Engineers have ways of thinking which help them to shape their work. Engineers excel at finding issues to be addressed, defining exactly what they need; learning from failure as they work on solutions, and smoothly managing the systems which complex solutions often bring.
When applied to medicine, their contributions are invaluable, but like any problem-solving endeavour, collaboration and communication is key to ensure the solution they find benefits people.
Collaboration between clinicians and Engineers
After serving in the armed forces and becoming familiar with sonar and radar during the Second World War, Ian Donald, an obstetrician, become interested in how it might be applied to our bodies. At the time, ultrasound was mainly used for detecting flaws in metal and any attempts to apply the technique to bodies was ridiculed. Ian began researching while working at the Western Infirmary, Glasgow in the early 1950s. A chance meeting would help make his idea a reality.
Twenty three year old electrical engineer Tom Brown, heard about Ian’s research while changing one of the hospital’s lightbulbs. Tom had spent a life-time tinkering with electronics, even making a television set to watch the 1953 coronation. At the time, he was working at scientific instrument company Kelvin & Hughes had worked on flaw detection before. Using his skills and resources with Ian developed their first ultrasound machine in 1957, publishing their results a year later. Eventually, their work became the Diasonograph and ultrasound is now in routine use globally.
While not an engineer, surgeon John Charnley, applied engineering ways of thinking to solve the problem of squeaking hip replacements. In the early 1950s, he examined a patient who had been fitted with an acrylic plastic replacement hip that was so noisy the man's wife would avoid being in the same room with him.
Charnley spent many hours experimenting with ways to reduce the friction between the hip replacement and the hip joint. After several failures, made in his attic, he designed a two-component hip replacement made of metal and plastic. He was later joined by Harry Craven, a turner, who would make the replacement joints the day before surgeries. John later set up his own biomechanical laboratory to test the strength of the materials he was using. Charnley's prosthesis was copied and forms the basis of many modern designs.
He not only looked at the hip replacement parts but all aspects of the surgery to ensure the operation was as smooth as possible. He said ‘this type of surgery demands training in mechanical techniques which, though elementary in practical engineering, are as yet unknown in the training of a surgeon.’
It wasn’t just surgeons trying to improve things. In the 1960s, Kenneth Dobbie was working as an Electrical Safety Engineer at the Royal National Orthopaedic Hospital in Stanmore when he was ‘challenged’ by a sister to produce a power-operated saw to reduce the physical effort involved in cutting through bone and to reduce the time a patient needed to be under anaesthetic.
Dobbie’s second prototype was sent to one John Charnley. He worked closely with Kenneth in the development of the saws, suggesting improvements, making a tool tailored to the needs of surgeons.
Developing devices during the pandemic
Skilled healthcare and biomedical engineers found themselves at the forefront of the pandemic response. Using their knowledge and networks, they found ways to create much needed solutions to problems, quickly and safely.
At the start of the COVID-19 pandemic in March 2020, clinicians learnt from their colleagues in places such as Italy and China that using CPAP (Continuous positive airway pressure) rather than ventilation may improve patient outcomes.
Plugged into a hospital’s oxygen supply, this device helps precisely regulate the delivery of air and oxygen through a face mask to a person who is struggling to breathe. However, there were only 6 devices at University College Hospital London, so many more were potentially needed. To help meet demand, a multidisciplinary team led by Professor Rebecca Shipley and Professor Tim Baker reverse engineered and improved an off patent device called Respironics WhisperFlow®.
Alongside colleagues, Andy Cowell, Ben Hodgkinson and Pierre Godof, from Mercedes-AMG High Performance Powertrains, the team took fewer than 100 hours from their initial meeting producing their first prototype. Ten days after their first meeting, the Mark I Ventura had regulatory approval from MHRA (Medicines and Healthcare products Regulatory Agency). Further improvements led to the launch of the Mark II. Rapidly 10,000 devices were made and delivered to NHS hospitals. The team released their designs at zero cost for use in over 30 countries.
During the first wave of the COVID-19 pandemic, Personal Protect Equipment (PPE) was the only way for healthcare workers to protect themselves. University of Southampton colleagues, Paul Elkington, a professor of respiratory medicine and Hywel Morgan, a professor of bioelectronics, brought together a skilled team of clinicians and engineers to develop the PeRSo. Standing for Personal Respirator Southampton, their device is a portable powered air purifying respirator which delivers filtered air through a hood. Their first prototype was made in just a week using items they could easily find or 3D print, including dehumidifier filters, batteries, and a hood made from sails.
After several tests, prototypes and adaptions 20,000 devices were delivered to 20 NHS Trusts. The team released their designs online and provided modifications for what might not be easily found or in bulk.
For their efforts the CPAP team and the PeRSo team were among those who won Royal Academy of Engineering (RAEng) President’s Special Award for Pandemic Service for exceptional engineering.
Engineering solutions for the youngest patients
Biomedical engineer Ilias Tachtsidis at University College London leads a team developing a new way to identify potential brain injuries in newborns quickly and safely using light. Using a cap, light is passed through a baby’s brain and detected by a sensitive camera. Measuring these light levels gives an indication of blood flow, oxygen and how that oxygen is used in a baby’s brain. High quantities are essential for our brain health. Over 15 years this team of engineers, physicists, and clinicians, have developed a non-invasive tool for some of their youngest patients, with the consent of their parents.
Engineers on the smallest scale
In the 1970s Robert Langer questioned how complex medicines, such as chemotherapy, could be delivered. Using his knowledge from chemical engineering, he wanted to find solutions that would benefit people and their health. He developed new polymer materials that could contain and release medicines slowly and precisely inside the body, a discovery many people thought was impossible. In doing so, he created a new field of engineering – controlled drug delivery. He was awarded the 2015 Queen Elizabeth Prize for Engineering for his work which has benefited the lives of over 2 billion people.
Robert also pioneered the field of tissue engineering. Working with surgeon Joseph Vacanti in the 1980s, they developed ways to create human blood vessels and skin. Cells are scaffolded to materials compatible to our bodies, grown in a special environment and then implanted. There is great hope that one day, replacement organs might be possible.
Robert has been awarded over 1400f patents and founded over 20 companies, including Moderna – one of the companies that developed COVID-19 vaccine used globally.
Becoming a medical engineer
Since the 1960s, bioengineering, biomedical engineering and healthcare engineering have emerged as university departments, often starting as sub-departments within electrical or chemical engineering. Universities continue to open dedicated research facilities for multi-disciplinary teams to answer the world’s most pressing health challenges in a way that is tailored to the needs of its people.
While more and more people from a range of backgrounds are considering a career in biomedical engineering or healthcare engineering it doesn’t always have to start with an engineering degree. Listen to Uresha Patel, talk about her route into engineering as a Clinical Development Engineer Lead at CMR Surgical, the company behind the robotic surgical system Versius.
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