Medicine researchers, who developed the technologies used in the retinal
prosthesis, explains that the device will not restore normal eyesight, but instead provide a
visual aid that could help [the patient] distinguish a door from a wall, or a crosswalk painted in
a roadway.
Turning on a retinal prosthesis system at Duke Eye Center
View more on MedicalExpo Trends.com
A WEARABLE FOR EPILEPSY ALERTS
Courtesy of Empatica
Launched through the crowdfunding platform Indiegogo, Embrace is a new of its kind wearable
device. Looking like a wristband watch, it tracks physiological stress, arousal, sleep,... Its
manufacturer, Empatica, explains that the device relies on electrodermal activity, a skin activity
linked to emotions-related brain areas.
It could therefore be used as a marker for epilepsy seizures, identifying early signs of a
seizure. Empatica has partnered with the Epilepsy Foundation so that people with epilepsy
using the device receive an alert when something unusual happens. These alerts can also be
automatically forwarded through a smartphone to relatives or caregivers. The company also
announced its intent to get the device FDA-certified.
A health-tracking smartwatch able to detect epilepsy
MOM, A LOW-COST
ELECTRONICALLY-CONTROLLED INCUBATOR
The mOm prototype has been designed to fight against premature child deaths in places
where healthcare access is difficult, such as refugee camps. This inflatable incubator benefits
for example from a small form factor, allowing mOms to be easily stored and transported.
Simple electronic controls allow medical and even non-medical staff to ensure that the heat,
light and humidity environment is set up to the levels required for premature children.
Courtesy of mOm
mOms inventor also emphasizes the fact that the product can be sanitized extremely fast,
and can be operated without a main power source for almost 24 hours. The device, which has
received the prestigious James Dyson award, is still at the project stage.
mOms inventor explains how his product works
ISOLATION
STRETCHERS FOR EBOLA
The new Savions bed has been thought of during the
SRAS epidemic. And, because it has been released
recently, was nicknamed the Ebola bed, as it fits
well with the containment needs due to the recent
surge of this disease.
Courtesy of Savion
The IS 736 uses a carbon filter and blower so that

air circulates well inside the chamber: a patient can
then stay inside long enough to be fully examined
without risking expulsing potentially contaminated
air. The transparent chamber is equipped with
conduit sleeves and facilities easing the installation
of monitoring equipment. Rechargeable batteries
allow for 10 hours of autonomy.
A GEL TO STOP ANIMAL

BLEEDING IN SECONDS
Suneriss Vetigel could turn severe bleeding a thing of the past for animals, and maybe later
for humans. This veterinarian gel stimulates the clotting process by rapidly ensuring the
accumulation of platelets binding to the site of the bleeding, accelerating this binding and
creating a stable clot. According to Suneris, this whole process lasts no longer than a few
seconds.
Courtesy of VetiGel
The Vetigel also differentiates as a sustainable, biocompatible product, providing maximum

flexibility for follow-up care. At this stage, Suneris is looking for veterinarian willing to participate
in clinical studies, but also states that the veterinary market should not be the only Vetigels
market.
Vetigel on Bloomberg News
LIGHT AND EFFICIENT DIGITAL RADIOGRAPHY
Courtesy of Konica Minolta
A 3.6 kg 17 by 17 digital radiography detector: here is what Konica is offering with its
new AeroDR detector. This was made possible by removing the protective layer between the
scintillator and the sensor panel, while using a long-lasting lithium ion capacitor rather than
a lithium ion battery. Such a new design also allows for the device to benefit from a robust
monocoque structure, as shown in the drop and pressure test video.
According to Konica, the AeroDR should provide good radiation efficiency, with a high DQE at
low dose. The product is also available in a 2.9 kg 14 by 17 format.
9
Drop and pressure test for the AeroDR
ROBOTIC HORSE-LIKE REHABILITATION

Intelligent Motions Hirob intends to simplify the use of hippotherapy. Not only does this elegant
piece of hardware replicates a horses walking movement, but its seat, shaped like a horses
back, force the patient to maintain the stability of the upper body.
Courtesy of Intelligent Motion
Multiple automated choices are possible, with various horses movements generated via a robot,
and the possibility to adjust speed and intensity. Even though a first clinical study indicates that
the system is beneficial for patients with trunk instability suffering from neurological deficits,
Intelligent Motion is also testing the Hirob with patients suffering from Parkinsons disease,
paraplegia, and orthopedic diseases.
The Hirob at work
SIEMENS SMARTENS 1.5 T MRI

MRI is not only about the T race. With its 1.5 T Amira MRI, Siemens presents a product focused
on patient comfort, efficiency, and sustainability. Inside an Amira, the sound pressure can be
reduced by up to 97% compared to a standard 1.5 T MRI, and the bore can be illuminated. By
using predefined settings and standardizing operations, 75% of examinations last no longer
than 10 minutes.
10
Courtesy of Siemens
The Amira is also announced as eco-friendly. Not only does it use the zero helium boil-off
technology, it can also save 30% energy during standby. The system weights 4.68 tons and
fits in a 28 m room.
The Cutting Edge RESEARCH & REGULATIONS
SUTURE ANCHORS BECOME DEGRADABLE

Researchers at the Fraunhofer Institute IFAM, in Germany, have developed small degradable
body implants, which could limit the need for surgeries. Their degradable bone implants are
presented as mechanically stable enough to ensure proper bone growth during the whole
healing process, while being able to be gradually absorbed by the body.
Courtesy of Fraunhofer IFAM
The researchers have therefore chosen to use metal-ceramic composites: Iron alloys corrode
slowly and ensure high mechanical strength, while ceramic decomposes quickly, stimulates
bone growth and aids the ingrowth of the implant, said in a press release Dr. Philipp Imgrund,
manager of the Medical Technology and Life Sciences business field at IFAM.
TREATING EPILEPSY THROUGH THE CHEEK

A robot, a MRI system and 3D printed flexible needles: a team at US-based Vanderbilt University
is assembling a high-tech kit to ease treatment of epilepsy. The idea here is to address seizures
in a less invasive way than the current skull-drilling process, by operating through the cheek.
11
Courtesy of Vanderbilt University
Epilepsy can be treated by addressing the hippocampus. As it is located at the bottom of

the brain, it could be operated with needles coming from the cheek. The Vanderbilt team has
therefore designed flexible needles, made of a nickel-titanium MRI-compatible alloy, which
could be guided by a robotic system inside an MRI.
The Cutting Edge RESEARCH & REGULATIONS
A CANCER-DETECTING ELECTROSURGICAL KNIFE

