January 2000

VMW is a monthly Virtual Magazine on Telemedicine and High Performance Computing and Networking for readers interested in computer applications in medical environments. It is produced by an editorial team composed of professionals in publishing and an advisory board with professionals in telemedicine, provides the embedding into the everyday practice and research. You can put the editorial team to work as well. Read about our services and find out about the friendly rates.

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*** Virtual Medical Worlds Magazine's 1999 TOP 10 articles listing ***

The rich world of 3D medical imaging, the secret of surgery simulation, and the fast emergence of wireless telecommunications for telemedicine: these are the topics that hold in store the highest fascination for our readers ...


Special issue with an update on results from European R&D projects, 1999 !

Each year hundreds of European R&D projects produce important results. In this special issue, co-published by the magazines Primeur and VMW, we give an update from a number of projects in the HPCN and medical sectors that were supported within the Esprit or Telematics programmes from the European Commission.

Please, check in at the telemedicine project below:

TeleInViVo, the building of an economically viable telemedical workstation for 3D ultrasound

This special issue is published in conjunction with the ITIS-ITAB 99 event in Amsterdam.

When you want your project results published in one of our next special issues, please contact the editors of Primeur magazine or Virtual Medical Worlds magazine.

ITIS99logof Visit the Web site of the second International Conference on the Telemedical Information Society.
Combined ITIS'99-ITAB'99 Conference, April 12-13 1999, Amsterdam.
Also featuring all forum discussions!

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The Copernican revolution of computer-aided multimodal medical imaging and simulation
Spread over France, INRIA, the French National Research Institute in Computer Science and Control, has founded several research units hosted in Lorraine, Rennes, Rhône-Alpes, and Rocquencourt. Within a stone's throw from the French Riviera, the unit of Sophia Antipolis has built a sound reputation in the scientific fields of medical imaging, algorithmic geometry, computer vision, and surgery simulation. Dr. Nicholas Ayache is director of the medical imaging project Epidaure. He is equally involved in a number of other projects, such as Chir, Prisme, and RobotVis, that have been set up to experiment with ground-breaking computer technologies to optimise medical visualisation based on computed tomography (CT), magnetic resonance (MRI) as well as ultrasound and nuclear medicine.

Advanced tools turn disabled person's life into a mobile, safe and communicative adventure
Driving a wheelchair with only one finger or surfing the Internet handsfree with a laserpointer... The Technology Centre for Disabled Persons (CTG), hosted at the University of Antwerp (RUCA) campus, has designed a variety of advanced and innovative tools since its inception in 1990. Made to measure solutions bring comfort to the patient in cases where the physician or the physiotherapist no longer can guarantee further recovery. Recently, the Flemish government has awarded CTG a budget of 275.000 euro for the development of a special sensor to detect unconsciousness due to a patient's fall. The CTG grant fits in with the Strategic Technologies for Well-being and Welfare (STWW) Programme.

A day at the Teesside University School of Computing and Mathematics
The University of Teesside is one of the United Kingdom's leading universities for computing and mathematics. At the six-year-old Teesside Medical Computing Centre (TMCC), a lot of research projects are going on in the health care area, which are related to several medical disciplines. State-of-the-art information technology is applied to the scientific investigation of asthma, lower back pain, and diabetes care, as well as to the development of medical and physical devices for both physicians and patients. In addition, the many computer resources are addressed for the testing and validation of training systems, used in minimal invasive surgery simulation. A clinical support research group in particular concentrates on the design of a multi-media electronic patient record for telemedicine applications.

Parallelised Monte Carlo simulation strongly refines radiotherapy treatment planning
The Monte Carlo simulation constitutes a very efficient technique to describe the radiation transport in complex physical systems, such as the human body. The Department of Physics at the University of Barcelona has designed the Penelope programme to implement the Monte Carlo simulation in the clinical area of radiotherapy. Together with a team of researchers from the Hospital Clinic, the Polytechnic University of Catalonia, and the National University of Cordoba in Argentina, scientists of the UB Physical Department have ported the Penelope programme to a parallel system architecture, as to accelerate the Monte Carlo simulation.

Real time parallel image segmentation close upon the heels of nearly any brain disease
In a recently finalised 18-month project funded by the European Commission, a Dutch-German consortium has implemented a similarity-based image segmentation algorithm on a high-performance platform (HP-ISIS) to determine the brain-liquor ratio in a patient's brain. The academic and industrial partners aim at using scaleable high performance computing power to optimise image processing for fast and cost effective monitoring and diagnosis of brain diseases. The HP-ISIS system constitutes a non-invasive method for the identification of global atrophy, focal edema, cerebral attack, and Alzheimer's. In Germany alone, the targeted user group consists of some 250 hospitals, about 50 neuro-radiological departments, and a large number of doctor's practices.


