June 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.

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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.
Full coverage available!

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Successful molecular computer simulations may lead to new drug for psoriasis treatment
The 1998 Salvat Laboratories Award has been granted to Dr. Juan Jesús Pérez González from the Chemical Engineering Department at the Polytechnic University of Catalonia. Dr. González is also vice-president of the Pharmaceutical Society Service usergroup at the Cesca Supercomputer Centre. His research team has discovered a molecule, that in the very near future might be used for a new drug in the treatment of psoriasis, a disease for which currently there is still no appropriate medicine available. Psoriasis is a chronic skin-affection, affecting approximately 2% of the population. Its cause is due to genetic factors amounting to proliferation of the epidermis cells. Characteristic symptoms are the reddish skin and the white scaly spots affecting different regions of the skin and provoking heavy itch. Psoriasis is not contagious and probably has its origin in psycho-social factors.

European Institute of TeleSurgery finalist in 1999 Computerworld Smithsonian Award for medicine
The European Institute of Tele Surgery (EITS) has been established in Strasbourg in 1993 to meet the needs of medicine as it is rapidly evolving towards the information age. Surgery experiences the same type of revolution as has the aeronautics industry. Just as laparoscopy, or minimally invasive surgery, coined by surgeons as the "second French Revolution", has revolutionized surgery, the developments in information technology can be applied to revolutionize surgical training. The original concept of the EITS founders was to group together an international pool of practising surgeons, fundamental researchers, computer scientists and industrial partners, all working together towards the same goal of improving patient care in a digital world. To focus the international attention on nearly six fruitful years of hard work, the CWSA organization has selected EITS as one of five finalists in the medical category.

The use of Electronic Commerce in an International Telemedical Information Society
As part of the overall Euromed project, Euormed-ETS succeeded in providing a secure solution for medical data traffic and applications over the World Wide Web. Security has been built into the system by means of the Secure Session Layer (SSL) protocol as well as through the assistance of Trusted Third Party Services (TTPs). The establishment of the Web-based electronic health care record with countless hyperlinks however entails the emergence of electronic commerce with regard to telemedicine related health care activities. Dr. Despina Polemi from the National Technical University of Athens has investigated in which ways electronic commerce transactions can be harmoniously implemented into the telemedical environment of the Next Generation Internet.

Aegean Ministry willing to plan and implement permanent Telemedicine Station in Tilos
In February, we left Professor Cavina and his team from the Post-graduate School of Emergency Surgery at the University of Pisa in the midst of a difficult to solve funding problem. In fact, the "Tilos Medicine & Tele-medicine" (Tim-Tem) project workers were trying very hard to raise money for the installation of a permanent Telemedicine Station in the Greek island of Tilos to export it as a model for telemedicine services in rural and isolated areas. In the meanwhile, the mayor and physician of the island has succeeded in making the Aegean Ministry sensitive to the specific health care delivery issues in Tilos. As a result, the Tim-Tem team has now acquired the necessary funds for the station's immediate and full implementation. During the Easter holidays, the project people carried out a new on-field verification. Professor Enrico Cavina informed the VMW Magazine about the recent findings.

Unified Modelling Language approach to address security needs in health care information systems
During the "Healthcare of the Future" workshop, held at the HPCN'99 event in Amsterdam last April, Professor Bernd Blobel from the Medical Faculty at the University of Magdeburg presented a smart toolset for security analysis and design of health care information systems. The solutions for efficient systematization and support of aspects, views, and different user groups are based on a general conceptual security model, and a concepts-services-mechanisms-algorithms-data scheme with use of UML or Unified Modelling Language. The toolset has been developed within the European Commission (EC) funded ISHTAR project for the Implementation of Secure Health Telematics Applications in Europe.

Dutch Ministry of Health, Welfare and Sport plans establishment of ICT-platform in health care
As the opening speaker of the workshop "Healthcare of the Future", held during the recent HPCN'99 Conference, figured Drs. N.C. Oudendijk, who is manager of the Curative Somatic Care Department at the Dutch Ministry of Health, Welfare and Sport. New attention is emerging for the use of Information and Communications Technology (ICT) as part of the general health care infrastructure, to enhance overall co-operation, efficiency and quality. Support offering for fast development of the Electronic Patient File is marked with high priority. In order to co-ordinate all the ICT-related health care initiatives, the Dutch government in the autumn of 1998 agreed to launch an ICT-platform.