Removal of a tumor also requires the removal of surrounding healthy tissue, but surgeons
often have a hard time distinguishing healthy and unhealthy tissue. A team from Londons
Imperial College has developed an innovative solution, called the iKnife, which could reach
the market soon.
Courtesy of London's Imperial College
The iKnife combines an electrosurgical knife and a mass spectrometer. When the knife
operates, it generates smoke, coming from the tissue. The spectrometer analyzes this smoke
and compares the results to a reference library, enabling it to identify signatures of unhealthy
tissues. Initial studies have shown 91% accuracy.
The iKnife technology has recently been bought by US-based Waters Corporation.
Computational and Systems Medicine and the iKnife
TELEMONITORING PROVES WORTHY

FOR CARDIAC PATIENTS
Doctors working for the Geisinger Health System, a healthcare system which has implemented
telemonitoring, have assessed in a study the impact of telemonitoring on patients with heart
failure. 541 members were included in the sample.
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Courtesy of InTouch Health
The study focused on the impact of total cost of care and on hospital admission and readmission
rates. The results are suggesting that the odds of hospital admissions are much lower, by
23%, for patients using telemonitoring. The odds are even lowered for 90-days readmissions,
which decreased 38%.
The Medical Avant-Garde
Emotiv: Out-of-the-lab
Mind Reading
By Ludovic Nachury
The boundary between medical and non-medical devices is becoming more and more blurry.
Even sophisticated devices like EEG systems are faced with this issue. With its EPOC
headset, Emotiv, a Californian start-up, has become the most vocal advocate of out-of-the lab
EEG systems.
Even though the EPOC is known to have been used for
pure consumer application such as playing World of
Warcraft, this product is ultimately an appealing scientific
device. With 14 EEG channel locations, plus P3 and P4
locations and 9-axis inertial motion sensors, the EPOC
can provide valuable information about the brain. At the
same time, ease-of-use by non-medical professionals is
favored, with smart electrodes technology or a wireless
system forwarding the information to a smartphone.
We interviewed Kim Du, Vice-President of Corporate
Development for Emotiv, to try to understand why,
among the 50,000 users of EPOC, some medical
professionals pay such an interest to out-of-the-lab EEG
systems.
Courtesy of Emotiv
13
Several papers have been published about the product,

with people using it for neurofeedback. The EPOC has
been tested alongside the EEG standard system, with
good results. As an example, the EPOC has been able
to identify P300 signals [a key neurosignal to assess
cognitive functions]. Again, we know it is not going to
replace data collection from the brain scan of a clinic,
but the data coming from an EPOC can be used for
specific purposes.
It is not going to replace

data collection from the
brain scan of a clinic.
ME e-mag: The EPOC has generated interest from
neuromarketers and even some people in the video
gaming industry. From a healthcare standpoint, in
which areas has it been used?
14
K.D.: Our product is used to understand performance,

especially for kids with learning disability. But maybe
the most spectacular health application lies in the braincomputer interface area. Proof-of-concept instructions
have been developed to brain-control an electric
wheelchair via an EPOC. And Philips and Accenture are
using our product to give more freedom and autonomy
to ALS patients, allowing them to initiate actions with
their muscles or through mental activity.
ME e-mag: One of the most intriguing uses of the
EPOC I heard of was for a Mars exploration mission.
What has surprised you the most in your community?
ME e-mag: An epilepsy study in Bhutan, helping ALS

patients, the EPOC is indeed very close from being a
medical device.
Courtesy of Emotiv
Kim Du: First of all, it is important to clarify one point: the

EPOC is not a medically-approved device. We are not
even thinking of getting it FDA-certified. EPOC cannot
be used for diagnosis. Now, we now it has been used
on multiple occasions to explore brain activity outside
the lab.
K.D.: Well, the test for the Mars exploration project is not
that surprising; having an EEG on a space station is not
possible, but a product like ours can provide valuable
information in such an environment. Another very
interesting study is ongoing in Bhutan, where a group is
working on epilepsy. The goal is to operate brain scans
in place where it is hard to do EEG.
K.D.: Yes, in the US, it is not a medical device, but in

other places, like Bhutan, it can provide some level of
healthcare.
ME e-mag: Coming back to the product, what have
you included to ensure it can be used out of a lab,
and how is it evolving?
Space telesurgery with the help of an EPOC
K.D.: We tried to get rid of the inconvenience of the

gel. With an EPOC and its saline-based system, you
dont need to shave your hair. In the EPOC+, we added
a proprietary wireless system, which allows you to
have access safely to your EEG data on any Android
or iOS device. Basically, the system does not require a
specialist to be operated.
We obviously have also included features for
professionals, such as the compatibility between the
data gathered by an EPOC and EEG data software,
like Matlab.
Courtesy of Emotiv
MedicalExpo e-magazine: Since EPOCs release,

what kind of feedback did you receive from medical
professionals?
ME e-mag: You also announced the Insight. How

does it differentiate from your other products?
K.D.: The Insight is a completely brand new technology.
It benefits from hydrophilic sensor, able to auto-hydrate
and providing better connectivity. It is a complete redesign of the system, with a new headset and new
commercial-oriented functionalities.
Use of the Emotiv EPOC headset
Brain-control an electric
wheelchair via an EPOC
15
A Lesson Learned From Blood Sugar Wearables

Going Beyond The At Risk Cardiac Patients
Pacing In The Waiting Room
Wearable Devices Start To Fit With Hospitals
Securing Wearable Device Data
Key Products
Special Feature
LOST IN MEDICAL
WEARABLES
16
17
Special Feature
A lesson learned from

blood sugar wearables
By Racquel N. Cooper
The field of glucose monitoring has advanced

continuously in the last four decades, leading
to the development of highly evolved blood
glucose meters (BGMs), continuous glucose
monitoring systems (CGMS), and noninvasive glucose monitoring (NGM) devices.
Making diabetes management easier
Traditionally, people with diabetes measure
their blood glucose levels repeatedly
throughout the day using a lancing device.
This is uncomfortable for diabetics, leading
to neglect in monitoring of blood glucose and
poor diabetes management. CGMS enable
diabetics to continuously monitor their
glucose level, which has been shown to
significantly lower their A1c levels, resulting in
tremendous improvements in management.
18
Most commercially available CGMS rely

on invasive techniques using finger-stick
blood tests, as the CGMS still needs
to be calibrated many times by BGMs.

