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Recent Trend In Medical Technology and what We should look forward in KAMT.
Sang Wu Chang, KAMT, Rlt St. John of God Hosp., Labs. Dept.
Introduction
The word would be "change", if we could char- -acterize the last few years in a single word. Like- wise it seems certain that, in the years ahead, Me- dical Laboratory Technology will continue to und- ergo many and rapid changes. Therefore we must find ways to meet changing technology and chang- ing demands if we are to serve our members effe- ctively.
With continued emphasis on accuracy and preci- sion, coupled with the increasing demands for hea- lth care as well as specificity, efficiency, and eco- nomy, the number and variety of clinicopatholog- ical measurements and examinations should increa- se progressively during the next decade. The full utilization of electronic data processing, with the application of computers to improved and expended auto.mation and semiautomation, is inevitable and essential.
Clinical pathology serves asa bridge between the basic sciences and patients through the patient's physician. The selection, generation, and translation into meaningful form of basic information for dia- gnosis, prognosis and management, also require man power and space. Excellence in service for patient care as a foundation for teaching and rese- arch is a philosophy that should permeate clinical pathology policies and procedures and guide their
implementation. A key individual in clinical patho- logy is the emergence of the administrative tech- nologist who often has a combination background in medical technology as well as administration.
Education of all personel is a continuing process that will enhance quality and efficiency of work.
Emphasis should be placed on improvement in pro- ficiency and technical skill and personal satisfact- ion, with opportunities for professional advancem- ent and recognition.
Continuing education, with a personal responsib- ility for self-education, is an essential attribute of the professional medical technologists.
Automation with Continuous Flow Analysis
In recent years, automation is arrived at by eit- her the continuous flow system or by discrete sa- mple processing. Each system has advantages and drawbacks, however there is no doubt that, when compared to manual methods, both systems have the advantage of equal or better accuracy and cer- tainly much better reproductibility than any of the manual methods.
The continuous flow system is dependent on plastic tubes of different diameter to carry reagents and samples from a sampler tray through various types of equipment (such as dialyzers and water baths) until they reach the colorimeter with the
steady state solution. In colcrimeter an analog sig- nal is developed and transmitted to a recorder wh- ich plots out the curve for each sample. The flow of reagents and sample is made possible by the pr- oportioning pump tube with selected diameters which can aspirate appropriate volumes. The system, by means of glass c0ils, debubblers, mix, and a variety of glass fittings, allows samples and reag- ents to combine, mix, and be split into aliquots.
The interjection of air between samples, services a dual purpose: 1) To keep the integrity of the sample and 2) To elena out any carry over caused by reagents ahead of the stream.
Use of d:alyzers in the autoanalyzer system ob- viates the need for forming a P. F. F. where nec- essary. In the case of the autoanalyzer for determ- ining PBI, a digester replaces the dialyzer. A flame photometer replaces the colorimeter for sodium and potassium determinations. Fundemental to the Autoanalyzer system is the fact that the chemical reaction is not carried to equilibrium. Also standa- rds are subjected to the same conditions as the unknown. Control must always be run along with the standards. Control in both the abnormal and normal range should be used.
Tcday, multi-channel systems where as many as 12-22 different procedures are performed simultan- eously, are available.
In biochemistry laboratory hospital models are SMA 12-60 and SMA 6-60, Hycel 17 and mark X, Ortho Acuchem Microanalyzer, Honeywell Diclan 240, Union Carbide Centrifichem, etc. Centrifichem can perform 22 procedures 300 tests per hour. And also SMAC is the computer-controlled clinical che- mistry analyzer that is designed to perform as many as 40 analyses on a single samples at the rate of 150 samples an hour. Sample volume for a basic 20 tests profile is only 250-375 microliters of serum.
The computer incorporated into the SMAC system ensures ease of operation by assuming many funct- ions, such as startup and calibration, that formerly required the supervision of skilled technologists.
Korea may be the gateway to new laboratory business in southeast Asia. ALS planners, that's long-range projection on which automated lab. sers-
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vices is lasing plans to open ALSOK (Automated Lab. Services of Korea) this summer. Their partner in joint venture will be a Korean Biochemist, Mic- heal Chang, Ph. D. who studied at Univ. of Calif., and earned his doctorate at Brandeis Univ. Dr.
