August 1999

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.

Breaking news - just a click away:

Have a look at our special edition on cluster computing for medical applications!

"3D visualization for medical applications will become a major core technology over the next decade, with image acquisition, storage, computing and networking having requirements in the terabytes and petabytes. Thus, cluster computing and high bandwidth networking will be essential."

Richard Satava, DARPA

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.

The next issue is planned in November during IST 1999 in Helsinki.
When you want your project results in this issue, please contact the editors of Primeur magazine or Virtual Medical Worlds magazine.

ITIS99logof Visit the website of the second International Conference on the Telemedical Information Society.
Combined ITIS'99-ITAB'99 Conference, April 12-13 1999, Amsterdam.
Forum discussions freshly available as of 01-08-99!

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The integration of information technologies within telemedicine has to benefit the patient
Several issues were tackled in a vivid and lively discussion during the first forum session at the ITIS-ITAB'99 Conference last April in Amsterdam. All the hot items were addressed like the growing role of Information Technology implementation within the evolution towards a fully integrated electronic health care record; cross-border collaborations and multidisciplinarity as necessary means to generate the required form of patient file integration; the influence of national policies on the technical developments in telemedicine and the critical question of liability; as well as the emergence of novel services and the need for standardization. Co-Chairman Dr. Andy Marsh specifically concentrated the participants' focus on the matter of how to harmoniously integrate the great variety of emerging technologies into the everyday medical practice.

Standardization process in telemedicine only slowly evolves at the cost of hard effort
Dr. Gudrun Zahlmann who is working at the National Research Centre for Environment and Health (GSF) in Germany introduced the second forum session at the recent ITIS-ITAB'99 Conference in Amsterdam. In this discussion, the participants dealt with the pending standardization issues in the different fields of medicine, information technology and networking. In order to launch the debate, Dr. Zahlmann presented a concise survey of the current standards' scene. In the telemedical area, the need has occurred for image standards which allow visual data transmission. In medicine, a range of responsible organizations are taking care of coded medical vocabularies as to deliver specific professional knowledge at those places where it is needed. We are not talking high level medicine here, since the target is formed by the general practitioner. From the technical point of view however, there is more to standards than meets the eye...

Weighing the thousand ways and worries to establish an International Telemedical Information Society
As we move from data to information knowledge, we need models of simulation and data visualization. If we are looking at population studies for outcomes, also at the economical and financial level, the conclusion has to be that standards and high-end computing applications are urgently being required. This statement from Dr. Luis Kun formed the starting point of the third forum discussion during the ITIS-ITAB'99 April meeting in Amsterdam. There are a host of telemedical applications to start with, like Virtual Reality, Augmented Reality, prediction and diagnostic models, all of which are ways to try and push back the limits of technology. We shouldn't even think about the bandwidth that is available today, but it is good to bear in our minds the whole spectrum of possibilities. Conference co-chair Andy Marsh challenged the ITIS-ITAB audience to ponder on the structural bricks for the building of an International Telemedical Information Society.

Ophthalmology Hospital in Rotterdam ready for distant optometry
People displaying enhanced pressure within the eyeball incur the risk to suffer from glaucoma sooner or later. Optometrists will particularly screen those patients whose eye-measurement results look suspicious and also persons with a family history of glaucoma. At the Ophthalmology Unit in Rotterdam, a two-year experiment has been set up to perform optometry from a distance. The project enables ten local optometrists to transmit real time video-images to the hospital. The tele-optometry initiative introduces medical expertise to the opticians whereas the workload for ophthalmologists is substantially being reduced. In addition, the optic measurement results will be used for scientific research.

Parallelized elastic matching yields correct 3D map of the human brain
A multi-disciplinary research team at the Medical University of Lübeck is working on an atlas of the human brain within the human neuroscanning project (HNSP). For this purpose, several image modalities have been applied on a prepared male human post mortem brain. The data is particularly derived from histological sections as to obtain specific cellular information. The sectioning process however leads to deformed images which present a major problem for scientists to acquire an insight into the different cerebral structures. This type of distortions can be corrected through elastic matching, a solution that requires a high memory and computational power. Therefore, the team has designed a fast algorithm to be ported on a cluster of 48 Pentium II PCs connected via Myrinet, for parallel implementation.