Furthermore, the invasive sensor of CGMS
must be replaced every few days. Additionally,
there is associated patient discomfort and
skin irritation.
According
to
established
healthcare
guidelines CGM is approved only as a
complementary device that cannot replace
fingertip blood checks: this should be done
2-4 times daily to ensure that the CGMS
remains calibrated and to confirm the CGMS
information. Moreover, a conventional blood
glucose reading should be done before
making any therapeutic decisions.
The current trend has shifted toward NGMbased CGMS, which not only alleviate the
pain associated with glucose monitoring,
but have an additional benefit of employing
a smartphone as the receiver for CGMS.
However, current NGM technologies
encounter significant obstacles mainly
related to inaccuracies stemming from
environmental and physiological processes,
such as body water content, temperature,
poor correlation between blood glucose,
and glucose in body fluids. Multi-sensor
devices are currently being studied to detect
and compensate for such disturbances
responsible for the decreased accuracy.
Evolution of blood glucose monitors
Courtesy of Gluco Track
Diabetes is increasing worldwide and

has been declared a global epidemic by
the World Health Organization (WHO).
Glucose monitoring is an integral part of
diabetes management, and maintaining the
physiological blood glucose level is the only
way for diabetics to avoid life-threatening
complications.
The Gluco Track, a wearable glucose-measurement earlobe clip
Special Feature LOST IN WEARABLES
Courtesy of Senseonics
Courtesy of Dexcom
Replacing the finger prick for new, noninvasive technology

Advancing technology and continued
innovation promise to provide novel solutions
for diabetes management. Companies are
enthusiastic about developing glucose
monitoring features in future wearable
devices.
Google is collaborating with Alcon (Novartis)
to develop a smart contact lens that will
be able to provide a continuous, minimally
invasive measurement of the bodys glucose
levels. The lens is designed to measure tear
fluid in the eye and connects wirelessly
with a mobile device.
Speaking of the new smart contact lens, Dr.
Gerald Bernstein, director of the Friedman
Diabetes Institute at Beth Israel Medical
Center in New York City said, Its not an
easy thing to do. Do I think this is the ultimate
answer? Probably not. But I do think its
something worth pursuing. It is a lot more
convenient than the current continuous
monitor, which does the same thing.
19
In the smart textiles arena, a team of

researchers is using fiber optic sensors
in a modified pair of socks to identify high
temperature zones on the feet, stress areas
around the joints, and high pressure points,
parameters that are indicators of the potential
development of ulcers. This information is
then transferred via Bluetooth or Wi-Fi to
a users phone or to a medical caregivers
computer. Smart socks have the potential to
provide in-depth, real-time data about the
diabetic foot.
Last but not least, Senseonics, an
American company, has recently started
a new generation CGM system based on
fluorescence sensing technology.
The company is currently investigating a
nanotube-based glucose sensor, designed
to be fully subcutaneously implanted for a
year.
With so many exciting new devices on the
horizon, diabetes care and management can
only become easier.
Courtesy of iHealth
NovioSense, a Dutch company that has

recently received a European patent for a
tiny device that is placed in the eye to

continuously measure glucose levels in
tears, is also making fascinating progress.
The device has yet to receive regulatory
approvals, but the new patent should help
move the device forward.
Continuous glucose monitors

Company/Product
Technology
Description
FDA approval /CE mark
Minimally invasive glucose monitoring

Abbott
FreeStyle Libre Flash
Glucose levels read through a sensor that can be

worn on the back of the upper arm for up to 14
days.
The sensor collects continuous glucose data from the interstitial fluid just beneath the skins surface.
Using a handheld, color touch-screen reader device, users can scan the sensor patch to reveal real-time
glucose values, trend arrows, and eight-hour trend graphs. Unlike other CGMS, no finger prick calibration
is needed.
CE mark: September 2014
Medtronic Diabetes
MiniMed Duo
A subdermal CGM sensor and insulin infusion site

combined.
The world's first two-in-one breakthrough that combines a glucose sensor and insulin infusion set into one
on-body device, simplifying integrated insulin pump therapy and continuous glucose monitoring.
CE mark: June 2014
Dexcom
Platinum G4
The sensor is a small wire that is inserted under

the skin of the abdomen and measures interstitial
glucose values. These values are sent through the
transmitter to the hand-held receiver where they
are displayed for the user.
In addition to reporting interstitial glucose values every five minutes, the system reports trending
information in real-time for up to seven days (the life of each sensor). With an average 85% accuracy with
just two calibrations per day, the G4 is presented as about 10% more accurate than other FDA approved
devices which average at about 73% accuracy. In addition, the device allows users to sync data via a USB
port to a computer for better monitoring, or for sharing with doctors and caregivers.
FDA: October 2014

CE mark: June 2012
A G5 model is in development and a G6 is expected around 2017.

Animas
Vibe pump
The pump is fully integrated with the Dexcom G4 Platinum CGM. Such integration means that the pump
can provide info on possible highs and lows within five minutes of a reading from the G4 Platinum.
FDA: December 2014

CE mark: June 2011
The Vibe is the first integrated pump and CGM system to win FDA approval.
Pancreum
A wearable, replaceable, continuous glucosesensing device, with an automatic sensor insertion

mechanism. It is worn on the body and the sensor
measures glucose in the interstitial fluid every few
minutes for three to seven days.
A circular, three-wedge, closed-loop artificial pancreas that combines an insulin pump, a glucagon pump,
and a continuous glucose monitor into a single unit.
Still under development
Non-invasive glucose monitoring
20
InfraV
Smartwatch
Biometric sensors.
The first and only smart watch with non-invasive continuous blood glucose monitoring sensors. It will
actively alert the wearer of impending decreases or increases in blood glucose levels.
Has not received FDA approval,

therefore will be launched as a
health and fitness aid, which is
not recommended to diagnose
or treat illness.
Integrity
GlucoTrack DF-F
Uses ultrasonic, electromagnetic and thermal

technologies.
A high-tech earlobe clip that measures glucose using three different technologies. Within a minute of being
on the earlobe, GlucoTrack sends blood glucose data through a headphone-style cord to a smartphonesized handheld controller, where the glucose reading is displayed or even verbally announced.
CE mark: June 2013
Special Feature
Going beyond the

at risk cardiac patients
By Racquel N. Cooper
In recent years, technological advances have

focused on increasing the efficiency, comfort,
and convenience of ECG monitoring devices.
Improvements in electronics, wireless
communication, power supply, and data
storage have simplified the use of ECG
monitoring devices capable of continuously
acquiring data for much longer periods of
time. Moreover, these advances allow for the
transmission of pertinent ECG data in real
time, encouraging rapid analysis and timely
clinical intervention.
21
Holter monitoring has been the gold standard

of ambulatory ECG monitoring since 1961.
It is usually recorded for 24 or 48 hours
with 3- or 12-lead ECG configuration.
Although patient participation is not needed
in data transmission, the short duration of
monitoring can be inadequate if symptoms
are infrequent, patient noncompliance is
frequent, the data are not analyzed in real
time and in some cases, the relatively slow
review of the records limit every-day clinical
applicability. Furthermore, Holter monitors
are often bulky and lack wireless connectivity.
Better tools for better cardiac outcomes
Some Holter monitors now have the ability

to record for a period of 24 hours to up to
14 days. One example is the Custo flash
500 (Custo med), which has three electrodes,
short integrated ECG wires and continuous
ECG recording for up to seven days.
The devices currently used can be subdivided

