January 1999

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Special issue with an update on results from European R&D projects, 1998

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 projects below:

This special issue is published in conjunction with the large IST 1998 event (the former Esprit/Telematics conference) in Vienna.

Next issues are planned in April during ITIS-ITAB'99 (at HPCN Europe) in Amsterdam and in November during IST 1999 in Helsinki.
When you want your project results in one of those issues, please contact the editors of Primeur magazine or Virtual Medical Worlds magazine.

ITIS99logo Visit the website of the second International Conference on the Telemedical Information Society.
Combined ITIS'99-ITAB'99 Conference, April 12-13 1999, Amsterdam.

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Multimedia teleconsultation allows to select most adequate rehabilitation treatment for patients with movement disorders
Forty to fifty million people in the European Union suffer from some kind of motor disability, a number which represents 10 to 13 percent of the entire population. The Rehabilitation Departments of the University Hospital at the "Vrije Universiteit" (AZVU) in Amsterdam and at the Roessingh Research and Development (RRD) Institute in Enschede work together in a telemedicine pilot project to assess the value of a multimedia movement analysis and advanced telecommunications platform in everyday clinical practice. Via this teleconsultation initiative, physicians are able to support each other in choosing the right treatment for a particular patient. The medical pilot study forms part of the overall MESH-project, which deals with the implementation of all sorts of Multimedia services on the Electronic Super Highway. MESH is funded by the Dutch Ministry of Economic Affairs.

Europe's first commercial surgery robot operates on human hip and knee joints
At Erlangen University Hospital, the first commercially available operating robot in Europe recently went into clinical service after a series of e extensive bench-tests at the hospital's emergency surgery unit. The new high-precision robot has been developed in Germany and was showcased at the MEDICA 98 Fair, last November in Düsseldorf. During a direct live transmission from Erlangen University Clinic, the Medica Fair visitors were able to witness how the device's sleight-of-hand outperformed the accuracy of the surgeon's touch in a complex replacement hip operation. The robot will assist physicians in replacement interventions of both hip and knee joint implants.

IBM's "Open Clinic Solution" provides hospitals with integrated IT-infrastructure
Since many years, the health care sector constitutes one of the major strategic business fields of IBM. Through the careful selection of competent partners, the company is able to offer advanced information technology (IT) solutions to hospitals all over the world. This has resulted in the development of integrated health care management projects, such as the comprehensive "Open Clinic Solution" and the Internet-based Health Data Network. During the MEDICA 98 Fair, held last November in Düsseldorf, IBM and its partners showed the value of integrated but affordable system solutions for modern hospital management.

EASI 12-lead ECG solution in HP's patient monitoring equipment makes nurse's job easier
The entire Hewlett-Packard Viridia CMS product family of patient monitors will soon be incorporated with an innovative bedside 12-lead ECG or electrocardiogram monitoring solution. During the 71st American Heart Association Scientific Sessions, which took place in Dallas, HP presented the future integration of the EASI acquisition software algorithm, licensed from Zymed Inc., as a work-in-progress. Running EASI on the HP Viridia CMS will enable clinicians and nurses to obtain permanent 12-lead ECG at the patient's bedside with no more than five electrodes.

Paperless hospitals waver between PC network and "bonsai computer" solutions
The hospital of the 21st century will be paper-free or it simply will not be at all. As innovative information and communications technologies (ICT) are gradually entering the health care sector, typical one-liners of this kind enjoy a growing popularity among IT experts. Yet, clearly established trends in hospital data processing are difficult to pin down. Client/server architectures with access to the Internet show promising perspectives but PC solutions for health care institutions still remain expensive while none are really hacker-proof. The implementation of network computers or terminals perhaps may constitute a useful alternative. At the Medica 98 Fair, held in Düsseldorf last November, several IT providers demonstrated current and future solutions for hospital information management and telemedicine applications as well.

