Biomedical Engineering

Keynote Speakers

• Joseph Smith - California, USA

Invited Speakers

• Kathy Dallest - Brisbane, Queensland
• Ed Scull - Clinical Engineering at the Crossroads
• Michael Bevan - Canberra, ACT
• Lee Lister - Aeroscout
• Holger Voderberg - Stuttgart, Germany
• Paul Borgmeier - Big Green Surgical Company

Humanitarian Workshop

• Tom Judd - Washington DC, USA
• Luciano Moccia, East Timor
• John Kis - Hanoi, Vietnam
• Trevor Hezakie - Wagga Wagga, Victoria
• Michael O'Brien - Hobart, Tasmania
• John McLaren - Darwin, Nothern Territory
• Ian Norton

Medical Physics

Keynote Speakers

• David Brenner - New York, USA
• Wolfgang Dörr - Dresden, Germany

Invited Speakers

• Benjamin Blyth - Adelaide, South Australia
• Roger Price - Perth, Western Australia
• Ivan Williams - Melbourne, Victoria
• Eric Yeoh - Adelaide, South Australia
• Sergei Zavgorodni - BC, Canada

Uranium/Radon Workshop Speakers

• Andrew Johnston - Adelaide, South Australia
• Sharon Paulka - Darwin, Northern Territory
• Russell Robinson - Darwin, Northern Territory

Public Lecture

Public Lecture Speaker

• George Dracoulis, Australian National University

Michael Bevan

Biography
Michael Bevan is Associate Director Registration with Engineers, Australia. He is also Registrar of National Registers, responsible to the National Engineering Registration Board.
Since his appointments 1994, his key achievements have included the establishment of a credible professional registration system based on objective competency standards, the development and use of defensible competency assessment and audit systems and the achievement of broad acceptance of professional self regulation. Mr Bevan led the development of a Government approved scheme for the assessment of qualifications and competencies for registration as a Registered Professional Engineer of Queensland (RPEQ), through which Engineers Australia has now assessed more than 1,500 engineers.

Abstract

The Regulation of engineers, finding the right approach for a national economy

Moves towards a consistent State-based approach to the regulation of engineering date back some years. Engineers Adopted it as policy in 2009. Since September 2010, the National Engineering Registration Board has been developing strategies and literature to achieve this.

A five-minute speech from Rolfe Hartley, Chair of NERB will be shown.

The case for registration in the biomedical field (developed in 2008) will be reviewed in the context of the NERB initiative and synergies developed.

A discussion of relevant considerations will be facilitated.

Benjamin Blyth

Biography
Dr Benjamin Blyth is a post-doctoral researcher within the Flinders Centre for Cancer Prevention and Control at Flinders University, Adelaide, South Australia. His research focus is radiation-induced bystander effects and their relevance to the carcinogenic risks associated with low dose radiation exposures. Dr Blyth has published an experimental method in mice to investigate radiation-induced bystander effects in vivo, developed as part of a United States Department of Energy grant awarded to Professor Pamela Sykes.

Abstract

The relevance of radiation-induced bystander effects for low dose radiation carcinogenic risk

Where epidemiology studies lack the ability to prescribe radiation doses, customise sample sizes and replicate findings, radiobiology experiments provide greater flexibility to control experimental conditions. This control simplifies the process of answering questions concerning carcinogenic risk after low dose radiation exposures. However, the flexibility requires critical evaluation of radiobiology findings to ensure that the right questions are being asked, the experimental conditions are relevant to human exposure scenarios and that the data are cautiously interpreted in the context of the experimental model. In particular, low dose radiobiology phenomena such as adaptive responses, genomic instability and bystander effects need to be investigated thoroughly, with continual reference to the way these phenomena might occur in the real world. Low dose radiation-induced bystander effects are of interest since their occurrence in vivo could complicate the shape of the radiation dose-response curve in the low dose range for a number of biological endpoints with subsequent effects on radiation-induced cancer risk. Conversely, radiation-induced abscopal effects implicate biological consequences of radiation exposure outside irradiated volumes, and complicate the notion of effective dose calculations. Achieving a consensus on the boundaries that distinguish the radiobiology phenomena of bystander and abscopal effects will aid progress towards understanding their relevance to in vivo radiation exposures. A proposed framework for discussing bystander effects and abscopal effects in their appropriate context will be outlined, with a discussion on the future investigation of radiation-induced bystander effects. Such frameworks can assist the integration of results from experimental radiobiology to risk evaluation and management practice. This research was funded by the Low Dose Radiation Research Program, Biol. and Environ. Research, US Dept. of Energy, Grant DE-FG02-05ER64104.

Paul Bordmeier

David Brenner

Biography
Professor David Brenner is the Higgins Professor of Radiation Biophysics, College of Physicians & Surgeons of Columbia University, director of the Center for Radiological Research (CRR),
Director of the Columbia University Radiological Research Accelerator Facility (RARAF), and
Member of the National Council on Radiation Protection and Measurements (NCRP).

Professor Brenner focuses on developing mechanistic models for the effects of ionizing radiation on living systems, both at the chromosomal and the animal (or human) levels. He divides his research time roughly equally between the effects of high doses of ionising radiation and the effects of low doses of radiation.

In the field of medical imaging, he has focused on the risk / benefit balance of the higher-dose imaging techniques, particularly computed tomography (CT). In the field of radiotherapy, he has focused on optimising fractionation schemes for different tumour types, to maximise tumour killing and minimise serious side effects; this includes modelling the mechanisms of radiotherapy-induced second cancers, with the goal of reducing second cancer risks. Environmentally, he has focused on the biological effects of radon, both at the chromosomal and the human levels.

Plenary Lecture: Radiation Exposures from Medical Imaging: Cause for Concern?