into two main categories: external and
implantable. External devices consist of
Holter monitors, ambulatory event monitors
AEMs are small, portable devices that store

the recorded data and usually have a life
span of up to 30 days. Data are transmitted
wirelessly to a central monitoring station
Courtesy of SuddenLife
Ambulatory outpatient ECG monitoring

devices have rapidly evolved over the last
few decades and identify life threatening and
non-life threatening arrhythmias. The main
purpose of these devices that enable longterm monitoring is to evaluate suspected
arrhythmias that have not been detected by
office or hospital-based monitoring.
(AEM, also known as loop recorders) and

more recently, mobile cardiac outpatient
telemetry
and
patch-type
monitors.
Implantable devices comprise pacemakers
and implantable cardioverter defibrillators
(ICDs) equipped with diagnostic features and
implantable loop recorders (ILRs) (see boxed
text).
The ZioPatch demonstration
Courtesy of Intelesens
Cardiac arrhythmias may be associated

with serious conditions, such as stroke and
syncope. Reliable electrocardiogram (ECG)
monitoring is the cornerstone of arrhythmia
diagnosis and management.
and both physician and patient are notified

based on pre-specified alerts. This is the
first type of monitor providing immediate
feedback to the physician and patient.
Possible disadvantages of this method are
that the patient must trigger the activation,
unless an automatic trigger is built into the
monitor and the storage capacity is limited,
therefore events should be immediately
transmitted. Zensor from Intelesens is a
seven-day, 3-lead, cardiac event monitoring
device equipped with full ECG viewing
software. It is Wi-Fi enabled, non-invasive,
and transmits data wirelessly to a remote
database.
In contrast to AEMs, mobile cardiac
outpatient
telemetry
is
completely
automatic and requires no patient
intervention to either capture or transmit
ECG data. These systems typically use
some sort of wireless technology (such as
cellular phone networks) to transmit the data
to the companys central monitoring facility,
where the ECG is analyzed in real-time.
Examples include LifeWatchs LifeStar ACT
(Ambulatory Cardiac Telemetry) that uses
an auto-trigger algorithm to detect atrial
fibrillation (AF) and offers up to 30-days of realtime ECG monitoring, and the V Patch from
Intelesens, which automatically detects
and records events that are immediately
available on the web-based platform.
The rise of patches
22
Patch-type monitors provide real time

feedback to the care provider or directly to
the patient and are more useful in clinical
practice. Due to higher patient compliance,
they may drive immediate changes in medical
therapy or patient care to improve clinical
outcome.
The ZIO Patch is a small, single-channel,

ECG monitor that continuously, discretely,
and wirelessly measures heart rate for up
to 14 days. The ZIO Service processes and
analyzes the received ECG data before
the report is provided to the clinician. First
launched in the USA, the ZIO Service recently
received CE mark and is now available in
the UK.
The response to the launch of the ZIO
Service in the UK has been fantastic, with
the majority of Trusts in the UK embracing
the technology, said Martyn Dixon,
Managing Director of CardioLogic Ltd. The
major teaching hospitals want it and leading
stroke physicians have placed orders. At
the moment, we dont have patient reaction
information to the ZIO; however, information
from the States does show that patient
compliance is high with the patch, due to its
size and discreet nature.
LifeWatchs Vital Signs Patch (VSP) is
another example that recently received FDA
510(k) clearance. Once the VSP is activated
and connected with the supporting system,
it provides automation and alerts of key vital
signs via continuous wireless monitoring.
A further advance in ECG monitoring devices
is demonstrated by the BodyGuardian
Remote Monitoring System (Preventice),
which combines three essential monitoring
technologies - mobile cardiac telemetry,
event monitoring and Holter monitoring - into
one device.
The BodyGuardian Remote Monitoring
System uses algorithms to support remote
monitoring for patients with cardiac
arrhythmias for up to 30 days. A small
body sensor attached to the patients chest
collects ECG data then wirelessly transmits
the information to physicians via mobile
phone technology, providing a continual
connection between patients and their
care teams.
Courtesy of Lifewatch
90 SECONDS TO IMPLANT A LINQ

The ideal device provides continuous, long-term monitoring, 24 hours a day,
7 days a week with immediate feedback. Indeed, ILRs have been shown to be
six times more likely than conventional monitoring to detect atrial fibrillation (AF)
in patients who had just suffered ischemic stroke. However, implantable devices
require an invasive procedure, thus limiting their use.
Medtronic released their newest ILR called LINQ in 2014. This wireless device
can be injected under the skin of an un-sedated patient in as little as 90 seconds.
Enthusiasm among cardiologists is high. And, on paper, these devices hold
promise for improving outcomes in patients at risk for stroke. The problem is
that truly helping patients is not about implanting the device, but about the
labor-intense process of data interpretation.
Special Feature
Pacing in
the waiting room
by Guy Ramsay
So why perform gait assessment?
24
In clinical practice, gait assessment, either

by trained observation, in a gait laboratory,
or more recently, with a wearable device,
is generally done to detect movement
abnormalities, to estimate the patients
risk of falling, or to assess physical
recovery. As the first symptoms of many
neurodegenerative disorders, for example
Parkinsons disease or multiple sclerosis
include poor balance and a slower walking
pace with shorter steps, gait assessment
naturally has a role in diagnosis as well as
in characterizing disease progression and
severity. In Parkinsons disease for example,
stride length is correlated with disease
severity, so the ability to accurately quantify

gait characteristics is particularly useful
clinically speaking. Gait analysis is also
integral to treatment planning in cerebral palsy
and is used in the diagnosis of heart disease
and osteoporosis. In stroke rehabilitation, it
is employed to measure improvements and
to set goals.
The emergence of small, portable

devices offers a considerable leap in
measurement accuracy compared to
clinical observation, without the cost and
inconvenience of a dedicated movement
laboratory. Portable sensors provide
rapid and precise data on functional gait
impairment, which allows physiotherapy to
be more finely tuned to each patients needs.
The increased sensitivity of measurements
also enables milder disabilities or subtle
improvements after physiotherapy to be
discerned, providing the opportunity for
feedback and encouragement.
Winning features of wearable gaitmeasuring devices
Devices usually employ an array of different
sensors to provide four-dimensional
movement modeling and to overcome
Courtesy of Noraxon
Benefits of wearable gait sensors
Courtesy of Noraxon
In the public imagination, gait laboratories

where biomechanical movement is captured
by sensors and analyzed on the computer
are generally associated with improving
the performance of top-class athletes. Yet
undoubtedly, the real social contribution of
gait analysis is in healthcare. The advent of
small, simple, wirelessly linked, portable
widgets, brimming with accelerometers and
gyroscopes has meant that what was once
the exclusive domain of a dedicated gait lab
can now take place in doctors waiting rooms.
A few minutes of pacing up and down in the
waiting room thus takes on a whole new
meaning for the doctor-patient interaction.
Manufacturers of wearable gait

assessment devices
25
Some of the more established companies

producing wearable gait assessment devices
include Noraxon, BTS Bioengineering
and BioSensics in the US, Xsens in the
Netherlands, and Tec Gihan in Japan. All
of the these companies produce a range of
wearable sensory devices and associated
software including at least one product that
can be used as a wearable sensor in hospitals
and in doctors waiting rooms to perform gait
analysis.
Conversely, the LEGSys device from

BioSensics consists of two small devices
that are worn around the calves, rather like
mens sock suspenders. They can provide a
complete gait analysis within five minutes of
use.
Courtesy of BTS
the limitations of individual sensor types.

