[Which are the driving forces behind the demand of new technology?].
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Powerful forces encourage the growth of medical technology (health benefits, private equity capital, public funding, pervasive academic research, consumer demand, specialist training, reimbursement mechanisms, and industry competition). Countervailing forces that inhibit growth are the costs of the technology, difficulty in evaluating clinical and cost effectiveness, unequal patient access, and misuse, overuse, and underuse. While technology funding sources continue to expand, so do the methodologies for technology assessment. They are part of a broad movement to better manage the diffusion of medical technology. Specific proposals include more centralized planning, more discriminating federal funding, drug price controls, curtailing insurance reimbursements, more selective adoption of new technologies, and more rigorous attention to cost effectiveness. Savvy develops of and investors in new medical technology will anticipate these changes and take them into account in their planning.
The question in the title will be addressed by first answering the question: What is a technological imperative? A review of the literature makes it clear that there are many descriptions and explanations of the technological imperative in health care, and that not all of them are important to consider. One conception of the technological imperative that is important is the one that implies that technology reduces our responsibility toward our actions. I argue that that this conception cannot be justified. That is, there is no imperative that frees us from our responsibility for developing, producing, advertising, assessing, implementing, using, and banishing technology in health care. On the contrary, the increased possibilities provided by technology result in an increased responsibility. That is, there is no technological imperative, but technology promotes a moral imperative; in particular, it promotes a moral imperative to proper assessment.
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Most hospitals use technology strategically to differentiate themselves from their competition. The rapid rate of change in healthcare technologies necessitates development of a technology life-cycle management program. Having access to flexible sources of capital appropriate to each category of technology assets allows liabilities and assets to be matched on a "balanced" balance sheet.
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Visible light and near infrared light interact with biological tissue by absorption and scattering. Diffuse optical imaging and spectroscopy reconstructs tissue physiologic parameters based on noninvasive measurement of tissue optical properties. This technology can be used to differentiate physiologic and molecular signatures of both malignant and benign tissues, as they relate to the area of cancer research. Major advantages are the use of non-ionizing radiation, real-time continuous data acquisition, low cost, and portability. Limitations include low spatial resolution and limited reproducibility. This paper reviews the currently available state-of-the-art technologies for diffuse optical imaging and spectroscopy and their applications in cancer research.