Medical Technology

Contexts and Content

in Science and
Technology

Michael A. De Miranda
A. Mark Doggett
Jane T. Evans
This page left intentionally blank

ii
Medical Technology
Contexts and Content in
Science and Technology

Michael A. De Miranda
A. Mark Doggett
Jane T. Evans

iii
On the cover:
• The first magnetic resonance imaging (MRI) scans of a live human body showing a cross
section of a live human chest. Courtesy FONAR Corporation.
• MRI chamber courtesy of Harmony Imaging Center, Poudre Valley Hospital.
• Microscope courtesy of Ken Goldberg, UC Berkeley.
• Syringe courtesy of budgetstockphoto.com.

Interleaf:
• Skin fold test courtesy of Colorado State University Human Performance
Clinical/Research Laboratory.
• Ovariohysterectomy surgery being performed on a dog. Courtesy of C. Lasure-Hearne,
Cedar Valley College of Veterinary Technology.
• Blood vessel under magnification. Courtesy Michigan State University.

This material is based upon work supported by a National

Science Foundation Grant No. ESI-0138671; Karen F. Zuga,
Principal Investigator. Any opinions, findings, conclusions or
recommendations expressed in this material are those of the
author(s) and do not necessarily reflect the views of the
National Science Foundation.

Copyright © 2005
All rights reserved. Except as permitted under the United States
Copyright Act of 1976, no part of this publication may be
reproduced or distributed in any form or by any means, or
stored in a database or retrieval system, without the prior
written permission of the publisher.

ISBN: Pending (2005)

iv
Table of Contents

Foreword..........................................................................................................................................................viii
Preface ................................................................................................................................................................ix
Introduction........................................................................................................................................................x
Key Elements in Context and Content .........................................................................................................xi
Section I: Medical Technology in Context.....................................................................................................1
The History and Impact of Medical Technology .....................................................................................1
Evolution of Medical Technology..........................................................................................................2
Advances in Medical Technology Impact Medical Procedures .........................................................7
Medical Technology Issues ........................................................................................................................10
New Definitions of Life and Death .....................................................................................................10
Medical Codes of Conduct....................................................................................................................11
Decision-Making.....................................................................................................................................11
The Nature of Medical Technology .........................................................................................................16
Diffusion of Medical Technology ........................................................................................................18
Technology Transfer ..............................................................................................................................19
Section II. Structure of Medical Technology...............................................................................................22
Medical Technology Conceptual Framework .........................................................................................22
Knowledge ...............................................................................................................................................22
Educational Institutions.........................................................................................................................22
Governments...........................................................................................................................................24
Individual and Collective Knowledge..................................................................................................24
Common Procedures .............................................................................................................................26
Unique Procedures .................................................................................................................................27
Diagnostic Devices .................................................................................................................................28
Therapeutic Devices...............................................................................................................................29
Summary of the Conceptual Framework ............................................................................................30
Section III: Teaching About Medical Technology......................................................................................31
Medical Technology Literacy.....................................................................................................................31
Concepts of Science and Technology..................................................................................................31
Science and Technology Literacy .........................................................................................................32
Application of Energy Forms to Body Systems.................................................................................32
Knowledge, Processes, and Devices ....................................................................................................33
Interaction with Society and Environment.........................................................................................33
Consequences ..........................................................................................................................................34
Design and Diffusion.............................................................................................................................35
Fluency with Medical Technology........................................................................................................35
Learning about Medical Technology ........................................................................................................36
Elementary (3rd-5th Grade)..................................................................................................................36
Middle School (6th – 8th Grade)..........................................................................................................39
High School (9th – 12th Grade)...........................................................................................................41
Summary ..................................................................................................................................................43
Conclusion ...............................................................................................................................................43
Next Steps................................................................................................................................................45
A Vision for the Future .........................................................................................................................46
Section IV. Taxonomy, Framework and Context for the Study of Medical Technology .....................47

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Section IV. Taxonomy, Framework and Context for the Study of Medical Technology .....................47
Taxonomy Framework and Context ........................................................................................................47
Section V. Reference Material........................................................................................................................72
References and Resources for Medical Technology...............................................................................72
Medical Technology Web Resources........................................................................................................81
Acknowledgements .....................................................................................................................................82
Glossary of Terms.......................................................................................................................................84

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vii
Medical technician viewing an MRI image scan.
Courtesy of the Rocky Mountain Magnetic Resonance Center at Colorado State
 Foreword
Medical technology in some form has been part of medical practice since the early days in the
history of medicine. This well-written book is the first concerted effort to capture the essence of
medical technology and present it in a form that will make the study of medical technology a
viable content area of study for grades 3-12.

Medical Technology: Contexts and Content in Science and Technology Education is a medical
technology primer. It is designed to assist teachers and curriculum designers in developing
medical technology content in schools. The authors use a clearly organized approach to guide us
through the significant historical events of the field, including major technological
breakthroughs, and the ethical decisions that physicians and others made as they established the
foundation for today’s world of medical technology.

Any study of medical technology would be incomplete were it to attend only to the physical
characteristics of the artifacts themselves. This book pays careful attention throughout to the
social context and conceptual framework within which each technology was created and used. It
gives specific guidance on content background and it offers a rationale and structure in which to
conceptualize medical technology. The authors use vignettes throughout, which will help to
bring the field of medical technology to life for many students.

Increasingly, educators have been challenged by the rapid development of new technologies, and
the challenges brought forth by the development of new medical technologies are no exception.
Educators in science, technology, mathematics, and applied engineering will find information in
this primer with direct applications for the school curriculum.

Now, more than at any time in the history of formal education in America, educators are
challenged to bring the field of medical technology to life in the classroom. I join my colleagues
in congratulating Michael A. De Miranda A. Mark Doggett, and Jane T. Evans on writing an
excellent medical technology primer. The world of medicine is becoming an ever-more
important part of daily life. Everyone needs to understand the essentials of health care, and to
understand health care has come to include understanding the essentials of medical technology.
In the years to come we will surely see more and more new medical technology. This volume
could help students and educators become more knowledgeable consumers and critics of health
care during the remainder of the 21st century.

Joel D. Howell, MD, Ph.D.

Victor Vaughan Professor of the History of Medicine
Professor, Departments of Internal Medicine, History, Health Services Management and Policy
University of Michigan

viii
 Preface
Medical Technology: Contexts and Content in Science and Technology is one of a series of
documents envisioned to assist educators in improving and strengthening students’ knowledge in
a specific area of science and technology. Its purpose is to build a basic understanding of medical
technology using historical perspective, conceptual framework, and educational vignettes. It was
designed for use by educators who have an interest in introducing medical technology as part of
a science, technology, mathematics, or applied engineering curriculum. The Standards for
Technological Literacy (STL) published by the International Technology Education Association
(ITEA) described twenty content standards in technology for grades K-12. This primer
specifically addresses Standard 14 of that document: students will develop an understanding of,
and be able to select and use medical technologies. The American Association for the
Advancement of Science in Benchmarks for Science Literacy included the study of health
science for K-12 curriculum as Benchmark 8F. This primer is congruent with that benchmark.

In this document, the use of the term medical technology is expansive and encompasses more
than the field of clinical laboratory medicine as defined by the medical community. Our use of
the term medical technology is the application of procedures, information, and devices to
develop highly sophisticated solutions to medical problems or issues such as the prevention of
disease or the promotion and monitoring of good health. Medical technology is also commonly
confused with biomedical technology; however, there is a distinct difference. Biomedical
technology applies principles of biological and physiological sciences. Biomedical technology
employs living organisms (or parts of organisms) such as human tissue, DNA, or pharmaceutical
products for medical use.

The primer is organized into four sections. Section I assists the reader in understanding the
historical context of medical technology as it evolved over time and some of the technological
breakthroughs that were instrumental in shaping its current state. This section also highlights and
describes some of the social contexts and ethical issues raised by medical technology. The
section concludes with an introduction to the nature of medical technology and uses a guided
dialogue to describe the attributes and character of the technology. Section II presents the
conceptual framework for the study of medical technology and gives examples that educators
can use to develop educational exercises. Section III provides educators with grade-specific
concepts, vignettes, and ideas for developing medical technology curriculum and lesson plans.
Section IV offers a Taxonomy, Framework and Context for the Study of Medical Technology
Finally, Section V offers references and additional resources for professional development in the
study of medical technology.

This document was reviewed by physicians, nurses, technicians, and medical practitioners for
accuracy, relevance and clarity. Input was also gathered from scientists, engineers,
mathematicians, and science and technology educators. Please read the document, study it, and
join with other education professionals in developing a greater understanding of this exciting and
rapidly-changing field. The study of medical technology is not an independent discipline, having
a set of technologies of its own, but borrows and applies principles from many other sciences and
technologies. For this reason, medical technology is a growing field of interest and will continue
to be a viable subject for the generations of the future.

ix
 Introduction
One of our challenges was to produce a document of relevance for educational practitioners in
science and technology that could help them conceptualize and gain a basic understanding of the
medical technology field. Detailed lesson plans and classroom activities are not the focus of this
document. This document is designed to aid the teacher in understanding and applying the
principles and nature of medical technology in the design of curriculum and instruction. Thus,
one of the features of this text is that it does not tell practitioners exactly what to do when
teaching a unit or an integrated lesson related to medical technology; it provides a framework.

The reader of this text should be cautioned that medical technology does not fit neatly into the
traditional content classifications generally used by teachers of science and technology. Because
of the nature of medical technology, it cannot be put into a box—it squirts out and redefines the
traditional field of technological study. Because it does not fit in any one technology paradigm, it
may, on some level, characterize the future of technology: a cross-disciplinary field with
interfaces between human, technological, and scientific systems.

Taxonomy for a Complex Technology

Because of medical technology’s cross-disciplinary nature, it is valuable to introduce the reader
to taxonomy. Medical technology applies energy forms to body systems. Energy forms are the
physical forms of energy that exist in the universe, i.e., magnetic energy, thermal energy,
electrical energy, chemical energy, etc. Medical technology applies energy forms (generally
using devices such as x-ray machines, electrocardiographs, or precision lasers) to diagnose and
treat various parts of the human body or body systems. Body systems regulate the operation of
the human condition by controlling functions like circulation, digestion, or respiration. However,
medical technology literacy requires more than learning about energy forms and body systems.

Medical technologists must also know about the appropriate procedures and devices for the
diagnostic/therapeutic application of the energy forms to body systems. Therefore, knowledge,
procedures, and devices simultaneously define the application of medical technology.
Consequently, medical technology requires a foundation in both science and technology. In
addition to science and technology, the basis for medical technology resides within the context of
the social, political, and cultural world. Thus, medical technology is the application of energy
forms to diagnose and treat body systems using knowledge, procedures, and devices within the
context of both science and technology in society. A conceptual Venn diagram on the next page
characterizes this perspective.

x
Figure A. Interaction of Science and Technology with Regard to Medical Technology

Key Elements in Context and Content

To assist the teacher practitioner, this document was designed to be as user-friendly as possible.
The important paragraphs to read have been highlighted with the key icon shown below.

The reader should pay careful attention to paragraphs identified with this icon as they indicate a
key point, core concept, or item of importance that defines and conceptualizes the content or
context of medical technology. This is not to say that the reader will find the unmarked
paragraphs of little use, but that the authors understood the pace of busy lives that may require a
quicker read of the major topical areas.

xi
 Section I: Medical Technology in Context
What will this section cover?
Historical background
Social and ethical implications of medical technology
Introduction to medical technology

What will this section help me understand and be able to do?

Identify key medical technology breakthroughs
Describe the transition from general medical practice to specialization
Explain how medical technology has complicated perspectives of life and death
Develop an understanding for the meaning, nature, and characteristics of medical technology

The History and Impact of Medical Technology

In the early beginnings of humankind,

disease was viewed with mystery and was a

Courtesy National Library of Medicine

common occurrence that claimed many lives
(Porter, 1996). It was thought that disease
was caused by the negative interaction
between environmental elements and body
fluids (Reiser & Anbar, 1984). Poor health
was considered a physical, social, or
personal deficiency within the patient or the
environment in which the patient lived. The
four humors as described by Hippocrates
(460-377 B.C) and Galen (131-201 A.D.) Hippocrates
were an attempt to qualitatively measure a
deficiency or excess of bodily fluids (i.e.,
Courtesy National Library of Medicine

blood, phlegm, yellow bile, and black bile)

with respect to the changing seasons.
Hippocrates and Galen were the first
documented Western physicians to actively
engage in a rudimentary science of healing
designed to increase the quality of life for
their patients. Medical technology evolved
slowly in response to the high mortality
rates associated with diseases (e.g., black
plague) that in some cases caused the death
of millions. Medicine and medical Galen
technology has become the antidote for
illnesses and diseases that formerly resulted
in the destruction of entire societies.

1
 Courtesy of National Library of Medicine
The operating room at Brinkley Hospital, circa 1921
treatment, most of the general population
Evolution of Medical Technology during this period was reluctant to allow any
Early practitioners of medicine relied doctor to physically examine them.
primarily on the patient’s descriptions of
symptoms and their personal observations. It was not until the 19th century that
They rarely examined the patient’s physical physicians increasingly used machines for
body. Furthermore, emerging medical diagnosis or therapeutics. Hutchinson’s
universities in 13th century Europe device for measuring the vital capacity of
emphasized a theoretical and philosophical the lungs was one of the first technologies
approach that discouraged medical students developed to numerically measure an
from placing their hands on the patient while essential body function. Another early
learning the practice of medicine. This device was Herisson’s sphygmomanometer
began to change as many physicians started for blood pressure measurement. Chemistry
to realize that medical texts first published also began to play an important role and was
in the 11th century and the general physician increasingly used in the 18th and 19th
practices of the time had many errors. By centuries to diagnose aliments such as
the 18th century, doctors began to diabetes, anemia, diphtheria, and syphilis
increasingly use manual (or mechanical) (Reiser, 1978). Medicine slowly changed
techniques to diagnose patients and cadaver from the use of subjective evidence provided
dissection became more accepted as a by the patient to objective evidence obtained
medical practice (Reiser, 1978). While by mechanical and chemical technology
dissection of human cadavers and a devices.
physician’s touch were extremely helpful in
providing a more objective and accurate
2
 Courtesy of the National Library of Medicine
Surgery in the Sixteenth Century
started to become concentrated in urban
From General Practice to
centers and the large numbers of patients
Specialization
created economic incentives for doctors to
Medicine in the early 19th century was
relocate to those areas. Second, general
typically decentralized, rural, and consisted
practice physicians sought to escape the
of general practitioners. Medical technology
irregular hours of practice and specialization
stimulated the growth of medical specialists
seemed to hold more prestige. In addition,
in the United States. By the 1880s, the
there were no professional or administrative
number of specialist publications in
barriers that prevented specialists from
medicine was growing at a faster rate than
competing with the generalists for patients
those of generalist publications. The number
(Reiser, 1978). Third, the nature of medicine
of medical specialties recognized by the
changed such that general practitioners
International Medical Congress increased
could no longer keep up with the amount of
from eight in 1875 to an estimate of 34 in
knowledge required to make accurate
1915 (Reiser, 1978). In 1930, only one out
diagnostic or treatment assessments. Fourth,
of four practitioners was a medical
the machinery and equipment used in
specialist. By 1980, more than four out of
medical practice became quite complex
five doctors were specialists (Reiser &
requiring specialized technical expertise and
Anbar, 1984).
support.
There were many factors that drove medical
specialization. First, patient populations

3
 This exponential growth in medical
technology and data created the need for
more technicians, of all kinds, to test and to

Courtesy Museum of Health Care at Kingston

manage medical data. Medical technology
also created educational needs. Medical
technicians needed education to become
proficient in the use of technology to help
treat and diagnose illness. Patients needed
education when confronted with the often
confusing decisions regarding the tests and
procedures performed for their health and
well-being.

Critics of specialization assert that

Fleischer stethoscope 1923-1963 technology has created less face-to-face
contact between the patient and an actual
As more doctors became specialists, the doctor. Physicians have become more
need arose for more cooperative dependent on the use of technology for
arrangements since no single physician diagnosis and treatment. Technical
possessed all of the special knowledge equipment and the expertise of technicians
required. The result was an increase in the are now being relied on for many medical
number of physicians associated with decisions that were formerly doctors’
private medical groups and hospitals began opinions. Technology has taken the
to function as an integrator of medical diagnostic assessments that used to be based
technology. Medical services became on patient descriptions or doctor’s
organized around cooperative practice examinations and transferred them to
arrangements. An unfortunate by-product of medical, chemical, or radiological
this organization was a decreasing level of laboratories. The result has been an increase
local medical services in many rural areas in diagnostic accuracy at the expense of
(Reiser, 1978). Specialization forced close doctor-patient relationships (Reiser &
physicians to become centrally located and Anbar, 1984).
increasingly cooperative. Hence, the hospital
became the central locus for medical care
(Reiser & Anbar, 1984). Medical technology Technological Breakthroughs in
and specialization also increased the amount Medical Technology
of data required to diagnose and treat a Some of the early breakthroughs in medical
patient. Thus, the medical record became the technology were the thermometer,
central focal point for retaining patient stethoscope, microscope, ophthalmoscope,
information and created the need for laryngoscope, and x-ray. These devices
information technology to organize and allowed the physician to hear and see parts
store voluminous amounts of data. This, in of the body that had previously been
turn, created the need for medical observed only in cadavers. The device
technicians and data specialists such that by considered to be the first diagnostic medical
1969, 80 percent of those employed as
medical professionals were non-physicians
(Reiser, 1978).

4
 Courtesy of the National Library of Medicine
Medical laboratory, 1944

acquiring information about the lungs and

heartbeats of patients. However, skeptics
initially challenged its merit and
effectiveness. In spite of the initial
opposition to its value, the stethoscope is
Courtesy Museum of Health Care at Kingston

still being used by medical professionals

today (Reiser, 1978).