Tera Computer's multithreaded architecture
At New York University's Courant Institute of Mathematical Sciences, Dr. Charles Peskin walks a familiar path between his office and the school's computer lab. This morning, as he has for countless hours over two decades, Peskin pondered a question about the human body. "How can we use a computer", Peskin thought, "to simulate, in sharp detail and real time, the human heartbeat?" Later, as he departs the lab with the newest results of his research in hand, he has moved one step closer. He holds another part of the puzzle, a partial answer to a solution that will push the level of understanding about our body. While he is closer to a solution, Peskin remains a long way away from a final answer.

American-Russian exchange of telemedicine software and services via virtual private network over satellite
SevenMountains Software company, which is a leading provider of collaborative computing solutions for intranets, extranets and virtual private networks (VPN), has been asked to join a project conducted by the TELCOT or Telecommunications Management & Collaborative Technologies Institute at the California State University, Hayward, on behalf of Lawrence Livermore National Laboratory and the City of Livermore in order to create a prototype for joint research among scientists in the Bay Area, California and the region of Snezhinsk in Russia. The SevenMountains' 7M Integrate product will be utilised by the Institute as an intelligent data base management system. This system will provide control of patient records in multi-point and collaborative satellite-terrestrial environments in which electronic records are combined with medical images.

Sanger Centre's scientists speed the search for the secret of life with decoding of human chromosome
An international team of scientists has passed a milestone by deciphering, for the first time ever, the complete genetic code of a human chromosome and revealing the existence of hundreds of genes previously unknown in humans. Researchers from the Wellcome Trust-funded Sanger Centre at Hinxton Hall, Keio University in Japan and US laboratories at the University of Oklahoma and Washington University, St. Louis, succeeded in writing down the 34 million "letters" which make up the entire sequence containing all the protein coding genes of Chromosome 22. This is the first human chromosome sequence to be completed. It has revealed 679 genes. Improvements in software for finding genes will allow to find an even greater number. The work gives scientists a real insight into the way genes are arranged along a strand of DNA and how they can be controlled, paving the way for huge advances in medical diagnosis and treatment.

Global high-speed network to unlock Johns Hopkins' telemedicine expertise internationally
Johns Hopkins Medicine and Lucent Technologies have closed an agreement to promote telemedicine applications globally through the use of information technology. Under the terms of this contract, Lucent and Johns Hopkins International L.L.C., which was formed earlier this year to advance the international objectives of Johns Hopkins Medicine, will jointly design a secure, high-speed network to support Johns Hopkins' growing telemedicine applications and to manage incoming and outgoing information. The network is also expected to make it much easier for patients from around the world to access Hopkins' physicians and facilities.

Brazos Valley Telehealth Partnership teams with VidiMedix in deployment of large-scale Internet-based Network Medicine
VidiMedix Corporation has closed an agreement with The Brazos Valley Telehealth Partnership, a collaboration between Texas A&M System Health Science Center, the Family Practice Residency Programme of Brazos Valley and the St. Joseph Regional Health Center to utilise "Network Medicine", with the purpose to enhance the referral and consultation capabilities of participating resident, supervising, Family Practice, as well as specialist physicians.


Internet-enabled customer will radically change the face of health care industry by 2010
Consumerism, e-business and genetic mapping will bring about disruptive changes in the way health care is provided and paid for in the 21st century. This is stated in the report "HealthCast 2010: Smaller World, Bigger Expectations", issued by the professional services organisation PricewaterhouseCoopers. The survey, conducted by the company's health care division, questioned nearly 400 industry thought leaders from Canada, the United States, the United Kingdom, Finland, France, Spain, Germany, the Netherlands, New Zealand, and Australia.

Next health generation will witness convergence of financing systems and growing standardisation
"HealthCast 2010", a report on the future of health care practice, recently published by PricewaterhouseCoopers, among other items, addresses the issues of health insurance financing and the need for further standardisation in the next decade. Health care financing trends are converging in the industrial world since the United States tends to become more governmental and privatisation efforts are being promoted in Europe and Canada. In addition, the increasing costs and consumerism are likely to spur insurance changes. Governments, health purchasers and insurers are also growing more keen on supporting cross-border standardisation because lack of common platforms and benchmarks will cause inefficiency and costs to go on unchecked.