Abstract
CT usage rates are increasing by 5 to 10% per year in most countries with high-level health care systems - in the U.S. more than 75 million CT scans are currently performed each year. Because CT is such a superb diagnostic tool and because individual CT risks are small, the CT benefit/risk balance is generally by far in the patient's favor. However, organ doses from CT are typically far larger than those from conventional x-ray exams, and there is epidemiological evidence of a small but significant increased cancer risk at typical CT doses. It follows that it is particularly important that CT should operate under the ALARA (As Low As Reasonably Achievable) principle, and indeed opportunities exist to reduce the significant population dose associated with CT. The first opportunity is to reduce the dose per scan, and improved technology has much potential here. The second opportunity is selective replacement of CT with other modalities, such as for many head and spinal exams (to MRI), and for diagnosing appendicitis (selective use of ultrasound + CT). Finally, a fraction of CT scans could be avoided entirely, as indicated by CT decision rules. Clinical decision rules for CT usage represent a powerful approach for slowing down the increase in CT usage, because they have the potential to overcome some of the major factors that result in some CT scans being undertaken when they are potentially not clinically helpful. Underlying all of the above is the importance of continuing education for all health care providers associated with advanced radiological imaging.

Plenary Lecture: Understanding and Potentially Reducing Second Breast Cancers

Abstract
Long term survival after breast cancer diagnosis has increased markedly in the last decade: 15-year relative survival after breast cancer diagnosis is now 75% in the US. Associated with these excellent survival prospects, however, long term studies suggest that contralateral second breast cancer rates are in the range from 10 to 15% at 15 years post treatment, and are still higher for BRCA1/2 carriers, as well as for still longer term survivors. These second cancer risks are much higher than those for a comparable healthy woman to develop a first breast cancer. It follows that women with breast cancer are highly prone to develop a second breast cancer.

We propose here a new option for reducing the disturbingly high risk of a contralateral second breast cancer, in patients with both estrogen-positive and negative primary breast cancer: prophylactic mammary irradiation (PMI) of the contralateral breast. The rationale behind PMI is evidence that standard post-lumpectomy radiotherapy of the affected (ipsilateral) breast substantially reduces the long-term genetically-based second cancer risk in the ipsilateral breast, by killing the existing pre-malignant cells in that breast. This suggests that there are relatively few premalignant cells in the breast (hundreds or thousands, not millions), so even a fairly modest radiation cell-kill level across the whole breast would be expected to kill essentially all of them. If this is so, then a modest radiation dose - much lower than that to the affected breast - delivered uniformly to the whole contralateral breast, and typically delivered at the same time as the radiotherapy of the ipsilateral breast, would have the potential to markedly reduce second-cancer risks in the contralateral breast by killing essentially all the pre-malignant cells in that breast - while causing only a very low level of radiation-induced sequelae.

Therefore we hypothesize that low-dose prophylactic mammary irradiation of the contralateral breast, which would be performed at the same time as standard post-lumpectomy radiotherapy, is a breast-conserving estrogen-receptor-independent option that may have the potential to significantly decrease the disturbingly high second-cancer risks in the contralateral breast of long-term breast cancer survivors.

Plenary Lecture: The Mechanisms Behind Radon Does Rate and Age Effects

Abstract
Understanding the patterns of radon risks as a function of dose rate and age is important not only from a societal perspective, but also because it provides useful insights into the mechanisms of radiation carcinogenesis.

When radiation acts predominantly as an initiating agent, converting normal cells into premalignant ones which can subsequently develop into tumors, the effects of exposure are additive, i.e., a certain number of new pre-malignant cells are added to the background number. Thus the excess relative risk (ERR) decreases with age at exposure because the background cancer risk, which forms the denominator of ERR, usually grows rapidly with age. Reduction of the radiation dose rate allows more time for repair of damage leading to cell initiation, thereby reducing the initiation-driven ERR (a direct dose rate effect).

By contrast, when radiation acts predominantly as a promoting agent, enabling already existing pre-malignant cell clones to grow to larger sizes, the effect can be seen as multiplicative, i.e. the background number of pre-malignant cells is multiplied by a certain factor. The ERR in this case is expected to be essentially constant regardless of age at exposure. Reducing the dose rate allows more time for the promoting effects of exposure to act, thereby increasing the promotion-driven ERR (an inverse dose rate effect).

Epidemiological data on lung cancer in humans exposed to radon suggests a) the existence of an inverse dose rate effect, and b) only a weak dependence of ERR on age at exposure. Thus analysis of human data on radon-induced lung cancer by a model based on these principles suggests that radon acts mainly as a promoting agent in humans.

Kathy Dallest

Biography
Kathy Dallest, Clinical Safety Unit Manager
Kathy Dallest leads the Clinical Safety Unit within the National e-Health Transition Authority (NEHTA). The unit was established in October 2009 and undertakes clinical safety risk management activities within the development of NEHTA's products and services to deliver eHealth for Australia. She is a Registered Nurse and Public Health Practitioner with post graduate qualifications in Health Informatics. In addition to clinical practice in Australia and overseas, she has 17 years' experience of health IT, covering local and national health IT implementation as well as strategy, policy and program delivery mostly within the Scottish eHealth programme. Prior to returning home to Australia, led work to deliver Knowledge Management solutions to support the National eHealth Programme and to support improved patient safety and quality in healthcare on behalf of the Scottish Patient Safety Programme, Scottish Government and NHS Education for Scotland. She contributes to international health IT clinical risk management forums and groups.

Abstract

The latest news from the National E-Health Transition Authority (NEHTA)

• National implementation of lead sites using the Healthcare Identifiers (HI) Service and priority eHealth solutions
• A Personally Controlled Electronic Health Record (PCEHR) for Australia
• Development of the foundations required to enable eHealth
• Adoption of eHealth through engagement and collaboration

NEHTA is the lead organisation supporting the national vision for eHealth in Australia. NEHTA's role as managing agent on behalf of the Department of Health and Ageing (DoHA) is to deliver the Personally Controlled Electronic Health Record (PCEHR) work program for the Australian health community.
NEHTA was established by the Australian Commonwealth, State and Territory governments in 2005 to develop better ways of electronically collecting and securely exchanging health information.

Wolfgang Dörr

Plenary Lecture:
Pathogenesis of radiation effects in normal tissues and options for intervention
Plus
Options and pitfalls of normal tissues complication probability models
Radiation-induced cataracts

Biography
Professor Wolfgang Dörr is the head of the normal tissue radiobiology (NTRB) group, head of the radiobiology laboratory and deputy head of the Section on clinical radiation oncology and radiobiology at the Technical University Dresden (TUD), Germany. He is also deputy director of the experimental centre, the core animal breeding and experimentation facility of the faculty and animal welfare manager of both the TUD and the Research Centre Dresden Rossendorf (FZD), where part of the micro-imaging facilities are located.