For example accelerometers, which provide
three-dimensional motion sensing, are prone
to fluctuation of offsets; gyroscopes, which
measure rate of change of orientation, suffer
from zero bias drift. Small size, wireless data
transfer and low power consumption are all
key features to limit impedance and improve
practicality. The lower cost of the devices
has also enabled widespread use in a host
of different clinical, sporting, and research
settings. Clinicians should, however, ensure
that whatever wearable device they choose,
it has received FDA or UL certification in
the US or a CE certification for safety in
Europe, and has been validated for accuracy
on clinically relevant outcomes.
Indeed, some of the above companies have

specifically developed products for this,
which are simple to attach, affordable,
and can produce data in minutes. The
BTS G-Walk for example, is a Bluetoothlinked device, about the size of a clam-shell
cellphone, which is attached via a belt to
the patients waist where it records spatiotemporal parameters as well as pelvic
rotations.
BTS G-Walk spatio-temporal data testing
The bottom line

The advent of wearable gait analysis
systems that provide accurate data after
just minutes of walking in a confined space
has considerable implications for general
and hospital practice: while patients are
waiting for their appointments, they can also
be generating invaluable data, improving
diagnosis, facilitating measurement of
progression, and enabling doctors to set
measureable goals. While admittedly, these
devices will not make top-class athletes out
of ordinary patients, they are indeed a very
large and accurately measurable step in
that direction.
Courtesy of Hocoma
Valedo, a back pain therapy videogame developed with Xsens technology
Special Feature
Wearable devices
start to fit with hospitals
Technology is taking over the measurement

of the human body with sensors that
continuously, conveniently, and precisely
measure variables such as body
temperature, pulse rate, blood pressure,
ECG, blood sugar, blood oxygen, sleep
patterns and many more, according to
Soreons report.
Growing use by the hospital sector
26
But while the use of health wearables is

currently mainly restricted to the motivated
consumer who wants to track the number
of steps they take or monitor their calorie
consumption via their Fitbit or Jawbone,
their use among doctors and other health
care professionals is growing, particularly in
the US.
Earlier this year Oschner Health System
opened the O-Bar at its Center for Primary
Care and Wellness in New Orleans. Here,

a technology specialist assists patients
who want to download health apps or buy
devices. So far patients have downloaded
2000 apps, mostly focused on fitness, diet
and womens health and have purchased
blood pressure cuffs, glucose monitors and
fitness trackers.
Oschner O Bar, an hospital-based wearables bar
Scott Hague, director of development at UK

based technology consultancy Integrated
Change, says that wearables tailored to the
hospital sector are showing the most promise.
Theres great potential for how wearables
can interface with a hospital system and
provide notifications for doctors and nurses,
he says. They can be used to alert a nurse
when a patients critical signs need to be
checked. They can let the staff know when
blood tests or drugs orders are ready,
he says.
Courtesy of Zephyr
Wearable health technology is predicted to

revolutionize the health care sector over the
next few years. According to a report by the
Swiss research institute Soreon Research,
the worldwide market is set to grow to about
US$41 billion by 2020, from its current
US$2 billion.
Courtesy of Oschner
By Anne Gulland
Designed to be part of the system

One such product is ZephyrLife, a patch
worn by patients, which monitors blood
glucose, blood pressure, body weight, and
oxygen saturation. The device connects
to a central system monitored by a
How the ZephyrPSM was used to facilitate the Chilean miners rescue
doctor or nurse and as well as providing

information, it also lets doctors know when
changes in heart rhythm or breathing occur,
for example.
The patch can also be worn at home and could
thus assist in early discharge. The device
connects to a hub, which in turn transmits
data to the hospitals own systems. And
because the readings are taken automatically,
it eliminates any human error.
Courtesy of Epic
Leaf Healthcare, based in Utah in the US,

has developed a wearable sensor to reduce
the incidence of pressure ulcers by alerting
nurses when patients need to be turned.
Data collected by the sensor, which is placed
on the patients body, are communicated
wirelessly to central monitoring stations
or mobile devices and track a patients
tissue decompression.
27
Early days of health wearables

While the potential for wearable devices
is huge, challenges currently exist to their
widespread adoption. Cost is one barrier,
says Jeremy Schroetter, vice president/
healthcare chief technology officer of leader
in software R&D services GlobalLogic.
Another is interoperability: integrating a
mobile system with the hospitals current
IT system.
These kinds of integrations arent trivial as

there is no common system everyone can
plug into, says Schroetter. Interoperability
is a huge problem, but a lot of the healthcare
companies are looking at ways to solve this,
he adds.
For example, Epic, an electronic health record
market leader in the US, has partnered with
Apples HealthKit to enable iPhone and iPad
users to access their Epic medical records
via Epics MyChart app.
A report by consultants PwC, Health
Wearables: The Early Days, considers that
investments in software will be just as
important as investments in hardware.
Solutions to manage data overload
Another huge challenge will be the amount
of data generated, says Schroetter.
If youre getting megabytes, gigabytes or
even terabytes of data, there has to be a
physician in the system thats doing a review
and providing feedback that other doctors
can utilize so they dont have to look at oodles
of data, he says.
A doctor doesnt want to be looking at 50
different dashboards the information has to
be put into a format thats actionable for the
physician, he says.
Outsourcing the reading of scans to doctors
in India and China is becoming more common
in the US. Therefore, the same practice could
emerge as a way of handling the huge task
of data monitoring, says Schroetter.
Special Feature
Securing wearable
device data
by Guy Ramsay
MedicalExpo e-magazine: Just how

sensitive is data from wearable devices?
Yes it might be embarrassing, but is it really
all that serious if data from a wearable
monitor or a health app is hacked?
Seyedmostafa Safavi: We categorize this
as trespassing on the users privacy. Any
negative personal information exposed on
the Internet is at best only embarrassing.
A breach in security with any health data
can be serious. For example, insurance
companies might refuse insurance if they
knew you were in poor health. Or a business
might be in trouble if its founder was ill and
that information was leaked.
With the recent Sony Entertainment hacks,
data security has become an issue in the press
and a headache for database administrators.
Sensitive data generated by wearable devices
are presumably no exception.
Are there any particular security concerns
with data from wearable devices? Are doctors
doing enough to protect patient data?
28
We asked Seyedmostafa Safavi, a researcher