Novel Marching Cubes algorithm to distil detailed anatomical structures out of 3D patient data
A team of researchers working at the Institute of Communication and Computer Systems (ICCS), located at the National Technical University of Athens (NTUA), has designed a whole new implementation of the standard Marching Cubes (MC) algorithm. The innovative method will enable doctors to optimize reconstruction of anatomical structures from 3D medical images. The newly developed algorithm is able to reproduce all 15 predefined cases of cube configurations, established with the standard MC, as well as additional ones, which can be found in specialized literature. The process of extracting triangulated surfaces from volumetric data doesn't suffer from the recurrent type A "hole problem" in the standard MC. The new solution has been implemented in Java in order to create files in Virtual Reality Modelling Language (VRML) format from real 3D medical data. The algorithm thus can be used in telemedicine applications which are platform independent.

Tbilisi citizens to be provided with 24-hour a day cardiologic medical care
For the first time, the Republic of Georgia will be able to offer its patients who are suffering from cardiac disease, a 24-hour a day operating service for medical care, following the inauguration of a telemedicine pilot project. The project, to be partly funded with excess revenues generated by the International Telecommunication Union (ITU) Telecom exhibitions, will enable a trans-telephonic electrocardiogram for diagnostic and emergency services.

City of Barcelona Award 1998 for Scientific Research goes to protein research project
The City of Barcelona Award 1998 for Scientific Research has gone to Dr. Francesc Xavier Avilés for his work in protein engineering and research in experimental and computational molecular biology in particular, which has allowed him to identify several agents and their inhibitors. In fact, Dr. Avilés considers the award as the achievement of a whole team of researchers at the Institute of Fundamental Biology (IBF) in the Department of Biochemistry at the Free University of Barcelona (UAB). This research will likely have a substantial impact on biomedical and agronomic applications.

Parallel distributed architecture allows GenoMap to isolate the genomic locus for autism
The University of Iowa Department of Paediatrics co-ordinates an extensive study for autism gene identification. The research fits in with the methods of Genetic Linkage Analysis, one of the applications in the Human Genome Project. In this regard, GenoMap is the very first implementation of a system involving several groups of co-operating users at multiple scientific institutions in a common attempt to isolate the genomic locus of controlling genes in hard to cure diseases, such as autism and cancer. To this purpose, the Parallel Processing Laboratory at Iowa University has developed a whole new class of applications accessible through the World Wide Web in a three tier hierarchy of parallelism, including heterogeneity within a single problem instance, homogeneity among user subgroups within one problem domain, and multiple instances of the entire problem class, sharing the software and hardware computational resources.

Platinum Partnership Pioneer Award granted to the Human Genome Project
The Human Genome Project has won the prestigious Platinum Technology 21st Century Partnership Pioneer Award at the Computerworld Smithsonian Award Gala in Washington D.C. This has been made public by the Computer Associates International company that recently has acquired Platinum Technology International Inc. This award specifically honours the organizations which partner across industries, geographic and competitive boundaries to make useful contributions to the world. The Human Genome Project is a collaboration of hundreds of scientists worldwide dedicated to deciphering and mapping the genetic code of human beings.

RCSB Protein Data Bank fully operational since July 1st 1999
The Research Collaboratory for Structural Bioinformatics (RCSB) has taken over full responsibility for the Protein Data Bank (PDB) from the Brookhaven National Laboratory (BNL) on July 1st 1999, some three months ahead of the official schedule. This progress was made possible because all aspects of the project involving the RCSB, from the deposition of structural data, through query and distribution, to long term archival and clean up of original data have proceeded smoothly, thanks to the excellent co-operation between the RCSB and BNL staffs. Currently, different mirror sites of the primary archive are available at Rutgers and NIST, The National Institute of Standards and Technology. Sites in Europe and Asia are planned as well.

"Virtual Heart Hospital" to rise from CardioWorks electronic patient record system's foundation
Midwest Heart Specialists (MHS), a 32-physician cardiovascular practice in Illinois, has recently implemented a computerized patient record system, called CardioWorks, to enable efficient compilation of clinical data. A unique feature of this system is the ability to perform real time queries of the clinical database in order to present them to the clinician in the form of clinical alerts. The clinical data is obtained by a combination of nursing and physician entry as well as direct laboratory and hospital links. Pre-defined queries, in the form of alerts, are introduced to the clinician at the time of the patient encounter.

VIDAR Systems donates film digitizer to Armenian Telemedicine Project
Though the deadly earthquake in Armenia, formerly part of the Soviet Union, occurred more than a decade ago, the country continues to face considerable challenges, especially in providing adequate health care to people in both urban and rural areas. Since the earthquake in December 1988, Armenia has been the site of experiments in the use of telemedicine to provide access to health care in disaster situations. As part of these ongoing efforts, VIDAR Systems Corporation has donated a state-of-the-art x-ray film digitizer, making speciality care and consultations possible for many people whom otherwise would be left without treatment.