The Normal Tissue Radiobiology group of the TUD has a long-standing research record in experimental animal radiobiology with studies in various organs such as oral mucosa, urinary bladder, lung, skin, etc., including extensive experience in local organ irradiation, follow-up of the animals and assessment of functional and morphological changes.

Plenary Lecture: Pathogenesis of radiation effects in normal tissues and options for intervention

Abstract

Early (acute) side-effects of radio(chemo)therapy are observed during or shortly after a course of radiotherapy. In contrast, late (chronic) side-effects become clinically manifest after latent times of months to many years. Early effects are usually found in tissues with a high proliferative activity that balances a permanent cell loss (turnover tissues), such as bone marrow, or mucosae of the intestinal tract. The symptoms are based on radiation-induced impairment of cell production, resulting in progressive cell depletion. Late radiation side-effects are basically found in all organs. In contrast to the development of early side-effects, the pathogenetic pathways of chronic side-effects are more complex. The dominating processes occur in the parenchyma of the organs (i.e. in the tissue-specific compartments) and in the connective and vascular tissue compartments. Regularly, the immune system (macrophages, mast cells) contributes to the tissue reaction. Late radiation sequelae, with few exceptions, are irreversible and progressive, with severity increasing with longer follow-up times. Therefore, the longer the survival times of the patients (i.e. the better radiation therapy) the higher is the number of patients at risk for late reactions. Early and late radiation effects are independent with regard to their pathogenesis and, in general, conclusions from the severity of early reactions on the risk of late effects cannot be drawn. However, interactions between early and chronic reactions can result in consequential late effects (CLE), when the early-responding tissue compartments (e.g. epithelia) have a protective function against mechanical and/or chemical exposure. Hence, cell depletion allows for secondary traumata to the target structures of the late sequelae, in addition to the direct effects of radiation. Consequential late effects have e. g. been demonstrated for intestine, urinary tract, oral mucosa and lung.

Interventions in the "tissular" processing of radiation damage can be directed against any step of the "molecular" pathogenetic cascade, including early production of free radicals, activation of transcription factors, modulation of signaling cascades, or modulation of the immune response. Most promising, with first clinical studies, are the interaction with (some) growth factor signaling cascades, the interruption of chronic oxidative stress (in late tissue reactions), and the treatment (mobilization or transplantation) with stem cells.

A broader illustration of the various aspects of normal tissue pathogenesis and interventional options mentioned above can be found in "Basic Clinical Radiobiology, 4^th edition" [Joiner and Van der Kogel 2009].

George Dracoulis

Biography
Professor George Dracoulis, FAA
Australian National University

George Dracoulis was Head of the Department of Nuclear Physics at the Australian National University from 1992.to July 2009. The Department operates a major Accelerator Facility used by Australian and International Researchers for basic science and applied studies using nuclear techniques. His research interests, pursued at both local and international facilities, are in the spectroscopy and structure of unusual nuclear levels. He has published widely on nuclear structure topics including shape co-existence, the properties of high-spin isomers in trans-lead nuclei, and the structure and applications of high-K isomers.

He is a Fellow of the Australian Academy of Science, a Fellow of the American Physical Society and a Fellow of the Australian Institute of Physics. He was awarded a Centenary Medal in 2003 and was the recipient of the Australian Academy of Science's Lyle Medal for distinguished research in physics in 2003. He was awarded the Australian Institute of Physics' Walter Boas Medal for excellence in research in Physics in 2004 and the Chancellor's award for distinguished service to the University and Australian science, in 2009. He was appointed Professor Emeritus in 2010.

He was also a member of the Prime Minister's select Task Force that conducted a review into the prospects for Uranium Mining, Processing and Nuclear Energy in Australia in 2006, and has been involved in extensive public engagement on Nuclear policy issues in Australia and abroad.

Abstract

Nuclear Issues in Australia and Beyond; One Perspective

This lecture will outline part of the background and conclusions of the 2006/2007 review of the Nuclear fuel cycle and its possible role in Australia, from uranium mining to electricity generation. The presentation will cover aspects of uranium production, life-cycle greenhouse gas emissions from competing technologies, the scale of nuclear power world-wide, the predicted cost of electricity generation in Australia, and as far as time permits, the issues associated with politics, waste, risk, public perception and public acceptance in the year that is marked by the 25^th anniversary of Chernobyl and dramatic events in Japan.

Andrew Johnston

Biography
Andrew Johnston has over 30 years experience as a regulator with the SA Health Commission and the SA Environment Protection Authority, primarily in the area of radiation protection and radioactive waste management in uranium mining and processing, and also in the management of naturally occurring radioactive materials (NORM) and environmental radiation issues. During this time he has had extensive experience in occupational and environmental radon and radon decay product monitoring.

Abstract

Radon Measurement Workshop

The workshop will provide an overview of the physical properties of radon (222-Rn) and thoron (220-Rn) and their associated decay products, and the basis of the techniques developed for their measurement to determine radiation exposures in both occupational and environmental settings.

The advantages (and disadvantages) of the commonly used measurement methods and commercially available equipment, will be discussed in the context of taking practical measures to minimise occupational and public radon and radon decay product exposures

Trevor Hezakie

Biography
Born to a subsistence farming family up in the highlands of Papua New Guinea in the mid 1960s, I have fond memories of my childhood as that of adventure and pleasure in the jungles. I learnt at an early age to be creative and to improvise, to make tools, toys, weapons and the like.
I attended the local Henganofi Primary School from 1974 - 1979 and when a High School opened up in my area in 1980, I was one of a few in my district who got a place to go on to do Year 7 to Year 10. After completing Year 12 in 1995, I joined the PNG Defense Force Air Transport Squadron to do an Aircraft Maintenance Engineering Apprenticeship. In 1996 I went on to teaching Electronics at Port Moresby Technical College.
By 2001 I was running the recently completed Biomedical Engineering workshop (through PNG Medical Equipment Management Project - MEMP) at Lae's ANGAU Memorial General Hospital, the second largest hospital in PNG.
In 2004 I joined Greater Southern Area Health Services - NSW Health based at Griffith Base Hospital.
From August 2009 to March 2011 I was working for the Australian Volunteers International's Pacific Technical Assistance Mechanism initiative as a Biomedical Technician, working out of Vanuatu and Solomon Islands. On my return I had a short stint with Tamworth Rural Referral Hospital before moving further south to my current role as Senior Biomedical Engineering Technician at Wagga Wagga Base Hospital.