at the Cyber Security Unit at the National
University of Malaysia and co-author of a
recent review on the subject to elaborate.
ME e-mag: Of all the stakeholders involved

in data from wearable devices, is there a
weak link?
SS: Weak links emerge where the focus has
been on making features faster, lighter, or
cheaper at the expense of standardization
and security. Security matters also need to
be considered, as well as price and benefits.
ME e-mag: Is the real risk of hacking
wearable devices at the local, wireless
level, or rather at the cellular connectivity
level?
SS: A risk emerges when an application
developer or device manufacturer didnt or
wouldnt consider the possibility of a security

breach. So there is a risk at both levels,
both locally and regionally. Complete data
encryption and using secure connectivity
protocols, like VPN built-into the device, can
ensure safer data transmission.
ME e-mag: What should doctors be aware
of when patents offer data from wearable
devices?
SS: Doctors have to be careful with data
collection. They need to ensure that the data
have been recorded in a standard manner
and that the device has been certified for
accuracy.
ME e-mag: What can doctors do to ensure
greater security of patient data?
SS: If the hospital or clinic has an Information
Security Management System (ISMS),
doctors should adhere to that framework.
If not, we would recommend a security
awareness course. In general, the basic
thing that doctors can do is to update their
applications regularly, and to not share their
user-IDs or passwords.
ME e-mag: What degree of responsibility
do doctors have for the protection of
confidential data?
SS: When we talk about confidential data,
it can be digital or it can be non-digital.
Both are confidential. You cannot just throw
printed patient data into the dustbin. For the
same reason, you shouldnt be able to copy
patient data onto a USB drive. A systematic
process must be in place, starting with the
data collection. If an ISMS is practiced in
the hospital, doctors should find out about
it. Our advice to doctors is to ensure that
security is updated, to employ firewalls and

antivirus applications, and that the server
must be designed and implemented with
proper protections, both from online hacking
and from unauthorized physical access.
ME e-mag: What are the security
certification requirements that cover data
from wearable devices?
SS: Since we are focusing on information
privacy for wearable devices, we would
recommend adhering to the Markle Common
Framework guidelines.
[Editors note: The Markle Foundation is
a US-based organization whose mission
is to realize the potential of advances
in information technology to address
previously intractable public problems for
the health, security, and economic wellbeing of all Americans. The Markle Common
Framework is a set of policy and technology
practices that help medical professionals
and consumers share personal health
information while protecting privacy.]
ME e-mag: Are the private clinical
database-hosting services doing enough
to ensure security?
SS: In my opinion they are doing their best
to prevent security flaws, but to have proper
practices in place for security and privacy
in the healthcare industry requires an endto-end risk management process. This
includes risk assessment a determination
of the organizations level of acceptable
risk and then deciding what controls must
be implemented to reduce that risk to an
acceptable level. In addition, they have to
monitor, measure, and report compliance to
security and privacy standards.
BODYTELS PRE-CERTIFIED
TELEMONITORING PLATFORM
Even though the boundary between medical and non-medical

devices is getting thinner, certification is still a key concern
for wearable manufacturers. And not an easy one, as shown
by the limited number of CE and FDA approved wearables.
For example, the only certified product at Withings, one of
the most renowned companies in this space, is their wireless
blood pressure monitor.
This German company has chosen a unique positioning

by providing a pre-certified platform for chronic disease
telemedicine. Whether a company wants to develop a
telemedicine infrastructure, portal, sensor, or mobile
application, BodyTel can provide this component and ensure
it will benefit from its European medical certification, easing
access to market. Its key capacity lies in its information
transmission knowledge, guaranteeing a safe and efficient
data circulation.
This very easy-to-use device pairs with an Android or iOS

smartphone via Bluetooth. The patient just has to wind up
the blood pressure monitor around an inner arm to initiate
the measurement and receive the data on a smartphone.
These data can also be shared with the patients doctor.
Courtesy of Moticon
WITHINGSS APPROVED
BLOOD PRESSURE MONITOR
OpenGo physio demonstration
MOTICONS SENSITIVE INSOLES
The company also developed its own range of wearable

products with various weight monitoring devices, a blood
glucose monitor, and a blood pressure monitor.
How to use a Withings blood pressure monitor
As each insole contains a battery compartment, it is

completely autonomous, and is controlled wirelessly through
a PC or a smartphone. Through a smartphone, it is possible
to control the insole, and to start and stop recording. On
the PC, data can be extensively analyzed with data
management software.
Courtesy of BodyTel
Courtesy of Withings
Moticons OpenGo may be the most complete wearable feet

activity solution in the market. This sensor-rich insole contains
13 pressure sensing pads and a 3D accelerometer, able
to provide information about weight, balance, and motion.
The product can work in live or recording mode, and go to
sleep mode to save energy.
30
IPHONE
INSTANT HEART CHECK
SMART SOCKS TO ASSESS

MOVEMENTS QUALITY
With its CardioSecur active, Personal MedSystemss

promise is to be able to tell a patient in less than a minute
if he/she needs to do nothing, to plan a visit to the doctor, or
to go see this doctor immediately. The system is a 12-lead
ECG, working with four electrodes, plugged into an iPhone
or an iPad.
Sensor-rich textiles are gaining more and more traction.

One of the most interesting technologies comes from
Sensoria, a US-based startup, and their smart socks. In
each sock, three textile sensors are embedded under
the plantar area, able to detect foot pressure. These data
are transmitted, through conductive fibers relay, to an
electronic-rich anklet. There, information are forwarded via
Bluetooth to a mobile application.
Courtesy of Vigilant
It starts by storing a reference ECG. Further controls

are therefore compared to this reference and, based on
guidelines coming from the European Society of Cardiology,
may trigger or not an alert. Data can be either stored on the
iPhone/iPad or sent to a physician.
This lightweight (less than 1 ounce) anklet is also equipped

with a 3-axis accelerometer. Its battery can last 6 hours
and is therefore well adapted for out-of-the-hospital
monitoring.
A German cardiologist explains how he was able

to self-diagnose a cardiac event
Courtesy of Sensoria
A BEE TO MANAGE
GLUCOSE LEVELS
Improperly managing injection and blood sugar levels is a
major risk for diabetics patients. With its Bee, Vigilant tries
to provide them with a solution to easily record these data.
After an injection, a patient just has to twist the device so
that the exact blood sugar and injection level appears on the
Bees small LED screen. By pushing a button, the patient
sends via Bluetooth the information to a digital logbook
hosted on his/her smartphone (Android and iOS). If
the patient wants to, he/she can share this information
with relatives and doctors. The Bee is compatible with 10
insulin pens.
Sensoria explains how to wear the anklet
31
PAIN RELIEF
BECOMES WEARABLE
Neurometrixs Quell is one of the most fascinating pieces of
technology in the wearable field. This device intends to fight
chronic pain just by pushing a button.
Courtesy of NeuroMetrix
To use a Quell, a patient only needs to strap a band with

electrodes on the upper calf. Then, pushing a button triggers
a reaction which stimulates nerves, blocking pain
signals. According to the company, relief can happen in 15
minutes.
This FDA-approved device is also able to adapt to the activity
of the user, by providing different levels of stimulation during
the day (when the user is active) and at night (when the user
is lying). With its rechargeable battery, a Quells autonomy
can reach 40 hours.
100% AUTOMATIC BODY MANAGER?

