April 1998

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ITIS98logo Visit the website of he first International Conference on the Telemedical Information Society (ITIS '98)

ITIS'98 - your last chance to participate
It's kind of hard to imagine, but some of you may still have some doubts about whether attending the first International Conference on the Telemedical Information Society really would be worth your while. Well, here is your last chance to shake off your scepticism and to join a fascinating discussion platform that will explore the tremendous potential of a revolutionary and creative approach to health care on the verge of the 21st century. Just be sure to be there in Amsterdam on this month's 21st!

Exploring the medical applications of virtual reality techniques in the Dutch Cave
The Parallel Scientific Computing and Simulation Group (PSCS) of the University of Amsterdam is one of the main partners in Euromed, the project which aims at enhancing and standardising visualisation techniques to be used in telemedicine applications throughout Europe. Over the last ten years, the PSCS group has gathered an impressive expert knowledge with regard to the modelling and simulation of Dynamic Complex Systems as well as to the efficient mapping of these simulations to High Performance Computing (HPC) Systems. Dr. Jaap Kaandorp and researcher Robert Belleman are proud to dispose of an excellent infrastructure, among which the recently installed advanced Cave Automatic Virtual Environment (CAVE) plays an important role in the 3-D visualisation of medical data and in the creation of simulation techniques for surgical applications.

Advanced medical image analysis on the Web
The Laboratory for Clinical and Experimental Image Processing (LKEB) at the Medical Centre of the University of Leiden is actively supporting the specific mission of the Euromed project to enable doctors at remote locations to access advanced medical imaging analysis software, available at various specialised centres in Europe. Responsible project leader at Leiden, Rob van der Geest, is working on the establishment of a protocol, allowing the local doctor to receive and even control the result of the image analysis over the internet in graphical format. The elements needed to fulfil the required data transfer are a network connection and protocol, known as the generally available X-Windows System; a powerful software package, like for instance MASS; a DICOM-PACS archival system, and a special WWW-page. The correct implementation of all these ingredients produces the desired time- and-money-saving connectivity.

How to gain Web access to an image database
At the University of Joensuu in Finland, researchers Tuomo Kauranne and Alexander Kolesnikov have developed a tool for interfacing a Digital Imaging and Communications in Medicine (DICOM) image database with the World Wide Web (WWW). As one of the four telemedicine platforms, the University of Joensuu is a major partner in the Euromed project with regard to remote medical analysis applications. The research team has chosen to work with a server-side HTML-embedded script language, called PHP/FI, which allows items in the database to be created, retrieved, updated and deleted. To use the WWW-DICOM system, the end-user runs his WWW-browser requesting the PHP/FI scripts via a query form to start consultation or manipulation of the required medical images.

The blessings of ANALYZE for Computed Aided Surgery reduces patient risk
The successful marriage between high performance computing and sophisticated imaging systems for the production of multi-modality three-dimensional images of top quality has created an ideal opportunity for significant improvement in pre-operative surgical and treatment planning, as well as in post-operative evaluation. For more than a decade, surgeons at Mayo Clinic in Rochester have been developing, using and assessing the ANALIZE software system for interactive visualisation, manipulation and measurement of 3-D medical images. At present, over 3000 medical scientists, physicians and surgeons in more than 200 institutions throughout the world are working with ANALYZE for Computer Aided Surgery (CAS) and Radiation Treatment Planning (RPT) in various applications such as craniofacial, orthopedic and neurosurgery planning as well as radiation therapy planning. Undoubtedly, ANALYZE will result in minimised patient risk and morbidity and in a substantial reduction of health care costs.

The grapes of VRASP: a story of natural fermentation
The ANALYZE software system developed by the Biomedical Imaging Resource (BIR) at the Mayo Clinic in Rochester has rendered such tremendous services for both surgical planning and post-operative evaluation in different medical fields, that it has been split up into a library of functions, called AVW or A Visualisation Workshop . The AVW library provides a ready extensibility as well as a renewed development and implementation of advanced imaging algorithms, procedures and customised applications. In turn, AVW has led to the creation of a Virtual Reality Assisted Surgery Programme , known as VRASP, allowing the surgeon to benefit from the ANALYZE and AVW assets in the hospital operating room (OR) itself, for the optimisation of planning, rehearsal and, eventually, even surgical intervention.

EchoPlus imaging software defines acute brain infarction
The General Electric Medical Systems Company is a well known developer of medical imaging equipment. The EchoPlus diffusion-weighted imaging software constitutes the latest addition to its product's assortment and has recently been cleared by the American Food and Drug Administration. The package has been designed for the company's Signa Horizon and Signa Horizon LX magnetic resonance (MR) imaging systems in order to facilitate the detection and specification of brain tissue changes for particular disease conditions.