Abstract

From PNG Trainee to Pacific Island Mentor

Over the past two years (August 2009 - March 2011) I had the opportunity to be involved with Australian Volunteers International (AVI) as a field Biomedical Engineering Technician. I was deployed to Vanuatu and Solomon Islands under The Pacific Technical Assistance Mechanism (PACTAM), working for the Ministry of Health and hospitals in their respective countries. PACTAM is an Australian Government, AusAID initiative and managed by AVI. This initiative came about as a result of requests for technical assistance from Pacific Islands Governments and agencies and AVI recruits volunteering professionals from Australia and other countries for assignments that cannot be filled locally.
My deployment has been a roller coaster ride of challenges and re-discoveries. Having previously worked with the Papua New Guinea health system in a similar role, I had some idea of the challenges that I was facing prior to me taking up the assignment in Vanuatu and Solomon Islands. In both countries I was heavily involved with the local Biomedical Engineering and Hospital Maintenance teams by drawing up and implementing a routine service schedules and also setting up of an asset inventory and equipment management system for medical equipment. Mentoring of host country Biomedical Technicians and nursing staff training in the care and maintenance of medical equipment was an integral part of my service.
I also had the opportunity to work with Health Ministries, AusAID in-country representatives and other volunteers from around the world, support and other non-government agencies such as churches, Japanese Government Aid agency (JICA), Technical Training Schools and Nurse's Training School including local counterparts.

There is a large number of outdated equipment still in use in these countries so it was in itself a challenge for me to try to repair and maintain these. Further to that I came across donated medical equipment from different countries such as Taiwan, China, South Korea, Finland, Germany or the USA. Spare parts availability was very minimal, if not none at all. This was a major issue for developing countries so one has to be very resourceful in trying to solve a given task.
Looking back, I feel that the exposure I have had during the course of this assignment has made me a better technician despite the obvious risk of lagging behind current trends in biomedical engineering. It was a very rewarding and fulfilling experience and I came away with so much, which I have no doubt will be useful in my line of work and life in general.

On my return from the Islands I worked for three months at Tamworth Rural Referral Hospital Biomedical Engineering Department (Hunter New England Area Health Service). It took me some time to "catch up" on the latest changes and to re-settle into the normal work routine. I am now being employed by GSAHS as a Snr Biomedical Engineering Technician working out of Wagga Wagga Base Hospital.

Tom Judd

Biography

• National Project Director, Kaiser Permanente Clinical Engineering-CE (2006-present): Lead integration medical devices, IT, & EMR; 350-person department; > 400 clinics, 40 hospitals, 8.7M patients; 15K physicians, 8 USA regions; 36 years in healthcare: 12 as KP Director, Quality, Safety (1994-2006); in CE roles since 1979

Healthcare certifications: Clinical Engineering, Quality, Information Systems

• Education: BSAE, Naval Academy; MSAE, Naval Postgraduate; Johns Hopkins & Cape Town
• Consultant: since 1989, health technology for WHO in 40 countries, & independent USA
• Humanitarian: NGO boards, healthcare-Kyrgyzstan, Macedonia, Haiti; created ACCE Advanced CE Seminars 1991 www.accenet.org/default.asp?page=about&section=international;; created NGO Global Assistance for Medical Equipment, 2004 (Kosovo, East Africa)

Co-author global HTM paper, May 201

Abstract

A Health Technology Management (HTM) and Humanitarian Engineering (HE) Model

Health technology includes drugs, biologics, devices, procedures, and organizational and managerial systems. The profession of clinical engineering (CE) focuses on medical devices and lifecycle management (HTM) of these technologies. Developing countries face unique challenges creating competent CE staff and addressing HTM requirements such as planning, training, maintenance support, manufacturer relationships, and utilizing donated equipment. The global framework for how HTM allows healthcare systems to support efficient and safe care delivery is well established, and best practices for its various aspects documented.

This framework and best practices allows humanitarian engineering (HE) initiatives to address HTM challenges in developing countries in an evidence-based fashion, such as:

• Lack of competent CE staff.
• Limited access to technical documentation and spare parts.
• Poor planning and lack of commitment
• Irrational technology adoption processes.

Recent studies and surveys by the World Health Organization (WHO) and global HTM leaders detail progress by countries on different continents over the past 30 years, as well as current gaps. HE advocates - whether public or private - can then identify priority areas, and partner with others to incrementally meet needs using the model provided. Common success factors across regions include:

1. A champion with the vision, determination, and courage to challenge and change the status quo.
2. Political support from high-level decision-makers who are committed to improve health services.
3. Regional/international assistance with HTM guidance, training, information exchange, encouragement, and mentoring.
4. Vendors who understand that HTM will be beneficial not only to the health sector but also to them.

This presentation will provide methods and examples for identifying, planning, and funding this HE assistance.

Plenary Lecture: HTM Humanitarian Engineering Case Study in Kosovo

Abstract

Kosovo experienced devastation of its healthcare system due to regional upheaval and civil war ending in 1999. The international community then came alongside to help address a wide variety of healthcare needs, such as rebuilding and equipment hospitals and other facilities. Now its population of 2 million receives public healthcare from a system with a large teaching and multi-specialty hospital in the capital, five other regional hospitals, and 30 district clinics.

In the ten years from 2002 to the present - entities such as WHO, various country aid agencies, and NGOs - have provided general and targeted HTM and related initiatives. Many have been HE in nature addressing HTM elements outlined in my HTM-HE model presentation.

This case study will discuss the practical issues of various initiatives, noting approach, sponsor, "wins" and "losses", and outcomes for accomplishing real change or improvement in healthcare delivery.