Magnifiers were invented in the 1st century,

but microscopes were not used for medical
purposes until the 1840s. This was due
primarily to advances in lenses, better stains,
and lower costs. Hermann von Helmholz, a
German scientist, applied the principles of
optics with the invention of the
ophthalmoscope in 1850. This was the first
Early Zeiss microscope visual technology to view the interior of the
technology breakthrough was the eye (Reiser, 1978).
stethoscope. Rene Läennec, a French
physician familiar with acoustics, invented Another technology was the invention of the
the stethoscope in 1816 by serendipity. The laryngoscope invented by Manual Garcia in
invention offered numerous solutions for 1855. Garcia, a London singing teacher,
placed a mirror in the back of the throat and

5
another mirror to reflect sunlight into the the medical industry until World War II
mouth to observe the action of the throat and when it was widely used to diagnose
larynx. Two years later, Johann Czermak, a pneumonia, pleurisy, tuberculosis, and assist
Polish professor of physics, replicated his doctors prior to surgery (Marks, 1993).
experiment using artificial light (Reiser,
1978). The development of chemical procedures in
the 18th and 19th centuries significantly
Forty years passed before the use of advanced the use of medical technology as a
electricity resulted in the invention of the x- diagnostic tool for diabetes, kidney disease,
ray. Wilhelm Roentgen, a professor of anemia, diphtheria, and tuberculosis. As
physics in Bavaria, discovered by accident a physicians came to realize that a chemical
radiation that could penetrate solid objects evaluation of disease required more
of low density. He also found that these specialized skills, they increasingly
phenomena could be viewed on a delegated this type of work to other experts
fluorescent screen and stored on or technicians. By the mid-1800s, many of
photographic film. The invention of x-rays these chemical experts organized their work
allowed doctors to view the inside of the by establishing laboratories for the analysis
body without surgery. In spite of the benefits of medical specimens. By the mid-20th
of being able to produce images of the century, the use of technical laboratories for
internal body structure, the x-ray was not an medical diagnostics had become so
invention that diffused rapidly throughout prevalent that the U.S. Congress placed
them under
the regulation
of the Centers
for Disease
Control and
Prevention
Photos courtesy of the National Library of Medicine
(CDC)
(Reiser,
1978).

Wilhelm Roentgen First x-ray taken by Wilhelm

Roentgen of Mrs. Roentgen’s
hand (note the wedding ring)

6
 Advances in Medical
Technology Impact
Medical Procedures
The rapidly
expanding medical
technologies available
to the medical
profession also
advanced the

Courtesy of the National Library of Medicine

development of
complex surgical
procedures. The
Drinker respirator
was introduced in
1927 and the first
heart-lung bypass
machine in 1939. In
the 1940s, cardiac
catheterization and
Dentist office, 1950s angiography
procedures were
Advances in medical technology accelerated made possible through advances in material
in the early 20th century by improvements in science. The use of a cannula threaded
basic science and the intense cross- through an arm vein and into the heart with
fertilization of scientific and technological the injection of radiopaque dye for x-ray
discoveries such as electrical measurement visualization made seeing the heart, lung
techniques, sensor development, nuclear vessels, and valves possible for the first time
medicine, and diagnostic ultrasound (Cruse, 1999; Howell, 1996).
(Bennett, 1977). In 1903, William Einthoven
devised the first electrocardiograph and In the early 20th century, Elizabeth Kenny, a
measured the electrical changes that trained army nurse from Australia, treated
occurred during the beating of the heart. In polio patients using hot packs and muscle
the process, Einthoven initiated a new age manipulation. Her procedures, considered
for both unconventional at the time, were initially
cardiovascular rejected. After acceptance by the medical
medicine and community, her techniques reduced residual
electrical polio paralysis from 85% to 15% in one year
measurement (Beckstrand, 1999). Kenny's principles of
© The Nobel Foundation

techniques muscle rehabilitation became the pioneering

(Enderle, foundation for modern physical therapy. She
Blanchard & also invented a new stretcher device for
Bronzino, 2000; transporting people in shock. Kenny’s life
Snellen & was later chronicled in a 1946 movie based
Hollman, 1996). upon her autobiography.
William Einthoven

7
 medical technology available to clinical
scientists (Levinovitz & Ringertz, 2001).

Courtesy of the National Library of Medicine

Dr. John H. Gibbon is credited with
developing the first clinically successful
heart-lung bypass machine after almost three
decades of research. Using funding from
IBM, the first successful use of the device
was in 1953 on an 18-year-old girl with a
heart defect. The first machine was massive,
complicated, and difficult to manage. It also
caused bleeding problems and consumed red
Computer data entry in the early 1960s blood cells. Today, modern heart-lung
machines reduce patient bleeding through
devices that preserve the surrounding blood
The development of new knowledge and supply and reduce the body temperature so
procedures was so great that by the end of the heart beats slower. Thus, a surgeon can
World War II, an unprecedented quantity of protect the function of the heart and other
American engineers and scientists were vital organs during artificial circulation
directed to use their expertise to develop
technology. During this time, extraordinary The Science Technology Interaction
advances were made in electronics, material and Medical Technology
science, and thermodynamics, which were Another technology applied to the medical
instrumental in the development of medical field in the 1950s was the electron
technology (Blume, 1992). The Mobile microscope. The electron microscope
Army Surgical Hospitals (MASH) of the represented a significant advance in the
Korean War revolutionized medical
surgical practice and gave rise to a
new specialist, the Emergency

Courtesy of Greg Hood, John Burkardt, and Greg Foss;

Medical Technician (EMT).

As medical technology in the

United States blossomed so did the
prestige of American medicine. Pittsburgh Supercomputing Center

From 1900 to 1929, Nobel Prize

winners in physiology or medicine
generally came from Europe. In the
period 1930 to 1939 prior to World
War II, seven Americans were
honored with Nobel Prizes. During
the post-war period from 1945 to
1975, thirty-nine American life
scientists were honored and from This image was derived from supercomputer
1975-1995, thirty-one more were animations showing a group of pyramidal brain cell
honored. Most of these efforts were axons as they simultaneously convey a burst of
made possible by the advanced electrical activity from one cortical layer to another.

8
visualization of relatively small cells. Body
scanners to detect tumors arose from the
same science as well as the technology that
ushered in the atomic age. Science and
medical technologies tended to leapfrog past
one another throughout recorded history.
Thus, anyone seeking a causal relation
between them is likely to find that

Courtesy FONAR Corporation

technology is the cause and science the
effect with the converse also holding true
(Cruse, 1999).

In the 1970s, medical researchers adapted

computers that advanced medical
technology by performing complex
calculations, keeping records via artificial
intelligence, and controlling the instruments Drs. Raymond Damadian, Lawrence
that often sustained life. The development of Minkoff, and Michael Goldsmith (left to right)
new medical imaging technologies such as in 1977 with the world’s first magnetic
tomography and magnetic resonance resonance scanner that performed the first
imaging (MRI) united with three- scan of a live human being.
dimensional modeling was dependent on the
information and computer technologies that Future Trends
were able to graphically represent body The latest medical technologies now include
functions and condition (Bhatikar, Mahajan, robotic devices, keyhole surgery procedures,
& DeGroff, 2002). and genetic engineering created from
knowledge about DNA molecules. Medical
Medical technologies provided prosthetic technology is now creating breakthroughs
devices, such as artificial heart valves, that may, once again, result in the
artificial blood vessels, functional decentralization of medicine through the
electromechanical limbs, and reconstructive telecommunication technology known as
skeletal joints. These innovations are the telemedicine. The importance of accuracy
result of advances in science, technological and medical record integrity has resulted in
imaging/design techniques, and material automated diagnostics and computerized
science (Lalan, Pomerantseva, & Vacanti, data collection.
2001). In recent years, the intersections of
technology and medical science have Yet, medical technology has not fulfilled the
impacted the practice of medicine in needs of many patients as indicated by an
profound ways. Medical technology increased interest in holistic healing
advances in the past 50 years has exceeded techniques, spiritual medicine, and mind-
the advances during the previous body treatment. Technology breakthroughs
2000 years. In a culture steeped in science, it have proven their potential for improving
appears that the growth and use of medical the quality of life, but technology has also
technology will continue. generated additional and valid concerns
among general practitioners and patients.

9
 Medical Technology Issues

of this writing, the average life expectancy

Ethical Concerns
for males was 74.3 years and 76 years for
The technological and scientific innovations
females. This is in sharp contrast to the life
reviewed represent a small segment of the
expectancy of 47 years at the turn of the 20th
medical technologies that have influenced
century. While this increase cannot be
the progression and capabilities of medical
attributed directly to medical technology, the
care providers. The innovations in medical
modern technologies that promote health,
technology have endowed modern medical
early diagnosis, and make restorative
care providers with the ability to sustain and
surgical procedures possible have
prolong life, repair damaged body parts,
contributed significantly to theses gains over
peer into the human body, cure and treat
the past 100 years (Cooper, Stewart, Kahl,
many diseases, and otherwise ameliorate a
Brown, & Cordell, 2002).
wide range of undesirable physical and

Courtesy Poudre Valley Hospital

Telemedicine systems are used for home health monitoring. The patient (pictured on
the left) is being checked remotely by the doctor (pictured on the right)
for hand-flexibility following an operation for carpel-tunnel syndrome.
mental conditions for which little could have
been done in the recent past. However, to New Definitions of Life and Death
see only the benefits of medical technologies Medical technology has advanced the
is to fail to see the whole picture. Along reevaluation of traditional definitions of life
with these impressive advances and and death. Live fetuses can be removed from
technological innovation come a number of the womb many weeks prior to normal
difficult and often perplexing ethical issues delivery and patients can be resuscitated
with regard to quality of life and definitions after heart, lung, or brain failure. For
of death (Beach & Morrison, 2002; Blake, example, premature births no longer
1988; Rajput & Bekes, 2002). constitute as great a threat as they did 30
years ago because of the artificial
There is little doubt that the use of medical environments that medical technologies
technologies has, in many instances, provide. Technology has not only helped
extended the possibility of life in individuals individuals avoid death but also has been
and increased the life expectancy of society effective in adding more productive years to
as a whole. In the United States, at the time

10
 take as their guiding principle the concepts
of service to humankind and the respect for
human life, and to do no harm nor malice.

Courtesy Poudre Valley Hospital

While the established codes of conduct are
useful in promoting the ethical treatment of
patients and the conduct of the health
service providers, the codes fail to provide
answers to more difficult moral dilemmas
involving the use and appropriation of
medical technologies (Bronzino, 1992). For
Ultrasound equipment is now used for a example, all of the fundamental
variety of purposes including scans of the responsibilities of a physician cannot be met
carotid arteries located in the neck. at the same time. When a patient suffering
from massive insult to the brain is kept alive
people’s lives. Medical technologies such as by means of artificial respiration equipment
pacemakers, artificial kidneys, insulin and the equipment is needed elsewhere for
pumps, hearing aids, joint implants, and in- the recovery of a surgical patient, it is not
home health monitoring systems have been clear in the code of ethics guidelines how
so successful that professionals responsible such decisions should be made.
for the care of critically ill patients have
been able to maintain patient “vital signs” Decision-Making
for extensive periods of time. In the process Consider the case of a patient who sustained
however, serious ethical questions a serious head injury in an automobile
concerning the quality of life provided these accident. When the emergency medical
patients have arisen. personnel and ambulance arrived at the
accident scene, the patient was unconscious
Medical Codes of Conduct but still alive with a beating heart. After the
In the practice of medicine, moral dilemmas victim was rushed to the emergency ward of
are not new. They have been present a local hospital, the resident in charge
throughout medical history. As a result, over verified the stability of the patient’s vital
the years there have been efforts to provide a signs of heartbeat and respiration during the
set of guidelines for patient care and the initial examination. The physician ordered a
ethical use of medical technologies. These
efforts have resulted in the development
of specific codes of professional conduct.
Courtesy of Harmony Imaging Center

For the medical profession and

professionals who use medical
technologies, the World Medical
Association adopted a version of the
Hippocratic Oath titled the Geneva
Convention Code of Medical Ethics in
1949 (Rosenblatt, 2000). In 1999, the
House of Delegates of the American
Medical Association revised a set of
Principles of Medical Ethics (World Modern CT scanner
Medical Association, 1999). These codes

11
computerized tomography (CT) scan to changed to a straight line indicating weak or
indicate the extent of the head injury. The no electrical activity. However, since the
results of this technological procedure heart-lung bypass machine was maintaining
clearly showed extensive brain damage. the patient’s vital signs, what should the
What was the status of the patient? Was the surgeon and her staff of medical technicians
patient still alive? do? Should her staff continue on the basis
that the patient was alive or was the patient
Alternatively, consider the events dead?
encountered during an open-heart surgery.
During this procedure, the patient was The impact of medical technologies on the
placed on a heart bypass machine while the increasing occurrence of situations like these
surgeon attempted to repair a damaged heart cases has required medical professionals and
valve. As time passed on this long and society to reexamine the definition of death.
complex procedure, the EEG monitor In essence, the advancements in medical
sounded a loud alarm that alerted the technologies that delay or prevent death
operating room staff that the normal pattern have actually hastened its redefinition
of electrical activity displayed in the brain at (Penticuff, 1990).
the beginning of the operation had suddenly

Photo by Gary Meek

Using computers with software color enhancement connected to a high-powered

microscope, scientists can view organic compounds with high clarity.

12
Medical Concerns, Ethics, Decision Making, Social Issues, and Codes of Conduct
The Cases of Karen Ann Quinlan and Terri Schiavo

Medical technology has created new ethical dilemmas for medical professionals. Medical technology has
forced the re-evaluation of the traditional definitions of life and death. The concept of birth is now subject
to debate as live fetuses can be removed from the womb many weeks prior to traditional delivery. The
concept of death is also being revisited as patients can now be resuscitated after prolonged heart, lung,
or even brain failure. The ethical considerations of death and when it occurs can be illustrated through
two cases: one hallmark case in the 1970s and a recent case still unresolved.

In the mid-1970s, Karen Ann Quinlan was the first modern icon of the debate regarding the right-to-die
versus the ability of a medical technology to keep a patient “alive” long after the traditional indicators of
cardiac or respiratory failure. The 21-year-old Quinlan collapsed and lapsed into a persistent vegetative
state after ingesting alcohol with prescription tranquilizers at a party. Despite severe brain damage and a
coma, she was not considered dead because her cardiac and respiratory functions could be maintained
using machines. Her family waged a much-publicized New Jersey legal battle and succeeded for the
right to remove her from the life support technology that kept her breathing. However, Quinlan kept
breathing after the respirator was unplugged and remained in a coma for almost 10 years until her death
of acute pneumonia in 1985.

In 1990, 26 year-old Terri Schiavo went into a chronic vegetative state as a result of cardiac arrest due to
a potassium imbalance. She was not diagnosed as comatose, but was so brain-damaged that she
seemed robbed of any cognitive ability. After eight years, her husband sought to withdraw the feeding
tube to allow her to die, but her parents and sister wanted to continue supplying her body with food and
water claiming that Terri might eventually be rehabilitated. Initially, the courts ordered the feeding tube
removed in 2001, but the parents received a temporary legal injunction to restore the tube. The
controversy escalated when Terri’s feeding tube was removed by a court order for the second time in
2003. Then, in an unprecedented move, the Florida state legislature passed a law tailored to her case
that authorized the state governor to issue a one-time stay to reinsert the tube. The final outcome of the
case remains pending at the time of this writing.

As medical professionals, sociologists, legal experts, and judges attempt to untangle the medical, ethical,
and constitutional questions, technology becomes a symbol of both vital force and antagonistic purpose.
Medical technology raises questions about the obligations of physicians, and of ethical criteria congruent
with innovation development. The elusive resolution of human dilemmas that result from the
advancements and capabilities of modern medical technologies could not be more apparent. Is an
individual in a state of brain death any less in possession of the characteristics from one whose
respiration and circulation are mechanically maintained? It is a matter that society must decide. Until
society decides, it will not be clear what is beneficial or undesirable in regard to the intersection of human
values, morals, and ethics with respect to innovative medical technologies.

13
 brain tissue results. Consequently, the evidence
Medical Technology Creates Trade-Offs
of death began to shift from the pulsating heart
Historically the definition of death has been
to the vital functioning of the brain. Once the
closely related to the extent of medical
technology of the EEG was introduced to
knowledge and the availability of technology.
monitor the brain’s activity, another factor was
For the centuries prior to artificial respirators,
added to the definition of death. The moral
death was defined as the absence of breathing. It
resolution of the death from lack of brain
was often believed that human existence resided
function perspective argues that when the brain
in the spiritus (breath); its absence was
is irreversibly damaged, so are the functions that
indicative of death. With the advances in
are identified with self and human
knowledge of human physiology and the
characteristics, such as memory, feeling,
development of medical technologies to revive a
person who is not breathing, attention then
turned to the pulsating heart as the focal point in
determination of death. However, this view
changed with the addition of technological

Courtesy Poudre Valley Hospital

advances in supportive therapy, resuscitation,
cardiovascular assistive devices, and organ
transplantation (Dickerson, 2002).

Hospitals use medical telemetry devices to

Courtesy Poudre Valley Hospital

monitor patient vital signs and other important

parameters by transmitting this information
using wireless technology to a remote location
such as a nurses' station.
thinking, and knowledge. As a result, it became
widely accepted that the termination of activity
of the lungs, heart, and brain defined clinical
A laboratory technician prepares death. The irreversible cessation of functioning
a slide for analysis. of all three major organs was required before
anyone was pronounced dead (Humber, 1991;
Ott, 1995). With the development of advanced
As the knowledge of the human organism medical technologies that supported artificial
increased, it became apparent that one primary respiration, the medical profession encountered
support of life was blood and one of the critical an increasing number of situations where a
components of blood was oxygen. The advent of patient with irreversible brain damage could be
diagnostic technology to monitor a patient’s maintained almost indefinitely. Once again, new
blood gas levels led to the understanding that all medical technology advancement created the
vital organs require oxygen. Hence, any organ need to reexamine the once simple definition of
deprived of oxygen for periods greater that three death. Patients may, however, select criteria for
minutes begins to suffer damage. The critical the level of medical intervention through an
functions of the brain are particularly sensitive to advance directive.
oxygen depravation and irreversible damage to

14
 division between doctor and patient. The overall
Social Impacts
consequence is that the physician spends less
One of the greatest social concerns regarding
time with patients, but requires greater amounts
medical technology is its cost versus benefit.
of data for an accurate diagnosis at higher cost.
Medical technology increases the cost of
Nonetheless, concerns in the medical community
medicine making it more difficult for people
regarding the risks of over-reliance on medical
with low incomes to afford quality care. There is
technology have not changed the practice of
the criticism that reliance on machine technology
depending on it.
to produce objective measures and reduce
potential liability results in greater cost to the
Precision in medical diagnosis hinges on three
patient. At the same time, there is an increasing
characteristics: the consistency or stability of the
consensus among citizens in Europe and the
phenomena (disease or illness) being measured,
United States that it is the obligation of society
the intrinsic accuracy of the measure or test used
to provide health care for citizens. Medicare and
(also known as repeatability), and the ability of
Medicaid are two examples of programs that
the observer (physician or technician) to
were created by the U.S. Government to
accurately record and interpret the data (known
subsidize the cost of health care for seniors and
as reproducibility). Medical technology has
low income families.
improved the repeatability of the measures used
to diagnose and treat illness. However, new
Another concern is that medical technology
diseases and illness continue to wage war
enlarges the physician’s knowledge of disease,
successfully against humankind (e.g., acquired
but it also creates a dependence upon machines
immune deficiency (AIDS), amyotrophic lateral
and laboratory experts. This creates the risk of
sclerosis (ALS), Parkinson’s disease, cancer, flu,
making medical judgments based solely on
and the common cold). Their persistence
technical data without allowing for the
indicates the powerlessness of the use of medical
possibility of error or considering the patient’s
technology to address unpredictable or unstable
views. Doctors who have an overdependence on
ailments. The use of medical technology has
chemical laboratory tests or x-rays for diagnostic
improved the accuracy (reproducibility) of
purposes without regard to their relevance may
medical diagnosis, but it has not eliminated
actually be
human error as
putting the
evidenced by
patient at
the continuing
greater risk. The
and sometimes
emphasis on
tragic medical
what diagnosis
mistakes.
the technology
Technology will
Courtesy of Harmony Imaging Center

provides rather
always be
than what the
grounded in the
patients says or
people who use
the physician’s
it and the
professional
medical systems
judgment results
in which it is
in potential
applied.