CONVERGE data warehousing system runs on AViiON family of servers
Health care organisations are desperately in search of integrating information systems to meet their challenging data management demands. Data General Corporation and Atlanta-based Systems Techniques, Inc. (STI) have decided to work together in order to market STI's CONVERGE Integrated Data Warehousing System with Data General's AViiON family of Intel-based servers, which support Unix as well as Microsoft NT. The alliance between both companies should provide a delivering answer to the crying need for an end-to-end data warehousing solution for the health care industry.

New health care triumvirate for US manages care organisations
Three expert companies in health care technology have united their forces in order to deliver a technological and administrative infrastructure to provider-based managed care organisations across the United States. The infrastructure will include Data General's NT AViiON enterprise servers and CLARiiON storage systems, Health System Technologies' Trillium Managed Care Information System and, Innovative Outsourcing's technology and administrative services. Together, the service provider and the two vendors will supply a competitive and efficient outsourcing solution for the health care industry.

Hewlett-Packard named medical systems supplier at the soccer World Cup 98
Starting from June 10th 1998, the XVI soccer World Cup is being played in France where 64 matches are scheduled in ten cities. The medical support for such a big sports event constitutes a challenging job for the French Organising Committee. Emergency care has to be readily available in each of the ten World Cup venues. In every participating stadium, four emergency rooms staffed by highly skilled physicians, will be installed to stand by in case of serious injury or illness. On top of this, Hewlett-Packard (HP) Company's Medical Products Group has been assigned as official patient-monitoring and defibrillator supplier to the tournament.

"Tim-Tem" creates model for emergency care on remote islands
The Greek isle of Tilos and the Department of Surgery of the University of Pisa have been respectively selected as the operative and the scientific as well as organisational seats for the "Tim-Tem" experiment. This Tilos Medicine & Tele-medicine project has been set up to create an exportable model for first aid telematic assistance during emergencies on European isles and in isolated regions with no hospital. The programme runs from October 1997 until June 1999 and consists of three phases. First, the project members will execute a clinical and ecographic mapping of the local population which will permit access to a "Dispatch System" in the second stage. Finally, a number of operative telemedicine applications are planned. As an additional purpose, the experiment aims at improving health care facilities in the tourist season.

A concept for computer assisted oral implant planning
In the Laboratory for Medical Imaging Research (ESAT) at the University of Leuven, Professor Verstreken and his team are designing a system for oral implant surgery planning. The initial input consists of Computer Tomographies (CT) of the jaws, combined with three-dimensional surface rendered models of the bone. These images are integrated in a specific kind of Computer Aided Design (CAD) implant models. The thus obtained views are exported to an HTML format in order to be shown in the operating theatre, with use of netscape as an HTML browser. The final step to be taken includes the interactive guidance during surgery, which is currently being investigated.

From multiplanar reformation to virtual endoscopy: a survey of medical visualisation techniques
At the University of Erlangen in Germany, some thorough research is going on with regard to the rapid developments in medical imaging. The academic experts, Markus Blank, Ralf Petzold and Willi Kalender have given an account of the progressive improvements in visual data rendering which finally have resulted in virtual endoscopy (VE). VE presents itself as a powerful tool that might partly substitute the invasive process of conventional endoscopy in the near future. The so-called fly through procedure allows the physician to conduct a more effective examination providing better comfort for both patient and operator.

Southern Sweden integrates telemedicine as part of daily hospital life
Between the hospitals of Southern Sweden, the transmission of digital x-ray images and the use of video conferencing are steadily being transformed into a daily routine, according to Telecom Idag. A majority of the Swedish county councils already reserve a part of their budget for investments in telemedicine technology.

Telemedicine system tested by astronauts in space
Aboard the space shuttle Endeavour, the Telemedicine Instrumentation Pack (TIP) developed by the KRUG International Corporation has been successfully tested by two astronauts especially trained to use the system. As a result, the TIP will be applied on earth to examine patients in remote areas around the world.

Share sell-off helps CompuMed to develop digital densitometer
CompuMed, a Californian company, specialises in providing solutions to medical problems with the aid of computer technology. Recently, a sale of 8750 shares has been completed for $875.000 to a group of institutional and accredited investors. The proceeds of the sale will enable the company to accomplish further developments to their digital OsteoView(TM) densitometer.

Cooperative ConNEXTions supports telemedicine services among others
In the USA, two regional transmission and generation cooperatives are partnering in a new regional services company (ServCo), called Cooperative ConNEXTions LLC. This strategic support services company will provide a wide range of facilities to its customers, such as telephone, television, Internet, system monitoring, equipment financing, appliance repair and service, home security with medical alert, and interactive learning. In addition, telemedicine will form an important part of the package.

Lucent Technologies markets videoconferencing system developed by AG Communication Systems
AG Communication Systems, based in Phoenix, manufactures advanced telecommunication products and provides access, wireless and intelligent network services. In order to commercialise the ATIUM VIA 188 video code and network management and scheduling software, the company has signed an agreement with Lucent Technologies, a public and private network builder and supplier of communications systems and software as well as microelectronics components, headquartered at Murray Hill. Together, both companies will be able to deliver, among other services, the computing capacity for the supply of telemedicine applications.