Plenary Lecture: Future of the Clinical Engineering Profession in the USA

Abstract

Healthcare in the USA is undergoing a major transition as the federal government is currently investing $20B USD in health information technology (HIT) infrastructure. This encourages deploying of electronic medical records (EMRs), using medical devices linked with IT networks-EMRs to enhance care reimbursement, and developing interoperability and risk management standards to guide and direct safe care. My integrated delivery system Kaiser Permanente (KP), with an over 50-year history, now serves nine million USA patients - two thirds in either Northern (NCAL) or Southern California (SCAL), but also in six other geographic Regions.

KP has now deployed an EMR in all Regions, four of which are (owned) hospital-based, and four of which are ambulatory-care based (with community hospital partners). KP also has a robust IT department as well as over 350 clinical engineering (CE) staff in its 8 Regions, conducting the full range of HTM elements identified in my HTM-HE Model presentation, with several HTM best practices. KP CE and IT is recognized to be among the USA leaders for biomedical device assessment, integration, and deployment activities. Appropriate CE-IT partnership is considered to be essential for success of both health care in general, and the CE profession in particular in the USA and among developed countries.

Three case studies will illustrate this KP CE-IT partnership and how it represents the leading-edge present and future of the CE profession locally and globally:

• High Acuity Devices - Deployed 1600 patient monitors & 600 ventilators after Testing
• Digital Operating Room (DOR)- Endoscopy; eg, deployed 200 DORs after Simulations
• Clinical Alarm Management - Deployed in to 29 hospitals after Simulation and Testing

John Kis

Biography

John Kis is the production manager at Medical Technology Transfer and Services in Hanoi, Vietnam. This role began as a volunteering assignment with Engineers Without Borders and has since turned into a full-time position. John graduated from RMIT with a degree in Electronic Engineering and has since been designing electronics in robotics, defence and communications projects in a number of roles.

Abstract

Engineering for Development in a Developing Country - A Practical Perspective

For over 10 years a small engineering company in Vietnam has been making devices for neonatal intensive care units in South East Asia. Through the Breath of Life Program run by East Meets West, these machines have been delivered to over 200 hospitals and are used to treat over 20,000 newborn babies each year.

Undertaking biomedical engineering and manufacturing in a developing country presents a unique set of challenges which have large impacts on quality. These problems exist in many areas of the engineering and production cycles. Vietnam does not have a well developed engineering industry so suppliers of parts have limited stock and what stock they do have is a) often of dubious authenticity, b) low quality. Availability of imported components/equipment, and restrictions/delays when ordering them, reduce engineering options.

The quality of parts made by 3^rd party contract manufacturers such as sheet metal fabricators and PCB manufacturers is poor. Metalwork is very often inaccurate, changes to designs are made by the manufacturer without consent, and incorrect materials are used. PCBs have broken traces, extra copper causing short circuits, and very poor tinning of exposed tracks.

Attention to detail in assembly and manufacturing is a very rare trait. Even simple tasks that do not require skilled labour are performed inaccurately.

By creating devices which are designed with these problems in mind, and by implementing rigorous quality control procedures such as site monitoring, incoming material tests and assembly tracking mechanisms, appropriate biomedical devices can be built in a developing nation.

Lee Lister

John McLaren

Biography
John McLaren is the Deputy Chair of Rotary Australia World Community Service (RAWCS), a Rotary organisation that enables Australian Rotarians to undertake humanitarian aid projects. John lives in Darwin and has been a Rotarian for around 30 years. He is a Past District Governor and has played a key role in providing aid and assistance in Timor Leste since the UN vote in 1999. John is an accountant with extensive experience in governance and the not-for-profit sector. He is involved in a range of community organisations and is married with 2 teenage daughters.

Abstract

"Teaming up with Rotary"

There are a vast number of communities around the world that rely on the generous work of volunteers to provide goods and assistance to improve their way of life. Rotary Australia World Community Service (RAWCS) is an Australian Rotary organisation that delivers everything from simple shelter through to sophisticated CAT scan equipment to places that most of us have never heard of. RAWCS enables volunteers to undertake vital work and encourages others to provide financial assistance to support this good work.

Rotarians come from all works of life and represent a broad range of professions - some of you here may by members of a Rotary Club. Rotary's motto is "Service above Self" and RAWCS is about enabling Rotarians and Rotary Clubs to assist disadvantaged communities with humanitarian aid projects. RAWCS does this by:

" Supporting Australian Rotary volunteers in identifying and undertaking humanitarian projects.

" Enabling Rotarians; the public and the corporate sector to provide support to Australian Rotary volunteers undertaking humanitarian projects through:

Project Volunteers;
Project Funding;
Safe Water Saves Lives;
Rotarians Against Malaria; and
Donations In Kind.

" Providing financial and other incentives for donors and volunteers alike to support this humanitarian work.

RAWCS can assist in you in providing humanitarian assistance and you can make a huge impact on the lives of those less fortunate.

Luciano Moccia

Biography
Luciano Moccia is the International Coordinator of the Breath of Life Program, implemented by the East meets West Foundation. After a Masters degree in Political Economy (University of Trento, Italy) and a Master of Arts in Social Sciences (University of Roskilde, Denmark), Luciano has worked for 10 years in Vietnam in public health. In 2004, he started BOL, promoting the research of locally-built, sustainable technologies for newborn care in partnership with the private sector. Luciano has co-authored studies in newborn care technologies presented at the Global Health Conference in Washington DC, and other international events in global health.

Abstract

Affordable and sustainable newborn care in developing countries: the Breath of Life Program

Participants will be able to understand the development of the Breath of Life (BOL) program, which has been a key success story in reducing neonatal mortality/morbidity in Vietnam, and the implications for wider distribution to other developing countries.

Since 2005 the East Meets West Foundation (EMW) through BOL has been supporting the management of neonatal intensive care units Vietnamese public hospitals, providing so far technologies to more than 200 public hospitals. EMW machines are low-cost, locally manufactured, ensuring easy access to replacement parts and continuous technical support. Because of their simple technology, these devices can be easily employed in any level of health-care facilities in developing countries.