Parallelized Branch-and-Bound algorithm speeds up angiographical 3D data reconstruction
Before the medical applications' conference track audience at the HPCN'99 event, Dr. Yudith Cardinale from the department of Computing and Information Technology at Simon Bolivar University in Venezuela, presented the potential of parallel algorithm use for 3D reconstruction of angiographic images. The academic research team in Caracas developed ANIA, a tool for Angiographic Image Analysis and study which allows to create the solution space for the problem of reconstruction from biplane images. This process involves a combinatorial generation of feasible solutions through the use of a priori knowledge about coronary arterial conditions. The job is performed by means of a sequential Branch-and-Bound algorithm. Since its execution takes about seven days, the team has parallelized the algorithm to reduce the runtime while simultaneously achieving a good load balancing.

NBCR to offer biomedical researchers access to HPC and data management facilities
The United States National Biomedical Computation Resource (NBCR) integrates, develops, and delivers transparent access to HPC or high-performance computing and data management, with the end goal of making sophisticated biomedical technologies as easy to use as the Web. NBCR was recently awarded a five-year $5.9 million grant which will allow to continue its research efforts. The focus of NBCR is to unite biomedical research efforts that might not otherwise come in contact, according to Peter Arzberger, who is executive director of the San Diego Supercomputer Center (SDSC) as well as NBCR principal investigator. Together these projects allow researchers to achieve results which, separately, might be impossible to obtain.

Feedback Research Services selects Dr. Perednia as 1999 Telemedicine Speaker-of-the-Year
"A person venturing into a new territory and combining a unique perspective with substantive content." This is how Feedback Research Services, a US publisher of newsletters and market reports about telemedicine, care management, home care, and related subjects, motivates the decision to make Doug Perednia, M.D. this year's Telemedicine Speaker-of-the-Year. The current President of the Association of Telemedicine Service Providers (ATSP) earned his title with two thought-provoking presentations, which were held in the course of 1998. In the first speech, for the audience of the ATSP September 1998 Meeting, Dr. Perednia addressed the subject of "Regional Planning for Telemedicine". In the second talk for the 1998 TeleMed Meeting, the award winner states that "telemedicine IS like an underdeveloped country with a death rate graph which matches India's."

Oases on Web serve as personal guides to more health and more hope
Telemedicine can mean a lot more than technology alone. While software programmers all over the world are trying hard to solve the Y2K computer problem, Mayo Clinic Health Oasis assists both healthy and sick people, in order to work on their own personal programming for mind and body. In turn, Rest Ministries Inc., a non-profit Christian organization, offers hope and support to patients living with chronic illness or pain. The Web, in both cases, serves as a medium for mental as well as physical healing.

Two novel supercomputer-engineered anticancer agents to benefit tumour treatment
At the 90th Annual Meeting of the American Association for Cancer Research (AACR), BioNumerik Pharmaceuticals has presented new data on two novel supercomputer-engineered small molecule agents designed to help address common and important unmet needs in cancer therapy. BNP7787 is a new chemo-protecting agent, developed to increase the therapeutic index and protect against the common toxicities of widely used anticancer drugs, such as taxane and platinum based agents. In turn, karenitecin is a novel silicon-containing anticancer compound that has showed potent antitumour activity at concentrations as low as parts per trillion in laboratory testing with human cancer cell lines and in animals bearing human tumours. The agent is in the drug class known as camptothecins and has been designed to avoid problems with oral bio-availability, unfavourable metabolism, toxicity and drug resistance that have been associated with other camptothecins.

NASA brings the hospital to the patient in the "Virtual Collaborative Clinic"
On May 4th 1999, NASA demonstrated the telemedical use of 3D patient images, transmitted over a high-capacity computer network to five remote sites, for diagnostic, surgical, and training purposes. The initiative was aimed to improve patient care from a distance by supporting remote collaboration of physicians at different locations on earth. The operation should be seen in the light of future space travel, when astronauts will need to have access to medical advice, training and care from distant sites. This "Virtual Collaborative Clinic" concept will not merely benefit the spacecraft crews travelling to the International Space Station and to other planets, but primarily patients, situated in isolated parts of our own planet.


Distributed Parallel Storage Server caches medical images for remote consultation
The recent HPCN'99 event also provided a conference track on the use of high performance computing and networking in medical applications. Dr. Brian Tierney from the Lawrence Berkeley National Laboratory, based in California, brought an account of the numerous advantages of a distributed parallel storage server (DPSS) for high speed data cache. The highly scalable architecture plays a key role in the caching of large amounts of data that can potentially be accessed by many different users. Such a kind of distributed storage allows hospitals to offer their health care professionals remote and location independent access to high volume patient image data for diagnostic purposes, made available by tertiary imaging facilities.