Ultrasound machines monitor the health of a fetus.

15
 Courtesy FONAR Corporation,
An early sagittal Magnetic Resonance
Image (MRI) of the brain.

The Nature of Medical Technology

Science is a collection of disciplines that are in

Understanding Science and Technology
continuous states of development. Disciplines
Science is concerned with the study of natural
such as physics, biology, astronomy, and
world and the interrelationship between the
sociology are rapidly changing or being
physical, biological, psychological, and social
modified into other fields such as astrophysics
worlds. Scientists use ideas generated through
or sociobiology. Science does not have fixed
particular ways of observing, thinking,
borders, but it is defined by differing levels of
experimenting, and validating. Thus, science
discovery and overlapping interest. A critical
could be described as a world view, a method of
tenet of medical technology is that it is highly
inquiry, and as an enterprise of complex activity
dependent on the integration of sciences such as
(AAAS, 1990). The union between science,
acoustics, chemistry, electronics, mechanics,
mathematics, engineering, and technology
and optics. Without these areas of scientific
creates a powerful combination for the
investigation, medical technology would not be
development of knowledge and capabilities to
possible.
extend human potential.
Technology is the modification of the natural
Scientists hold the view that the natural world is
environment in order to satisfy perceived human
understandable and can be explained or predicted
needs and wants (ITEA, 2000). Generally, there
using historical data, experimental findings, and
are three layers of the meaning of the word
methods of quantitative or qualitative analysis.
technology. First, as a physical artifact, machine,
However, scientists recognize that this
or an instrument; second, as an activity, or as a
understanding is subject to change based on new
means to accomplishing a goal, and third, what
information or theory and that some of the
people know (Howell, 1996). Rogers (1984)
natural world will never be understood
asserted that “technology is a design for
completely. Additionally, science:
instrumental action that reduces the uncertainty
• demands evidence, in the cause-effect relationships involved in
• uses both logic and imagination, achieving a desired outcome” (p. 12). In other
• seeks objectivity, words, technology provides human beings with
• has a professional code of ethics, the ability to modify their environment. In the
• avoids prescriptive conclusion, broadest sense, technology extends the abilities
• and is complex (AAAS, 1990). of the human beings to create, innovate, or
change the world (AAAS, 1990). Technology

16
also has other shared characteristics. In general, as science, arts, humanities, mathematics,
technological systems: and engineering.
• require control to keep them operating • Medical technology, science,
correctly, mathematics, and engineering have
• always have unintended side effects, become so interdependent that they can
• are prone to failure over time, scarcely be separated (AAAS, 1990).
• interact strongly with social systems, • Medical technology is systems-based
• and are complex (AAAS, 1990). (i.e., it represents a collection of devices,
procedures, and knowledge).
Technology generally consists
of two components: tangibles
and intangibles. Tangibles are
the physical elements associated
with a technology such as the
equipment, material, or product.
Intangibles are the knowledge,
skills, procedures, principles,
and information base required to

Courtesy Garth Englund Blood Bank

successfully implement the
technology (Rogers, 1983). The
most profound technologies are
those that slowly disappear by
weaving themselves into the
fabric of everyday life until they
become indistinguishable from it
(Weiser, 1991).
Patients can now donate blood using a machine
What is the Nature of that simultaneously extracts blood platelets,
Medical Technology? plasma, and red blood cells.
Medical technology is designed
to improve the detection, diagnosis, treatment, • Medical technology consists of energy
and monitoring of disease and illness. Medical forms (mechanical, optical, electrical,
technology uses applied mechanical, chemical, acoustical, etc.) applied to body systems
mathematical, and computerized knowledge (circulatory, digestive, muscular,
systems (AAAS, 1990). The nature of medical respiratory, etc.) for specific diagnostic or
technology is contextual, interdisciplinary, therapeutic purposes (Evans, 2003).
interdependent, and systems-based.
• Medical technology is dependent on the The Office of Technology Assessment
application, purpose, environment, and (OTA) (1982) defined medical technologies as
setting in which it is applied. drugs, devices, medical and surgical procedures,
• Medical technology draws on knowledge, and organizational and support systems within
information, and theory from many fields which medical care is delivered. The Food and
of study. Drug Administration (FDA) classified medical
• Medical technology has interdisciplinary technology as diagnostic, therapeutic,
linkages with many other disciplines such monitoring, prosthetic, surgical, laboratory,

17
testing, and miscellaneous devices. The FDA and
the European Union (EU) both define medical

Courtesy Poudre Valley Hospital

technology separately from pharmacological,
immunological or metabolic methods, but those
methods may assist the functions of medical
technology. Pharmaceutical drugs or vaccines
achieve their principal intended action in or on
the human body through organic chemical action
(IOM, 1985) and are more appropriately defined
as a biomedical technology. Medical
technologies are generally applied for six People who work with medical
purposes: prevention, diagnosis, treatment, technology are trained professionals.
rehabilitation, patient support, and administration
innovation development process model (Rogers,
(OTA, 1978). If one applies these definitions,
1983). The process of developing a medical
then medical technology is the application of
technology starts with the recognition of a
devices, procedures, and knowledge for
problem or need. This problem is a result of a
diagnosing and treating disease for the purpose
social construction and is based upon both
of maintaining, promoting, and restoring
scientific/technological expertise and political
wellness while improving the quality of life.
forces. Medical technologies developed to
Diffusion of Medical Technology address a problem or need generally come from
Diffusion refers to the spread of an innovation the interaction between basic and applied
over time in a social system (Rogers & research. Basic research is the development of
Shoemaker, 1971). The diffusion of medical scientific knowledge for the sake of knowledge;
technology can be generally described using the it does not have a specific purpose or objective.
Conversely, applied research is the specific
investigation of a technology to solve practical
problems. Applied research uses basic research
as a starting point. Occasionally, a medical
technology is discovered by accident such as the
invention of the stethoscope or radial keratotomy
eye surgery.

Once a technology is identified and tested

through research, it is then developed by putting
it into a form that is likely to meet the expected
Courtesy Ferro Corporation

needs of those who will adopt the technology to

solve the identified problem. This form typically
includes a prototype or model of the innovation.
Once a prototype is successful, it is converted
into a product or service for sale in the
marketplace. This process includes production,
packaging, marketing, and distribution of the
Researchers at corporate sponsored
innovation and is called commercialization
research centers are essential for
(Rogers, 1983; IOM 1985). Development of
providing primary research and technical
medical technology typically involves extensive
support for the development of core
testing before being accepted as common
medical technologies.
18
practice. Because medical technology is One criticism of the diffusion process is that
inextricably linked with human beings, it creates there is no coherent system or organization that
a need for extra caution and care with respect to comprehensively monitors, collects, indexes, and
implementation. Often, government approval is disseminates information on medical technology.
required for implementation. Once implemented, The effects of this are that some needed medical
new medical procedures or tools are introduced technologies may never be realized or be
through medical journals and direct instruction implemented too late while other technologies
or training. are commercialized without thorough evaluation.
Another criticism is that the diffusion process is
The diffusion and adaptation of a medical too slow with few methods for identifying
technology takes place through communication innovation knowledge gaps or setting priorities
channels such as consensus development, a for the evaluation of critical technology (IOM,
technique developed by the National Institutes of 1985).
Health (NIH), to bring together scientists,
practitioners, and consumers to determine if new Technology Transfer
innovations are safe and effective. However, Technology transfer is the communication of
most of the time, the diffusion of medical information from research and development to
technology happens by chance and is highly the users or vice versa. Technology transfer also
dependent on factors such as prevailing theory, occurs when an innovation is transferred to
the innovation itself, the clinical or practical another application as an idea, prototype, or
setting, the attributes of the potential adopter, useful product. There are many examples of
regulatory constraints, financial incentives, and technology transfer such as applications that
the methods used to evaluate the innovation began as military or space exploration and later
(IOM, 1985). became commercial products. Also, medical
technologies develop as
The final phase of a result of
innovation development breakthroughs in other
is the consequence of disciplines. Medical
Courtesy Harmony Imaging Center

the technology. technologies can also

Consequences are the transfer to other non-
changes that occur, both medical commercial
positive and negative, applications. The
as a result of the development of
adoption or rejection of Computed Tomography
a technology. Not all (CT) scans is an
medical technologies example of a medical
are adopted and some technology that now has
are discontinued after Modern imaging technology has made it a variety of other uses.
their introduction. An possible to see parts of the body that were The imaging techniques
example of previously visible only after death. essential in many of the
discontinuance was the banning of silicon sensing technologies carry over into areas of fine
implants because of leakage problems. An art, drawing, and photography (Evans, 2003).
example of non-adoption is the rejection of Technology that is not successful in medicine
certain types of birth control because of may prove successful elsewhere and vice versa.
religious, social, or health concerns. Figure 1 graphically depicts this process.

19
Figure 1. Technology Transfer Process

20
An Example of Technology Transfer
The Development of Computed Tomography (CT) Scanning Technology

The development and use of a specific technology can be very complex. The CT scanner was developed by
combining advances in computers, mathematics, instrumentation, and x-rays. Based on the conventional principles
of x-rays, where structures are differentiated by their density and ability to absorb energy, CT scanners combined
and improved several technologies resulting in a clearly defined three-dimensional perspective of low density body
structures. This technology involves x-raying successive cross sections of the body to build, with the aid of a
computer, a three-dimensional image. Tomography overcame the two dimensional limitations of x-ray by showing
objects in a particular plane. Simultaneously, instrumentation made the measurement of the x-ray radiation easier.
Advanced mathematics made the reconstruction of images from large sets of tomographic data possible, and
modern computers provided the capability for the mathematical models.

Working independently, Alan Cormack, an American physicist,

and British engineer Godfrey Hounsfield developed the first
Courtesy Harmony Imaging Center

workable CT instruments in 1967. The first prototype scanned

only the head and was used in 1971. The first commercial
model was used at the Mayo Clinic in the summer of 1973 and
began to be installed on a wide-spread basis in 1974. Currently,
6,000 scanners are in use in the United States. Because of
advances in computer technology, scanners are now much
faster and can make images of the entire body. Technology
improvements have also led to higher-resolution images, which
improved diagnostic capabilities. For example, a CT scan can
now show doctors small nodules or tumors, which they could
Modern CT Scanner not see using x-ray. The CT scan is also known as a CAT
(computerized axial tomography) scan.

The diffusion of the CT scanner within the medical community was more rapid than that of any other modern
medical technology that has been statistically documented. This dissemination occurred in spite of its high price.
(Early head scanners cost $300,000 and whole body scanners are over $1 million dollars today.) Most CT scanners
were first adopted in medicine because of the strong financial incentives associated with their use in hospitals and
the fear of malpractice suits by doctors. This was not the case for the CT scanning technology that was later
applied outside the field of medicine.

Medical Computed Tomography technology is now providing important solutions outside of medicine in industry
and business. Some of the current applications for CT scanning are:
• screening of luggage for explosives at airports
• scanning logs in the timber industry for grain patterns or defects
• border patrol screening and drug interdiction
• raw diamond scans prior to cutting
• scanning of food for foreign particles or dense material
• non-destructive testing of durable goods

Thus, it appears that CT scanning is a technology that has come full circle in its development and application. The
CT scanner represents a technology that was developed from basic scientific principles for a specific medical
application and is now being used for purposes other than medicine.

21
 Section II. Structure of Medical Technology
What will this section cover?
A conceptual framework for medical technology

What will this section help me understand and be able to do?

Identify the key elements of medical technology
Develop a theory of medical technology

Medical Technology Conceptual Framework

Medical technology is the application of devices,

procedures, and knowledge for diagnosing and Educational Institutions
treating disease for the purpose of maintaining, Educational knowledge of medical technology
promoting, and restoring wellness while resides in hospitals, clinics, universities, public
improving the quality of life. A representation of libraries, medical laboratories, and the Internet.
this taxonomy is shown in Figure 2. This section The educational knowledge of medical
will describe the conceptual structure of medical technology is both general and specialized. This
technology in detail. knowledge consists of information or raw data,
the contextual or applied setting, and the
foundation or source on which the knowledge
was based. General educational knowledge about
medical technology is common knowledge and is
taught at public schools or shared at medical
institutions. This primer represents the
development of general education in medical
Courtesy Poudre Valley Hospital

technology for the purpose of increasing general

knowledge about the subject. Specialized
knowledge of medical technology is discipline-
based and usually resides in educational
departments at institutions of higher learning or
medical schools. Specialized medical technology
knowledge might include the specializations and
Medical technicians must possess unique disciplines of cardiology, neurology,
observational and analytical skills. homeopathic remedies, pediatrics, chiropractic,
anesthesia, or veterinary medicine.
Knowledge
All technology starts with knowledge and this
knowledge comes from multiple sources. In the
case of medical technology, most of this
knowledge comes from three primary sources:
educational institutions, governments, and the
collective or individual knowledge of those in
the medical field.
22
 Enabling/
Misc.

Prosthetic

Preventive

Common

Restorative
Procedures/
Devices Energy
Forms Processes
Imaging
Diagnostic/ and
Therapeutic Body Systems
Unique
Monitoring

Science
Measurement and
& Testing Technology

Diagnosis
Individual & Educational
Collective Government Institutions

Knowledge Sources
Figure 2. Medical Technology Conceptual Framework

23
 Individual and Collective Knowledge
Governments The third source of medical technology
A second source of medical technology knowledge is the individual and collective
knowledge comes from governments. There knowledge that resides within the minds of
seems to be an increasing concern among people and the organizations that practice
democratic societies for access to quality health medicine and health care. This is the knowledge
care. In fact, the right to use medical technology possessed by people such as researchers,
and services is beginning to be viewed as an physicians, radiologists, technicians, and
obligation of governments to its citizens. It is not laboratory workers in hospitals, clinics,
surprising, in this environment, that governments insurance agencies, private companies,
take a serious interest in the application and governments, and schools. This source of
administration of medical technology knowledge is the most complex of the three
knowledge. Because of the importance and cost because it exists in various locations and
of medical services, governments typically have formats. It can best be explained using the
many research and regulatory agencies that set conceptual model shown in Figure 3.
standards, approve new medical devices or
techniques, and control costs. Much of the Common knowledge about medical technology
medical research in the United States is funded is both known and available. One can go to the
by the federal government through universities local library or Internet and gather this
or medical centers. Some of the common knowledge. Common knowledge is characterized
research and regulatory agencies include the by its accessibility, availability, and general
National Institutes of Health (NIH), the Centers understanding among the local population or
for Disease Control and Prevention (CDC), the society. An example is the general knowledge of

Known and Available Known and Hidden

(Common Knowledge) (Tacit Knowledge)

Unknown and Unavailable Unknown and Hidden

(Ultimate Truth) (Undiscovered)

Figure 3. The Conceptual Model of Knowledge

Food and Drug Administration (FDA), and the the existence of x-ray technology or the
Office of Health Technology Assessment awareness of medical procedures such as
(OHTA). These governmental agencies set appendectomy or tonsillectomy. Knowledge that
agendas for research funding, investigate is known and available can be easily retrieved
outbreaks of infectious diseases, monitor or and stored with little effort and is the basis for
approve new drugs and devices, and evaluate standard operating procedures or the use of
medical technology. common appliances.

Tacit knowledge, like common knowledge, is

known, but it differs because it is hidden from

24
the general population. This knowledge is to be able to manipulate these molecules into
known, but it resides narrowly within certain medical devices that can target and cure diseases
people, companies, laboratories or disciplines like cancer or leukemia. Theory indicates the
who have use for it. Tacit knowledge is knowledge is possible, but the actual
characterized by limited or proprietary access. understanding of how it might work remains
Selected individuals or organizations possess this unknown and hidden.
knowledge, but do not necessarily share it with
the wider population. As such, this knowledge is Ultimate truth is the most controversial as it
gained only through asking specific questions of assumes that some knowledge will always be
people who know, purchasing it, or by being unknown and also unavailable, even to those
exposed to a discipline or environment where the who actively seek it. The positivist purist would
knowledge is used. An example of tacit medical claim that all knowledge is subject to discovery
technology knowledge is the technique used by a sooner or later. Most scientists agree that even if
surgeon to suture a head wound or the type and there is no method of securing complete or
model of the machine used to perform CT scans absolute truth, increasingly accurate
on animals. Knowledge that is known and hidden approximations can describe the world and the
requires more effort to acquire and is usually way it works (AAAS, 1990). However, for the
specialized in nature. purposes of this model, one could also argue that
there will be some scientific or technical
knowledge that will always remain unknown and
unavailable.

Why is Knowing about Medical

Technology Important?
Courtesy Poudre Valley Hospital

Knowledge of medical technology is important

for several reasons. First, the field of medical
technology is expanding. There continues to be
an increasing demand for technical skills and
people who have a basic level of medical
technology understanding. The demographics of
the population in the United States indicate that
the opportunities for jobs in health care will
Cardio-catheterization x-ray equipment allows
expand (BLS, 2004). Many of these
physicians to see inside the coronary arteries of
opportunities will require a fundamental
the heart.
knowledge of medical technology. Second, more
and more people interact and deal with medical
The last two types of knowledge, undiscovered
technology on a personal level then ever before.
and ultimate truth, are not as useful for a
Knowledge about the field of medicine and
discussion about medical technology, but they
where to get valid information are becoming
are of theoretical interest. Undiscovered
more important. People who may be caring for
knowledge is knowledge that exists, but it has
older family members in the future should be
not yet been uncovered. For example, in the field
familiar with information on the aging process or
of medical technology, scientists know how
the medical services and devices available for
molecules are arranged and how they interact to
seniors. Individuals may also encounter
create materials and compounds. Yet, the
situations in their own lives where knowledge of
scientists have not yet discovered the technology
medical technology is helpful as they seek

25
diagnosis for illness or become interested in circulatory, respiratory, endocrine, or digestive.
alternative treatments. In addition, successful The processes are made possible through the use
diagnosis, treatment, and doctor-patient of various energy forms; forms normally
relationships are built upon the ability of both associated with the study of physics, such as
parties to communicate clearly with language mechanical, electrical, magnetic, or thermal.
that describes what is happening and what is Therefore, medical technology procedures are
likely to occur in the future. Thus, medical both common and unique, use energy forms
technology knowledge is of great importance to applied to human body systems, and are
the health and economic well-being of society. generally diagnostic or therapeutic.