Patient stress is conjured in newest generation of open-sided nuclear spin tomographs
Some fifteen years ago, nuclear spin tomography was introduced in Germany as a revolutionary method of diagnostic medical imaging. On the occasion of the Medica 98 Forum last November, the latest product in this discipline was showcased in Düsseldorf to the professional health care public, as a fully open-sided unit. The patient no longer will experience any claustrophobic fear nor feelings of stress like before, because he found himself locked in a narrow "tube". The newly designed family of nuclear spin tomographs has the aspect of a Grecian temple, a magical place for meditation as it seems, which can equally be applied for image-aided surgical interventions.

Patient perception surveys linked with outcomes management systems to optimize quality of care
The Picker Institute and HBS International, Inc. have decided to join their efforts in the respective fields of patient experience analysis and outcome information gathering to improve patient care in hospitals. HBSI provides outcomes management solutions to over 800 health care facilities to enhance their operational efficiency and overall performance. The Picker Institute in turn constitutes a not for profit affiliate of CareGroup, whose aim consists in approaching the quality of medical care through the patient's eyes. Picker has assessed the health care experiences of about 200.000 different patients at more than 500 hospital institutions. HBSI and Picker will now co-operate to offer a standardized patient survey connecting patient perception data with clinical, functional status and financial information.

Java imaging solutions support advanced medical visualization in PACS stations
Medical imaging and radiology professionals are continuously in search of advanced solutions to enhance the quality of the various image processing functions in their equipment. In this regard, Java has become the new creed. Over the past year, Sun Microsystems has worked very hard to optimize its Java technology in order to provide the PACS (Picture Archival Computer System) review stations with new medical visualization features. The newly developed Java tools support grey scale visuals, as well as fast look-up and retrieval of both 8- and 12-bit images. In addition, the company has made available an early access version of the Java Advanced Imaging (JAI) Application Programming Interface (API) object library.

Ampersand Medical Group aspires to leadership in cytological invitro and invivo diagnostic systems
What's in a name? A quick glance at the active acquisition policy of Ampersand Medical immediately shows that this privately-held business group takes its company name very literally. In a short time, Ampersand has succeeded in acquiring a number of diagnostic and therapeutic medical device and systems companies. InPath, a cytology system provider, and the Samba cytology/telemedicine business from the French Unilog company are just a few examples. Currently, Ampersand is trying to purchase both the AcCell and TracCell product lines, developed by AccuMed International, Inc.

Alpha system architecture will help to reveal the omega of the human genome
Celera Genomics recently signed a strategic alliance agreement with Compaq Computer for the delivery of integrated hardware, software, networking and services solutions. Celera, a Rockville based unit of the Perkin-Elmer Corporation, is working hard on the completion of the full sequencing of the human genome. With the support of Compaq, the new and privileged IT partner, the company hopes to reach its ambitious goal within the following three years. The unveiling of the human genome will constitute the final source of basic genomic and medical information to further the development of revolutionary therapeutic as well as diagnostic methods. For this purpose, Compaq will implement and maintain an entire IT infrastructure, based on the powerful Alpha architecture.

Worldcare launches spin-off and assists in clinical trial for cancer treatment
WorldCare Limited provides a broad range of telemedicine and teleradiology services on a global scale. The company's technology division which was set up three years ago, will start to operate independently from now on. Under the name of WorldCare Technologies, it will concentrate on leading-edge telemedicine applications via the Internet and advanced clinical information management solutions for electronic health care delivery. As a second but fully owned subsidiary of the same company, WorldCare Clinical Trials offers digital image management assistance in a clinical trial that was organized to obtain an accelerated US Food and Drug Administration (FDA) approval for Hoffmann-La Roche's newly developed oral, chemotherapeutic agent, Xeloda. Measurements of the medical images showed a less by half tumour size reduction in one out of four Xeloda-tested patients.