However, the BOL program is more than just the deployment of appropriate technologies for low resources countries: the program provides also recipient hospitals with intensive training, continuous follow up, constant monitoring, and technical support. Only a comprehensive and organic approach to the problem of newborn care can provide sustainable results and a reduction in infant mortality and morbidity.
BOL program has been very effective in Vietnam: the significant results have encouraged the enlargement of the program in other neighboring countries, such as Cambodia, Laos and East Timor. In 2011, pilot programs are planned to start in India, Philippines, Myanmar, Bangladesh, and Thailand.

Ian Norton

Michael O'Brien

Biography
Michael O'Brien is a 25 year old Industrial Designer, who now works from Hobart, Tasmania. In 2010 he graduated from the University of Technology Sydney with a BA in Industrial Design and a BA in International Studies.

Michaels design approach is largely influenced by his international experience, with several years spent living, studying and working in Barcelona, Mexico City, and Ciudad Del Este -Paraguay.

In 2010 he designed a Surgical Lamp for Developing Nations. The Design has won several awards; the Casey Hyun Industrial Design award, the Jack Greenland Scholarship and shortlisted for the 'India Future of Change' competition. The design proved to be highly feasible and in 2012 the Surgical Lamp is scheduled to be installed in field hospitals across Nigeria.

Abstract

Flat Packed Surgical Lamp

As an industrial designer I believe in democratic design. I consider that if necessity is the mother of invention, then designers should ideally design for needs, not wants.

In developing nations, power outages or no access to an electrical grid means hospitals are left without lighting. Throughout rural Africa, kerosene lamps are often the only light source in a hospital. My design is a Low-cost, Battery Operated Surgical Light for developing nations.

This presentation explores the issues involved in designing a product for developing nations. Firstly the problem is researched; Where the problem exists; the extent of the problem and why it occurs in these areas.

Secondly the initiatives and programs that are already in-place are discussed as well as previous 'ad-hoc' solutions to the problem.

Thirdly the technical considerations of any such design that must addressed before shape and form are developed.

Lastly all the details and features of my specific design are presented and reasons for form and function are explained.

Sharon Paulka

Biography
Sharon Paulka has been working in Radiation Protection in the Uranium Mining Industry for over 20 years. She has worked at most Australian uranium mining operations including Ranger, Olympic Dam, Beverley, Jabiluka, Nabarlek & Honeymoon.

She also has assisted many of the developing Australian mines, many of the junior exploration companies and has worked as a consultant internationally in the USA, Canada, Namibia, Vienna and Spain.

Abstract

Challenges in Radon Management at Uranium Mining Operations

Radon and its radioactive decay products are present some unique challenges to radiation protection professionals working at the uranium mining operations.
This paper will detail some examples of these challenges and methods that can be employed to ensure doses to workers and members of the public are kept As Low As Reasonably Achievable (ALARA). Examples will be presented for conventional open pit and underground mining and In-Situ recovery operations.
One of the challenges facing new operations seeking approval is the demonstration that radon and its radioactive decay products sourced from the operations will not adversely impact local populations. Methodologies recently employed in the most recent environmental impact statements from uranium mining companies seeking approval are reviewed.
The International Commission of Radiological Protection are currently reviewing the dose conversion factors used radon and its decay products. The challenges this change will present to uranium mining operators are presented.

Roger Price

Biography
Roger Price did a PhD in atomic physics at University of WA (UWA) and is (since 1994) Head, Medical Technology & Physics and WA Radiopharmaceutical Production & Development Facility, Sir Charles Gairdner Hospital. He has Adj. Prof. appointments in Schools of Surgery & Physics UWA; Deputy to the WA Radiological Council; Treasurer of the ANZ Bone & Mineral Society; Member, Osteoporosis Working Group, WA Health Dept; Member, editorial board of Journal of Osteoporosis & manuscript reviewer for several journals. Reflecting 100 peer-reviewed publications, Roger's research includes metabolic bone disease - particularly the relationship between bone mass, microstructure and strength; accelerator production of metallo-PET isotopes, plus biconjugation with proteins. He supervises postgraduate projects including solid targetry physics & chemistry plus biomedical applications of Cu-64 and Zr-89. He has a keen interest in promoting medical physics in developing countries, particularly Indonesia.

Abstract

Rise of the Machines: Cyclotrons & Radiopharmaceuticals in the PET-CT-MR Golden Age'

Roger I Price1,2

1Medical Technology & Physics, Sir Charles Gairdner Hospital, Perth, Western Australia;
2Schools of Physics & Surgery, University of Western Australia, Perth, WA.

Introduction. One particularly inspiring narrative in the evolution of medical imaging over 35 years begins with the introduction of quasi-routine production of 18F, enabled by advances in reliability of (medical) cyclotrons; invention of the 'molecule of the century' [18F]FDG and its robust synthesis; comprehending betrayal of major tumour-cell types by their glucose avidity; astounding advances in PET scanners (recently, time-of-flight); and marriage of anatomic with functional 3-D imaging as PET/CT or (recently) PET/MR. Though the explosion in PET is identified historically with diagnostic oncology plus quantitation of nuclear medicine, plus the collateral leverage of advances in CT and MR, other potentially transformative opportunities (pre-diagnosis or quantifying treatment response) are emerging in dementia and diabetes - as exemplars of PET-addressable mass afflictions - driven by advances in specificity/sensitivity of targeting molecules. PET delivers femto-M functional sensitivity (e.g.; receptor-targeting) - several magnitude-orders of narrow-context superiority over MR or CT - exemplified by the rapid rise of solid-targetry metallo-PET (64Cu, 89Zr), & concomitantly, preclinical radioimmuno micro-PET/CT/SPECT imaging.
Innovation. Though [11C] PET has elucidated brain, prostate & other cell +/-tumour mechanisms, realistic clinical rollout demands longer halflife [18F]-labelling. [18F] innovations beyond [18F]FDG elucidate numerous metabolisms, including choline, hypoxia, apoptosis & amino-acid, and notably will soon provide a routine-clinical [18F]-alternative to [11C]-based beta-amyloid dementia diagnosis.
Frontier. PET is constrained by cost/dose, shackled to 'twentieth-century' technologies - cyclotron, hotcell & synthesis unit. Example is [18F] bone scintigraphy; acknowledged as clinically superior to [99mTc]MDP, its widespread implementation awaits cheaper isotope, accessible PET/CT scanners, and maybe 'true' shortage of [99mTc]. Generator-sourced 68Ga-PET is transforming neuroendocrine-tumour imaging. In turn, generator cost-effectiveness (including 99mTc) demands advances in nuclear +/- accelerator technologies. 'Benchtop' petawatt laser-based [18F] production & fluidic-microchip [18F]FDG syntheses, hinting at future cheap 'personalised' production, remain orders-of-magnitude distant. PET benefit/cost can only be improved by combination of demythologising/industrialising radiopharmaceuticals production, diagnostic-quality simultaneous multi-modality imaging (feasible with PET/MR), plus relentless pursuit of economies-of-scale.