Common Procedures
The common procedures used in medical
technology are those used frequently and across
the medical spectrum of diagnosis and treatment.
They are procedures commonly applied by
physicians and medical personnel with the
general population and are well-known by both
budgetstockphoto.com

practitioners and patients. Some of the common

procedures used in medical technology are the
following:

• Surgical procedures such as separating or

joining parts of the body, excision of
tumors or disease through invasive
Procedures methods or lasers, repair or replacement
Procedural technologies can also be thought of as of bones and common joints, wisdom
processes. In manufacturing, there are certain teeth extraction, and arthroscopic or
processes that are used throughout industry for laparoscopic surgery.
different products and different applications.
Processes such as forming, casting, molding, • Rehabilitative/Preventive procedures
conditioning, joining, separating, finishing, and such as sanitation of instruments and
assembly are universally acknowledged within
the field of manufacturing as standards for
production operations. However, some
operations are unique to the product or
application. Medical technology, like other
disciplines, uses common and unique processes.
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In the practice of medicine, there is a cyclic

relationship between diagnostics and
therapeutics. The process begins with a
diagnostic measurement followed by therapies or
treatment. The process then returns to
diagnostics to assess the effectiveness of the
treatment. One of the unique characteristics of
Bio-hazard waste containers decrease the
medical technology processes is that they are
transmission of disease.
generally applied to human body systems such as
26
 operating rooms; resuscitation, traction, common to the specialists, but the procedural
personal protective equipment and knowledge itself is not widespread among the
clothing worn by physicians, nurses and medical technology community. A few examples
technicians; bio-hazardous waste of the many unique medical technology
disposal; teeth cleaning and cavity repair; procedures are outlined below.
physical exercise therapies, and
psychiatric or psychological therapies. • Alternative therapies are medical
procedures outside what is traditionally
taught in urbanized Western medical
schools or covered by medical insurance.
They include, but are not limited to folk
medicine, herbal medicine, diet

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programs, homeopathy, faith healing,
new-age healing, chiropractic,
acupuncture, naturopathy, massage, and
music therapy.

• Radiology is medical imaging techniques

using advanced computers and other
complex equipment to allow doctors to
Automated equipment counts the number of see inside a patient's body such as x-ray
white blood cells from samples. or CT scans. Although the word
radiology implies radiation, not all of the
• Laboratory procedures such as specimen techniques actually use radiation.
analysis methods, diagnostic microscope, Although radiology is most commonly
centrifuge, urinalysis, or blood work used for diagnosis, it is also used for
practices. treatment. Most of the actual imaging is
carried out by highly trained
• Information and Communication technologists. The images are then
procedures such as the application of analyzed by specially trained doctors
medical software and artificial called radiologists.
intelligence systems; use of telemedicine
for diagnostic and therapeutic treatment, • Anesthesiology is the medical specialty
statistical analysis of medical data; and concerned with the administration of
use of monitors, pagers, cell phones, or
Human Performance Clinical/Research

video.
Courtesy Colorado State University

Unique Procedures
The unique procedures used are generally
associated with medical specializations such as
alternative medicine, radiology, anesthesiology,
neurology, and ophthalmology. While they may
Laboratory

use procedures and processes that are common

within the specialization, their approaches tend
to utilize internal tacit knowledge. Information
that is shared inside the specialization may be The Graded Exercise Test (GWT)
measures heart rate.
27
 medication to aid in pain management
Devices
and sedation. An anesthesiologist also
Medical devices involve all types of physical
monitors vital signs, heart rates, and other
technology and forms of energy (e.g.,
life functions while a patient is
mechanical, acoustical, electrical, chemical,
undergoing surgery.
optical, thermal, etc.). The devices can be simple
(thermometer, eyeglasses) or complex (CT scans,
• Neurology is the scientific study of the
x-rays). In general, medical devices fall into two
nervous system (i.e., brain, spinal cord,
categories: (1) devices that diagnose or sense the
peripheral nerves, and muscles) and its
body and (2) devices that treat the body or are
diseases. Specialists in this area treat
used for therapeutic purposes. Diagnostic
disorders such as seizures, developmental
devices can be classified as: measurement and
delay, neuromuscular diseases, and
testing (or biometrics), monitoring, and imaging.
severe or complicated language/learning
Treatment devices can be classified as
disabilities.
restorative, preventative, and prosthetic. Other
devices are not easily classified such as enabling
• Ophthalmology is the diagnosis, devices that are used for miscellaneous purposes.
treatment, and management of eye
Some devices, such as nanotechnology (the
diseases, including prescribing corrective
science of creating highly miniaturized machines
lenses, corrective/refractive surgery, and
that work at the molecular level), could be
surgery to remove cataracts and diseased
classified under multiple categories because they
eye tissue.
can potentially be used for a variety of purposes.

Why are Medical Technology

Procedures Important?
The procedures used in medical technology are
important because procedures both come from
and contribute to the body of medical
knowledge. Procedures act as the link between
what is known and what is done. They form the

Courtesy AT&T Bell Labs

relationships and connections in medical
technology. Procedures are also the basis for
assessing the impact of medical technology on
society. Some medical procedures such as
abortion and human cloning are controversial.
Procedures reflect the area of medical
technology where decisions of appropriateness, Gears smaller than a human hair
cost, resources, and feasibility begin to be created using nanotechnology.
important indicators of acceptance or use.
Medical processes and procedures sometimes
procedures create unintended impacts in spite of Diagnostic Devices
rigorous evaluation by the FDA and medical • Diagnostic devices assist the physician or
community. Procedures are the “operating technician in the diagnosis of illness or
software” of medical technology. disease using indirect methods.
Diagnostic equipment might include the
microscope, stethoscope, blood pressure

28
 components inside the body through non-
invasive means. They might include
devices such as x-ray, magnetic
resonance imaging (MRI), computerized
tomography (CT), ultrasound, or Positron
Emission Tomography (PET) using
radioactive dyes.

Therapeutic Devices

Courtesy Poudre Valley Hospital

• Restorative devices restore critical human
functions and operations through
modification or adjustment without
replacement of the function. These
devices might include the dialysis
machine, heart-lung machine,
defibrillator, respirator, pacemaker,
Machine used to inject x-ray dye into cardiovascular assistive devices, robotics,
patients for angiography. insulin pumps, hearing aids, glasses,
braces, or wheelchairs.
device, or instruments for analyzing
blood or urine. • Preventive devices are closely related to
measurement and testing devices, but
• Measurement and Testing devices are they are more for the prevention of
also known as biometric devices because adverse consequences or the verification
they directly measure or sense the of body changes. They might include
operation of human body characteristics,
functions and components. These devices
might include electrocardiogram (ECG or
EKG), fingerprints, eye retina scanners,
and voice, hand, or facial pattern

Courtesy Poudre Valley Hospital

recognition systems. A growing field of
biometrics incorporates the measure of
human physical attributes for the purpose
of identification and authentication.

• Monitoring devices are used to monitor

and detect anomalies in human
components or functions and alert the
user of potential or immediate changes to Much of the modern medical technology
body chemistry, activity, or operation. today is automated.
They might include the devices used to
monitor the vital signs of patients during devices such as diabetes test kits, heart
surgery or in an intensive care unit (ICU). rate checkers, medicine pumps and
patches, and fetal monitors
• Imaging devices allow the physician to
view human functions, operations, or • Prosthetic devices restore human
function or capability through
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 replacement of the damaged or missing Acoustic technology allows physicians to hear
component. Prosthetics include artificial inside the body more accurately then using their
heart valves, artificial blood vessels, ears. Optics and microelectronics allow medical
functional electromechanical limbs, professionals to manipulate and move body
reconstructed skeletal joints, artificial components while never physically touching
kidneys, and implants. them. Laboratory instruments analyze the
composition and characteristics of body fluids or
Enabling/Miscellaneous devices are simple tools tissues more precisely than a specialist could
that extend or assist the physical capabilities of possibly taste or smell.
the medical professional. They might include
hand tools such as forceps, dental picks, clamps, Summary of the Conceptual Framework
or surgical knives. These Knowledge, procedures,
devices could be used for and devices interact

Courtesy Colorado State University Human Performance Clinical/Research Laboratory

diagnosis, treatment, or depending upon the context
both. of their application.
Medical technology applies
all three to satisfy various
Why are Medical needs and solve problems.
Technology Devices Knowledge of medical
Important? technology is inert until it is
Medical technology devices applied. The processes and
are important because they devices create the
are the mechanisms through environments that change
which diagnosis and the world, but they would
treatment are delivered. not be possible without
They are integral to medical medical knowledge. The
technology for delivering applications of medical
medical technology technology can be
procedures and are knowledge-intensive,
sometimes considered its procedure-intensive, or
centerpiece. Medical device-intensive.
devices are certainly one of Applications can also be
the first things individuals combinations of two or
will think of when asked to three of the above that
describe medical Patients use devices to measure leg
pull-strength after surgery for incorporate
technology. Often medical knowledge/procedures,
technology devices are rehabilitation therapy.
procedures/devices,
thought of as an extension of the human senses, devices/knowledge, or all three. Thus, the
allowing physicians and technicians to see, hear, framework of medical technology could be
touch, smell, and taste beyond their normal described as theoretical, applied, physical, and
range. Imaging technology allows doctors to see contextual.
inside the human body without opening it.

30
 Section III: Teaching About Medical Technology
What will this section cover?
Core areas for medical technology literacy
Medical technology concepts
Educational discussion, curriculum development, and classroom planning

What will this section help me understand and be able to do?

Identify the key concepts and design of a medical technology curriculum
Learn grade appropriate educational vignettes for discussion and reflection

Medical Technology Literacy

Concepts of Science and Technology body, medical technology interfaces with or is

The foundation of medical technology rests in applied to diagnose or treat specific body
science. Scientific principles, levels of inquiry, systems such as the respiratory, circulatory, or
and scientific methods form the basis for the endocrine systems. This link is important
technological world. The development of because it delineates medical technology from
ultrasound technology other types of
would have never technology.
been possible without
the scientific Even though medical
knowledge of technology is strongly
acoustics. Magnetic linked to human
resonance imaging application, it is more
would not have been grounded in its
possible without scientific roots. Thus,
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scientific inquiry into it has application in

magnetic and other areas. Many
electrical energy. The medical technologies
medical technologist, are already being used
armed with in the area of
knowledge created veterinary medicine.
from science, seeks to Consequently, the
create solutions to challenge for
problems of human A laboratory technician places blood samples in achieving a level of
suffering, disease, and an automated chemical analyzer. medical technology
mortality. As a result, literacy is to promote
linkages form between science, technology, and the understanding that science and technology
body systems that create the area of inquiry are inseparable and must be learned
called medical technology. simultaneously. While the application of medical
technology is specific to body systems, it
Because of the importance of the relationship remains grounded in both science and
between medical technology and the physical technology.
31
 Core Concepts of Medical Technology
The following are the desired enduring
understandings of medical technology:

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• The study of medical technology requires
the development of both science and
technological literacy.
• Medical technology applies natural
energy forms to various body systems for
the purpose of diagnostic or therapeutic
outcomes.
• Medical technology integrates knowledge Color chip standards are used to
sources, procedures or processes, and compare human blood samples
various types of devices. against known chemical compositions.
• Medical technology interacts with society
and the environment. technology. Science is typically inquiry-based
• Medical technology has both positive and whereas technology is typically application-
negative consequences. based. Science builds knowledge slowly through
• The design of medical technology is repetitive inquiry and sophisticated methods.
generally a structured process while its Technology applies scientific knowledge through
diffusion tends to be random. experiments, practice, or trial-and-error using
creative, social, and political methods. The scope
• Students must be fluent with medical
of science is infinite; the scope of technology is
technology to be able to work and live
usually well-defined and has a specific focus.
with it productively and successfully.
For example, scientists were recently able to
grow an artificial eyeball and implant it into a
tadpole. Technologists are now working on
applying that scientific knowledge to humans.

There is a strong relationship between science,

technology, and other fields. The nature of
Courtesy Poudre Valley Hospital

medical technology is contextual,

interdisciplinary, interdependent, and systems-
based. It draws upon knowledge, practices, and
applications from every field of study and has
linkages with science, mathematics, and
engineering. Alternatively, many medical
practices and devices are now being adapted for
use in other fields. For example, medical
A defibrillator administers an electric
imaging techniques are being used in wood
shock to the heart in order to
processing industries and medical biometric
re-establish normal heart rhythm.
identification systems are being used for security
Science and Technology Literacy and access.
One core area is to understand the nature of
Application of Energy Forms to Body Systems
science and technology. This includes
Medical technology typically applies energy
developing an understanding of the
forms using devices to various human body
characteristics and scope of science and
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systems. These energy forms are well
known in physics and engineering and
consist of the classifications used to
describe the physical world. These
classifications are commonly described as
acoustic, chemical, electrical, magnetic,
mechanical, nuclear, optical, and thermal
(McGhee et al., 1999). With regard to
medical technology, these energy forms are
generally used in combination for an

Courtesy Poudre Valley Hospital

application. For example, ultrasound uses
acoustic energy; magnetic resonance
imaging uses magnetic energy; positron
emission tomography (PET) combines
nuclear scanning energy with chemical
analysis; endoscopes employ optical and
electrical energy; and thermometers make
use of thermal energy (Evans, 2003).
Images that used to be viewed with photographic
Because medical technology is so closely plates or on paper copies are now available
associated with the human condition, it has instantaneously via computer software.
an inextricable link with the human body.
Medical technology applies the various procedures, and devices are contextual based on
energy forms to body systems for both their application.
diagnostic and therapeutic purposes. Some
common body systems are the circulatory, Interaction with Society and Environment
digestive, endocrine, muscular, nervous, Another core concept is to understand the
reproductive, respiratory, skeletal, and urinary relationship between technology and society.
systems. Just as an automobile mechanic needs Technology does not exist in a vacuum. It is
to know something about the application of the developed by humans, used by humans, and
vehicle in context (e.g., roads and highways), the interacts with the environment. Technology
medical technologist must also have some affects and is effected by cultural, economic,
knowledge about the body systems where the political, environmental, social, and historical
medical technology is applied. factors. For example, many grocery stores and
pharmacies now provide free access to blood
Knowledge, Processes, and Devices pressure monitoring gages
Medical technology is grounded in scientific and (sphygmomanometers) that can be used by the
technological knowledge from three sources: public for general health information in a social
educational institutions, governments, and the environment. No medical diagnosis is provided
individual and/or collective. Medical technology by these machines, only information. Yet, many
employs processes or procedures that are people use them for periodic health check-ups or
common or unique. These processes interface amusement.
with body systems in some fashion. Medical
technology consists of various types of devices, Scientists and engineers develop technology first
which also interface with body systems either as a response to satisfy perceived human needs
directly or indirectly. The knowledge, and wants. Once basic needs and wants have
been satisfied, higher levels of innovation

33
become important, not just because of increased (Blume, 1992). There were also patients who
expectations, but also because of the innate need reacted negatively to x-ray images, saying they
of human beings to create and produce. Medical revealed death, could invade personal privacy, or
technology has created new ethical and social see through clothing (Howell, 1995).
issues. New definitions of life and death are now
being debated. The cost and access to medical Every technological innovation has both positive
care are now becoming important economic and and negative consequences. While x-rays were
social decisions. found to be extremely useful for finding bone
fractures and foreign objects in the body, they
were also found to be
unhealthy for humans at
high or frequent levels of
exposure. With the rise
of hospitals, machines,
and specializations,
many people perceive
modern physicians as
“miracle workers” who
can cure or treat almost
any illness. However,
some would assert that
medical care is now less
accessible to rural
residents, more

Courtesy Poudre Valley Hospital

impersonal, and does not
promote the adoption of
healthy lifestyles that
may prevent disease.

Technologists recognize
that new innovations
create strong reactions
Medical professionals are responsible for the health and well-being of and take steps to alleviate
patients in the Surgical Neuro Intensive Care Unit (SNICU). fears and temper the
associated sense of awe.
Much of this is done through the dissemination
Consequences
of information about the technology.
Change and technology tend to produce strong
Technologists also attempt to discover or
emotional reactions in most people. One strong
mitigate the unintended consequences that may
emotion is a sense of wonder and exploration.
result from the introduction of the innovation.
When x-rays were first introduced, many
Mitigation may include changing or redesigning
fashionable socialites had x-ray pictures taken of
the innovation to better fit the culture or
their hands or feet as a sign of social status. A
assessing the trade-offs between product
second strong reaction to technology is fear.
performance and individual preferences. In some
While many were enthralled with the first x-rays,
cases, the technology may not be appropriate for
there were some physicians who maintained that
clinical examination was still more reliable

34
the application and will need to be reengineered through invention or procedure, which are then
for social consumption. developed into prototypes or models, and finally
commercialized into products or services for
Design and Diffusion sale. The diffusion of a technology has no
A core concept is the design and diffusion of coherent system or organization and is highly
medical technology. The design of technology is dependent on non-technical factors. The
generally limited by physical or economic development of a medical technology has both
constraints and the capacity of human positive and negative consequences that result in
imagination. It is also limited by purpose. either its adoption or rejection.
Technological design must be efficient and
effective because of its applied, purposeful
nature. In design, there are multiple solutions or
trade-offs that must be considered. For example,
technicians using Computer-Aided Design
(CAD) develop customized solid models of hip-
ball joint sockets from information provided
from precise CT scans. These solid models can
then be used to create patterns using rapid
prototyping technology which in turn can be

Courtesy Poudre Valley Hospital

manufactured to produce a perfectly fitting
titanium hip replacement joint.

The development and design of medical

technology uses a structured approach and is
diffused or disseminated through both formal
and informal communication channels. The
structured design of medical technology starts
with basic scientific research that is later applied An echocardiogram uses sound waves to
produce an image of the heart.

