GEH1032

MODERN TECHNOLOGY IN
MEDICINE AND HEALTHCARE

Chapter 0
Module Introduction
 Millions are Dying
• Fact:
Chronic Diseases kill Millions each year.

• Chronic diseases are the leading cause of death worldwide, resulting in roughly 40 million
deaths each year. They kill more people annually than any other cause (e.g. infectious
diseases, accidents, war, famine etc.).

• To place this number in perspective, the 2nd world war caused approximately 80 million
deaths over 6 years. This means that chronic diseases kills as many people as three
world wars running concurrently at the same time!

• Chronic diseases severely affects the quality of life of many and pose as a heavy financial
burden on individual families, as well as raising healthcare spending by governments.

• 80% of all deaths due to chronic diseases occur in low income countries, where the
diseases push many families into poverty due to heavy medical bills and loss of income.
GEH1032 Sem 1 2019-20 TK Chan Source: WHO World Population Ageing Report 2015, World Population prospects: 2015 Revision, Department of Statistics Singapore
 Chronic Diseases
What are chronic diseases?
• Chronic diseases are long-term, generally incurable illness or condition that affect a person’s
daily life and require ongoing medical attention.

• They are non-infectious, incapable of being transmitted from one person to another.

• They are usually caused by the malfunctioning, breakdown or damage to body systems,
resulting in abnormal health conditions, i.e. diseases. Some common chronic diseases are heart
disease, stroke, cancer, arthritis, chronic lung disease, diabetes, osteoarthritis, dementia etc.

What causes chronic diseases?

• We do not usually discuss what causes a chronic disease, as it is usually difficult to clearly
establish a specific and definitive cause for any chronic disease.
• However, we do know the major risk factors of chronic diseases, which shall be discussed:
➢ Ageing
➢ Lifestyle
➢ and one other factor that will be discussed sometime later in the course.
GEH1032 Sem 1 2019-20 TK Chan
 Global Population Ageing
• Fact:
The global population is ageing rapidly.
• This process is driven by advances in medical technology as well as increase in educational
standards and affluence levels in many countries, resulting in declining fertility rates, lower
infant mortality rates and increasing life expectancy.

➢ Life expectancy at birth has risen substantially across the world. In 2015, life expectancy is
78 years in developed countries and 68 years in developing regions. In the 1900s, average
life expectancy was 45 to 50 years in the developed countries of that time.
Singapore: 80.7 for males, 85.2 for females (2017)1

➢ Total fertility rate has decreased significantly from 5 children per woman in the 1950s to 2.5
children in 2015 (global average). Singapore: 1.16 per woman (2017)2

➢ The elderly population (aged 60 years and above) stands at 901 million globally in 2015.
This number is expected to more than double to 2.1 billion by the year 2050. FYI
GEH1032 Sem 1 2019-20 TK Chan Source: WHO World Population Ageing Report 2015, World Population prospects: 2015 Revision, Department of Statistics Singapore
 2050 FYI
World Population Demographics
Number of People

1950 2019

Year
In Singapore, the number of citizens aged 65 and above is
increasing rapidly. The elderly population has doubled
from 220,000 in 2000 to 440,000 today, and is expected to
increase to 900,000 by 2030.
Singapore is already the oldest nation in Southeast Asia.
The size of our elderly population is projected to more
than double that of the population of young people aged
15 and below by the year 2030.
Our ageing population will create profound challenges for
the country and the impact is already being felt today, e.g.
Straits Times 06 Dec 2017 rising healthcare expenditure, falling student numbers etc.
GEH1032 Sem 1 2019-20 TK Chan Source: UN Concise Report on World Population 2014, WHO World Population Ageing Report 2015, World Population prospects: 2015 Revision
 Old Age Support Ratio
• The Old Age Support Ratio is the most commonly quoted statistic that provides a measure of the
extent and the burden of population ageing. This is also known as the Potential Support Ratio.

Number of people considered to be of working age

Old Age Support Ratio =
Number of people considered to be elderly

• This ratio refers to the number of people of working age supporting every elderly person.

• In Singapore, the support ratio is 4.8 in 2018 and this is projected to decrease to about 2.0
working adults per elderly by 2050.
13.5
Singapore Old Age Support Ratio*
11.3
10.5
9
7.4
5.7 5.4 5.1 4.8

1970 1980 1990 2000 2010 2015 2016 2017 2018

FYI
GEH1032 Sem 1 2019-20 TK Chan
 Limitations to Old Age Support Ratio
• The old age support ratio provides a measure of the proportion of people that are likely to be
“dependent” on those who are assumed to be providing such support.

• This ratio is not universally relevant to all aspects of human society. Its usefulness depends on
the specific contexts that we are considering. Using it as the sole indicator of all the various
effects of population ageing may be misleading.