Computer taught to help doctor detect stroke lesions in Magnetic Resonance Images
A group of researchers from the Computer Vision Laboratory and the Mathematics Department at the University of Massachusetts is working together with a team of physicians, attached to the Neurology Division in the Radiology Department at Baystate Medical Center, Springfield in the Stroke Project. The common aim is to design intelligent computer vision techniques to support the clinical study of ischemic strokes treatment. The project staff is trying to teach computers to interpret magnetic resonance images (MRIs) as to determine in which way stroke patients are responding to therapy.

Building an integrated electronic medical record database from scratch
Since 1988, Scott & White Hospital and Clinic has been actively involved in medical informatics in general, and in developing an electronic medical record system in particular. Dr. Dennis Myers and Dr. Kim Culp, two researchers at the Texan hospital, have designed a comprehensive data model, describing the creation and flow of information in the Scott & White integrated health care delivery system. They linked the model to two key elements of any record system: the user "interface", and the data repository. In the meanwhile, the database has grown to about six million documents. Plans have been made to expand the system to all of Scott & White's 18 Regional Clinics, as well as to make the system accessible, under the strict condition of proper authorization and security, to users from home via dial-up.

Computer assisted surgery leads Flemish orthopaedists from chaotic intuition to accurate precision
In the operating room, one tiny millimetre can make the difference between illness and health, mobility and paralysis, success and failure. The orthopaedic surgeons at the University Hospital of Antwerp (UZA) have been the first in Belgium to introduce computer assisted surgery to facilitate their precision work. Within the UZA, the advanced CAS procedures are already frequently being applied for bone, head and neck surgery. The Müller Institute at the University of Bern in Switzerland has developed the CAOS or Computer Assisted Orthopaedic Surgery system that has been implemented in the Antwerp University Hospital to the tremendous delight of the Flemish surgeons who immediately have discovered the great potential and accuracy of the CAOS system.

Digital 3D images have Antwerp surgeons read patient's skull like a map
In the Ear-Nose-Throat (ENT) Division of the Department for Head and Neck Surgery at the University Hospital of Antwerp (UZA), the computer has become a loyal companion for operations relating to the sinus cavities in the skull. These cavities, situated near the nose for example, are separated by slice-thin walls. When a bone tumour has to be removed from the sinuous cavity in the forehead, the surgeon must be very careful not to penetrate by accident the cranial cavity. The surgical clearance of a stuffed sinus in the case of chronic sinusitis, which makes the patient suffer from inflammation of one or more of the sinuses, has to be performed without inflicting damage to the sinus wall. The new computer assisted surgery system substantially reduces the risk to make any mistakes.

Pioneering Interventional Centre moves to new buildings in the autumn of 1999
In 1996, the National Hospital established a specialized centre for minimal invasive therapy in Oslo. The Interventional Centre was founded to develop new image guided surgical procedures and revolutionary treatment strategies, as well as to perform comparative and cross-disciplinary research between traditional methods and innovative techniques based on advanced technology. In essence, the centre functions as an experimental laboratory to study in depth the impact of medical information technology on the social, economical and organizational aspects of modern health care. In the autumn of 1999, the National Hospital will be moving to a newly built complex where all the required facilities are provided to host both of Interventional Centre's fully merged operation theatres and radiology suites.

Gyrus stimulates physicians to use PlasmaKinetic technology for prostate gland treatment
Dr. Dillan Goble, director of the medical research company Gyrus, has developed a minimally invasive solution to treat prostate hypertrophy, a typical old men's disease. Instead of using a scalpel to remove the damaged tissue, the affected gland part is entered into the intense kinetic energy of an ionised plasma corona, where the tissue is instantaneously vaporised to its constituent elements and washed away in the irrigating flow. The system has the great advantage that only a small incision has to be made in the patient's body to insert the electrode and the vacuum cleaning channel. To date, some 200 patients have been treated successfully with the PlasmoKinetic method which guarantees a much faster recovery than conventional surgery.

LifeLine to install EMerge patient registration software in Swiss Hospices Cantonaux
LifeLine, a Dutch company specialized in datacommunication and Electronic Data Interchange (EDI) in the health care sector, has signed its first contract abroad to implement a central patient index in the Hospices Cantonaux in Lausanne, Switzerland. The EMerge software will be installed in the university hospital, the children's medical centre, a few smaller clinics and a psychiatric unit. The Swiss canton hosts about one million citizens who will each receive a unique patient identification.