Few wearable devices have generated as much controversies
as the GoBe. This product pretends to be a 100% automatic
body manager, able for example to measure calories intake
through the skin, without any logging.
32
Most of the medical comments regarding the GoBe doubt it

can fulfill its promise but the promise of effortless calorie
measurement grabbed a lot of attention.
Courtesy of GoBe
To do so, the GoBe relies on a proprietary algorithm mixing

data from three sources: a pulse sensor, to assess blood
flow; an impedance sensor, to monitor fluid levels; and an
accelerometer. Its funding came from a campaign on the
crowdfunding platform IndieGogo.
GoBe : 100% automatic body manager
Medica 2014
THE YEAR OF MOBILE

AND HYPER-REALISM
By Ludovic Nachury
If you have attended the 2014 edition of Dusseldorfs Medica tradeshow, you certainly will have noticed,
besides the gigantic size of the event, the presence of wearable devices almost everywhere. As we are
covering this trend in the special feature of this issue of the e-magazine, we have decided to focus our
Medicas video coverage on two other key trends : mobile developments and hyper realistic imaging.
The wide range of medical tools designed to work with mobile devices was extremely impressive. Almost
everyone has jumped into the mobile arena, from wearable rapid diagnosis start-ups such as OJ-Bio
to big names like Samsung, organizing health data monitoring and transmission via a smartphone or a
tablet.
Medical imaging has also reached new heights. Barco has readied its Nexxiss IP imaging management
platform for the upcoming 4K hyper high-definition. And research institutes are working on new evolutions,
such as Fraunhofer Institutes panoramic endoscopy technology.
1.
33
GE Voluson E10s
Hyper Realism
2.
Intelesens Zensors
Real Time ECG
3.
4.
5.
6.
Fraunhofer Institutes
Panoramic Endoscopy
Barco Nexxiss
4K Readiness
Samsung/TapChecks
Wireless Health
OJ-Bios
Mobile Diagnosis on a Chip
Medica 2014 THE YEAR OF MOBILE AND HYPER-REALISM
GES VOLUSON E10 : RAISING THE BAR OF ULTRASOUND IMAGING
Imaging quality reached unprecedented levels at Medica

2014. Among the most spectacular system was GEs new
ultrasound imaging Voluson.
The E10 provides both faster frame rates and resolutions
for 2D, color, 3D and 4D imaging. It can reach 800
volumes per second, making possible 4D fetal heart
examination.
The system also improves orthogonal plane resolution,
facilitating complex visualizations.
Volusons probes have also evolved, with a new electronic
curved convex matrix probe. Using more than 8,000
piezoelectric crystals, this probe can conduct efficiently
ultrasound signals, while its heat level is managed by an
active water cooling system.
34
Courtesy of GE Healthcare
Everything is four times faster
INTELESENSS ZENSOR: SIMPLE AND COMPLETE WEARABLE ECG
Multiple ECG wearable devices were displayed during

Medica. With its Zensor, Intelesens has been able to
differentiate by providing a product both comprehensive
and easy-to-use.
This 3-lead ECG, respiratory and accelerometer device
is able, through a Wi-Fi connection paired to a smartphone,
to transfer both irregularities and continuous monitoring
data with just one device, a feature the company boasts
as unique.
Its patches can be installed by general practitioners, or
even by the patients. For two weeks, they will automatically
send their data. During this period of time, the patient will
only need to recharge the batterys device.
Event detection and full disclosure data

on one device
Courtesy of Intelesens
35
SAMSUNG / TAPCHECK: AN EASY-TO-USE MOBILE DIAGNOSIS EXPERIENCE
To get an idea of what could be the near future of personal

health recording, Samsungs booth was a good place to
go. Relying on the products of its partner TapCheck, the
Korean company was displaying a complete ecosystem.
With the TapCheck wearable products, patients can easily
record, for example, their blood pressure level. Just by
placing it near to a Samsung tablet, patients can then send
this record to a health system shared with their doctor.
Such a system only makes sense if the safety of the health
data is fully guaranteed. TapCheck has therefore decided
to rely on Oranges cloud and data safety services.
Helping the patient to easily store

and record health information
Courtesy of TAPcheck
36
FRAUNHOFER INSTITUTE: ENDOSCOPY BECOMES PANORAMIC
After 3D and 4K, panoramic views? If the Fraunhofer

Institute succeeds in turning its research product into
commercial systems, doctors may benefit from a new way
of visualizing their patients organs.
The project tries to apply to endoscopic imaging the same
panoramic imaging process used by digital cameras: it
stitches together pictures to provide a panoramic view. To
be used in surgery, this stitching need to be done in a realtime. Therefore, the Fraunhofer Institute has developed a
specific algorithm, using the power of a graphic processor.
As of today, the project has been tested on phantom
bladders, and should be tested soon on patients.
Stitch pictures online and in real-time

to become a map of the bladder
Courtesy of Fraunhofer
37
BARCOS NEXXIS 4K: BEYOND THE FULL-HD OPERATING ROOM
In 2012, Barco launched Nexxis, its video-over-IP digital

operating room platform. At Medica, the Belgium company
presented the evolutions making its solution 4K (4 times
high-definition resolution) ready.
Barco showed images processing devices, able to execute
image composition and to mix 4K and non-4K images. It
also presented a large and a small 4K display.
As of today, 4K is still a technology-to-come in the operating
room but, according to Barco, its democratization should
happen soon. The company is hoping for 4K endoscopy to
get into the market in 2015 and to become a standard in
three to four years.
4K will be driven by 4K endoscopy
38
OJ-BIO: AN OUT-OF-THE LAB DIAGNOSTIC DEVICE ON A CHIP
One of Medicas most elegant solutions may well be