• For healthcare demand and expenditure, the support ratio does not provide the full picture.
This is because it is not the elderly, but the people who are ill that require healthcare.

• More accurate indicators are the proportion of population who are in ill-health or the average
proportion of life lived in ill-health per person. Alternatively, we can consider the average
number of healthy years lived per person.

• Nonetheless, older people do have a higher probability of developing age-related chronic

diseases. Therefore, the incidence rate of many of such diseases increases with age, resulting in
the high prevalence of chronic diseases in the elderly.

GEH1032 Sem 1 2019-20 TK Chan

 Ministry of Health Singapore

Life Expectancy at birth (2018)

Straits Times Male: 81.0
07 Dec 2015 Female: 85.4

“ … while life expectancy rose over the past decade, healthy years rose faster.”
GEH1032 Sem 1 2019-20 TK Chan
 Lifestyle Risk Factors for Chronic Diseases
Non-Modifiable Risk Factors
• Non-modifiable risk factors are factors that we are unable to alter or change.
• Examples: Age, Ethnic Background, Family History etc.

Modifiable Risk Factors

• Modifiable risk factors are factors that we can directly control. These factors are generally
a result of poor lifestyles and life choices. Examples are:
1. Poor diet
(excessive intake of salt, sugar and saturated fat)
2. Lack of physical activity (Sedentary lifestyle) I call these the
3. Being Overweight or Obese NOTORIOUS
(High body mass index, i.e. BMI > 23) 5
4. Tobacco smoking
5. Harmful use of alcohol
GEH1032 Sem 1 2019-20 TK Chan
 Chronic Diseases
• Chronic diseases are incurable. The best way to deal with them is in fact prevention or delay of
onset. Once the disease manifests, the patient can only hope to manage the disease properly:
control the symptoms and slow down the progression of the disease.

• Chronic diseases usually take a long time to develop. .

Prevention should therefore start at a young age while the body is still healthy.

• The Notorious 5 risk factors are expressed through the intermediate medical risk factors such
as high blood pressure (hypertension), high blood glucose levels (hyperglycemia), high blood
cholesterol (particularly LDL cholesterol), low bone density (osteoporosis) etc.
• Many believe that if people develop chronic disease due to unhealthy lifestyles, they have no one
but themselves to blame. However, individual responsibility can have its full effect in reducing
lifestyle induced chronic diseases only if individuals
➢ are educated early in life on the importance of healthy living/aging and healthy life choices
➢ have reasonable access to healthy food and healthy living
➢ are encouraged by family and supported by society/government to make healthy life choices

GEH1032 Sem 1 2019-20 TK Chan

 Prevalence of Chronic Disease
by population proportion If improperly managed, chronic
in the United States, 2010 diseases will have a snowballing
effect, resulting in people
MCC suffering from more than one
chronic condition at the same
time. This is known as Multiple
Chronic Conditions (MCC).
FYI
Older people are more likely to
suffer from MCC.
MCC incidence
by age groups in the In a study conducted in the United
United States, 2010
States, more than half of the
population suffer from MCC.
65+ Among the elderly aged 65+, over
45-64 80% of the people with chronic
diseases suffer from MCC.
18-44
0-17 FYI
FYI
GEH1032 Sem 1 2019-20 TK Chan Source: 2010 MEDICAL EXPENDITURE PANEL SURVEY DATA, Department of Health and Human Services, USA
 % of U.S. Population with chronic diseases (cc) and their
FYI
respective costs as % of total healthcare spending
Cost of MCCs:
U.S. Case Study
0 cc
48% of the population
0 cc 1 cc with no chronic disease
takes up only 14.2% of
2 cc the 2010 total healthcare
spending.
3 cc
8.7% of the population
1 cc 4 cc with 5 or more chronic
diseases takes up 35% of
2 > 70% of the total spending.
3 Total
4 Healthcare
5+ Spending !! MCCs are
disproportionately
more expensive to
31.5% of Population treat!
with MCC FYI
GEH1032 Sem 1 2019-20 TK Chan Source: 2010 MEDICAL EXPENDITURE PANEL SURVEY DATA, Department of Health and Human Services, USA
 Medical Technology
We can draw two important conclusions:
➢ The importance of effective management of chronic diseases.
It is essential to have effective management of chronic diseases: early diagnosis, treatment
and prevention (or delay in the onset) of these diseases. Proper management of chronic
diseases in the early stages will also prevent deterioration into MCCs, which then require
a disproportionately large demand and spending in healthcare.

How well chronic diseases are managed may determine whether the increase in
healthcare demand and spending will remain sustainable in the future.

➢ Medical technology plays an important role chronic diseases management.