Russell Robinson

Biography

M App Sc, BSc, Gad Dip Occupational Hygiene, Grad Cert Management, MAIOH, MARPS

From 1983, I worked as a Radiation Physicist at Health and Medical Physics in Queensland. I became interested in uranium mining after reading a technical report on radiation parameters at Nabarlek Mine. I moved to the Northern Territory in 1988 to work, as a Mines Inspector, with the Department of Mines and Energy. Then my interests included radiation protection in uranium and non-uranium mines, underground ventilation and occupational hygiene. In 1990, I produced a paper on radon and non-uranium mines.

In 2005, I became the Manager of Radiation Protection in the Northern Territory. The Radiation Protection Act covers many applications of both ionising and non-ionising radiation.

Abstract

Highlighting Some Important Requirements in Radiation Protection

A number of issues are listed that will need to be considered by an operator. A new operator does need to be familiar with many issues that may become significant, in the short-term. There are some issues that may become significant in the long term. Radiation practices must undertake monitoring of personal and of the environment. It is likely that that all uranium operations will be required to do different types of monitoring.

For example, baseline-radiation monitoring is needed at the start of a new operation to provide information on background radiation levels that are needed during an operation. These can be used for background correction, and at the end of an operation. Baseline monitoring can be used for rehabilitation purposes. Baseline monitoring is an indication of background radiation before any operational footprint is left. Environmental monitoring is needed to establish a baseline of radiation exposures before an operation commences because it is difficult to convince stakeholders that monitoring can reflect a preoperational phase, after an operation is in full production. It would be unfortunate for an operation to approach the end of its life and discover that necessary details should have been obtained at the start.

This talk is intended to discuss a number of issues of significance to a new or existing operation.

Ed Scull

Joseph Smith

Biography
Dr Joseph Smith is the chief medical and science officer for West Wireless Health Institute, WWHI, a non-profit medical research organization in San Diego founded by the Gary and Mary West Foundation.

WWHI is dedicated to cutting the cost of health care by accelerating the availability of wireless medical technology:

• Innovate – by committing resources to develop meaningful innovation in health care technology, solutions, and business models.
• Validate – by championing the clinical and economic validation of specific technologies and solutions.
• Advocate – by working to shape the external environment to accelerate the adoption of novel medical technology such as wireless health solutions.
• Invest – by evaluating of internal and external opportunities to accelerate and create innovations in health care.
• Commercialize – by creating the capacity to move products and solutions through the initial commercialization process.

Dr Smith has a distinguished background in both medicine and engineering, with more than two decades evaluating emerging medical technologies as well as practicing cardiology and cardiac electrophysiology in both clinical and academic organisations.

Plenary Lecture:
Engineering and Medicine: An Awkward Marriage with Beautiful Children
Plus
Healthcare Delivery in Crisis: Coming Collision of Care, Cost, and Chronic Disease

Abstract
The marriage of engineering and medicine is often strained, as representatives of the two parties think and speak differently. They are, however, driven by a shared passion to solve meaningful problems, and as a tangible manifestation of that passion, physicians and engineers have worked together to generate many, many wonderfully effective intellectual offspring. Pacemakers and Implanted Cardioverter-Defibrillators (ICDs), undeniably the love children of electrical engineers and physicians, now save and improve the lives of millions of people throughout the world. Similar complex marriages have given rise to the no-less remarkable progeny of hemodialysis machines, heart-lung bypass machines, drug-eluting stents, minimally invasive surgical tools, and even heart valves you can now change over a wire. In this discussion, we will review past triumphs and go on to explore whether there is now a need to revitalize and redefine this relationship, as we now may be less in need of the gifted gadget and perhaps more in need of a wholesale revision of the process of care delivery.

Holger Voderberg

Biography
Holger Voderberg (37) is Strategic Marketing consultant with Philips Medical Systems focusing on IT solutions in the field of patient monitoring.

During his 10 year career with Philips Holger acquired his knowledge in many different roles such as Service Engineer, Technical Consultant and Sales Representative.

In his current role, Holger is developing strategies for the seamless integration of patient monitoring devices in existing hospital IT networks worldwide.

Holger holds a degree in biomedical engineering and lives in Stuttgart, Germany

Abstract:

In the recent years connectivity as well as interoperability solutions have been growing demands towards biomedical devices from caretakers, biomedical and IT departments in hospitals worldwide.

The recently published IEC 80001-1:2010 is directly addressing the implications of those considerations on integrated IT networks in hospitals.

Philips medical systems is one of the leading companies worldwide to provide a solution to integrate their market leading patient monitoring System in existing hospital IT infrastructures.

This solution is based on Industrial standards such as Ethernet networks and 802.11a wireless Networks and addresses the expectations of all stakeholders:

• Supporting clinical workflow
• Cost effective
• Secure (providing IT security compatibility such as WPA2-Enterprise or Network Access Control)
• Easy to implement and to maintain

A Clinical Network supports the reliable transmission of real time life critical patient data in a highly demanding environment.

The Philips customer provided network solution is a tool for the hospital to focus on the patient while using the best infrastructure available to transmit all relevant patient data: their own.