Applicare's RadWorks 4.0 medical imaging software to benefit from Pegasus wavelet compression technology
About a year ago, the US Government's Department of Defence (DoD) placed an order of 40-80 million Euro with Applicare, a Dutch company specialized in visualization software, for the large-scale DIN-PACS (Picture Archival Computer System) project. Today, Applicare Medical Imaging has signed an agreement with Pegasus Imaging Corporation, based in Florida, to integrate the latter's advanced wavelet image compression techniques into the RadWorks product line, as developed by Applicare. The latest version 4.0 in this programme assortment offers tools for storage and processing of medical images, produced with X-ray, Magnetic Resonance, Computed Tomography (CT), and Ultrasound.

Parallel computed virtual heart models form upgrade for existing angiographic equipment
Detailed 3D reconstruction of a patient's heart geometry allows the physician to accurately diagnose any serious failure within the cardiac structure. At present, the production of a complete 3D data set takes the cardiologist about 1 to 2 hours of manual measurement. The objective of the Esprit funded 3D HeartView project is to implement an advanced method of 3D image processing based on 2D angiography sequences with minimal user intervention. In order to speed up the procedure for routine clinical use, the system is ported on a high performance parallel hardware platform to form a powerful add-on for the digital angiographer. The project partners are eager to prove to the major suppliers of angiography devices that the 3D HeartView accelerator offers valuable improvement for medical problems and as such is bound to open new markets.

Industrial pilot project launches satellite distance learning for European physicians
The private Swiss company, European Medical Network AG, has initiated a pilot project in order to distribute distance learning applications to physicians in Germany, Switzerland, the United Kingdom, France and the Netherlands. Deutsche Telekom, the European Union of Medical Specialists (UEMS), IBM, and the Fantastic Corporation are the participating members in the initiative. Since the project involves satellite technology, the European Space Agency (ESA) will act as the major sponsor. Fantastic's CEC Pro and MediaSurfer software have been selected to support the medical training.

Parsemed algorithms reconstruct ultrasound scans to 3D images in no time
In the Western countries as well as in Japan, the acquisition of 2D images by means of sonography has become a very popular imaging modality for clinical diagnosis. Yet, specialists in the medical fields of gynaecology, obstetrics, cardiology and radiology have an urgent need for more accurate visualization tools, provided by 3D systems. Unfortunately, current 3D applications require too much computational effort to be performed in real time. The use of open and cost effective high performance computing and networking (HPCN) techniques constitute a realistic solution to this problem. ProHPC, the French division within the Technology Transfer Nodes (TTN), has set up the Parsemed-3D project to demonstrate the value of a real time 3D reconstruction system for optimized medical diagnosis.

First dynamic 3D model of human knee joint enables realistic simulation in automotive and implant industries
In only one year, from July 1997 to July 1998, three partners in the Esprit funded KneesUp project have produced an accurate 3D model of the human knee, including soft tissues, to demonstrate the biomechanical environment of the knee joint. The team applied finite element modelling and high performance computing and networking (HPCN) technology to build the KneesUp simulation model for implant testing and injury prediction in car crash scenarios. For this purpose, a series of four concrete simulation cases have been developed and studied. These demonstrations include a normal gait cycle and a heel strike impact as showcases for the orthopaedic and implant industry, and a lateral pedestrian and toe panel intrusion foot impact as illustrative examples for the automotive industry. In addition, the partners used the model to observe the behaviour of a first prototype for a meniscal implant.

Objective human factors' analysis prevails over abstract methodology in telemedicine project on Greek island
Professor Enrico Cavina of the Post-graduate School of Emergency Surgery within the Department of Surgery at the University of Pisa has made available the first results of the "Tilos Medicine & Tele-medicine" initiative. The Tim-Tem project, running from October 1997 till June 1999, aims to develop a concrete telemedicine case study on a little Greek island, called Tilos, to create an exportable model for telemedicine services in rural areas, such as islands and isolated regions. The preliminary results clearly show that treatment of acutely ill patients in remote areas implies more than the implementation of advanced technologies and abstract protocols. Careful observation of the daily routine in the two medical ambulatory rooms on the island and a lively interest in the specific human and cultural factors, which play a vital role in the minds of the local people, call for a simple, practical no-nonsense approach, characterized by useful training facilities and basic technologies.