Medical technology is used for health screening for delay of onset, early detection,
improved diagnosis accuracy and improved treatment for chronic diseases when they
manifest. This allows people to cope better with the disease and while still enjoying a high
quality of life, reducing healthcare costs for both governments and individuals.

GEH1032 Sem 1 2019-20 TK Chan

 Goals of Healthcare and Medical Technology
on Tackling Chronic Diseases
• Effective healthcare and medical technology may serve to accomplish some, if not
all, of the following outcomes:
▪ Delay the onset of chronic diseases through healthier living and better management
of health through regular medical care during healthy years.
▪ Allow for early detection and prevention of some diseases, returning patients to
health and reducing the number of chronic diseases that a patient might suffer from.
▪ Better treatment and management of symptoms that improve quality of life for
patients in cases where diseases are not subject to cure.
▪ Reduce the incidence rate and prevalence of disabilities. Severe or mismanaged
chronic diseases may lead to disabilities, which reduces the quality of life for the patients.
In many cases, disabilities will require expensive rehabilitation and therapy treatments, as
well as expensive full-time care (e.g. maid, full-time healthcare worker, hospices etc.)

▪ Reduce mortality (i.e. deaths from diseases) among patients, effectively extending life
span of the population while at the same time preserving the quality of life.
GEH1032 Sem 1 2019-20 TK Chan
 Effective Use of Healthcare and Medical Technology
Some words of caution on Medical Technology:
➢ Research and implementation of new medical technology are expensive and they
cause a rise in healthcare spending.
Newer and advanced medical technology have been shown to contribute significantly to the
increase of healthcare costs, both for government and the patient. However, advancement in
medical technology serves to reduce disease incidences and to return sick people back into
health, who then return to contribute to the workforce and economy. The interdependency
between these factors are complex and not yet entirely understood.

➢ The effective use of healthcare is essential to its sustainability.

Effective use of healthcare is crucial for future healthcare sustainability, in an environment of
global population aging. Unnecessary, ineffective and inefficient use of medical technology may
contribute to an increase in healthcare infrastructure demand and spending while providing no
improvement in the medical outcome for the patient. What constitutes an effective healthcare
system is still under debate, many factors have to be considered: size and wealth of a particular
nation, its population demographics and social welfare systems etc.
GEH1032 Sem 1 2019-20 TK Chan
 Ok … so what is your point?

Chronic diseases have reached epidemic levels worldwide.

If left unchecked, chronic diseases will cause an unsustainable

financial burden on individual families as well as governments.

With direct implications in healthcare spending and medical

infrastructure demand, medical technology and its effectiveness in
chronic disease management may fundamentally affect the way
societies and governments function in the future.

GEH1032 Sem 1 2019-20 TK Chan

 Module Objectives
• In this module, we seek to achieve basic understanding of the various common chronic
diseases, as well as the basic physics and implementation of the modern diagnostic
imaging and radiation therapy technology that is used today.

• The module will concentrate on the applications of such medical technology in the
detection and treatment of age-related chronic diseases such as cancer, ischemic stroke
and heart disease (atherosclerosis), Alzheimer’s and Parkinson’s diseases, diabetes etc.

• Modern medical technology that we shall discuss can be broadly categorized into:
➢ Technology used for imaging (i.e. to look within the body)

➢ Technology used for treatment (i.e. to remove or kill the disease cells etc.)

• We seek to answer, at a basic level, the following questions:

➢ How do these technology work? Why do these technology work the way they do?

➢ What are the capabilities and limitations of each type of technology?

➢ Are they safe?
GEH1032 Sem 1 2019-20 TK Chan
 GEK1540 Technology in Medicine and Healthcare

Visible Sound Radio- Magnetic Radiation Nano-

Laser X-Ray
Light Wave activity Field Therapy technology

Chapter Chapter Chapter Chapter Chapter Chapter Chapter Chapter

1 2 3 4 5 6 7 8

Medical Imaging (Diagnostic Imaging)

+ Treatment of Chronic Diseases

Cancer Treatment using Radiation

Future Medical Technology

GEH1032 Sem 1 2019-20 TK Chan
 Chapters
Chapter 1: Endoscopy: Internal Optical Imaging using Endoscopes

Chapter 2: Lasers in Medicine and Surgery

Chapter 3: Sonography: Imaging using Ultrasound

Chapter 4: Radiography and CT: 2D and 3D imaging using X-Rays

Chapter 5: Nuclear Medicine: 3D imaging using Radioisotopes

Chapter 6: Magnetic Resonance Imaging (MRI)

Chapter 7: Radiation Therapy: Cancer therapy using radiation

Chapter 8: Nanomedicine: Nanotechnology in Medicine

GEH1032 Sem 1 2019-20 TK Chan

 Important Points to Keep in Mind

This course is heavy in content.