OJ-Bios diagnostic device. Their small disposable cassette
is a fast, connected, and low-cost immunoassay device.
It relies on a surface acoustic wave chip. Such a chip can
detect a binding event: for example, for flu virus detection,
proteins of the flu virus will bind to the chip, triggering
an electronic signal turned into a result on the device. This
result is then sent to a mobile phone.
Low-cost and working with various immunoassays, these
tests should last no more than five minutes.
We combine a very sensitive biochip

and a very small rapid low-cost device
39
History THE SUSRUTA SAMHITA
History
The Susruta Samhita: a written guide

th
on 4 century BC aesthetic surgery
Mastering reconstructive surgical techniques today reflects the study of 4th

century BC discoveries in India, notably
on plastic surgeries of human facial anatomy. The renowned medical book Susruta
Samhita, written by Susruta, the father
of surgery, describes over 300 surgical
procedures, 120 surgical instruments and
classifies human surgery in eight categories.
40
The book remains the only authentic text

on ancient Indian medicine, Ayurveda. After
the appearance of the Susruta Samhita,
Ayurvedic texts presented Susruta as a
fully mythologized figure, for example as a
descendant of Dhanvantari, the physician
of the gods in Hindu mythology.
The book alone supports Susrutas title,

but the Father of Surgery was also the first
medical man to have performed dissection
of a human body and to describe the
anatomy of the human being. However, he
insisted upon training students in surgical
techniques using fruits, vegetables and
artificially prepared parts of the human
bodyhes considered to be the first surgeon
in the world to implement this method.
The Susruta Samhita represents the
equivalent of modern free flap operations.
Among the 300 procedures occurring at
that time was rhinoplasty, now one of the
most common operations. In Susrutas time
the operation provided a solution for those
sentenced by the Hindu Laws of Manu. The
laws, that governed much of life in ancient
India, dictated that the punitive measure
for the crime of adultery was to have the
offender's nose cut from the face. (Persaud,
1997) Susrutas surgical practices for
repairing the mutilated noserhinoplasty
were adopted later by European surgeons
under the name The Indian Method. While
Susrutas work was an important step for
our surgeons, an evolution can obviously
be noted when comparing the procedure
for a rhinoplasty operation at that time with
our current techniques.
Courtesy of LACMA
Courtesy of Christian Medical College, Vellore
by Erin Tallman
4th century BC vs. 21st century rhinoplasty

Susruta Samhita
Modern Rhinoplasty
(source the Internet Journal of Plastic Surgery)
(source A R DSouza, London Facial Surgeons)
The portion of the nose to be covered should be

first measured with a leaf. Then a piece of skin of
the required size should be dissected from the living
skin of the cheek, and turned back to cover the nose,
keeping a small pedicle attached to the cheek.
History of rhinoplasty surgery dates back to ancient

India where it all began. Today, growth in skill, training
and technology available has resulted in two basic
techniques:
The part of the nose to which the skin is to be attached

should be made raw by cutting the nasal stump with a
knife. The physician then should place the skin on the
nose and stitch the two parts swiftly, keeping the skin
properly elevated by inserting two tubes of eranda
(the castor-oil plant) in the position of the nostrils, so
that the new nose gets proper shape. The skin thus
properly adjusted, it should then be sprinkled with
a powder of licorice, red sandal-wood and barberry
plant.
Finally, it should be covered with cotton, and clean
sesame oil should be constantly applied. When the
skin has united and granulated, if the nose is too short
or too long, the middle of the flap should be divided
and an endeavor made to enlarge or shorten it.
The closed rhinoplasty technique

The open rhinoplasty technique
There are several variations centred on these two
basic approaches, depending on what is required
based on patient factors. It also depends on, the
surgeons training and philosophy.
Open rhinoplasty involves a cut in the midline partition
of the nose called the columella and the rest of the
incisions are inside the nose. The main advantage
of open rhinoplasty technique is, excellent exposure
of the nasal tip as well as rest of the nose. This gives
the surgeon complete control over the procedure,
particularly tip modification and reconstructing nasal
valve etc.
Closed rhinoplasty, is where all the cuts are made
inside the nose.
Practical Information UPCOMING EVENTS
UPCOMING EVENTS
THE LEADING INTERNATIONAL DENTAL SHOW
Held every two years in Cologne, the worlds leading trade show for the dental sector, presenting
the entire range of products available.
IDS
10-14 March 2015
Cologne, Germany
SOUTHEAST ASIAN HEALTHCARE & PHARMA SHOW

SEACare 2015
6-8 April 2015
Kuala Lumpur, Malaysia
Southeast Asias most established trade show for the healthcare industry, also including a pharma
and beauty focus.
CHINA INTERNATIONAL MEDICINAL EQUIPMENT FAIR
41
CMEF
15-18 May 2015
Shanghai, China
The largest medical devices exhibition in the Asia-Pacific region, covering tens of thousands of
products and providing services to the entire medical industry chain.
Practical Information UPCOMING EVENTS
UPCOMING EVENTS
THREE LEADING EVENTS AT THE SAME TIME
Three market areas are represented at Salons Sant Autonomie: HopitalExpo, Health-ITExpo, and
GerontHandicapExpo.
Salons Sant Autonomie
19-21 May
Paris, France
A COMPLETE MEDICAL EXHIBITION FOR LATIN AMERICA

Hospitalar
19-22 May
Sao Paulo, Brazil
Hospitalar displays from the most sophisticated state-of-the-art medical technology up to more
practical equipment.
THE LEADING MEDICAL TRADE FAIR IN THE USA
42
FIME
5-7 August
Miami, USA
Find products among the largest worldwide group of medical manufacturers and learn from seven
educational conference tracks.
Practical Information COMPANY INDEX
COMPANY INDEX
43
Abbott
InfraV
Samsung
Alcon
Integrated Change
Savion
Ammangirrbach
Integrity Applications
Second Sight
Animas
Intelesens
Senseonics
Apple
Intelligent Motion
Sensoria
Barco
iRhythm
Siemens
BioSensics
Jawbone
Suneris
Bodytel
Konica
TapCheck
BTS Bioengineering
Leaf Healthcare
Tec Gihan
CardioLogic
Liebherr
Vanderbilt University
Custo med
LifeWatch
Vigilant
Dexcom
London's Imperial College
Waters Corporation
ElitechGroup
Medtronic
Withings
Emotiv
mOm
Xsens
Empatica
Moticon
Zephyr
Epic
National University of Malaysia
Fitbit
Neurometrix
Fraunhofer Institute
Noraxon
GE
NovioSense
Geisinger Health Systems
OJ-Bio
Global Logic
Oschner Health System
Google
Pancreum
Hamilton
Personal MedSystems
HealBe
Preventice
e-magazine
Next Edition
April 14, 2015
Techno-Caring of Elders
+ IDS 2015 Coverage
MedicalExpo e-magazine - A Publication of VirtualExpo SAS - Capital of 60,000 euros - SIRET n 432 439 701 000 41 - Code APE 7112B - www.medicalexpo.com

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