Chang returned to this country in January to pre- pare the Seoul Commercial Lab.
It'll be possible that the reference labs. with co-- mmercial service is to open it for continuous flow analysis computerized in the labs. in order to serve·
rapid information to physicians.
With automation in hematology, the mechanical determination of red and white cell counts are co- mmon in many labs., the instruments performing those functions basically fall into two main types: 1) Optical 2) Electrical. Such instruments as a Autoc-- ytometer using the optical system count particulate- material such as red cells or white cells as they appear under dark-field illumination as a spot of light. The light is picked up by a photomultiplier·
which creates an electrical pulse for each cell seen.
The electrical instruments of the coulter counter is based on the single fact that both red and white cells, as well as ot her cells, are poor electrical' conductors in comparision to the medium in which·
they are suspended. There is a hemalog system- which is backed up by technicon's worldwide field' service forces with total automated hematology profiling 8 tests. Now there's an easier way to do·
differential counts, the Honeywell ACS 1000 is an automated computerized scanning system that ena- bles the operator to perform leukocyte cliff. counts, RBC morphology, and platelet sufficiency with gre- ater speed and less fatigue than in previous meth- ods. It also can use reticulocyte counts, bone-mar- row studies and other blood exams., and may also be used to perform microscopic exams. in microbi- ology, histocytology and cl. cytogenetics. MLA Ele- ctra 600 is for automated coagulation testing. It would be possible that automated machine will be- able to be used in serology, radioimmunoassay,.
etc.
Computerization in the Laboratory
Computer is a device that carries out computati-
ons autom atically and in most cases electrically at high speeds. Two types of computers are available:
Digital and analog. A digital computer deals with numbers and therefore with discrete quantities.
Adding machine is its protype, but a computer op- erates much more rapidly and stores enormous qu- antities ("memory"). This can: 1) store information, 2) supply information, 3) recall selectively, 4) gene- rate new information by processing and combining data fed into it. It can compare sets of data, disc- ern the regularities and dissimilarities, and measure statistical correlations. An analog machine doesn't deal with discrete numbers but with continuous varieties. Analog in puts are normally stored on high fidelity magnetic tapes which can be played back. These computers are most often utilized as input devices in conjunction with a digital compu- ter. This involves the use of an "analog-digital computer". A device that reads the analog's conti- nuous flow of data at regular intervals and converts the readings into a series of numerical values.
Computerization, and its impact on many aspects of the laboratory, is just begining to be felt. The advantages that have been realized in many Comp- uterized clinical laboratories include: 1) The more rapid reporting of the test results 2) Reduction of clerical error, 3) Improved legibility, 4) A unified update report of the lab. results for each patient available for future retrieval or study, 5) Increased presision and accuracy of results through the use of a computer controlled quality control program, 6) Correlation of laboratory data.
In computerizing the cl. labs., two types of appr- oachs have been taken those of on-line and off-line procedures. An operation is said to be offlineif data to or from the lab. instruments is not directly con- trolled by computer. An on-line real time computer process is one in which the data is fed directly into the co:nputer from lab. instrument with no human intervention in the recording of the test results.
These lend themselves best for continuous flow and other types of automated instruments in the lab.
and also can easily be shared by a number of peo- ple. It can accept information at any of these stati- ons and process each batch of information in the
order of receipt.
International Technology And Continuing- Education
The 12th IAML T congress (biyearly), first to·
be held in June 1976 in Chicago, U.S.A. ASMT, as host society, plans to tie the congress to the U.S bicentennial celebration. Reduced travel and lodging rates are being arranged and plans call for lodging all international visitors in one Chicago Hotel.
Some 5, 000 technologists are expected for the congress. Space is being reserved for more than 700·
exhibits and 75 workshops. They have been to lea- rning to accept excellent demands of the principles, concepts, and facts to move ahead in the field of medical technology through considerable workshops for their continuing educations and also have a ca- reer ladder for lab. personnel. For example, CLA.
CT. MLT, MT, M, H, G, BB, HT, CT, NM, SC, SH, SM, SBB, RLT, RMT. etc. For special certif- ication, they require masters or doctorate degree in specialty.
Most these societies in U. S., ASCP, ASMT,.