Pan-European research network TEN-155 thrown into top gear
Since December 11th 1998, the European research community can finally breathe more freely, thanks to the operational start of the advanced pan-European research network TEN-155. The powerful, newly established information highway interconnects sixteen European university networks all over the continent at speeds of 155 Mbps. Scientists and students, working at academic and research institutions, will experience an increased capacity within their trans-European communications of no less than at least seven times the speed they were used to. As an immediate and direct consequence of the recent liberalization within the European telecommunications market, the international bandwidth potential for the very first time equals the one, available on the national services, which are used by the European academic and research community.

World's first fully immersive VR-CUBE installed at PDC in Sweden
King Carl XVI Gustaf of Sweden inaugurated the world's first six-sided VR-CUBE located at the Center for Parallel Computers at the Royal Institute of Technology in Stockholm. The CUBE, built by TAN Projektionstechnolgie in Germany, can project images onto the floor, the ceiling, and the four walls of a room. The system tracks user's position and angle of sight, and the images that are projected onto the six surfaces change correspondingly. PDC will make the CUBE available to academic researchers and commercial enterprises throughout Sweden and can be used for applications, ranging from analysis of glacier flows to rendering of biological data.

Hong Kong PolyU installs four new laboratories to train nursing students with Virtual Reality
The Department of Nursing and Health Sciences at the Hong Kong Polytechnic University (PolyU) recently celebrated the official opening of its four innovative Nursing Laboratories for clinical education. PolyU invested nearly $10 million to provide the training labs with virtual reality as well as state-of-the-art information technology equipment in order to simulate a true to life hospital environment. The University is proud to host the first school of nursing in the world to apply sophisticated virtual reality techniques for hands-on experience in a co-ordinated and organized way, which is not only reserved for doctors.

Silicon Graphics offers powerful hardware systems' support for PACS solutions
Several industrial companies which are specialized in Picture Archival Computer Systems (PACS) and advanced medical imaging solutions benefit from the computational power, delivered by Silicon Graphics' visual computing and high-performance systems.

First portable ultrasonic unit in notebook format showcased at Medica 98
The performance of ultrasonographic examinations on a personal computer seems to come into perspective with the introduction of the world's smallest and lightest ultrasonic unit in notebook format at Medica 98. The visitors of the annual World Forum for Doctors' Surgeries and Hospitals in Düsseldorf were offered the world premiere of this portable device for use in emergencies.

Siemens Medical to select Silicon Graphics O2 workstation for advanced 3D angiography visualization
New high resolution viewing methods are being developed for the medical sector to help the physician make a solid diagnosis and to support a preponderated choice between micro-invasive treatment or interventional surgery for a specific patient. One of the largest manufacturers of diagnostic imaging solutions is Siemens Medical Systems, Inc. This company decided to choose the O2 workstation, developed by Silicon Graphics, to serve as the visualization platform for an innovative 3D X-ray angiography application.

CritiControl simulation software trains students and doctors in lifesaving emergency treatment
In November 1998, NEC has presented a new software package to the market, especially designed to assist physicians and medical students in learning how to deal with sudden cases of emergency. The programme, that is referred to as CritiControl, is produced to smoothly run on any personal computer and includes all the aspects of lifesaving treatment. The German publisher Springer-Verlag is distributing the multi-language software version in English, French and German. The programme is for sale in 22 different European countries.