CyberCare and Nortel to partner in international electronic tele-home care system
Medical Industries of America (MIOA) has announced that the CyberCare company, currently in the process of being acquired by MIOA, and Nortel have signed an agreement to jointly monitor a complete, reliable home health/remote health system which enhances the accessibility and delivery of medical care at a lower overall cost. The new CyberCare System promises to significantly advance the health care delivery in North America and abroad.

HBSI and the Picker Institute to integrate operational cost and patient satisfaction information
HBS International Inc. (HBSI), a company providing outcomes management systems to the health care industry, recently has developed HBSI ACTION, an operational analysis and performance tool. The integration of HBSI ACTION and Picker's patient satisfaction survey scores helps health care organizations determine how operational decision-making impacts the patient satisfaction levels.

VTEL to upgrade SmartLink 6.1 for industry's first multimedia conference server
VTEL Corporation has issued the newest release of its SmartLink Multimedia Conference Servers (MCS), based on 155 Mbps Asynchronous Transfer Mode (ATM) support and enhanced features which make multipoint videoconferencing as natural as face-to-face meetings. Relying on the best-selling multimedia conference server architecture in industry, the company's SmartLink MCS enables videoconferences over any circuit-switched network including ATM, ISDN, and Frame Relay and also supports the widest mix of connection speeds.

Imagetool to provide high speed telematics for fast radiological findings
A series of 32 Computed Tomography (CT) patient images now can be transmitted in no more than four minutes through an ISDN-connection to the general practitioner. This means a time-saving of about 30 minutes, that can be decisive in many cases for the patient's survival. Imagetool, a German expert in digital image processing, provides its novel IT-Assist solution since December 1998 to a radiological communication co-operation in Oberbayern, where the software is being put to the test. This alliance consists of certified radiologists and several hospitals. General practitioners on duty have equally been integrated into the service. The physicians can analyse the images at home without having to come to the practice.

Display of 1.5 GB images (500 million pixels) in about five seconds
PFU started marketing a high-definition image browsing system, called "Gigaview". The software supports the easy configuration of a high-definition image data archive for storing images, and enables high-speed display/browsing.

Internet Engineering Task Force sessions made available across Europe
UNINETT or the Norwegian academic network for research and education, was hosting this year's Internet Engineering Task Force (IETF) which took place in Oslo from July 12th to 16th. Throughout this five-day event, there were live audio and video feeds from two simultaneous working group sessions. UNINETT was responsible for their transmission. Each of the sessions was multicast over the Internet in one high-bandwidth 2Mbit/s, and one low-bandwidth 128Kbit/s stream.

HP Biomed on-line supports biomedical departments in maintaining patient monitoring systems
Being an expert provider in the medical instrumentation industry, Hewlett-Packard Company has launched HP biomed on-line. This new Web-based support service will answer all possible questions asked by biomedical engineers relating to the HP patient monitoring systems. The easy access as well as reliable answers made available through biomed on-line will enhance the efficiency of biomedical departments and increase equipment uptime.

Accord to show advanced multipoint technology at telemedicine conference in Jerusalem
Accord Telecommunications, the company which is redefining the conferencing and collaboration industry, has recently been chosen to provide its MGC-100 Multipoint Control Unit (MCU) in support of the highly visible Fourth International Conference on Telemedicine that was held in Jerusalem from June 6th to 10th 1999. The attendees of the International Telemedicine Conference were able to experience the power of next generation multipoint technology and how it can be applied in telemedicine applications.

Starship Foundation to fund New Zealand telemedicine network for sick children
A national telemedicine network will soon improve the care of sick children throughout New Zealand. The network will link physicians, nurses, and other health professionals through state-of-the-art video conferencing equipment, allowing them to remotely discuss with each other the clinical pictures of children they are treating despite being hundreds of kilometres apart.

HP delivers complete thin-client/server solution to University of Utah Hospital
Hewlett-Packard Company has implemented the successful thin-client/server solution of NetVectra Windows-based terminals and NetServer systems at the University of Utah Hospital. The NetVectra Windows-based terminals support Remote Desktop Protocol (RDP) for links to applications running on Microsoft Windows NT Server 4.0 Terminal Server Edition and the Independent Computing Architecture (ICA) protocol for connections to programmes running on Citrix MetaFrame or Citrix WinFrame servers.