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Kirby G Vosburgh

Publications and source records attributed to Kirby G Vosburgh.

3 recordsLinked to original sources

Beyond VR: creating the augmented physician.

The ongoing shift of high tech capability from the specialist to the primary physician and the merging of medical and surgical therapies will demand more sophisticated measurement and control, but more positively, it will be possible to differentiate each individual situation and tailor treatment to provide an optimum result for each person, for each condition, in each environment, if these could all be measured, understood, and effected. The effective augmentation of the caregiver's physical, sensory, and cognitive capabilities will require more transparent, nuanced, and adaptive interfaces to information and to its therapeutic application. While the enhancement and classification of digitized findings is a beginning, the key may be better tracking and presentation of the chronological course, particularly the prior events which set the physiologic or morphologic data in context. Systems engineering approaches will define paths toward optimized, autonomous treatment, where the most rapid progress may be made through functional partitioning using scale-independent models, and the delineation of intermediate stages between today's macroscopic presentation of disease and molecular-scale treatment. These stages will comprise the steps toward useful patient avatars; our task is to fill in, with successively more powerful models, the convergence of large scale and small scale information, as it is used to support diagnostic and therapeutic decisions.

Delivery of Health Care↗

The concept of image-guided therapy.

Parallel with current applications in minimally invasive surgery, the introduction of new imaging modalities, and the availability of high-performance computing, new image-guided therapies are being developed at an impressive rate. Indeed, across a broad front of imaging technologies, rapid advances are being realized. Vastly refined technology for processing and using images, as well as improved therapeutic end-effectors, have no doubt hastened this remarkable progress. At the same time, advances in clinical evaluation and complementary technologies will provide the necessary infrastructure through which IGT can be applied in diverse therapeutic settings--from the already well-established neurosurgical applications to the thermal ablation of tumors in organs other than the brain. That IGT is more efficient and effective and less expensive than conventional surgery has been confirmed both in extensive, long-term studies and in ongoing, revolutionary applications in the operating room. We have laid critical groundwork with this extraordinary technology and have now begun to realize quantifiable benefits in terms of improved surgical and patient outcomes.

Humans↗

Moore's Law, disruptive technologies, and the clinician.

The advancement of technical power described by Moore's Law offers great potential for enabling more cost-effective medical devices and systems. However, progress has been slow. Many factors for this failure have been cited, including the anti-rational economic structure of healthcare and the complexity and long time scale of medical development. Christensen et al. suggest that "disruptive technologies" may circumvent some of these difficulties. "Disruptive Technologies" are defined as those that are established in one market, but then penetrate and overwhelm another market. These incursions are accelerated by economic factors, and capitalize on functionality, reliability, and advancements supported by the original market. Christensen has cited many examples from industrial and service businesses, but few examples can be found yet in healthcare. We argue that positive technology impacts in medicine occur most readily when innovators augment the skills of and collaborate with caregivers, rather than seeking to displace them. In the short term, a new approach may improve efficiency or quality. In the longer term, such approaches may obviate human tasks at lower-skill levels, and even permit task automation. One successful example has been the introduction of flexible monitoring for physiologic information. Systems for computer-aided diagnosis, which have failed to impact complex decision making, have succeeded in simpler specialty areas such as the interpretation of EKG's and mammograms, and may do the same with analysis of some pathology images. The next frontier may the operating room, and the adoption of such systemic technologies by caregivers in emergency medicine and general care may then have an even wider "disruptive" effect. Responding to time and cost pressures, and the desire to move care to the patient, other workers, such as radiologists, will drive the trend away from isolated, complex, large-scale devices, and toward integrated, modular, and simpler networked technologies. In summary, technological "push" will continue in the demanding cutting-edge application areas as always, but the "disruption" will occur through wider application of lower-cost technologies, pulled by the users. The capabilities described by Moore's Law will allow the advancements necessary to facilitate this dissemination of capability and its ultimate benefit, so long sought.

Cost-Benefit Analysis↗