HPC platform to deal with inverse scattering problem due to diffraction tomography scanning
Medical imaging departments in hospitals still scarcely use the multiview imaging procedure, known as diffraction tomography. During the HPCN'99 conference track on medical applications, Dr. Theofanis Maniatis from the Technical University of Athens, proved that this method, allowing to reconstruct cross-sections of an object from scattered field measurements, can be successfully implemented in a high performance computing (HPC) environment. The HPC platform enables to solve the time-consuming inverse scattering problem which consists of finding the object's shape and refractive index. The algorithm parallelization makes it possible to speed up both the integrals' calculation and the cost function partial derivatives with respect to the unknowns in the non-linear optimization method. Fast execution of the inverse scattering algorithm turns diffraction tomography into a feasible and clinically realistic medical imaging application.

Neuro-navigation techniques visualize boundaries between sick and healthy tissue in the brain-pan
At the University Hospital in Utrecht (UMC), physicians apply so-called neuro-navigation techniques to distinguish healthy tissue from cancer tumours during brain surgery. The combination of information technology with mechanics allows to accurately determine the boundaries between sick and healthy tissue in medical imaging. As a result, the most deeply seeded tumours can be removed with great precision. The coordinates of the various surgical instruments in motion are projected upon the Magnetic Resonance Imaging (MRI) scan which visualizes the tumour to be eliminated. The doctor can navigate the operational microscope in such a way that the surgical field remains visible at any moment.

Snomed RT and Read Codes to be combined into an international terminology of health
The vision of a unified international terminology supporting the integrated electronic medical record was advanced by the announcement of a historic collaboration between CAP or the College of American Pathologists and the United Kingdom's Secretary of State for Health on behalf of the NHS or National Health Service Executive. The agreement calls for the cooperative development of a new work which combines Snomed RT, CAP's Systematized Nomenclature of Medicine, with Version 3 of the Read Codes, being the NHS thesaurus of health care terms. The contract was signed on April 14th 1999 and signals a major milestone for the international medical community.

First live hip replacement surgery webcast on Arthritis Action Day
May 1999 has been proclaimed National Arthritis Month in the United States. At this occasion, America's Health Network announced the webcast of a live hip-replacement surgery on May 18th, as part of Arthritis Action Day. The procedure, to be performed by Dr. Scott Oliver at Jordan Hospital, Plymouth, Massachusetts, would enable Richard Shurtleff, 69, to once again walk without the need for crutches. The webcast has been the first Massachusetts surgery live on the Internet for public viewing.

Artificial Intelligence programme to teach itself accurate assessment of prostate cancer treatment options
Northwest Prostate Institute is a Northwest Hospital clinic, which is dedicated to the diagnosis, treatment and research of prostate disease and cancer. Dr. Leroy Korb is attached to this institution in the capacity of board certified radiation oncologist. Together with Jeff Brandt, Ph.D., president of Xaim, Inc., he has introduced an innovative medical software at the annual American Cancer Society Science Writers Seminar in Miami, that is used for artificial intelligence or artificial neural networks. This highly efficient new method, which is applied to assist both physicians and patients in choosing effective treatment options for organ-confined early-stage prostate cancer, was originally developed for military uses.


LION Bioscience introduces job management to bioinformatics
Bioscience AG will bundle the Codine resource management system with its "bioSCOUT"! bioinformatics applications and products. The combination of company-wide bioinformatics systems with Codine allows network-wide users of "bioSCOUT"! to achieve faster and more reliable results. Bayer Leverkusen is the first customer of the combined product.

HBSI selected as 1999 Computerworld Smithsonian Award finalist for its visionary use of IT in medicine
The Computerworld Smithsonian Awards (CWSA) programme each year identifies and recognizes remarkable achievements of individuals as well as companies in their application of information technologies for the benefit and improvement of society. The established categories cover different fields, such as business, education, and medicine. For the 1999 award in medicine, HBS International has been selected as one of five finalists. This provider of outcomes management systems to the health care industry was nominated for the HBSI EXPLORE, a powerful clinical analysis and resource utilization database.

Alternans Test to accelerate preventative treatment for patients at risk for cardiac arrest
Cambridge Heart, an American company established in 1992, has designed a new test system to identify certain patients at risk for sudden life threatening arrhythmia or cardiac arrest and resultant cardiac death (SCD). The United States Food & Drug Administration (FDA) has given the company clearance to market its non-invasive cardiac diagnostic test, called Alternans Test. Cardiac arrest incidents are responsible for more than 300.000 lives a year in the United States and as such the number one cause of death. The Alternans system works like a "super stress test", that measures extremely subtle beat-to-beat fluctuations in a person's heartbeat, referred to as T-wave alternans.