AMT and ISCL T Board of Registry of Medical Technologists are considering possible use of the continuing educations to qualify candid ates for upgrade certification exams. from lower level to higher level.
The college-level exam. program offered by coll- ege entrance exam. board and proficiency exam.
controlled by the U.S. D. E. H. W. are for all lab.
workers who have not a baccalaureate degree. Th- ese are only possible ways to qualify a supervisor or technologist.
Trends of Internat'l. Societies and Relati- onship
KAMT is one of the IAMLT members in prese- nting total memberships of 84, 000 in 32 countries, but our association is very young. In U.K. U.S.A., New Zealand. etc., they changed the name of their·
society to Medical Technology. Several years ago, the names changed such as American Society for Medical Technology, U. K. Institute of Medical
"Technology, New Zealand Institute of Med. Lab.
·Technology, etc. Some countries of them, South Africa, Canada, Australia, etc. are considering their name to change to Medical Technology.
As we know, times are changing. With time, the scope and nature of KAMT must be changed. We are no longer a association only of medical techn- ologists. Our memberships and activities have expa- nded to include lab. technicians, students of medical technology, and other realated to and interested in the field of this technology. I really hope it will be proposed that the Korean Assn of Medical tec- hnologists will be remumed "Korean Assn. for Me-
·dical Technology."
U.K. Institute of Medical Lab. Technology is co nsidering a name change to "Institute of Medical Laboratory Sciences" on the presumption that 'tec- hnology' no longer aptly defines the laboratory pr- . ofessions. Members of the institute's council believe
the change would recognize that "Medical Lab. Te chnology, as we now know it, stems from a wide- variety of scientific disciplines."
In the IAML T congress, Albert Antoni, Malaysia and Sunil Yi, Seoul, Korea were recently first rec- ipients of education a wards sponsored by Ortho Diagnostic, New Jersey. The award enabled them to attend the 150th postgraduate course in applied immunohematology at Orthos Philip Levine labs.
In occasional, we have been seeing some Korean technologists on the professional magazines and of- ficial journals through all over the world.
In world problem of medical service, Dr. Dybarer, the Univ. of Copenhagen, Denmark urged collabo- ration in selecting common terminology rules in four areas: 1) Quantities, 2) Description of diagno- stic materials, 3) Description method procedures, 4) Formate of procedural description, for internat'L control level.
Conclusion
Medical Technologyis the branch of medicine which deals with laboratory tests, procedures, and use of clinical lab. equipments. Medical Technolog-
i~ts translates theory into action under scientific knowledge we possess as well as the scientist or
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engineer does theoritical work because we are people who work directly with them in every field of sci- ence and technology. Medical Technologists in Ko- rea perform a wide variety of medical lab. tests and procedures, experiments and analyses for the diagnosis, treatment, and prevention of disease and have generally completed a 2 years course of studies at a Korea community college, including practical training at a approved laboratory. Graduates of these courses who pass the qualifying examination controlled by the Ministry of Health and Social Welfare, government of Korea for certification of llcense. But the activities, services, and policies of our association are limited in this field. We encou- rage all of our members to take an active part in our assn. and to utilize all of its services and facili- ties. And also Building Fund Chairman Ki Yeon Kim, KAMT suggesets that all members become
"friend of KAMT Building" by contributing 1, 000 won to the home office improvements campaign.
He urges all to "tuck any spare money in your membership renewal envelope. We do contribute to achieve our goal, completing our project, buying something tangible and building for permanence.
Let us contribute great or small investment in our future.
In conclusion, I really hope the above mentioned statements will be helpful to consider possible use of the KAMT Board of Registry of Medical Tech- nologists under joint collaborate program with KMA, KHA, KSP, KSCP and government agencies for certification program of the career ladder for Medical Laboratory personnel.
Acknowledgements
I am deeply grateful to several friends for revie- wing the manuscript and Prof. John M. Adams, M.D., Ph. D. at UCLA Center for the Health Sci- ences for offering many helpful suggestions. I wo- uld like to express my sincere thanks to Rev. Br.
Robert in St. John of God Community, Mr. Patton and Miss Oh Han Kim in Chun J u Presbyterian Hosp., Labs., Dept. who are most helpful in the preparation of the manuscript and Miss Hea Sun Chang who typed and retyped most of the manus-
cript.
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