Fluency with Medical Technology

It is not enough to understand and have
knowledge of technology. Today, most people
must also have a basic level of fluency with
Courtesy Poudre Valley Hospital

technology in order to successfully interact with

each other or use basic services. People also need
to be technologically literate in order to assess
the technical products, services, the systems
available, and be able to make sound choices or
decisions about them. The nature of the
technological world will require that people be
able to manage the technology around them and
The intravascular ultrasound machine uses be able to observe, investigate, test, and analyze
acoustics and high resolution computer its effectiveness. It is highly probable that most
rendering to make pictures that accurately people will interact with or need the use of a
represent the characteristics of medical technology sometime during their
blood vessels and arteries.
35
lifespan. Knowledge of how to use a heart the capacity to heal and improve quality of life.
defibrillator or how to perform cardiopulmonary However, medical technology used
resuscitation (CPR) may be of great value. In inappropriately can be disastrous and take many
terms of economic impact, according to the lives.
Bureau of Labor Statistics (BLS, 2004), the
demand for medical professionals with technical Learning about Medical Technology
skills is among the fastest growing occupational
fields. The future of medical technology is likely The first priority of medical technology
to have a great impact on the health, wellness, education is to provide literacy in medical
and economic development of society. technology to all students. This literacy will
benefit students and society in multiple ways.
The primary reason for the development First, medical technology literacy will create a
of medical technology literacy is that the more diverse pool of graduates who are able and
management of technology should not be left in interested in pursuing professional careers in
the hands of the uninformed. People who do not medicine using medical technology. Second,
understand the potential implications, benefits, medical technology literacy will create a more
or consequences of a technology run the risk of informed consumer; a consumer who is able to
distinguish and make sound choices regarding
Courtesy Sam Castro, Univ. of Wis.-Milwaukee Research Profile Magazine

treatments and medical services for themselves

or others. Third, medical technology literacy will
improve the relationships between the
professional medical community and patients
because they will begin to communicate using
common terms and understand both the human
and technical limitations of the technology. This
will ensure that the technology will be used
appropriately rather than just using the latest
piece of equipment.

The following section is designed for educators

to use as a resource in the development of a
medical technology curriculum or the generation
of ideas for experiences and activities in the
topic. It is organized by grade levels: elementary,
middle school, and high school. Each grade level
section includes the medical technology concepts
Second graders invent their appropriate for that group and a vignette example
own math games. of how a concept might be organized for the
classroom.
misusing it. When people use technology in
inappropriate ways, bad things happen. Elementary (3rd-5th Grade)
Examples of inappropriate uses of technology The curriculum for medical technology at the
are the recent proliferation of nuclear weapons in elementary level should be organized to help
developing countries or the invasion of privacy students achieve the basic elements of verbal
using sophisticated software. Medical skills, mathematical skills, and social skills.
technology, like other forms of innovation, has Their experiences in medical technology should

36
be geared toward knowledge of the basic device professional development curriculums at teacher
technologies, psychomotor skills, and technical- preparation institutions. In-service training is
social interrelationships. This study should helpful in developing teacher confidence through
incorporate related concepts from other practice and skill development.
disciplines such as science, technology,
mathematics, and humanities. Discussion of
3rd-5th Grade Key Concepts
medical products, devices, and healthcare
systems that benefit society is appropriate. • Context: Integration of medical
Children can be engaged in the design and technology to other disciplines
fabrication of simple medical devices or develop • Relationships: The use of medical
medical procedures for common illnesses and products or systems to inform, heal or
colds. Teachers can also demonstrate the prevent disease
application of common medical devices to build • Technologies: Devices that repair or
relationships with other subjects. Medical restore body functions
technology education can be part of integrated • Applications: Application of common
thematic units that explore the relationship of health devices and practices
medical technology to humans, society or the • Social Impact: Benefits of medical
environment. It can also be taught as part of a technology
health and wellness curriculum with a designated • Processes: Construction of physical
time slot. models
• Learning Approach: Active learning with
The materials and resources required for common medical devices (stethoscope,
elementary medical technology education are microscope, sphygmomanometer,
minimal and can include student or teacher thermometer)
prepared items along with basic supplies. In • Supplementary: The role of medical
addition, simple medical devices such as a technology in healing
thermometer, stethoscope or
sphygmomanometer (blood
pressure gauge) can be used to
reinforce basic skill development
using active learning. Engaging
the learners with common
household objects designed to
inform, prevent, or heal injuries
and prevent disease are helpful in
establishing a context for medical
technology.
Courtesy Poudre Valley Hospital

Medical technology can be taught

in a regular classroom by any
qualified elementary teacher.
Specific pre-service teacher
training is not required at this
level, but it could be incorporated
into technology education
A nurse performs an electrocardiogram on an infant.

37
 3rd-5th Vignette

This example describes a method for developing an activity that illustrates how devices can repair or
restore body functions. This example highlights a conceptual element of medical technology for grades 3-
5 and is congruent with the International Technology Education Association (ITEA) Standards for
Technological Literacy, Standard 14E, and the American Association for the Advancement of Science
(AAAS) Benchmarks for Science Literacy, Benchmark 8F.

Mr. D’s fourth grade class was studying about health, wellness, and some of the tools used to promote healthy
living. During this unit of study, the class talked about the technological advances in health care. One of the girls in
the class is physically challenged and uses the aid of a wheelchair. She mentioned that the advances in technology
made her new chair lighter, and easier to move around the room. Taking advantage of this opportunity, Mr. D asked
the students to think of other devices that repair, replace, or provide mobility for people with disabilities.

The students made a list of all the devices they could think of. The list included devices such as crutches, battery-
operated wheelchairs, pacemakers, and artificial limbs such as hands, arms, and legs. Mr. D told the class that
artificial limb replacements are called prostheses and the process of making artificial limbs is known as prosthetics.
Mr. D asked the class to think about the technology required to design and develop a prosthetic device for the loss
of a hand. The students were then instructed to draw sketches or diagrams of prosthetic hands. The students
shared and explained their drawings with the class.

The next day, Mr. D brought in some chopsticks and located various common items around the classroom. The
objects Mr. D selected were a portable radio, a book, a pencil, the classroom TV, and a student’s shoe. He asked
each student to operate each object using only the chopsticks (i.e., turn on the radio, turn the book pages, or tie the
shoe). The class then discussed the difficulty of performing these simple tasks with the chopsticks. Mr. D then
asked the class how a prosthetic device might work under those conditions.

The students were then divided into smaller groups and asked to answer the following questions:
• How could a prosthetic device be connected to a person?
• What problems might occur in using a prosthetic device?
• How would a prosthetic arm be different from a prosthetic hand?
• What are the ways prosthetic devices have influenced society?

As a follow-up, Mr. D asked a local manufacturer of prosthetics to speak to the class and show several different
types of prostheses. Some of the students went on the Internet and found a web site about the history of
prosthetics.

Example modified from NASA Explores http://www.nasaexplores.com/index.php

38
 Internet, and field trips to hospitals or clinics
Middle School (6th – 8th Grade) could also be utilized.
The curriculum for medical technology at the
middle school level should be organized to Medical technology at this grade level can be
provide activity-based learning situations that taught by interdisciplinary teams that include a
help students explore and science,
develop a broader mathematics,
perspective. Medical or technology

Courtesy Sam Castro, Univ. of Wis.-Milwaukee

technology experiences teacher.
can assist students in Specific pre-
learning about the service teacher
devices, processes, and training in
knowledge sources. At medical

Research Profile Magazine

this grade level, further technology
development about the should be part
nature and evolution of of a technology
medical technology will education
assist students in curriculum and
deepening their in-service
understanding of Eighth grade students investigate the effect of training should
scientific and energy from the sun being absorbed on the earth’s be required.
technological concepts, various surfaces.
principles, and contexts.
Students can begin to apply problem solving
strategies, design concepts, and apply systems
thinking to assess the impact and consequences 6th-8th Grade Key Concepts
of medical technology. Students should also be • Context: Relationships to other fields of
given the opportunity to see the relationship of study
medical technology to other fields of study. • Relationships: Sanitation and prevention of
Sanitation, disease prevention, and medical disease
technology advances with applications are all • Technologies: Advances and innovations in
appropriate topics. Middle school students can medical technology devices
design and engage in innovation activities related • Applications: Applications of medical
to medical products, systems, or procedures. technology devices and procedures
They can learn to apply engineering, computer, • Social Impact: Assessment of impact and
and industrial design principles to medical consequences (e.g., ethical and social
technology. In addition, they can begin to form concerns)
interests, discover talents, and develop skills • Processes: Development of physical and
related to medical technology. conceptual models about medical
technology
The materials and resources required would • Learning Approach: Experiential and active
include the basic equipment used in a science or learning through exercises, guest speakers,
technology lab, but it might also include and field trips
conceptual models that could be developed on • Supplementary: Genetic engineering
paper or computers. Medical professionals, the processes

39
 6th-8th Vignette

This example presents an approach for developing an exercise in developing sanitation procedures for the
prevention of disease. This example highlights a conceptual element of medical technology for grades 6-8
and is congruent with the International Technology Education Association (ITEA) Standards for
Technological Literacy, Standard 14E, and the American Association for the Advancement of Science
(AAAS) Benchmarks for Science Literacy, Benchmark 8F.

Students in Ms. G’s seventh grade science class were reading about the great influenza epidemic of 1918. Ms. G
asked the students to think of the last time that many students were out sick with colds or the flu. She began a
class discussion about epidemics and public health by asking students to compare the health conditions at the turn
of the 20th century with modern conditions in the 21st century. The students made a list of the similarities and the
differences. They listed items such as access to medicine, ventilation, diet, and sanitation. “How,” Ms. G asked, “do
each of these factors contribute to the spread of illness?”

Next, the students were instructed to identify some of the technological improvements for the prevention and
treatment of flu epidemics. The students brainstormed improvements identifying flu shots, new medicines, and
healthy practices such as hand washing or the use of tissues. Ms. G asked the students to think about the factors
at their school that caused colds and flu to spread quickly: crowded classrooms, shared lunchrooms, and winter
conditions. Ms. G then instructed the students to list the preventive measures they would recommend to stop colds
or flu from spreading. She reminded them that any public health measure would need to be considered carefully so
as not to disrupt daily life or violate people's civil liberties.

Based on their list of recommendations, Ms. G assigned students to prepare informational posters on preventive
measures and the various sanitation procedures. These posters were geared toward students, teachers, and
administrators for the prevention of colds and flu. Ms. G was fortunate in that the timing of this lesson was just
before flu season. Both the principal and school nurse suggested hanging the posters in various locations around
the school to remind everyone about healthy and sanitary habits. As a result, the school had its best attendance
record ever during the flu season.

Example modified from PBS Teacher Source http://www.pbs.org/teachersource/

40
 The materials and resources required
include the equipment used in science
and technology labs for the
development of physical models
along with higher levels of

Courtesy Argonne National Laboratory

computerized conceptual models.
Medical professionals, the Internet,
medical textbooks, journal articles,
and field trips are also recommended
as resources.

Medical technology at grades 9-12

can be taught by interdisciplinary
teams as part of a science, math,
Students watching a demonstration of engineering, and technology
high temperature superconductivity. curriculum. It can also be taught by
specialized licensed science or technology
High School (9th – 12th Grade) education teachers. Specific pre-service teacher
The curriculum for medical technology at the training in medical technology should be
high school level should be organized to develop included as part of a technology and science
a richer and deeper understanding of the field education curriculum and in-service training
and its relevance to career opportunities. The should be required and periodically recertified.
integration of, and contrasts between medical
technology and other disciplines is appropriate at
this grade level, especially where there is direct 9th-12th Grade Key Concepts
application. Extended laboratory exercises, • Context: Relevance to career
hands-on experiences, and the application of development
scientific principles to medical technology issues • Relationships: Medical technology versus
are recommended. Students can also apply biomedical technology
scientific principles, problem solving, and • Technologies: Telemedicine/hospital
engineering methods in the solution of medical information and communications systems
technology problems. Students could begin to • Applications: Application of scientific
explore the capabilities, uses, and consequences principles, problem-solving and analysis
of medical technology in detail while employing to medical technology issues
resources to analyze the behavior of technology • Social Impact: Analysis of medical
systems. Contrasts between medical technology technologies capabilities, uses, and
and biomedical technology can be helpful as well consequences
as discussions on specific medical technologies • Processes: Design, production, and use of
such as telemedicine and hospital medical technology
communication systems. The goal is for every • Learning Approach: Hands-on
student to graduate with a solid foundation in experimental and laboratory learning
medical technology so they make informed • Supplementary: Alternative and
choices regarding healthy lifestyles, participate preventive medical techniques
in the debates regarding medical technology or
can pursue a career in a technical field.

41
 9th-12th Vignette

This example develops a strategy for discussion and design of telemedicine and hospital
information/communications systems. This example highlights a conceptual element of medical
technology for grades 9-12 and is congruent with the International Technology Education Association
(ITEA) Standards for Technological Literacy, Standard 14E, and the American Association for the
Advancement of Science (AAAS) Benchmarks for Science Literacy, Benchmark 8F.

Two high school instructors decided to team teach a module on telemedicine to their 12th grade computer science
and technology class. First, they asked students for their definition of telemedicine. After a brief discussion, the
class agreed that telemedicine is a method that integrates telecommunications, computers, and medical
technologies for the purpose of delivering health care.

The instructors then presented the class with a scenario. With the aging population, there is an increasing need for
home health care. Elderly patients could avoid routine trips to the hospital or doctor by sending pictures, video or
vital sign measures. The instructors then divided the students into teams and gave them the assignment to develop
a telemedicine system for the home. A constraint was that the system had to be small enough to fit in a single room
in a house. As part of the design, students were asked to develop the following:
• A list of items that a doctor might want to see or measure to determine a patient’s health or the extent of an
injury.
• A description of the components and equipment required for a personal telemedicine system.
• A conceptual diagram or sketch of the personal telemedicine system, including hardware and information flows
at both the patient’s home and the hospital or clinic.

Upon completion, the student teams presented their telemedicine designs to the rest of the class. Each team
explained the operation of their system, gave an estimated cost, and answered questions regarding use and
effectiveness. Students then engaged in a general discussion about the advantages and disadvantages of
telemedicine. The instructors raised additional questions for group discussion and research. Some of the additional
issues were:
• The willingness of patients to use telemedicine instead of traveling to a clinic or hospital
• The use of telemedicine as a replacement for trips to the doctor or hospital.
• Should personal telemedicine system should be limited to homes? If not, how could it be used in school or
business?

Some of the students did additional research on telemedicine and used the material for their final class project and
paper.

Example modified from NASA Explores http://www.nasaexplores.com/index.php

42
Summary conceptual educational
The concepts presented on the standard while the other
previous pages assist students columns describe how the
in developing an appreciation standard might be taught for
for the nature of medical that grade.
technology. The context of
medical technology provides a Conclusion
rational framework for study The content and context of
while the relationships define medical technology in

Courtesy of GTEC
the interdependency of education is a growing field of
medical technology within study. Yet, there are many
each context. Medical who remain unaware and
technology consists of ideas uninformed about it. A recent
from many different Information technology, International Technology
disciplines that are applied to computing power, and greater Education Association/Gallup
specific issues. These levels of magnification now allow Poll survey (Dugger & Rose,
technologies, usually in the medical scientists and 2002) asked over 1000 people
form of devices or technicians to see the detail of about their attitude toward
applications, are improved human cellular structures. technology. The results of the
and change over time survey indicated that many
depending on the needs and wants of society. Americans view technology
narrowly; they think primarily of computers and
Science, technology, and society have a the Internet, rather than the ability of people to
reciprocal relationship. Science affects modify the natural world. While computers and
technology and technology impacts society. the Internet are important parts of technology,
Society, in turn, affects the development of both they are not fully descriptive of the breadth of
science and technology. Technology consists of technological development. Technology is the
processes used to advance the scientific pursuit practical application of scientific knowledge to
of knowledge. If knowledge and science is the in a particular area. Medical technology is the
driver of technology, then technological modification of the world through medical
processes are the catalyst for social change. devices, procedures, and knowledge.

Each student learns and uses knowledge using In the ever-changing world of technology, the
different approaches. Certain approaches may be development of scientific and technological
more appropriate at certain stages of literacy will assure that everyone can participate,
development. Infants develop a keen sense of live, and work productively to the full extent
touch, growing into children who draw pictures, possible. The alternative is a regression back to
then into adolescents who accumulate language fear, suspicion, and mistrust. The development
and mathematics skills. Thus, the learning of an economically viable health care system
approaches for the study of medical technology depends on the improvement of medical
should be developmentally appropriate. In technology. Citizens who are literate in medical
addition, supplementary information may be technology understand the limitations and
helpful in establishing a framework for learning possibilities of healthcare systems. Patients who
medical technology. Table 1 summarizes these understand the potential risks and rewards of a
grade specific concepts within a matrix model. technology-based medical system are less likely
The first column of the matrix describes the to misuse it and are more likely to participate in
making sound choices about it.
43
Table 1. Grade Level Key Concept Matrix
Grade Level 3-5 6-8 9-12
Key Concepts
Integration to other disciplines-e.g., Relationships to other fields of Relevance to career development-e.g.,
Context math, science, social studies study-e.g., engineering, doctors, nurses, medical technicians,
computers, design service, repair, administration
The use of medical products or Sanitation and prevention of Medical technology versus biomedical
systems to inform, heal or prevent disease-e.g., vignette technology-e.g., x-ray vs. vaccines
Relationships
disease-e.g., prevention of disease,
body temperature
Devices that repair or restore body Advances and innovations in Telemedicine/hospital information and
Technologies functions-e.g., vignette medical technology devices-e.g., communications systems-e.g., vignette
artificial hearts, hips, knees
Application of common health Applications of medical Application of scientific principles,
devices and practices-e.g., technology devices and problem-solving and analysis to medical
Applications
toothbrushes, eyeglasses procedures-e.g., blood pressure technology issues-e.g., hip replacement
gauge in grocery store CAD
Benefits of medical technology-e.g., Assessment of consequences, Analysis of capabilities, uses, and
Social Impact restoration of functions for people ethics, and social concerns-e.g., consequences-e.g., medical decisions,
with disabilities Karen Ann Quinlan trade-offs
Construction of physical models-e.g., Development of physical and Design, production, and use of medical
Processes stethoscope, microscope conceptual models-e.g., technology-e.g., cardiopulmonary
diffusion process resuscitation (CPR)
Active learning with common medical Experiential and active learning Hands-on experimental and laboratory
Learning devices-e.g., thermometer, through exercises, guest learning-e.g., Internet research,
Approach sphygmomanometer speakers, and field trips-e.g., cooperative education
hospitals, device manufacturers
The role of medical technology in Genetic engineering processes- Alternative and preventive medical
Supplementary
healing-e.g., casts, splints, bandages e.g., cell counts, lab procedures techniques-e.g., acupuncture

44
 exercises, guest speakers, or field trips. Finally,
Next Steps pilot test the course material, involve others in
The following is a suggested approach for evaluating the content, and make adjustments
teachers who are interested in incorporating the based on the both student assessments and
study of medical technology into their school teacher evaluations. Table 2 summarizes the
program. First, in conjunction with state and suggested steps for developing a medical
district standards, pick the appropriate core technology curriculum.
concepts you want the students to master from
your class or project. For example, one of the Table 2.
core concepts is that the study of medical Developing a Medical Technology Curriculum
technology requires the development of both Step Activity
science and technological literacy. Second, 1 Select the appropriate medical technology
extract and organize the content taking into core concepts
consideration the specific understandings
required, prior knowledge, and connections to 2 Extract and organize content
other required material. At this point, you may 3 Define assessment criteria
discover that you do not possess the required
level of expertise in the content area so you will 4 Pick key concepts for the grade level and
need to develop strategies for accumulating this develop curriculum, units, and lesson
knowledge through others or through personal plans
research. Third, when you are comfortable with 5 Pilot course material, evaluate, and adjust
the content, you can begin to define the
assessment criteria using matrices, rubrics, or
other means. These assessment criteria are
developed to provide the
basis for capturing the
essential ingredients of the
content to be measured and
indicate a student’s level of
medical technology literacy.
Fourth, pick the key concept
areas for the grade level that
would best support the core
concepts you have previously
selected. For example, a Courtesy Harmony Imaging Center
middle school teacher may
decide that the best way to
develop both scientific and
technological literacy is to
demonstrate the application
of a few medical technology
devices and procedures. After
selecting the key concepts,
develop your plan for the
curriculum, the units Medical technology requires knowledgeable professionals
required, and the daily that can understand and operate complex
lessons, which might include equipment using precise procedures.