Future delivery of Ultrasound telediagnosis demonstrated live at RSNA
During the annual meeting of the Radiological Society of North America (RSNA), the ultrasound systems' provider, Acuson Corporation, in conjunction with three major telecommunication companies, Cisco Systems, Optivision and Ameritech, organized a live transmission of an ultrasound examination performed at Loyola University Health System (LUHS), located in Maywood, Illinois. The telediagnosis was sent over fibre optic lines to the conference at McCormick Place in Chicago and featured the former American football player and present television sports analyst, Tom Waddle. The live demonstration showed the enormous potential of high-resolution ultrasound technology for the diagnosis of sports injuries, as well as the advanced level of telecommunication equipment to link medical experts all over the country.

First telemedicine link between Vietnam and American University Hospitals initiates medical education programme
The global telecommunications company MCI WorldCom recently established the first Integrated Services Digital Network (ISDN) connection to Vietnam. UPLIFT, an international organization that provides humanitarian airlifts to countries and people in need, inaugurated the ISDN link with a live interactive telemedicine session between its partnering hospitals in Vermont and Washington DC, and the participating sites in Hanoi. The demonstration sets the start for a long-term Telemedicine Programme which will link three hospitals in Hanoi and Hanoi Medical College with the University of Vermont (UVM) College of Medicine/Fletcher Allen Health Care as well as the George Washington University Medical Center (GWUMC).

ATM network enables simulation of telemedicine applications at RSNA meeting
Open Business Systems, a wholly-owned subsidiary of Osage Systems Group Inc., has implemented the Asynchronous Transfer Mode (ATM) network for the Assembly and Annual Meeting of the Radiological Society of North America (RSNA), which took place in December 1998 at McCormick Place in Chicago. During the conference, the RSNAnet was intensively used for teleradiology and telemedicine simulations, in order to demonstrate to the audience of health care professionals how this type of applications can be used efficiently in a real life hospital setting.

NekTar codes to lead corkscrewing blood flow into proper channels
There was a time when blood flow in the human body could only be represented in "still" images, which were acquired through magnetic resonance (MRI). At the National Center for Supercomputing Applications (NCSA) supported by the University of Illinois, Dr. George Karniadakis and Dr. Spencer Sherwin recently have developed and adapted the so-called NekTar computer codes to accurately model various kinds of fluid flows. The true-to-life simulation of the human blood flow allows the researchers to find adequate surgical treatment for atherosclerosis, which occurs as a fatty blockage in the vessels and causes the arteries to slowly obstruct until the heart finally stops beating. A major change in the shape of arterial grafts might encourage the blood flow to swirl down the tortuous veins. The corkscrewing turbulence prevents the arteries from silting up with plaque.

Meta-MEME listens to "leitmotive" in DNA sequences to discover evolutionary relationships
The detection of ancestral relationships among protein and DNA sequences no longer seems impossible thanks to a new Web engine based on artificial intelligence (AI) as used in speech recognition systems. Research teams at the University of California (UCSD) and the Supercomputer Center (SCSD), which are both located in San Diego, have developed Meta-MEME, a computational tool, to support biologists in their search for evolutionary connections in the enormous stream of protein and DNA sequence data, arising from the Human Genome Project and related sequencing efforts. Meta-MEME explores the hidden language of similar motifs in evolutionary fingerprints on the protein or DNA codes to define the members that belong to the same sequence family.

Holistic brain mapping approach sheds new light on brain functions and related ailments
In 1992, Dr. John Mazziotta and Dr. Arthur Toga started with a Brain Mapping Programme in the Department of Neurology at the University of California (UCLA) School of Medicine to explore the structure and function of the human brain in health and disease. The researchers apply innovative brain imaging technology to produce visualizations from Magnetic Resonance Imaging (MRI) and alternative brain imaging data to obtain a better insight in neurological and cerebral disorders, such as cavernous angioma. It was this congenital blood vessel abnormality which was responsible for the death of Florence Griffith Joyner, the famous Olympic gold medalist, earlier this year. The multi-disciplinary research programme integrates different sources of information to support physicians with a holistic view on how to diagnose brain related diseases as well as optimize the safety of surgical treatment.