Ivan Williams

Biography
Dr Williams began his career at the Peter MacCallum Cancer Centre, (PMCC). Interspersed with his early clinical work he obtained a MSc (Research) in physics From the University of Melbourne by designing, building and testing a parallel-plate ionisation chamber. Between 2004 and 2008 Dr Williams returned to full-time research. Supervised by Prof. Rob Lewis at Monash University he completed his PhD on "Optimisation of Phase Contrast Imaging in Mammography". Dr Williams then left Australia for Ireland to take up a position at St Luke's Hospital, Dublin. Dr Williams left Ireland in 2010 as Acting Head of the Department of Physics at St Luke's Hospital for the Directorship of the Australian Centre for Clinical Dosimetry.

Abstract

The Australian Clinical Dosimetry Service

The Australian Clinical Dosimetry Service, ACDS, has been established by the Department of Health and Ageing to provide clinical dosimetry assessments for radiotherapy facilities across Australia. The ACDS, operating from ARPANSA, will verify the radiation dose delivered patients by clinical linacs. The ACDS will achieve this aim by performing a no-cost three-level dosimetric intercomparison within participating facilities. The three levels of audit are:
Level 1: An independent measurement of linear accelerator output under reference conditions.
Level 2: An independent measurement of linear accelerator output under non-reference conditions
Level 3: An independent measurement of linear accelerator output and planning computer output with an anthropomorphic phantom. A generic protocol will follow the patient path with the phantom being imaged, contoured and irradiated as though it was a patient. Dosimetric analysis will enable the ACDS to review the entire treatment chain for a defined protocol.

The ACDS will present the results of the on-going Level I audits and the transition to OSLDs and the development and testing the first Level II audit and Level III audits.
In three years the ACDS and its achievements will be assessed to determine whether this model of a national clinical audit service, developed in the Australian context, is the best for the Australian context. I look forward to that review and to see the achievements of the ACDS for the Australian community over the next three years.

Eric Yeoh

Biography
Professor Eric Yeoh has been Director of Radiation Oncology at the Royal Adelaide Hospital since 1994. As well as clinical and administrative commitments he has teaching and research supervision roles at the Universities of Adelaide and South Australia. His research centred in the areas of: (i) the pathophysiology and management of radiation bowel disease, (ii) optimization of radiation dose fractionation schedules in prostate and head and neck cancer, iii) chemo-radiation for head and neck, oesophageal and breast cancer iv) the effect of bowel and bladder morbidity on quality of life following radiotherapy for prostate cancer and v) biomarkers which predict radiation morbidity to identify preventative strategies has resulted in a career total of $865,027 of competitive grant support including 2 project grants from the NHMRC, Australia, 13 project grants from the Cancer Council of South Australia and 7 project grants from the RAH/IMVS Research Review Committee. He is internationally recognized as an authority in radiation bowel disease and has published a total of over 140 peer reviewed scientific and conference papers including the first published randomized trial results of hypofractionated versus conventionally fractionated radiation therapy for the treatment of localized prostate carcinoma.

Abstract

Normal Tissue Complication Probability (NTCP) - the Clinician's perspective

3D radiation treatment planning has enabled dose distributions to be related to the volume of normal tissues irradiated. The dose volume histograms thus derived have been utilized to set NTCP dose constraints to facilitate optimization of treatment planning. However, it is not widely appreciated that a number of important variables other than DVH's which determine NTCP in the individual patient. These variables will be discussed under the headings of patient and treatment related as well as tumour related factors. Patient related factors include age, co-morbidities such as connective tissue disease and diabetes mellitus, previous tissue/organ damage, tissue architectural organization (parallel or serial), regional tissue/organ and individual tissue/organ radiosensitivities as well as the development of severe acute toxicity. Treatment related variables which need to be considered include dose per fraction (if not the conventional 1.80/2.00 Gy/fraction, particularly for IMRT), number of fractions and total dose, dose rate (particularly if combined with brachytherapy) and concurrent chemotherapy or other biological dose modifiers. Tumour related factors which impact on NTCP include infiltration of normal tissue/organ usually at presentation leading to compromised function but also with recurrent disease after radiation therapy as well as variable tumour radiosensitivities between and within tumour types. Whilst evaluation of DVH data is a useful guide in the choice of treatment plan, the current state of knowledge requires the clinician to make an educated judgement based on a consideration of the other factors.

Sergei Zavgorodni

Biography
Prof. Sergei Zavgorodni is a Senior Medical Physicist at the Vancouver Island Centre of British Columbia Cancer Agency and Adjunct Professor at the University of Victoria. As a clinical physicist he provides physics support to cancer treatment and application of new technologies to radiation therapy. He published his research on stereotactic radiotherapy, radiotherapy with internal radioisotopes, radiation shielding, treatment plan evaluation and radiobiological modeling. His recent research has mainly focused on development and applications of Monte Carlo methods to radiotherapy dose calculations and evaluation of new treatment planning algorithms.

Abstract

The role of Monte Carlo methods in verification of advanced treatment planning algorithms and VMAT / IMRT quality assurance

The most advanced modern treatment planning (TP) algorithms are "radiation transport" based. As compared to convolution-superposition based algorithms that are currently in common clinical use, they solve Boltzmann radiation transport equation by either deterministic (AcurosXB) or Monte Carlo methods. In order to verify these algorithms dosimetrically, well-proven, accurate methods of dose verification have to be used.

In our institution we developed Vancouver Island Monte Carlo (VIMC) system that was the first one capable of Monte Carlo (MC) modeling of VMAT delivery. Beam model in VIMC system has been tuned up to reproduce 6 and 18 MV Varian clinac beam measured data in water to within 1% in most parts of the treatment volume. This allowed us to benchmark the newest (at the time) dose calculation algorithms AAA and AcurosXB. Results of AAA and AcurosXB benchmarking for open and IMRT/VMAT fields in phantom as well as patient geometries demonstrate superior performance of AcurosXB in geometries with extreme interfaces.

Advanced radiotherapy delivery techniques VMAT & IMRT are currently applied to various treatment sites and require patient-specific dosimetry QA as a de-facto "industry standard". In our institution Monte Carlo methods have been used for QA of IMRT and VMAT deliveries along with EPI based and traditional phantom/detector based methods. Comparison of these methods shows that MC based approach is the most versatile, but less robust than EPI and phantom/detector based ones. Hybrid methods, combining the versatility of MC and robustness of EPI based methods are under development.

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