45
A Vision for the Future
The field of medical technology will need This vision must be shared by those who have a
professionals who have the appropriate stake in the future of engineering, technology,
knowledge and expertise about diagnosis, and science education. This is not just teachers,
treatment, and alternative methods. Local, state, but administrators, parents, medical
and federal government decision makers will professionals, and the general public. This
need to be informed about the applications and document represents the beginning of an effort to
benefits of medical technologies so appropriate expand and disseminate information that is
controls and regulations can be developed. becoming essential for student educational
Educational leaders will need to understand the development. A greater understanding of
impact of medical technology on society and medical technology and the education of medical
how society perceives technology so that technology must become a valued subject at
learning institutions and students can realize every level.
their full potential.

Courtesy Poudre Valley Hospital

Cardiac stress tests assess heart performance

prior to rehabilitative exercise therapy.

46
Section IV. Taxonomy, Framework and Context for the Study of Medical Technology
What will this section cover?
The development of a taxonomy for medical technology
Using the medical taxonomy
Integrating the taxonomy into the curriculum

What will this section help me understand and be able to do?

How the medical technology knowledge-base for science and technology were organized
Link the medical technology taxonomy to other technologies, i.e. energy forms
Integrate problem-solving and decision-making into a medical technology context

Taxonomy Framework and Context

Introduction

Health and education are vital issues for individuals and society, and relationships between health

and education were recognized long before Congress created the Department of Health, Education and

Welfare in 1953. Since that time, governmental agency names and responsibilities have changed, but the

need for improved health care and education has only become greater. Many of the critical issues in both

health care and education relate to access and knowledge (Altekruse & Rosser, 1992). The more

individuals know about managing and taking responsibility for their own wellbeing and education, the

greater their access to better health care and increased knowledge.

The access imperatives in health care and education coincide with a national trend toward an

increased reliance upon technology. The International Technology Education Association (ITEA)

addressed this issue in the Standards for Technological Literacy: Content for the Study of Technology

(2000). This standards document asserts: “…technology is evolving at an extraordinary rate, with new

technologies being created and existing technologies being improved and extended” (p. 2). Further, ITEA

stated: “In a democratic society such as ours, individual citizens need to be able to make responsible,

informed decisions about the development and use of… technologies” (p. 57). The expanding scope of

47
technologies and ITEA’s commitment to preparing students for life in a technological world led to the

inclusion of a medical technology standard and benchmarks for learning.

The purposes of this paper are to describe how the content for medical technology was defined and

organized into a taxonomy and to propose a decision model that students and teachers can use to assist

them in making responsible and informed decisions about technology. The rapid changes in technology,

pointed out by ITEA, can affect not only the decisions we make about technology, but also the way we

think, the way we feel, and how we live our lives. It is important that we do not allow technology to shape

our decisions and our lives, but that we apply our knowledge and understanding to the questions of how

we will relate to technology. When we allow technology to shape our decisions, we relinquish our

responsibility for making decisions. The ITEA standards document calls upon us all to make responsible

and informed decisions.

Within the context of medical technology it is unrealistic to think that we can teach students today

everything they will need to know tomorrow. If we teach students how to make informed and responsible

decisions related to technology, when they are confronted with questions we have not anticipated, they

will be prepared to resolve dilemmas and choose an appropriate course of action.

Medical Technology Standard

Standard 14 – “Students will develop an understanding of and be able to select and use medical

technologies” (ITEA, 2000, p. 141).

Standard 14 in the Standards for Technological Literacy: Content for the Study of Technology

(2000) proposes a new curricular context for technology studies in K-12 education. A project to define the

content for this standard was undertaken by Zuga and Lewis, who proposed and received a National

Science Foundation grant to support the present research. One of the objectives delineated in the grant

48
was to use “…the new standards as the primary catalyst to create …professional development materials

that would support the in-service needs of technology teachers” (Zuga & Lewis, 2001, p. 5). To address

this objective, a taxonomy of medical technology content and a decision model have been created. The

decision model is embedded within the medical technology curriculum report, so the two can be used

together to enhance the study of medical technologies in K-12 education.

Standard 14 of the ITEA Standards for Technological Literacy inspired the decision model which

is a part of the Technology Teacher In-Service Education (TTSE) project. The scope of the standard is

quite broad and must be considered within the context of K-12 education. There are numerous medical

technologies that only the most sophisticated experts understand and can use. Further, technologies are

changing rapidly and the content of the field will be different tomorrow from what it is today. Hence, our

job is to find a way to organize and present the field of medical technology in such a way that enables

students to investigate the content and concepts and encourages teachers to facilitate that exploration.

Recognizing that we are limited in the quantity of content that can be included in the K-12

environment sets a boundary in one dimension. However, ITEA’s further statement, “Individual citizens

need to be able to make responsible, informed decisions about the development and use

of…technologies” (p. 57), charges us to accept the greater challenge of addressing ethical issues and

cultural values extending beyond the boundaries of content and context.

Technological Changes

Technology can shape the way we think, the way we feel, and the way we make decisions. Ursula

Franklin wrote in her 1993 call for standards, “…recent advances in science and technology have

increased the machinery of dominance and oppression” (p. 733). She identified significant ways that

technology is threatening human rights, and we cannot ignore that our teaching about technology must

include an examination of the implications of technology as well as its practice.

49
 Franklin points out that technology can be particularly dangerous because while it maintains

control, it also becomes invisible as we become accustomed to it. Surveillance technologies provide

examples where fear and concern motivate us to welcome the protection and acquiesce to the invisible

control. Supermarket savings cards might seem particularly benign. They allow us to save money when

shopping on a daily basis and sometimes offer rewards for continued patronage. However, in exchange

for the savings, we give away the privacy of our shopping habits. Can we be sure, for example, that a

pattern of unhealthy food choices is not being shared with insurance companies which might monitor risk

factors for health issues? Surveillance cameras in schools ostensibly provide protection from violence, but

can also invade the privacy of students and teachers. We can confine the content of medical technology

within boundaries for the purpose of defining context and setting rules for inclusion and exclusion; but we

cannot and should not expect those boundaries to protect our human rights.

According to Neil Postman (1998), a critic of technology and chairman of the department of

culture and communications at New York University, “…all technological change is a trade-off.” He

points out there are always consequences to technological developments; as something is given,

something else is taken away. In reference to medical technology specifically, he says: “Medical

technology brings wondrous cures, but is, at the same time, a demonstrable cause of certain diseases and

disabilities, and has played a significant role in reducing the diagnostic skills of physicians” (1998, p. 2).

Rebecca Dresser (AWISCO, 2002), professor of law and ethics in medicine at Washington

University in St. Louis, has written about ethics, science and medicine. Her comments about the need to

“…strike a balance between improving medical procedures while managing the risks of experimental

interventions” relate to ethical issues that confront us when we consider the intersection of medical

technology and responsible and informed decisions. Dresser noted, “It seems that every step we take

50
forward in science is also a step into the land of unexplained questions.” The threats to human rights

mentioned by Franklin are among these unexplained questions described by Dresser.

Dr. Ruth Hubbard, emerita professor of biology at Harvard, echoes the same concerns in her book,

Profitable Promises. In writing about refined procedures for DNA testing, Hubbard stated: “I no longer

need to demonstrate symptoms. If I have the DNA marker, I will be diagnosed as sick with the associated

condition: invisible genes become one with visible traits” (Hubbard, 1995, p. 73). The implications of

genetic testing are complex and further demonstrate Franklin’s thesis, “Recent advances in science and

technology have increased the machinery of dominance and oppression” (Franklin, 1993, p. 733).

These writers exhort us to consider the implications of technology. Whether we call the effects of

technological procedures and practices side effects, secondary effects, or unintended effects, they are

effects all the same. With so many issues to consider, and faced with new decisions about technology

each day, the understandings students develop today about making informed and responsible decisions in

the context of technology will be called upon to inform their choices as they confront the issues and

questions of tomorrow.

The issues, concerns, and warnings discussed by Franklin, Postman, Hubbard, and others were

considered by those working on the TTSE project. This report considers those concerns in relationship to

Standard 14 and the K-12 curriculum. This paper represents my work on the project, which has

progressed through three phases; investigation of language, conceptualization of a taxonomy for medical

technology, and development of a decision model. Throughout these phases, I have focused specifically

on the context of medical technology.

Importance of Language in Medical Technology

The term medical technology connotes a broad range of human-made machines, techniques, and

procedures, all related to the practice of medicine and its allied disciplines. Indeed, the Appendix (ITEA,

51
2000, p. 213) to the standards document suggests a broad range of benchmark topics for inclusion, based

on student grade levels. Some of those topics, such as vaccines, medicines, and immunology are directly

related to Standard 14 and have been included in this organizational structure. Other benchmark topics

appear to be more naturally related to content from other standards. For example, use of systems to inform

is conceptually related to Standard 17, Information and Communication Technologies, and genetic

engineering, shares both tools and techniques with Standard 15, Agriculture and Related Biotechnologies.

It might also be accurate to state that medical technology is an allied health profession that is

practiced in laboratories and supports the operation of hospitals and medical facilities. However, this

definition would exclude extra-institutional procedures, such as home testing of blood sugar, an

increasingly common practice of persons with diabetes who have received specialized training allowing

them to participate in their medical care (Blair, 2001).

Taken in the context of Standard 14, medical technology denotes the human-designed procedures

and techniques carried out by individuals in maintaining, promoting, and restoring wellness. It is

important to note that human bodies respond automatically in certain situations, thereby maintaining,

promoting and restoring wellness. Examples of this would be the normal digestive process, or the

naturally occurring formation of antibodies to fight infection. These processes are intentionally excluded

from the definition of medical technology because men and women working to maintain, promote, or

restore wellness of others did not design them.

The language of medical technology includes the terms we use to name artifacts, materials, and

activities, the ways we communicate about procedures and processes, and the contexts for thinking about

social meaning and practice (Ehn, 1989). Language facilitates meaning making and conveys values and

beliefs; however, it is also dependent on context for meaning (Gergen, 1995). As a result, not only

medical terms were of interest in this project, but also the contexts of the terms for the way in which they

52
transmit meanings.

Papert’s constuctionism suggests that constructivism understates the role of language in learning.

In his writing about the use of technology as a tool in learning environments, Papert extended the

constructivists’ adage, “you learn better by doing,” adding his own message, “[You learn better by doing],

and best of all by thinking and talking about what you do” (1991, p. 42). Based on this reasoning, students

will learn best about medical technology when they are given the opportunity to construct meanings based

on their personal experiences and to interact and communicate with others about those understandings.

Investigations begin with students selecting technologies to investigate that are within the context of their

interest. Teachers guide students through discovery, and understanding develops as students think and talk

about what they do.

This taxonomy for medical technology and the accompanying context evolved from the study

of the language from the medical field. In essence, the terms were the data for the conceptualization of

the taxonomy, the second phase of my involvement in this project. The taxonomy was designed to

anticipate growth in the field. As new terminology emerges, students will be able to organize the

concepts within the framework. Kyphoplasty is an example. It is a relatively new procedure that we

did not find in our search for terms in September 2002. However, interventional radiologists are

refining the techniques for this minimally invasive procedure, and as patients receive the benefits of

this treatment for spinal injuries, students will be able to find the natural place for the term in the

taxonomy. (MedicineNet.com (2004) defines Kyphoplasty as a therapeutic technology using inflatable

balloons to reposition a crushed spinal column.)

Designing Taxonomies

Taxonomies are systems for organizing and classifying information according to similarities,

differences, and attributes (McCarthy, 1995; Montague Institute Review, 2001). The purpose of this

53
medical technology taxonomy is to situate the field of study within the broader context of technology

education and to provide a structure of hierarchical relationships for decision making. “A good taxonomy

helps decision makers see all the perspectives, ‘drill down’ to get details from each, and explore lateral

relationships among them” (Montague Institute Review, 2001).

In this medical technology taxonomy, the basic units for organization are medical procedures and

techniques. Blood tests and sonography would be examples. Machines, and supporting processes, such as

centrifuge machines, global positioning systems, and communication pagers have not been included. The

taxonomy is organized deductively with more general concepts toward the top of the system. The top-

down approach allows the field of medical technology to be conceptualized within the context of

technology education and supports integration of technology concepts within the larger framework

presented by the ITEA standards document.

Within the field of technology education, there is historical precedent for organizing content

according to taxonomic frameworks. The Industrial Arts Curriculum Project (IACP) generated A

Rationale and Structure for Industrial Arts Subject Matter (Towers, Lux, & Ray, 1966) which included

taxonomies for industrial technology and construction technology. The IACP arranged terms related to

management, production, and materials in industrial and construction technologies according to their

functional meanings. For example, in industrial production technology, processing was broken down into

the more specific categories: separating, combining, and forming (Towers et al., 1966).

A 1984 report funded by the Technical Foundation of America, Industry and Technology

Education: A Guide for Developing Contemporary Industrial Arts/Technology Education Curricula

provides another example of a taxonomic framework. That report’s, Appendix C (Wright & Sterry, 1984)

organized 242 terms according to their functional definitions. In Wright and Sterry’s example,

54
construction production processes were divided into the following categories: preparing the site; building

the structure; installing utility systems; enclosing the structure; etc. (p. 225).

Paul DeVore (1980) discussed taxonomic analysis related to technological systems in Technology:

An Introduction. He wrote: “Taxonomic analysis is another way to classify the component elements of a

system. A taxonomy orders elements according to a central theme, a hierarchy, and relationships” (p.

246). DeVore further stated that subsystems could be arranged on the basis of function, activity or

problem category. The example he provided was for a taxonomy analyzing a transportation technology

system.

While Towers et al. (1966) and Wright and Sterry (1984) emphasized activities and functions in

their taxonomies, DeVore’s (1980) suggestion of organizing around problem categories sets forth an

approach that is especially suited to a taxonomy of medical technology for K-12 education. Students

exploring ways of solving problems in human body systems can use the taxonomic organization to work

from generalized concepts and to discriminate between procedures as they gain new understanding about

medical procedures, processes and techniques.

Taxonomic Content Levels

The proposed taxonomy of medical technology content (Figure 1), employs seven levels. Those

levels, what each represents and includes are explained in the following sections.

55
 K-12 Content Taxonomy

Nature of Technology Technology and Society Design Abilities for Technological World Designed World

Standards 1-3 Standards 4-7 Standards 8-10 Standards 11-13 Standards 14-20
Š Characteristics & Scope Š Cultural, Social, Political, Economic & Š Attributes of Design Š Apply Design Process Š Medical Technologies
Š Core Concepts Effects Š Engineering Design Š Use and Maintain Products Š Agriculture/ Bio-Related
Š Relationships & Š Environmental Effects Š Design in Problem & Systems Š Energy and Power
Connections Š Role of Society in Development and Use Solving Š Assess Impact of Products & Š Information/Communication
Š Influence on History Systems Š Transportation
Š Manufacturing
Š Construction

Sensing Technologies Therapeutic Technologies

Energy Flow Methods Energy Flow Methods

Š Acoustic Š Acoustic
Š Chemical Š Chemical
Š Electrical Š Electrical
Š Magnetic Š Magnetic
Š Mechanical Š Mechanical
Š Nuclear Š Nuclear
Š Optical Š Optical
Š Thermal Š Thermal

Body Systems Body Systems

Š Cardiovascular Š Cardiovascular
Š Digestive Š Digestive
Š Endocrine Š Endocrine
Š Excretory Š Excretory
Š Immune Š Immune
Š Integumentary Š Integumentary
Š Musculoskeletal Š Musculoskeletal
Š Nervous Š Nervous
Š Reproductive Š Reproductive
Š Respiratory Š Respiratory

Vaccines

Figure 1. Medical Technology Taxonomy

Level I – Field

This level represents the field of technology education as it has been set out by ITEA in the

standards document. The content included in the Standards for Technological Literacy (2000) comprises

that knowledge which all students are encouraged to master as they develop the abilities necessary “…to

use, manage, assess, and understand technology” (ITEA, 2003, p. 2).

Level II – Elements

The elements of technology education were conceptualized by ITEA and include the following

five categories: Students will develop an understanding of The Nature of Technology; Students will

develop an understanding of Technology and Society; Students will develop an understanding of Design;

Students will develop abilities for a Technological World; Students will develop an understanding of The

56
Designed World. Each of these elements corresponds to a chapter in the standards document (ITEA, 2000,

p. 15).

Level III – Standards

The twenty ITEA standards are organized into five categories which are listed under Elements.

Standard 14, selecting and using medical technologies, is part of the Designed World. The implication of

this placement for the taxonomy is that everything included in the lower levels is necessarily also part of

the designed world. As a consequence, a naturally occurring medical event is not included in the

taxonomy. The naturally occurring process by which wounds heal would be an example of such an event

that is not included.

