Dr. Douglas C. Schmidt, associate professor of computer science at Washington University in Missouri, has transformed Java, the Web's most popular programming language, into a system for electronic medical imaging via the Internet. The MedJava solution will be implemented in the ambitious Project Spectrum which has to interconnect the independent heterogeneous computer systems of 18 acute care facilities and over 5500 physicians into a single integrated network within the BJC Health System, the multihospital affiliate of Washington University. Since a growing number of clinics aims at the conversion from film-based technology to digital image acquisition and transmission, MedJava seems to constitute the appropriate tool to promote teleradiology as a means for remote diagnostic conferencing and eventually for distant surgery.
MedJava has been developed as a distributed electronic medical imaging system with stringent networking and computation requirements. Its performance has been extensively tested against that of xv, an equivalent image processing application written in C and C++. Asynchronous Transfer Mode (ATM) high speed networks were used to benchmark both programmes. Ten times in a row, the Schmidt team transmitted 8-bit images through eight different imaging filters while keeping the average result of the various trials. Although the xv application outperformed MedJava both in speed and image quality, the latter showed superior flexibility and portability while the overall image clearness and transmission were far better than initially expected.
Taking into account that the image processing requires a vast computational power, MedJava performs extremely well in teleradiology. The current Web browsers, such as Netscape and Internet Explorer, however have difficulty at rendering and displaying large images due to memory constraints. Therefore it is expected that future browser technology will be adapted to handle these kinds of remote medical imaging tasks. MedJava has the major advantage that no expensive software equipment is required for magnetic resonance imaging (MRI) and computed tomography (CT) scanners, because the most recent upgrades of all essential programmes can be directly downloaded into the browser on request.
In the meanwhile, BJC Health System abides the promising prospect of on line access to patient data via advanced clinical workstations that are linked to high speed networks in order to try out teleradiology, remote consultation capabilities, and practice management support tools. At present, images are already available for distribution from a central server at the medical facility in St. Louis to be viewed by physicians at home on their personal computer by means of specific software, according to project co-ordinator, Dr. James Blaine, who is professor of radiology at the School of Medicine. The intranet ISDN network connection was provided by Southwestern Bell, co-sponsor of the Project Spectrum, in conjunction with Kodak, IBM and Motorola.
In addition, Washington University's Mallinckrodt Institute of Radiology has installed an ISDN "off-hours teleradiology" service to facilitate the interpretation of CT and MRI images at the BJC satellite hospitals. The time-saving aspect of teleradiology will no doubt lead to substantial reductions in cost. Reason enough to replace the expensive use of X-ray film with digital and electronic image processing. Evidently, conversion involves the complex re-engineering of the entire radiology practice. Siemens Medical Engineering, the German expert manufacturer, based in Erlangen, has supported part of the research, performed by Dr. Schmidt. This company now is designing an own version of MedJava for a wide range of medical imaging devices, such as CT and MRI scanners, as well as angiography and ultrasound installations.
Dr. Schmidt anticipates that, along with the gradual maturing of the Java technology, optimized interfaces linking Web browsers to the Java Virtual Machines, will expedite the task of image rendering and processing through the use of "just-in-time" (JIT) compilers. These allow to translate Java code into alternative programming languages, used by other systems. In turn, the Java Virtual Machines execute a host of Java re-usable tools, referred to as classes. As a result, radiology will be immersed into a virtual digital world in which medical images are stored in large databases, which will be accessible via high speed networks, in order to transmit the visual data over miles of distance. There is more to learn on the filmless hospital in this month's VMW issue. For supplementary details on MedJava, please check out the Washington University's Web site.