Australian report predicts transition from peripheral telemedicine to mainstream e-health
The Australian Commonwealth Department of Communications, Information Technology and the Arts (DOCITA) recently published the report From Telehealth to E-Health: The Unstoppable Rise of E-Health . The author of the document, drawn up by order of the National Office for the Information Economy (NOIE), is John Mitchell of John Mitchell & Associates. This report succeeds the 1998 government account Fragmentation to Integration: the Telemedicine Industry in Australia in which a plea is made for the integration of telemedicine into the general health care practice. The new e-health document describes how the increasing combined use of information and telecommunications technologies (IT&T) has expanded the narrow concept of telemedicine as a synonym for videoconferencing towards the encompassing notion of electronic health.

Process modelling to assess telemedicine service quality in a flow chart
In the Telemedicine and Telehealth Session at the Annual Meeting, that was organised by the American Medical Informatics Association (AMIA) last November, a group of researchers from the Department of Radiological Sciences at the University of California in Los Angeles (UCLA) introduced a variant of the process modelling method, which is being used in industry, for health care management. The individually tailored approach has a few major advantages for the accurate quality assessment of telemedicine or telehealth services in particular. The methodology enables system designers to mould the service in a flow chart, allowing them to pinpoint and solve all possible points of failure in advance, till the system is fully ready for implementation.

Three-tier framework generates XML-based browser pages for tumour documentation
In the Institute of Medical Informatics, situated at the German Justus-Liebig-University in Gießen, a scientific team is developing a framework to combine the use of Extensible Markup Language (XML) with dictionary techniques. The work, performed in partnership with the company MED medicine online GmbH, is aimed at promoting and designing a set of standard conformable applications for tumour documentation in oncology. The German team was invited to present the preliminary results in a special session on "XML used for knowledge representation" during the Annual Meeting of the American Medical Informatics Association.


Cabletron Gigabit solution to enhance Japanese hospital network with telemedicine capabilities
Saiseikai Kumamoto Hospital, which is located in Kumamoto City and is rated one of Japan's "top three hospitals" by the local IT business magazine Nikkei , recently selected a Cabletron Gigabit Ethernet solution to dramatically reduce the average patient treatment time from 20 days to approximately 14 days. Saiseikai Kumamoto Hospital cares for patients in a Japanese region with a population of 13 million people and deploys Cabletron Systems' leading communications solution for the rapid distribution of time-critical patient information.

New York's Elmhurst Hospital to go digital with Agfa PACS system
Agfa has been awarded a $5.6 million contract for a new digital x-ray system by Elmhurst Hospital Center in New York. The company's IMPAX picture archiving and communication system (PACS) and the Agfa Diagnostic Center (ADC) system will allow to generate digital patient images and quickly transmit these electronically to different locations for viewing by radiologists and diagnosticians. The Elmhurst Hospital, that has 500 beds and performs approximately 125.000 radiological procedures annually, is one of the major East Coast health centres. The fact that Elmhurst has chosen Agfa reaffirms the company's reputation as one of the world's leading imaging companies.

First implant and start of global clinical trials for Advantage, Medtronic's new prosthetic heart valve
Medtronic Inc. has announced the first implant and the start of worldwide human clinical trials for its Advantage bileaflet mechanical heart valve. Approximately 265.000 prosthetic valves are implanted globally each year, and it is estimated that mechanical valves are used in about 60 percent of these cases. Prosthetic heart valves are utilised by surgeons to replace the heart's natural valves whenever they have been rendered ineffective by age or are damaged by disease, making it difficult for blood to be pumped efficiently through the heart.

Freshly issued HBSI bi-annual report shows hospital operating margins still declining
Just recently the HBS International Company, as a major provider of outcomes-management systems to the health care industry, has released a bi-annual report that tracks hospital operating margin trends in the United States. The report, "The Health of Our Nation's Hospitals: A Report on Operating Margins", reveals that profit margin averages are continuing to decline. In fact, second quarter 1999 operating margins have dropped by 50 percent compared to the same period in 1997, shrinking from 6.22% to 3.11%.

No kingdom for a horse, but a lancet for a joystick in Robodoc's realm
In the Saint Pierre Hospital in Brussels, the robot has chased the surgeon out of the operating theatre. Shortly, the same thing will happen in Utrecht where Intuitive Surgical's da Vinci telerobotic system will be used to perform bypass surgery on a patient's beating heart. Already, the surgeon of the future is practising on his PlayStation. Instead of manipulating a lancet, Cyberdoctor feels the touch of a joystick through his fingers, moving through an "empty space". Guided by sophisticated 3D computer images and changing camera positions, the surgeon has the impression of travelling within the patient's body. There is no haptic feedback, at least not yet, when cutting through bone or tightening the rope of a stitch. The appearance of Robodoc in the operation room definitely forces new skills upon the surgeon.