Level IV – Purpose

The purposes of medical technologies are divided into two categories by determining whether they

are used for diagnosis or used for treatment of problems. The technology categories that are used as

organizers are sensing and therapeutic. The health and medicine fields also include categories such as

prevention, rehabilitation, and surgery; however these are not medical technologies according to the

definition proposed for this taxonomy. As it was defined earlier, medical technology is the human-

designed procedures and techniques carried out by individuals in maintaining, promoting, and restoring

wellness.

In the practice of medicine and in the process of maintaining, promoting and restoring wellness to

the human body, there is a cycling between evaluative and therapeutic technologies. The process begins

with measurement of human functions; health care workers make decisions about diagnoses and

therapies; treatments are followed; and finally, the process returns to measurement of function in order to

assess the improvement in functions.

57
 Writers from the field of science and engineering assert that there is an identifiable discipline

known as “Sensor Science.” The article, Sensor Science – Essentials for Instrumentation and

Measurement Technology, states: “Applying Classical Taxonomy to ordering Sensor Science is … shown

to depend upon the cardinal link between humans and machines. This provides a context for describing

the information flow interfaces between humans, machines and their universal environment” (McGhee,

Henderson, & Sydenham, 1999, p. 89). Based on this rationale, the medical technology taxonomy

includes the category of sensing technologies, as sensing also is based upon the link between humans and

machines, procedures, and techniques. The purpose of diagnostic medical technologies is to sense and

measure human functions.

All of the procedures, whether they are part of the diagnostic or treatment phases, are based upon

forms of energy. The categories, sensing and therapeutic represent the different purposes of the

procedures.

Level V – Energy Forms

Hutchinson and Karsnitz (1997), authors of the technology textbook, Design and Problem Solving,

identified energy processing as a basic element in technological systems. While we identify energy forms

as being essential to the processes in medical technology, Hutchinson and Karsnitz took a more

conservative approach, and indicated that energy was a possible input to technological systems.

In the medical technology taxonomy at the energy forms level, sensing and therapeutic

technologies are divided into categories based on energy forms. According to the McGhee et al. (1999),

classification of sensors has been an ongoing effort for more than thirty years. The eight categories, which

those authors recommended, were borrowed for this medical technology taxonomy. The eight categories

are: acoustic; chemical; electrical; magnetic; mechanical; nuclear; optical; thermal. While these eight

58
categories are shown as separate entities, in a majority of situations, multiple energy forms are used in

combination.

These categories were tested, medical procedures were examined, and after extended

investigation, medical technology procedures and techniques were found to fit within this classification

scheme. Examples of all eight follow: ultrasound procedures use acoustic energy for sensing; vaccines use

chemical energy for therapeutic purposes; MRI (magnetic resonance imaging) studies are based upon

magnetic energy that creates images of structures in the body; resistance exercise, a therapy, is powered

by mechanical and chemical energy; positron emission tomography (PET) combines nuclear scanning

with chemical analysis for measurement; endoscopes rely upon optical and electrical processes;

thermometers depend upon thermal energy when measuring body temperature.

The complexities of energy forms at this level of the taxonomy will require students to actively

research the procedures they are investigating. The energy forms involved in even common medical

procedures, such as X-rays, are actually quite complex. However, modern information technology

provides a wealth of resources. As an example in the case of X rays, The Ohio State University

Department of Extension Research has posted numerous fact sheets related to radiation on its Internet site.

X-rays are explained in “What is Ionizing Radiation” (Fentiman, Leet, & Veley, n.d.).

Level VI – Body Systems

Linking technology with the human body is the essence of medical technology, and in order to

emphasize the importance of the relationship between technology and the human body, body systems are

placed below energy forms in the taxonomic hierarchy. Health and medicine reference materials used in

researching medical technology routinely categorized the human body according to body systems

(Ettinger & Burch, 1999; Insel & Roth, 2002); however, there is not a uniform method of categorizing the

59
human body into systems (American Medical Association, 2003; Bailey, 2003; McGann, 2003; Medem,

2003; Spitzer & Whitlock, 1998).

Bailey (2003), in her article, What You Need To Know About Biology, categorizes the human body

according to organ systems differentiated by functional processes. After examining numerous

classification systems, Bailey’s method was chosen for inclusion in the taxonomy because it is logical and

readily available to students through the Internet. The systems are: circulatory, digestive, endocrine,

integumentary, muscular, nervous, reproductive, respiratory, skeletal, and urinary. As is the case with

energy forms, these organ systems may operate synchronously as well as in isolation. The human body is

an integrated system “…made up of several organ systems that work together as one unit” (Bailey, 2003,

¶ 1).

Level VII – Applications

Procedures and techniques define the scope and nature of medical technology. The example, vaccines,

shown in Figure 1 illustrates how the taxonomy can be applied. Students can begin their explorations into

medical technology with a procedure that is known to them. To illustrate, a student may demonstrate an

interest in Sickle Cell Anemia and research medical procedures related to this condition. According to the

Sickle Cell Information Center at Emory School of Medicine (2002), “A simple blood test called the

hemoglobin electrophoresis can be done by your doctor or local sickle cell foundation. This test will tell if

you are a carrier of the sickle cell trait or if you have the disease.” Further research could lead the student to

the organ systems and organs affected by the disease, the energy forms used in measuring and treating the

condition, comparisons with other types of anemia, and the decisions to be made by those who have Sickle

Cell Anemia.

Integrating the Taxonomy into the Curriculum

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 Purposeful integration of curriculum topics promotes the development of problem-solving and

decision-making skills, and also assists students in organizing their cognitive structures. Frameworks

demonstrating connections between the concepts and relationships between ideas help students network

their thinking processes and store information in their memories in an organized way. This concept was

discussed in Organization of Memory by Collins and Quillian who stated: “How information is put into

memory obviously has much to do with how it can be retrieved” (Collins & Quillian, 1972, p. 341.

Decision making and problem solving are important abilities for students to develop, and it would

be most instructional if the teaching methods were synchronized with these goals. The taxonomic

structure suggests connections and relationships within and between topics of instruction. Students can

adopt and use that scaffolding while developing unique networks within their own memories.

An example of this transfer of learning can be seen in the case of students who already have an

understanding of automotive repair methods using computers to diagnose problems. The application of

energy as a sensing technology to diagnose internal problems in automobiles can be transferred to the

field of medical technology where energy also is used in sensing technologies to extend first-hand

observations and learn about problems in human body systems that are otherwise not discernable. This

example of using sensing technologies to diagnose automobiles, from transportation technology, and

human body systems, from medical technologies, illustrates a lateral relationship between technologies.

In addition to lateral relationships in the medical technology taxonomy, seven levels are arranged

according to a hierarchy of generality, with the most general category at the top. Medical technology

enters the structure at the third level, and the lower levels, four through seven, are key to defining the

scope and nature of medical technology.

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 Using the Medical Technology Taxonomy

Kindergarten -12 students have different levels of awareness about medical procedures and will

naturally be engaged in solving different problems. The Application Level (Level VII) in the taxonomy is

intentionally designed to encourage teachers to create a stimulating environment where students at

different stages of development and interest in a diverse range of topics can explore the processes from

the entry points at which they have the most interest. An example of this would be high school students

deciding to investigate ultrasound techniques they have read about in physics classes, and grade school

children choosing to learn more basic concepts such as measuring heart rates while exercising. Both

examples demonstrate the use of acoustic energy; ultrasound uses sound waves to image structures in the

body, and stethoscopes amplify sounds of the heart and lungs.

Although the taxonomy is proposed primarily for use by teacher educators and in-service teachers,

the example of acoustic energy illustrates ways students might also benefit from working with the

taxonomy. Students and teachers will see how medical technology fits within the broader scope of

technology education, how medical technology relates to the study of energy, and how medical

technology has different applications depending on which human body system is being investigated.

Problem Solving

Problem solving effectively engages students in learning and is used frequently in primary and

secondary education. In teaching problem-solving methods, means-end analysis is a well-known heuristic

(Ashcroft, 1998). The medical technology taxonomy lends itself to applications of this method. Ashcroft

(1998, p. 402) wrote in his book, Fundamentals of Cognition, “In this approach, the problem is solved by

repeatedly determining the difference between the current state and goal or subgoal state, then finding and

applying an operator that reduces this difference.” Ashcroft’s explanation of the heuristic can be applied

to the taxonomy and students can solve problems by making decisions about goals and subgoals as they

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work through the discriminating levels in the taxonomy. As an example, if the problem of interest were

ankle pain, this condition might be diagnosed using sensing technologies, perhaps magnetic resonance

imaging, to view the patient’s musculoskeletal system and determine if a bone has been broken or tendons

have been damaged.

In Everyday Cognition (1999), Rogoff speaks to the relationship between problem solving and

context. She points out that concepts developed within a context are generalized for use in other contexts.

This point is important when we consider the many contexts for study within technology education

specifically and general education more broadly. Rogoff’s reasoning suggests that what students learn in

the context of medical technology can be applied in other problem-solving contexts or vice versa. The

student who has learned in an introductory technology class about laminating as a way to strengthen

materials in a bridge-building project should be able to generalize the concept and apply the problem-

solving procedure when she confronts the question of strengthening broken bones. Grafting procedures in

agricultural and medical contexts share theoretical elements with lamination in the context of construction

technology.

Considering how one might repair a broken bone or strengthen a bridge bed are both examples of

problem-solving exercises that could be found in the literature about technology education. Often the

terms problem solving and decision making are used interchangeably, and a distinction becomes important

as I begin to explain the third phase of my involvement in the TTSE project. Here a model for decision

making in the context of medical technology is developed. The distinction between problem solving and

decision making is explicated by Kushniruk (2001, p. 367), who analyzes complex decision-making

processes in health care. He states: “…decision making can be considered a problem-solving process in

which the solution is in the form of a decision, typically leading to action.” Applying this distinction to

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the earlier example of grafting demonstrates that repairing a broken bone is a problem-solving process,

choosing grafting as the best approach for repair is decision making, a solution leading to action.

Decision Making

Problem-solving and decision-making skills are essential to technological literacy (ITEA, 2000).

Being able to solve problems within specific contexts, leads to students’ understanding of how to make

informed decisions. It is our goal that students will learn to transfer their knowledge and skills from one

context to another and become responsible decision makers. This transfer of learning can be encouraged

through integrating concepts and subjects within a curriculum. Freeman, Field, and Dyrenfurth (2001, p.

62) described, “…a viable industrial technology strategy for employing contextual learning to build cross-

functional skills.” These authors cited the importance of students developing cross-functional skills in

order to be equipped to transfer their learning to different contexts and solve real-world problems. To this,

I would add that the success of the problem solution is only as strong as the underlying decisions.

Purposes for the Decision Model

When Gradwell (1999) juxtaposes the immensity of technology and the role of the individual, he

highlights the importance of individuals in society being equipped to make responsible decisions. He

emphasizes the role of values in decision making and cautions technology educators that in

“…emphasizing the technical aspects of industry, or the techniques of making a product, social concerns,

values or cultural influences [are] rarely included, under the consuming weight of purely technical

information” (p. 243).

Postman’s (1998) concerns noted earlier are echoed by Gradwell who states: “…each new

technology does not simply add something to its environment: it fundamentally changes everything”

(Gradwell, 1999, p. 244). Like Dresser (2002), Gradwell discusses the significance of balance in

technology among responsibilities, resources, and expression (1999, p. 251). In his diagram, (Figure 2),

64
responsibilities represent values and ethics, and contribute equally with resources and expressions in

technological decisions. He suggests that “…a particular inquiry could start from any of the three points

and progress to the others, ensuring that social relevance and ethical decisions are always a controlling

factor” (p. 251). With this model and the accompanying text, Gradwell conceptualizes a way we might

represent the integration of technologies within society and culture.

Gradwell reminds his readers that DeVore (1980) suggested that technologies be evaluated based

on societal purpose rather than primarily on efficiency. While our responsibility to consider the effects of

technology has been pointed out on occasion by other writers, the idea needs to be reiterated and brought

to the forefront for students.

Integrating Decision Making within Technology Contexts

ITEA (2000, p. 7) addressed the issue of an integrated curriculum: “As envisioned by the

standards…the study of technology is a way to apply and integrate knowledge from many other subject

areas – not just mathematics, science, and computer classes, but also the liberal and fine arts.” The

medical technology taxonomy presents opportunities for combining the study not only of science and

technology-related subjects, but also of the liberal and fine arts. The imaging techniques that are essential

to many of the sensing technologies carry over into the area of fine art, with drawing and photography as

two examples. Understanding the relationship between technology and society, the ethical responsibilities

of individuals, and the economic implications related to medical technology can be explored in social

studies classes. Bush (1983, p. 156), in her writing about the assessment of technology, proposed

important questions for consideration: “…Who is making technological decisions?, on what basis?, what

will the effects be?”

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 Decision Models

Decision models in the literature, applicable to the technology contexts range from references to

Ben Franklin’s What Do I Do? decision maker to examples in technology education textbooks to a

complicated model from the journal, Decision Science. Franklin’s method was to make a pair of lists

representing pros and cons for a dilemma. He believed that working on the lists over a period of days

helped him gain perspective on the decision, and careful evaluation of the list made him less likely to

make mistakes in deciding what to do in a given situation (Prosavac & Carey, 1989). The method has a

later iteration known as Multiple-Attribute Utility Theory (MAUT) which is used in the fields of business

and needs assessment (Altschuld & Witkin, 2000). The simplicity of Franklin’s method might make it

appropriate for use with young children.

The systems model proposed by Hutchinson and Karsnitz (1997) is not exactly a decision model;

however, the authors suggests in the text with the model that problem solutions “often take the form of

systems” (p. 5). Their model shows a feed-back loop and includes inputs, processes, and outputs as the

main elements. The inputs are listed as people, energy, capital, tools/machines, materials and information.

The systems idea for problem solving is often criticized for including people as inputs, and therefore parts

of systems (S.K. Damarin, personal communication, February 19, 2003). This criticism reflects the idea

that people use systems, whereas if people were part of systems they would be in the position of being

used themselves.

Hutchinson and Karsnitz also discuss technological dilemmas in their book and offer a “…five-

step process to analyze the ethical dilemma created by technological activity” (1997, p. 16). These authors

are to be commended for including this section and for their discussion of outputs that categorizes

combinations of desirability and expectation for various system outputs. Their treatment of important

issues avoids responsibility for decision making in suggesting that “…all systems produce wanted and

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unwanted outputs” (p. 8). Ethics appears a category for evaluation in their attribute matrix; however this

later section concentrates on design solutions and does not relate individual or societal responsibility to

the effects of technology.

Jackson, Kloeber, Ralston, and Deckro (1999) proposed a more complicated model in their article

discussing the US Department of Energy’s decision criteria for waste-site remediation. These authors

suggest that their proposed model could be used as “a generic technology selection tool that can be used

to make better informed decisions” (p. 217). Unfortunately for all of us in society, the values being

considered in decision making about waste site remediation are: capital costs, research and development

costs, time to full productivity, compatibility with other existing or innovative technologies, and risk of

successful implementation. Perhaps these elements are adequate for “better informed decisions,” but they

do not meet the ITEA standard for making responsible, informed decisions. This model and others

privilege efficiency over responsibility.

The model proposed here for decision-making within the contexts of technology and the context

of technologies reflects the significance of language, and thereby culture, and ethics. The boundaries are

fluid as they are in real-world situations, and the decision-making realms move in and out and between

contexts; however, it also allows for the way that contexts occasionally overlap and impinge on one

another. The model is iterative; constraints and resources are constantly changing while the decision

making process is repeated, mirroring the way decisions reoccur and compete within our environments.

Regardless of the number, shape or magnitude of decision contexts with which we deal, language and

ethics extend beyond the boundaries of contexts guiding the decisions we make and the ways we use

technology.

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 Figure 2. Decision Model

The decision model was developed based on research about decision making and observations of

technology education students in decision-making situations. The components for the model, constraints,

resources, context, language, and ethics emerged from a literature review. Observations of students

demonstrated how the elements interact in decision-making processes. As this model has been configured,

it is differentiated from others in that it recognizes the importance of language and ethics and the

commingling of elements in the process.

Red, green, and blue were chosen purposefully to represent the model visually. Additive color

theory explains that white light is a combination of red, green, and blue. Thus, the combining of these

three colors to render white light in the model represents the coalescing of factors in the decision-making

process.

The blue stylized arrow represents constraints on the decision making process, which “…alter the

premises on which decision makers act” and include “…mental models held by the decision

maker…Mental models house an individual’s knowledge, experiences, biases, values, and beliefs about

how the world works” (Swanson, 2003, p. 379). Kushniruk’s (2001) analysis of complex decision making

pointed out further that the expertise of the decision maker operates as a constraining factor on the process

as well.
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 Resources include elements such as energy, materials, information, capital; all of which

Hutchinson and Karsnitz (1997) identified as inputs to their system model. Resources function more

externally than constraints on the decision maker. Considering the context of medical technology,

resources would represent new knowledge acquired by students as they investigate topics and carry out

their investigations.

From observations of students engaged in problem-solving and decision-making activities, it

seems that the decision model represents decision processing more accurately then the linear processes

suggested in the literature. This is not to suggest that students who are made aware of the model will

necessarily make better decisions. The hope is that in encouraging them to become more aware of the

process, they will consider the effects and consequences of technology more astutely.

As new technologies are aggressively developed, we are at risk of allowing technology to shape

our decisions. If we do, we relinquish our responsibility for making decisions. The ITEA standards

document calls upon us all to make responsible and informed decisions. Particularly within the context of

medical technology, it is unrealistic to think we can teach students today everything they will need to

know tomorrow. Today we can acquaint students with models for making informed and responsible

decisions so that when they are confronted with questions we cannot anticipate, they will be prepared to

resolve those dilemmas and to choose a course of action.

Conclusion

The three most important features of the medical technology taxonomy and decision model are

that together they integrate technology with other disciplines (health, biology and engineering), offer

students a framework for learning and practicing decision-making skills, and present a way to approach

content for study in K-12 education.

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 ITEA has recognized that education in the 21st century is moving toward integration of disciplines

and interdisciplinary approaches to teaching skills for a global society. “Understanding the symbiotic

relationships between technology and science, mathematics, social studies, language arts, and other

content areas is vital for the future” (ITEA, 2003, p. 15). Teacher educators and in-service teachers

deserve to be prepared for this reality.

With increased emphasis on individual responsibility for making informed decisions and greater

awareness of the need for solving world problems, an integrated approach to teaching technology is

especially important. Working with the medical technology taxonomy and decision model, students and

teachers can learn together about making responsible choices and rational decisions.

