Fractures treated with ultrasound technology
Surgeons from the Royal Infirmary Hospital in Glasgow, Scotland have discovered an innovative new use for ultrasound technology.
Ultrasound treatments have become a familiar sight in the hospital’s fracture clinic, where doctors are using it to heal broken bones.
It has been described as a simple and painless treatment and surgeons believe it can speed up the recovery time of fracture patients, in some case by as much as a third.
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Orthopaedic surgeon Angus MacLean is one of the doctors behind this unusual use of ultrasound.
Talking to BBC Scotland, MacLean explained exactly how the technology is used to treat broken bones: “We use it for difficult fractures, the ones with problems with healing and it's a very simple, painless treatment that we can give.”
At the moment the use of ultrasound has been limited to very severe or problem fractures, because the treatment costs in the region of £1000 for each patient.
MacLean added: “It's a very interesting scientific development and there's good evidence that it just vibrates the cells a little which then stimulates healing and regeneration in the bone.”
“The evidence suggests that ultrasound speeds things up by about 40 percent, but the main interest for me is to use it to make sure the bone heals rather than the bone not 'knitting' together which then leads to serious problems,” he said.
One patient that has benefitted from ultrasound healing is Gary Denham, after falling and breaking his ankle into eight pieces.
Upon initial inspection if the injury, doctors feared the injury was sound bad his foot would have to be amputated.
However, after undergoing the ultrasound treatment his injury had healed within four months.
MacClean commented on Gary’s case. He said: “Before we used ultrasound I would expect to see this kind of injury healing with some difficulty, and some of them don't heal at all.
“Even if they do heal, it can take between six and 12 months and patients have ongoing pain during that time.
Gary also told the BBC about his experiences with the novel treatment: “It's got a wee strap and that goes round where the break was.
“I put some gel on the probe and then I just put the probe inside the strap and then just basically leave it for 20 minutes. There's no sensation at all, it's completely painless,” he said.
“I'd never heard of it before, but my leg healed after four months and I'm looking to go back to work within eight months.”
The team at the Glasgow’s Royal Infirmary Hospital have always been seen as leaders in the development of ultrasound, after it produced the first images of a human body using the technology in the 1950s.
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Why are healthcare networks so vulnerable to attacks?
Forescout Research Labs has published a study on the vulnerabilities impacting the healthcare industry’s connected devices. The research division of Forescout Technologies has published the report as part of its Project Memoria, and it reveals that healthcare organisations are affected five times more by TCP/IP vulnerabilities than any other sector.
Elisa Costante, a software engineer and Forescout's Vice President of Research, explains why this is and how to prevent it.
What is Project Memoria?
Project Memoria aims to improve the security of TCP/IP stacks and understand what the main security issues are. TCP/IP stacks are a very core component of every network device, whether it's an iPhone connected to the internet, or a robot controlling the process of manufacturing. If they're connected to the internet they need to have a piece of software controlling communication.
There are several variants of this software and we're analysing them to understand if they have security bugs or vulnerabilities that if misused by attackers, could lead to disruption of the device itself, and to the network at large. Our goal is to make the industry aware of the problem, and engage with stakeholders as well as the customers.
Why is healthcare particularly vulnerable?
This is what the data is telling us. We have a device cloud, which is like a data lake of device information. This device cloud has a lot of information about the devices, like who the vendor is, what the role of the network is, and which vertical this is. We are able to leverage this information, and join it with the intelligence we have from Project Memoria to understand which devices are vulnerable.
We found that in healthcare there was a huge spike in the number of devices that are vulnerable - as much as five times more than in other verticals. The reason seems to be because of the number of devices, and because of the intrinsic difficulty of addressing the problem.
The problem surrounding TCP/IP stacks is that there is not one single vendor that is vulnerable; on average, a healthcare organisation has 12 vendors that are vulnerable.
Let's say that on average we have 500 devices per healthcare organisation. Then you need to contact 12 vendors for each of these. These vendors then need to issue a patch to secure the device, and this patch cannot just be automatically delivered and installed in 500 devices. You have to be realistic and think about whether each of the devices is critical, for example if it goes down will it turn the lighting system off, or stop the MRI machine from working.
Patches are very complex to deploy. On top of that, the patch needed might not even be available. That's why we want to understand this problem better so we can provide solutions.
How much of the responsibility of keeping a device secure lies with the vendor?
There are responsibilities that lie with all the different stakeholders, and one of these is the vendor. There might be multiple vendors involved, which makes it very complex from a management perspective.
For instance the device at the end of the chain, which might be an MRI, contains a board that has a connectivity module, and this has one of the stacks that is vulnerable, which could have four different vendors.
If the vendor responsible for the TCP/IP stack releases a patch, this patch has to go down the chain. We identified chains with a length of six vendors, so you can imagine how complex this is. Some vendors have good hygiene security and some don't because they don't know how to deal with it - they need training.
This is a new issue related to the software bill of materials, which is being tabled for legislation at the moment to create policies regarding the complexity of the supply chain. We need to shed light on this issue so that legislators can put these policies in place to help with security.
What can healthcare providers do themselves to stay secure?
Visibility is important; they need to know what they have in their network. In the case of vulnerable devices they should find out if there's a patch available. If there isn't, because it's an old device for example, but it's still critical to the system, they may want to isolate it so it only communicates with the devices it really needs to.
Interestingly enough, our research found that most of the healthcare organisations we analysed had a flat network, which means they don't have isolated devices. For instance, a drugs dispensing machine, which you typically find in pharmacies, is connected to a building automation light system, which is connected to a switch. This is also connected to an IoT sensor device. Why would you have all of them together in the same place?
The first step is having this information, which often comes as a surprise. Then you can take action; you can segment a network, and if you can't do that you can control the network's access by isolating devices that are risky.
How can Forescout help healthcare organisations?
Forescout is uniquely positioned to help. We provide visibility end-to-end, which means having a full inventory of devices that includes quite granular detail, so they can know what the operating system is, who the vendor is and so on. Then we enable them to do network segmentation.
This enables organisations to write policies around how to secure their networks, for example if a device is vulnerable specify which connected devices must be isolated, or which device it must communicate with exclusively.