TriZetto to provide InfoMedtrics' health care decision-support software via the Web
Health care information leaders InfoMedtrics Inc. and The TriZetto Group Inc. have closed a strategic alliance, providing a joint solution to help improve the quality of health care information and better control costs. As an application services provider (ASP), TriZetto will promote, host and offer access to InfoMedtrics' Healthcare Information Center (HCIC), the industry's only software solution which manages all lines of health care information.

Cloverleaf to integrate astronaut medical records into one single NASA database
The Cloverleaf interface engine, developed by HIE Inc., a leading enterprise application integration (EAI) software and services provider, has been selected to integrate data for CMIS, NASA's Comprehensive Medical Information System project at Johnson Space Center through an agreement with Wyle Laboratories, Inc. Under the terms of the agreement, HIE will provide software and services for Wyle Laboratories' implementation of the CMIS. CMIS will integrate complete and current patient medical data from the different medical operations sources into a single system at the Johnson Space Center.

Customised toolset delivers integrated telehealth solution to the Canadian clinician's desktop
TecKnowledge Healthcare Systems Inc., based in Nova Scotia, and Visual Telecommunications Network Inc., headquartered in Vienna, Virginia and referred to as ViTel Net, have established a new telehealth alliance. The relationship brings together the expertise of two leaders and pioneers in the telehealth industry and unites the strength of their telehealth experience. As such, ViTel Net and TecKnowledge will offer a holistic approach to telehealth implementation for Canadian health care organisations to benefit from.

HIE to deliver HIPAA-compliant real time integrated e-healthcare solution
HIE Inc., a major enterprise application integration (EAI) software and services provider, has released an updated version of Cloverleaf 3.6 that integrates full support of the freshly created X12N electronic transmission standard mandated by the Health Insurance Portability and Accountability Act. The 1996 HIPAA regulates the simplification of administrative health care insurance processing and standardisation of electronic patient health and financial data. The goal of HIPAA is to facilitate better data interchange between organisations, while protecting the confidentiality and privacy of patient information.

CyberCare granted patent on patient-friendly tele-monitoring system
CyberCare Inc. received a patent award no. 5987519 for a broad-based telemedicine system using voice, video and data encapsulation for the purpose of communicating medical information between central monitoring stations and remote patient monitoring stations. The company's Electronic House Call System (EHC), an Internet-based system that remotely monitors chronically ill patients at their home, will utilise this patented technology.


New IBM top supercomputer Blue Gene to study human body
A computer - nicknamed "Blue Gene" by IBM researchers who are developing it - will be capable of more than one quadrillion operations per second (one petaflop). This is 500 times faster than the world's current fastest supercomputer. Blue Gene's massive computing power will initially be used to model the folding of human proteins. This fundamental study of biology is one of the "grand challenge" applications. Learning more about how proteins fold is expected to give medical researchers better understanding of diseases, as well as potential cures.

Market overview in Telemedicine Industry Report 2000 shows where opportunity knocks
The global telemedicine industry will grow forty percent annually over the next ten years, forecasts industry expert Peter Leitner. The Chief Executive Officer of Waterford Telemedicine Partners Inc., Leitner is equally founder and chairman of Waterford Advisors Inc., creators of the Waterford Telemedicine Index. Founded by Waterford Advisors Inc. in July 1999, the Waterford Telemedicine Partners company provides industry and company-specific research reports to institutional, corporate and individual investors and their advisers. The firm is headquartered in New York City.

Security Net provides full-fledged E-resource for safe and private health care data traffic
3Com Corporation has launched "Security Net": a Web-based resource centre to help health care IT professionals enhance patient privacy and confidentiality and keep data secure when moving or storing patient records and medical images over a network. This 3Com Security Net site provides resources for the health care industry to comply with the upcoming electronic information security standards mandated by the United States Federal Health Insurance Portability and Accountability Act (HIPAA).

Good Samaritan Society ready to experiment with adapted version of Electronic HouseCall System
CyberCare Inc. has executed an agreement with The Evangelical Lutheran Good Samaritan Society of Sioux Falls in South Dakota to supply a smaller version of its Electronic HouseCall System that will remotely monitor chronically ill individuals, who have to wait for their admission to the skilled nursing facilities at the Good Samaritan Society.

Enhanced telemedicine market growth in 1999 still no billion dollar deal
Driven by increased spending on information technology, the market for store-and-forward and real time clinical imaging systems is demonstrating double-digit revenue growth in 1999. This is announced by Feedback Research Services which equally has forecast that the combined worldwide sales of video-based home care, telemedicine, and teleradiology systems would possibly reach $172.0 million for 1999.