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 Figure 1. (Addendum) Medical Technology Taxonomy

Level I Level II Level III Level IV Level V Level VI Level VII

Field Elements Standards Purpose Energy Form Body System Application

Standards 1-3
Š Characteristics &
Nature of Scope
Technology Š Core Concepts
Š Relationships &
Connections

Standards 4-7
Š Cultural, Social,
Political, Econom ic &
Technology
Effects
and Society
Š Environm ental
Effects
Š Role of Society in
Developm ent and
Use
Š Influence on History

Standards 8-10
Š Attributes of Design
Technology
Design Š Engineering Design
Education
Š Design in Problem
Solving

Vaccines

Standards 11-13
Š Apply Design
Abilities for a Process
Technological Š Use and M aintain Energy Form s
W orld Products & System s Š Acoustic Body System s
Š Assess Im pact of Š Chem ical Š Circulatory
Š Electrical Š Digestive
Products & System s Š M agnetic Š Endocrine
Š M echanical Š Integum entary
Š Nuclear Š Muscular
Š Optical Š Nervous
Š Therm al Š Reproductive
Standards 14-20 Š Respiratory
Š Skeletal
Š Medical Therapeutic Š Urinary
Technologies Technologies
Š Agriculture/ Bio-
Related
Designed
Š Energy and Power
W orld
Š Inform ation/
Com m unication Sensing
Š Transportation Technologies Body System s
Š Circulatory
Š Manufacturing Š Digestive
Š Construction Š Endocrine
Energy Form s Š Integum entary
Š Acoustic Š Muscular
Š Chem ical Š Nervous
Š Electrical Š Reproductive
Š M agnetic Š Respiratory
Š M echanical Š Skeletal
Š Nuclear Š Urinary
Š Optical
Š Therm al

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 Section V. Reference Material
What will this section cover?
List of references
Web-based resources
Contact information

What will this section help me understand and be able to do?

Identify published resources
Link to important medical technology web sites
Learn the key authors and contacts in the field of medical technology

References and Resources for Medical Technology

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 Medical Technology Web Resources

Commercial
Canada’s Medical Device Technology Companies http://www.medec.org/
Medical Information Technology Systems, Inc. http://www.mitsi.org/
Medtronic (commercial medical technology company) http://www.medtronic.com/
Applied Medical Technology, Inc. (commercial medical technology company) http://www.appliedmedical.net/

Government
United States National Library of Medicine http://www.nlm.nih.gov
U.S. Food and Drug Administration (FDA) http://www.fda.gov/
National Institutes of Health (NIH) http://www.nih.gov/
Department of Health and Human Services http://www.hhs.gov/
Centers for Disease Control and Prevention (CDC) http://www.cdc.gov/
National Institute of Standards and Technology, Health Care http://www.nist.gov/public_affairs/healthcare.htm
National Center for Health Statistics (NCHS) http://www.cdc.gov/nchs/
Veterans Affairs Health Benefits and Services http://www.appc1.va.gov/Health_Benefits/
Bureau of Labor Statistics http://www.bls.gov/

Professional and Industry Organizations

Advanced Medical Technology Association (AVA Med) http://www.advamed.org/
American Hospital Association (AHA) http://www.hospitalconnect.com/
Engineering in Medicine and Biology Society (EMB) http://www.eng.unsw.edu.au/embs/index.html
American Public Health Association http://www.apha.org/
American Society for Testing and Materials (ASTM) http://www.astm.org/
Association for the Advancement of Medical Instrumentation http://www.aami.org/
Rehabilitation Engineering and Assistive Technology Society of North America http://www.resna.org/
The European Medical Technology Industry Association http://www.eucomed.be.
Medical Technology & Practice Patterns Institute http://www.mtppi.org/
Medical Technology Leadership Forum http://www.mtlf.org/
Medical Device Manufacturers Association http://www.medicaldevices.org/public/default.asp
Center for Integration of Medicine & Innovative Technology http://www.cimit.org/index.html
Computer Integrated Surgical Systems and Technology http://www.cisst.org/
American Society for Clinical Pathology http://www.ascp.org/
Clinical Laboratory Management Association http://www.clma.org/
American Society for Clinical Laboratory Science http://www.ascls.org/
International Technology Education Association http://iteawww.org/

Educational
ACT’s World-of-Work Map Career: Area Q Medical Technology http://www.act.org/wwm/wow/career_q.html
Medical Dictionary Online http://www.online-medical-dictionary.org/
National Library of Medicine (NLM) http://www.nlm.nih.gov/
Medical Technology and Practice Patterns Institute (MMPPI) http://www.mtppi.org/
NASA Explores http://www.nasaexplores.com
PBS Teacher Source http://www.pbs.org/teachersource/

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 Acknowledgements

Authors
Michael A. De Miranda, Colorado State University
Mark Doggett, Colorado State University
Jane T. Evans, The Ohio State University

Project Staff
Karen F. Zuga, The Ohio State University
Nick D. Benson, Colorado State University

National Advisory Board

Joel D. Howell MD, University of Michigan
Stuart W. Leslie, The Johns Hopkins University, Society for History of Technology
Harry M. Marks, The Johns Hopkins University
Matthew S. Hickey, Director, Human Performance Clinical/Research Laboratory, Colorado State University
Kristina D. Rinker, Co-Director Biomedical Engineering, Colorado State University
Gene E. Martin, Texas State University-San Marcos
Richard Satchwell, Illinois State University
Rod Custer, Illinois State University
Michael Daugherty, Illinois State University

Medical Advisory Board

Rhonda Akin, RN, Boulder Community Hospital
Kim Dinniryer, RN, Surgical Services, Boulder Community Hospital
Scott Sampson, RTR, MRI, Harmony Imaging Center
Mike McMahan RT, MRI, Harmony Imaging Center
Gary Jurgens, RTR, X-ray, Harmony Imaging Center
Char Hunt, BS, RT, (M) (CT) (CDT) X-ray, Harmony Imaging Center
Rob Kozusko, RN, Clinical Coordinator, Cardiac Unit, Poudre Valley Hospital
Brian Zink, RTR, Team Lead, Diagnostic Radiology, Poudre Valley Hospital
Laura Sullivan, BS, RDMS, RVT, RDCS, Ultrasound, Harmony Imaging Center
Steve Roths, RN, Quality Assurance, Cardiovascular Intensive Care, Poudre Valley Hospital
Rebecca Couch, Cardiovascular Lab Supervisor, Poudre Valley Hospital
Robert B. Carpenter, Director, Laboratory Services, Poudre Valley Hospital
Jeff Muntz, Coordinator of Information Design and Development. Poudre Valley Hospital

Science and Technology Educator Review Board

Angela Gurnea, Divisadero Junior High School, Visalia, California
Robert Steketee, Cache La Poudre Junior High School, Laporte, Colorado
Teri Tsosie, Valley School, Hermosa Beach, California
Chip Miller, Summit High School, Bend, Oregon
John Ritz, Old Dominion University
Mark Sanders, Virginia Polytechnic Institute and State University
Doug Wagner, Manatee County School District
Rodger W. Bybee, Biological Sciences Curriculum Study (BSCS),
Roger B. Hill, University of Georgia
William E. Dugger, Jr., International Technology Education Association, Technology for All Americans Project
Franzie Leopp, Illinois State University
Brigitte G. Valesey, Educational Consultant

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 Courtesy Poudre Valley Hospital
Medical technicians observe, analyze, and
make decisions using problem-solving skills.
Courtesy Harmony Imaging Center

Detailed high-resolution picture of a

fetus using ultrasound technology.

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 Glossary of Terms
AIDS: Acquired immunodeficiency syndrome, a disease in which the immune system is weakened and therefore less able to
fight certain infections and diseases; AIDS is caused by infection with the human immunodeficiency virus (HIV).
ALS: Amyotrophic lateral sclerosis, a thickening of tissue in the motor tracts of the lateral columns and anterior horns of the
spinal cord; results in progressive muscle atrophy that starts in the limbs.
Anemia: A condition characterized by oxygen carrying deficiency caused by a low amount of red blood cells, iron deficiency,
or sickle cell formation of red blood cells.
Anesthesia: Drugs that a person gets before and during surgery so he or she will not feel pain.
Appendectomy: The surgical removal of the appendix (to treat acute appendicitis).
Arthroscopic surgery: A surgical procedure of making small incisions, inserting tubes with fiber optics, and either diagnosing
or repairing damage using cameras, lasers, or small tools inserted through the tubes.
Artificial intelligence: The field devoted to developing hardware and software that enable a computer to exhibit `intelligence'
as defined and recognized by a consensus of human beings.
Biology: The science that studies living organisms.
Biomedicine: The branch of medical science that applies biological and physiological principles to clinical practice.
Cadaver: A term generally applied to a dead human body preserved for anatomical study. An individual who has recently died
and his or her organs are given for transplantation.
Cancer: The name given to a group of diseases that can occur in any organ of the body, and which all involve abnormal or
uncontrolled growth of cells.
Cannula: A small tube inserted into an artery or vein.
Cardiology: The study of the heart and its functions in health and disease.
Cardiovascular: The function pertaining to the utilization of oxygen by the body through use of the heart, lungs and the
circulatory system.
Catheterization: The process of examining any part of the body by introducing a thin tube (catheter) into a vein or artery and
passing it into the area being studied (i.e. the heart).
Centrifuge: A machine that rotates (spins) rapidly and uses centrifugal force to separate substances of different densities.
Chiropractics: A system of treatment based on the manipulation of the spinal vertebrae, the misalignment of which is believed
to be responsible for pain and illness.
Clinical scientist: A person with advanced knowledge of one of more sciences who performs clinical research through the
study, observation and treatment of patients.
CPR: Cardiopulmonary resuscitation; a first-aid method to restore breathing and heart action through mouth-to-mouth
breathing and chest compression.
CT scan: Computed tomography scan. A series of detailed pictures of areas inside the body; the pictures are created by a
computer linked to an x-ray machine; also called computed axial tomography (CAT) scan.
Diabetes: A disease where insulin, a hormone produced in the pancreas, does not transport glucose effectively from the
bloodstream. Diabetics have to inject insulin so that the body can get enough glucose.
Diagnostics: The branch of medical science dealing with the classification of disease and the process of identifying or
determining the nature and circumstances of an existing condition.
Diphtheria: An acute contagious infection caused by the bacterium Corynebacterium diphtheriae; marked by the formation of
a false membrane in the throat and other air passages causing difficulty in breathing.
DNA: Abbreviation for deoxyribonucleic acid. DNA molecules carry the genetic information necessary for the organization
and functioning of most living cells and control the inheritance of characteristics.
Electrocardiograph: A medical instrument that records electric currents associated with contractions of the heart.
Electroencephalogram: A procedure that records the brain's continuous, electrical activity by means of electrodes attached to
the scalp.
Electromechanical device: The term given to a device that incorporates both electrical and mechanical features.
Electron microscope: An instrument that uses electrons, instead of light, to produce a magnified image of an object. The
magnification that can be achieved is about one thousand times that of a light microscope.
Emergency medical technician (EMT): An individual trained to render immediate basic life support to ill and injured
individuals, under the direction of a physician, and to safely transport them in a monitored environment to health care facilities.
Endocrine: The physiology of internally secreting glands.

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Endoscope: A medical device for viewing internal portions of the body. It is usually comprised of fiber optic tubes and video
display instruments.
Exercise therapies: Preventive health care that complements other forms of medical interventions. Examples include yoga, tai
chi, bicycling, swimming, dancing, aerobics, weights, etc.
Flu: An acute infectious, epidemic disease marked by depression, fever, inflammation of the nose, larynx and bronchi along
with muscular pains; caused by a virus; also referred to as "influenza".
Fluorescent: The quality of having the ability to emit light when struck by electrons or another form of radiation.
Forceps: A pliers-like tool that locks closed; also called "hemostats."
General practitioner: A physician whose practice is based on a broad understanding of all illnesses and who does not restrict
his/her practice to any particular field of medicine.
Genetic engineering: A way of directly manipulating genetic material in a cell or organism to produce desired traits/
characteristics and eliminate undesirable ones.
Heart-Lung bypass machine: A device that takes over the function of the heart and lungs during heart surgery allowing the
heart to be stopped and repaired.
Holistic medicine: Therapies based upon holistic principles recognize that each person is an individual and attempt to treat the
whole person - body, mind and spirit.
Homeopathic remedies: The applications of small doses of medicines, herbs, or both that are believed to stimulate the
immune system.
Immunology: The study of the body's natural defense mechanisms against disease.
Innovation: The process by which new products or new methods of production are introduced, including all the steps from the
inventor's idea to bringing the new item to market.
Keyhole surgery: Also known as laparoscopic surgery. This is a surgical method of carrying out an operation without having
to make a large incision. This type of surgery reduces the length of the hospital stay and leaves little scarring.
Kidney disease: Any one of several chronic conditions that are caused by damage to the cells of the kidney.
Laryngoscope: A medical instrument for examining the larynx.
Magnetic resonance imaging (MRI): A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and
a computer to produce detailed images of organs and structures within the body.
Material science: the scientific study of the chemical and physical properties of tangible substances out of which things are
made.
Medical record: the case history of a medical patient.
Medical specialist: A physician who practices one branch of medicine.
Metabolic: Pertaining to the total of all the physical and chemical changes that take place in living organisms and cells.
Naturopathy: A method of treating disease using food and exercise and heat to assist the natural healing process.
Neurology: The special branch of medicine concerned with the nervous system and its disorders.
Nobel Prize: An annual award for outstanding contributions to chemistry or physics or physiology and medicine or literature
or economics or peace.
Nuclear medicine: The branch of medicine that uses radioactive materials either to image a patient's body or to destroy
diseased cells.
Ophthalmology: The medical specialty relating to the treatment of diseases and disorders of the eye.
Ophthalmoscope: An instrument specially designed to allow visualization of the back of the eye and lens.
Pacemaker: A surgically implanted electrical device used to cause heart contractions and control heartbeats.
Parkinson’s disease: A degenerative disorder of the central nervous system characterized by tremor and impaired muscular
coordination.
Pediatrics: The medical specialty concerned with the development, care and treatment of children from birth through
adolescence.
Pharmacology: The science of the properties of drugs and their affects on the body.
Physics: The science that deals with matter and energy and their interactions in the fields that would include, optics, heat,
electricity, magnetism, atomic structure, and others.
Pleurisy: An inflammation of the inner lining of the chest wall often resulting in chest pain worse on coughing and deep
breathing.
Pneumonia: An inflammation of the lungs attended with chill, sudden temperature elevation, rapid breathing, pain in the side,
and cough.
Polio: A viral infection that attacks the motor neurons in the brainstem and spinal cord and may produce paralysis.
Positron Emission Tomography (PET): A nuclear medicine diagnostic imaging technology for observing the functions of
organs and tissue by mapping the emission of particles called positrons from decay of radioactive elements injected into the
body.

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Prosthetics: The branch of medicine dealing with the production and use of artificial body parts.
Psychiatric/psychological therapies: The field of medicine that diagnoses and treats psychological disorders by using medical
or psychological forms of therapy.
Radial keratotomy: A surgical technique employing radial incision made in the periphery of the eye cornea to reduce
nearsightedness.
Radiology: The branch of medicine that is concerned with the use of various forms of radiation for diagnostic and therapeutic
uses.
Radiopaque dye: A dye, such as Barium sulfate, that is impenetrable to X-rays and appears as a light area on a radiograph.
Rapid prototyping: The conversion of an electronic computer-aided design model into a solid physical model directly from its
digital representation.
Reconstructive: Methods and procedures that help restore to good condition; "reconstructive surgery"; "rehabilitative
exercises."
Respirator: A mechanical device used to substitute for, or to assist with, breathing.
Resuscitation: The act of reviving a person and returning them to consciousness.
Robotics: The use of automated machines to replace human effort or the technology of building machines (robots) with
computer intelligence and humanlike physical capabilities.
Sensor: A device that responds to a physical stimulus, such as thermal energy, electromagnetic energy, acoustic energy,
pressure, magnetism, or motion, by producing a signal, usually electrical.
Serendipity: The phenomenon of making discoveries by accident. In science, serendipity is the discovery though methods that
run counter to established research experiments, such as the discovery of penicillin. The coinage of the term is attributed to the
British writer Horace Walpole from a Persian tale "The Three Princes of Serendip" where the heroes make discoveries
accidentally.
Microscope: An instrument that magnifies objects by means of lenses so as to reveal details invisible to the naked eye.
Sociology: The science that deals with the organization of social groups and how they change or stay the same.
Specimen: A piece or portion of a sample or other material taken to be tested. Specimens normally are prepared to conform to
an applicable test method. In medical technology, a fluid, excrement, or tissue sample.
Sphygmomanometer: An instrument used to measure blood pressure.
Stethoscope: an instrument used to listen to the heart and other sounds in the body.
Suture: The closing of a cut or wound by the use of stitches.
Syphilis: A venereal disease that can cause lesions of the central nervous system and the cardiovascular system.
Telemedicine: The use of medical information exchanged from one site to another using electronic communications for the
health and education of patients or providers and to improve patient care.
Therapeutics: The general name applied to different methods of treatment and healing.
Thermodynamics: A branch of physics that explains the effect of temperature and heat, and the conversion of energy from one
form to another.
Thermometer: A device for measuring temperature.
Tomography: A technique used in remote sensing for retrieving atmospheric parameters in a plane (cross-section) by taking
measurements at different angles (and possibly different frequencies).
Tonsillectomy: Surgical removal of the tonsils, usually to treat tonsillitis.
Tuberculosis: A disease, also know as consumption or "TB," which causes small rounded swellings (tubercles) to form on
mucous membranes; pulmonary tuberculosis affects the lungs.
Ultrasound: A diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of
blood vessels, tissues, and organs. This imaging technique is typically used to take pictures of an unborn fetus.
Urinalysis: The chemical analysis of urine.
Veterinary medicine: The branch of medicine that deals with the diagnosis and treatment of diseases and injuries of animals
(especially domestic animals).
World view: The beliefs about the limits and workings of the world shared by the members of a society and represented in
their myths, lore, ceremonies, social conduct, and general values.
X-ray: A diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and
organs onto film.

The Technology Education Teacher Enhancement project is a collaborative effort of The Ohio State University, University of
Minnesota, Colorado State University, University of Georgia, University of Wisconsin-Stout, Purdue University, and Eastern
Michigan University. This project material is based upon work supported by the National Science Foundation under Grant No. ESI-
0138671. Any opinions, findings, conclusions or recommendations expressed in this material are those of the author(s) and do not
necessarily reflect the views of the National Science Foundation.

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