Medical profession to develop from trade to technology in wireless hospital

Brussels 26 May 2000Dr. Ing. Luc Lambrecht is working as an internist at an outpatient clinical centre in Aalst, Belgium. Starting from his double-tracked experience both as a physician and an electro-technical engineer, Dr. Ing. Lambrecht, at the recent Health Care 2000 event, addressed the multi-faceted technological environment in which today's medical experts are expected not only to easily discover their own path but equally to provide their patients with top quality of care at the diagnostic as well as the treatment level. This lively impression from the hospital work floor made two things very clear. A growing tendency exists to evolve towards wireless clinics while surgery increasingly is turning into a playground for technicians in which computer-illiterate physicians are being referred to the background.

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Bio-engineering as an integration of mathematical, physical, and chemical sciences with engineering principles, gradually has conquered the medical field during the last decades. It involves disciplines, such as micro-image processing with magnetic resonance (MRI) and ultrasound (US); digital images storage with PACS and tele-radiology; functional genomics for disease prevention; biosensors, electronics and mimetics' implementation for tissue-sensor interaction; signal analysis in neural networks; and therapeutics for a controlled and targeted delivery. The 21st century hospital has to be prepared to integrate all these innovative technologies, according to Dr. Lambrecht.

At present, the outpatient clinical centre in Aalst is managing 60.000 patient records with one central operator and has a throughput of 5000 new patient cases each year. The hospital is equipped with a laser, a mini-PACS system, and a videoconferencing tool for educational purposes. Future objectives are focused on integrating diagnostics with radiology and ultrasound, as well as with a tarification service for the administration. Dr. Ing. Lambrecht equally described speech technology as an indispensable tool for the evidence-based medicine. In fact, the outpatient clinical model should serve as a prototype for case studies of networking implementation in several hospital services via the integration of radiological information systems (RIS) with HIS or hospital information systems, and picture archiving communication systems (PACS).

The modalities for imaging which are represented in the local hospital are X-Ray, ultrasound, and endoscopy. RN, applied in nuclear medicine, and MRI for brain scanning are not in-house. The ultrasound system is portable as to enable ambulant medicine. Endoscopy is used in preventive examinations in which probes with factor X5 are utilised for enhanced resolution. The dream of Dr. Ing. Lambrecht is to apply virtual colonoscopy with CT-scans that has a far less invasive character for the patient than the traditional procedure. Breast research is performed with MRI instead of X-ray to protect the patient from a potentially dangerous radiation dose.

Networking with PACS and the installed mini-PACS system is possible via a star network which includes fast Ethernet and is running on a Windows NT platform. Data security is guaranteed by using the RAID method, standing for the redundant array of inexpensive disk. Multi-processor, multi-tasking and multi-threading characteristics have been implemented. Dr. Lambrecht explained how ultrasound equipment has been coupled with the endoscopic facilities. The advantages are numerous and result in a filmless centre with quality control and providing great confidentiality and the possibility to enter requests for second opinions via the Web.

Dr. Lambrecht also pictured the situation in the United States where PACS is full scale present in 1700 medical centres. The SPECT, MRI, CT scan, and angiography data are combined on a single workstation. Yet, the use of PACS systems has some major disadvantages too because they imply the need for specific workstations for intensive care, for instance. There is also the danger of the substantial burden of increasingly large studies, generated by new MR sequences and faster CTs that may provoke the slowing down of some PACS workstations. In addition, PACS implementation without understanding the importance of RIS and HIS integration constitutes one of the major problems which emerge in these types of network settings.

At the outpatient clinical centre in Aalst, mini-PACS has proven to be faster than PACS in any case. The new trends in medical imaging are defined by a filmless, electronic image viewing and management procedure, which allows to obtain an earlier and more reliable diagnosis through quantitative and functional imaging, as well as tissue-specific contrast enhancement. This will result in improved therapies, enabled by image guidance, tele-radiology, tele-surgery, and quality control. In anaesthesiology, technology already plays a principal role, just like open-heart surgical interventions nowadays require the presence of biotechnology engineers in the operating theatre.

The challenges of bio-engineering in the third millennium will consist in the control of the main killers which are cardiovascular diseases and cancer. In this regard, preventive actions need to be undertaken for patients at risk for coronary complications. Dr. Ing. Lambrecht also stressed the importance of telemedicine for the control of patients with special risks. An example forms the Ambulance Health Telematics Programme, a project that is funded by the European Commission. The emergency medical technician in the ambulance can immediately contact the hospital emergency department through a set of portable devices. At the clinical centre, a multimedia database that includes ECG, X-ray, CT, and MRI is directly connected to the HIS and PACS.

A spectacular breakthrough lies ahead in molecular medicine. The complete DNA sequence of the human genome will be deciphered in 2001. This will be the onset for disease prevention based on one's individual gene fingerprint. Novel methods of prevention, diagnosis and treatment, as well as new drugs with rational design will be developed by 2020. Dr. Ing. Lambrecht indicated that physicians will see how the human organism is functioning as a holistic system. Cancer, of which lung cancer shows the highest mortality rates, will be fought with new imaging modalities. Additionally, preventive information campaigns will continuously address the populations to develop healthy food supply patterns, whereas in cardiovascular treatment, other markers will be needed than cholesterol. Dr. Ing. Lambrecht concluded that the problem no longer will be the technical feasibility. Instead, the medical experts and bio-engineers will be faced with the essential question: "What do the data mean?"


Leslie Versweyveld

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