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Embedded Linux On a Digital Stethoscope
An anonymous reader writes "A team of electrical and computer engineering students at Calvin College is designing a digital electronic stethoscope running uClinux as its operating system. While there are many embedded devices built on Linux operating systems, medical devices running open-source software are extremely rare because of the perceived difficulty in obtaining FDA validation. The device is in its early stages of development, but major hardware choices have been made, and the team has recently released a Project Proposal and Feasibility Study."
OK I'll bite. Why does a stethoscope need an OS in the first place? How much file I/O, multitasking, networking etc. does a single-purpose device like this really do?
...that and a very restrictive license that could easily go to several thousands of bucks in fines and fees if violated...
Stethoscopes either traditional or digital really aren't designed to diagnose anything in a clinic setting at least not where more accurate tests are availible. But that doesn't mean that they don't save a heck of a lot of time determining what to test for. Not to mention you seem to ignore areas of medicine such gastroenterology, pulmonology and emergency medicine.
"I don't necessarily agree with everything I say." - Marshall McLuhan
my partner's rapid heart beat was what lead to her being diagnosed with a certain illness. a doctor could very well play back the beats to show there was no reasonable way for him to know a person had a certain illness that related to it.
If you mod me down, I will become more powerful than you can imagine....
Disclaimer : I A A MD.
Currently, any exam can be recorded, stored, shared with an expert for additional advices, compared for reference, you can build libraries for teaching or for personnal reference, you can reprocess these data off-line to "clean them", you can mine them to discover whatever interests you, you can reproduce that data using a different way to display it (using false color instead of greys to help visualise contrasts, or more complex math like using fast fourier to transform Doppler-echo noises into a nice colored graphic) etc...
This include everything from the most high tech devices like 3D scanners, MRIs, etc. to the most simple technical examination (electrocardiograms) or even the most trivial step in examination : overall visual aspect (digital photo cameras are a very valuable tool in several arrays of medicine including dermatology and surgery).
And with all this digitalised information, you can even throw computer at the task of helping the clinicians. MRIs comes easily as an example where computer may help making something useful out of the data. But even much simpler exams like electro cardiogramme nowadays include small embed chip that can automatically recognise a couple of pathologies. Most modern machine will print in nice small message like "90% suspicion of grade I atrio-ventricular blocking", in addition of the actual tracks.
(And in fact modern defibrillator heavily rely on on-board electronic intelligence. The iron-like you still see in movies aren't used that much. The modern ones are semi automatic : you stick two big electrodes on the front and side of the chest. the machine goes automatically an ECG, decide the procedure to follow, and announce on a small embed screen and using voice. The practitioner only has to push a button to confirm and do the shock if he agrees with the machine's conclusions. Everything is automatic and comes with voice instruction so even untrained personal could use it).
Everything recordable and digitilized ? No. Nearly everything.
The century old stethoscope isn't. You use it, you hear something, but you can't share it or store it for further reference.
Meanwhile, there's a lot of information that trained doctor can hear in the stethoscope.
But it's hard to show to other (you can store it in a library to keep it for a lecture, you can't point it with a finger on the graph to a student), the student need luck to be around when there's something interesting for her/him to hear. It can't be reproduced.
It's almost some kind of voodoo art, where you have a couple of old expert who can diagnose almost anything with a simple stethoscope and by looking how the patient walk to enter the room. But they can't easily transmit their art. Sometimes you just wish you could keep them stored in formaldehyde.
This gadget that those engineer are working on is a nice alternative to the formaline. A simple gadget that'll help store, archive, send, etc. the noises you may encounter when examining with a stethoscope.
Also, I happen to be a little bit hard hearing. Not much. I doesn't pose any problem in normal life (I can enjoy classical music concerts for example). But when it comes to hearth noises, I start to show my limits and I suck with a stethoscope.
Such a device could enable me to obtain better (cleaned of noise) signal. Or even, as the devices use apparently open source software (uCLinux), it won't be too difficult to bolt in some crypto+network capability and display a visual representation of the sound on my Palm's screen.
I really think that throwing some electronics inside the stethoscope was long due, and I'm happy that the problem is currently being tackled with open source software.
"Sufficiently advanced satire is indistinguishable from reality." - [Tips: 1DrYakQDKCQ6y52z6QbnkxHXAocMZJE61o ]
The main clinical utility I see for electronic stethoscopes is teaching - I've heard some great murmurs, added sounds, rubs, etc and not had any medical students to share it with. I know that getting competent at cardiac and even respiratory auscultation would have been faster for me with recordings of pathology to teach with. From my observations, uptake of electronic stethoscopes has been minimal though - I think I've only seen one or two people using them.
The comments seem to be very 'everyone just uses tests anyway' oriented. This is much more true in the US context than where I practice (Australia) or in Europe, but even in the US, clinical examination is an essential tool for so many reasons, second only to talking to the patient. You can't do every test on everyone and clinical examination functions as a screening test for deciding who should be subjected to them.
The comment that you don't use a stethoscope anyway is ridiculous. Not everyone gets an echo, chest X ray or the other tests purported to replace it - they don't need it. And even if they do get these tests initially, that doesn't mean they get repeated every time you want to check the patients progress - another reason you do a baseline clinical examination and then repeat it to gauge progress. Remember, X-rays involve ionising radiation - in other words, each one exposes you to a tiny risk of cancer. It's actually irresponsible to just throw them around in settings where repeat CXRs are not required - over a practice lifetime, that type of medicine WILL kill someone (As one of my radiology teachers said, "no one will be able to trace it to your test, but that's not the point, is it?") And as for repeat echos - depending on how much detail you need, a full echo needs 20-40 minutes, an experienced echo tech, a bloody big machine, and is often uncomfortable. Not to mention cost. And delay in actually getting these tests - in critical care, which is my specialty, we probably do more tests than any other branch of internal medicine because our patients often can't speak to us - but the immediacy of clinical examination and its repeatability make it an indispensable tool.
In general terms, I find the increasing reliance on tests - which themselves may have side effects for patients, some of them merely unpleasant, others more serious - often for purely ass-covering legal reasons, and the resultant deskilling of doctors and decline in emphasis on teaching clinical examination skills, disturbing. Sometimes it seems that documentation is the modern substitute for success in healthcare.
" ... medical devices running open-source software are extremely rare because of the perceived difficulty in obtaining FDA validation ..."
That is totally inaccurate. There are plenty of medical devices in use running Linux, and they all get FDA approval without any issue. As long as you go through the same procedures in testing/quality-assurance and documentation it's all the same end result to the FDA. Even in the case of software which is complex relying on other pieces of software, black box testing solves the requirement for reproducing steps to a particular software operation.
What is it going to take to get those reporting on open source to cut down on FUD?