The tests and exam are not designed to be easy.
• Other important notes:

➢ Deep understanding is important! While this course requires you to absorb a

significant amount of content, simply memorizing and regurgitation without
understanding is not sufficient. The tests and exam will require you to answer questions
not based on what you have memorized, but based on your understanding of the content.
➢ Details are important! This course requires a very detailed and precise understanding
of the course materials. Simply obtaining a vague or a rough understanding is not enough
and will usually not result in a good grade.

• Additional Reading (Non-Compulsory):

Introduction to Physics in Modern Medicine 2nd edition by Suzanne Amador Kane
GEH1032 Sem 1 2019-20 TK Chan
 Additional Information
• Lecture Time and Venue
➢ Lectures are conducted every Monday and Wednesday 2 – 4 pm at LT21.
➢ Lectures start at 5 minutes past the first hour SHARP and end no later than 35
minutes past the second hour. There will be a 5-min break sometime midway through
each lecture session.
➢ There will be no webcasts of lectures.

• Use of Luminus and Emails

➢ All course information will be posted on Luminus, including the lecture materials (in
PDF format) and tutorials worksheets.
➢ Important announcements will be made over Luminus and/or sent to your NUS
emails. It is important to check your emails and Luminus course page regularly.
➢ Videos will be used in the course. The weblinks to the videos (if available) will be
posted onto Luminus after the end of each chapter.
GEH1032 Sem 1 2019-20 TK Chan
 Additional Information –
Please Read the Student Handbook!
• Required Skill in Mathematics:
➢ Simple mathematical operations, solving simple equations, sines and cosines (no
tangents), exponentials (ex) and natural logarithms (ln x).
➢ No differentiations and integrations will be required.

• Physical units will be involved: e.g. nanometers (nm), centimeters per second (cm/s),
electron volts (eV), Joules per square meter (J/m2), Megahertz (MHz), tesla (T) etc.

• Physical constants will be involved: Plank’s constant h, speed of light c , electron charge
e, electron mass me etc.

• Formula sheet (equations and constants) will be given in the exam and term tests.
• You will need to know how to use a non-programmable scientific calculator. This is
required in both tests and exams.

• Graphical calculators are NOT allowed in tests and exams.

GEH1032 Sem 1 2019-20 TK Chan
 Course Assessment
(a) Continuous Assessment – 50%
➢ Tutorials – 10%
▪ Questions will not be marked but module points will be given for attendance.
▪ Questions in tutorial worksheets serve to illustrate the proper manner of
answering the questions in the tests and the final exam.
➢ 2 Tests (MCQs / MRQs / Short Answer Questions) – 20% each
▪ Tests are tentatively set to take place in Week 7 (Test 1) and Week 11 (Test 2).

(b) Final exam – 50% (Closed book, MCQs, MRQs + Long Answer Questions)
➢ The final exam will not only test your knowledge of the course content, but also
your display of your understanding, both in breadth as well as depth.
➢ A reasonable command of English is required, along with legible handwriting and
some sketching skills.

GEH1032 Sem 1 2019-20 TK Chan

 Tutorials on Weeks 4, 6, 8, 10 and 12
Week Dates Tutorials
1 14 Jan – 20 Jan X
2 21 Jan – 27 Jan X
Venue : Block S16 #04-30
3 28 Jan – 03 Feb X
4 04 Feb – 10 Feb Tutorial 1
5 11 Feb – 17 Feb X
6 18 Feb – 24 Feb Tutorial 2
RECESS 25 Feb – 03 Mar
Weeks 4, 6, 8, 10, 12 only
7 04 Mar – 10 Mar X 12 – 1pm 1 – 2 pm 2 – 3 pm 3 – 4 pm
8 11 Mar – 17 Mar Tutorial 3 Mon
9 18 Mar – 24 Mar X Tue ST1
10 25 Mar – 31 Mar Tutorial 4 Wed
11 01 Apr – 07 Apr X Thu ST2
12 08 Apr – 14 Apr Tutorial 5 Fri ST3
13 15 Apr – 21 Apr X
READING 22 Apr – 26 Apr
EXAM 27 Apr – 11 May

GEH1032 Sem 1 2019-20 TK Chan

 Contacts and Consultations
Contacts
Dr. CHAN Taw Kuei
Email: phyctk@nus.edu.sg
Office: S12-03-16
Tel: 65164149

Consultation
• Preferred consultation mode is via email.
• Simple questions requiring short to moderate-length answers: via email or approach
me after the lectures.
• Complicated questions requiring long answers: Arrange for consultation date/time
over email.
I may not always be in office, so I urge all who need consultations with me
to always contact me via email.

GEH1032 Sem 1 2019-20 TK Chan