LINKMED offers on-line programme design and implementation assistance to case and disease management professionals
To support health care professionals with the development and deployment of care management initiatives, ThinkMed offers a new on-line resource. LINKMED in fact is a compilation of more than 125 Web sites that serve as valuable resources for planning, implementing and/or evaluating care management programmes and strategy. The different sites are grouped by categories including: health & medical supersites, disease- and condition specific resources, government sites, associations/conference opportunities, the business of health care, and trade publications.

L&H to acquire Fonix' Articulate Systems Division and launch medical market's first continuous speech dictation and reporting solution
Lernout & Hauspie (L&H), the Flemish expert company in speech technology, has signed an agreement to acquire substantially all the assets of the Fonix Healthcare Solutions Group (Articulate Systems). The move is expected to transform L&H into the leading provider of speech and language technology solutions to the medical market. The additional product offerings and resources obtained from this acquisition will allow L&H to expand its continuous speech product offerings from departmental-oriented solutions to those that address the total health care enterprise. The agreement will add the award-winning PowerScribe Radiology and Emergency Medicine systems, its blue-chip customer base and the sales, marketing, client services and development staff to L&H's Industry Solutions Group.

Building a digital imaging laboratory with HP's suite of echocardiography image-management tools
Three comprehensive and scalable solutions usher in the birth of the digital imaging laboratory. Hewlett-Packard Company has developed a series of innovative tools for advanced echocardiography image-management, ranging from on-board study management to fully networked systems. The suite of capabilities includes the new HP Study Manager, an on-board study-management application, the novel HP integrated digital interface, and also the HP EnConcert echo-information management system. The delivery of the digital laboratory is bound to change the face of echocardiography, as stated by Greg Petras, general manager of HP's Imaging Systems Division.


Call for papers: Special T-ITB Issue on Mobile Telemedicine and Telehealth Systems
A call for papers on behalf of the renowned publication IEEE Transactions on Information Technology in Biomedicine is launched by Dr. Robert S.H. Istepanian, as editor of the Special T-ITB Issue on Mobile Telemedicine and Telehealth Systems, to appear in March 2000.

Multimedia symposium on anemia management in dialysis patients posted on the Web
The Internet electronic journal HDCN has posted a multimedia symposium about anemia monitoring in dialysis patients on the Web. The abbreviation HDCN stands for Hypertension, Dialysis, and Clinical Nephrology. The symposium contents focuses in detail on the administering of intravenous iron preparations to hemo-dialysis patients. The five lectures were originally presented at a Satellite Symposium to the 31st edition of the American Society of Nephrology's Annual Meeting. The event was supported by a grant from Schein Pharmaceutical Inc.

Protein Research at Pittsburgh Supercomputing Center is Finalist for Science Award
Research at the Pittsburgh Supercomputing Center on how a new born protein changes into its mature shape has been nominated finalist for the 1999 Computerworld Smithsonian Award in Science. The project, that is a collaboration between PSC and two scientific researchers of the University of California in San Francisco, Peter Kollman and Yong Duan, is the longest-ever simulation of the folding action of a protein.

BioLogix to build out both professional and consumer medical community on the Internet
BioLogix International Ltd. is moving very fast these days. The company has entered into an exclusive development agreement with BigBook designer BigOnline to build a medical community for its Internet subsidiary, the MED TEL Corporation. The move bolsters its already strong competitive position within the e-health portal industry by adding a professional provider and physician network to its consumer-based health supersite and world of virtual health and medical reality. Moreover, this consumer Health Channel is the first major Web portal to deploy Infoseek's highly acclaimed Ultraseek Server Content Classification Engine (CCE) for managing massive amounts of health-related content and providing the user with easy topical browsing and searching.

Physicians on the Internet Conference pictures rapidly transforming Internet landscape
Jim Clark, founder of key Silicon Valley companies, like Silicon Graphics, Netscape Communications Corporation and recently, Healtheon Corporation, was invited by physicians and key technology industry leaders to discuss how doctors and the Internet can interact to deliver more effective, better quality health care. The presentation was held last month during the Physicians on the Internet Conference in San Francisco.

Innovative technologies for neurological surgery to conquer the market
According to the article "New Developments in Neurological Surgery", which appeared in the March 1999 issue of Medical Data International's magazine MedPro Month , new technologies in the areas of imaging, navigation and localization, as well as brain mapping and stimulation are reshaping the neurological surgery market and creating significant novel market opportunities for companies, that are well-versed in integrating advanced imaging, sensing, tissue ablation, microsurgical, and information technologies.