Reimbursement for telemedical consultations approved by American Congress
Recently, the American Congress agreed to a slightly amended version of the proposal introduced by Senator Kent Conrad on the telemedicine reimbursement for rural Health Personnel Shortage Areas (HPSAs). For the first time, the USA government has approved reimbursement of federal funds for regular, on-going medical consultations. Experts predict that the new legislation will yield 100 to 200 million dollar per year for telemedical health care delivery, starting from January 1st, 1999.

Virtual simulation system SeeImpact analyses and prevents neck injuries
The Medical Simulation Group at the Institute of Systems Science in Singapore has set up a project in cooperation with the Defence Medical Research Institute to develop a biomechanical model-based simulation system which is capable of recreating the environment in order to analyse neck injuries under various circumstances. The virtual reality system, called SeeImpact, comprises a model of the human head and cervical spine including the possibility to generate bone stresses and muscular forces. The research team wants the computer program to serve both as analytical and predictive tool for the end user. Extension and modification of the simulation model for related applications are being envisaged.

Telemedicine Program supports psychiatric care in Georgia
The state of Georgia is reorganising its inadequate and poorly distributed mental-health services into nineteen different regions. In parallel to this initiative, the Medical College of Georgia (MCG) involves its Telemedicine Centre in an operation that will render psychiatric care and continuing education more readily available to the mental-health care professionals and the public. This program is funded by a 1,5 million dollar National Patterns of Academic Excellence grant from the University System of Georgia Board of Regents. The education process also includes the establishment of a learning centre on the MCG campus where psychiatrists will be trained on how to use telemedicine.

Primary health care in American Vet Centres goes telemedicine
In the USA, combat or traumatised veterans can get medical counsel through a network of so called Vet Centres which is organised nationwide by the Department of Veterans Affairs (VA). At present, the tremendous advances in telecommunications technology are being used to expand the primary health care programs within these centres. Twenty locations benefit from a three million dollars provision in equipment and startup operating costs related to telemedicine. Ten Vet Centres receive another one million dollars to enhance their conventional medical services.

Hemodynamic model simulates interaction between coronary arteries and interventional equipment
Coronary artery problems constitute a delicate matter. Traditionally, interventional cardiologists use percutaneous treatment to cut and remove arterial plaque, but they often experience severe difficulties in predicting the final outcome of the operation. Additionally, the assessment of the specialised equipment is still based on crude models of the coronary arterial tree. In order to refine the process of coronary revascularisation, the Medical Simulation Group at the Institute of Systems Science (ISS) in Singapore has a plan to develop a computable hemodynamic model which will assist in the pre-treatment planning of complex cases by means of realistic simulation in virtual reality.

How to rate health care sites on the Internet at their true value?
The search for valid health information on the Internet may not turn out to be all that easy as it looks. Health professionals as well as patients experience great difficulties to orient themselves, surfing the wide ocean of health care data available on the Web. Dr. Alejandro R. Jadad and Anna Gagliardi, two researchers at McMaster University in Hamilton, Ontario, have tried to make a survey of Internet resources that review and rate Web sites providing health information. They were able to identify forty seven rating instruments that are used for validation purposes, but discovered that many of them were incompletely developed. This has led them to ask whether such instruments should exist in the first place. Do they measure exactly what they claim to measure, and finally, do they lead to more good than harm?

Russian expert joins American health care information systems integrator
The world-renowned health care expert, Victor S. Dorodny, has been appointed as Director of Health Affairs for Aviant Information Inc., a systems integration and consulting services corporation. In this newly created function, Dorodny will offer tactical and strategic guidance in order to support the company's health care information systems customers. Aviant already combines an experienced staff of medical professionals as well as networking specialists to develop effective solutions which improve information access for health care organisations all over the world.

Visible Human Datasets form basis for "endoscopic virtuality"
Dr. Richard Robb is one of the leading experts in the Biomedical Imaging Resource at Mayo Clinic in Rochester, involved with the progressive development of virtual endoscopy (VE) as a diagnostic and clinical tool. He actually prefers the term "endoscopic or computed virtuality" since it specifies more accurately the essence of simulated visualisation of patient specific organs based on computer processing of 3-D image datasets. The current availability of the Visible Human Datasets (VHD) from the National Library of Medicine offers a tremendous opportunity to turn VE into a reliable alternative for real invasive endoscopy, allowing viewing angles that up till now were inaccessible. True, a number of technical problems still need to be solved concerning image resolution and rendering, segmentation, registration and appropriate preparation of the data in order to refine and validate the simulation for routine clinical use. Very soon however, physicians will boldly enter regions of the human body which no eye has ever beheld.

Da Vinci simulates interactive catheter insertion for training purposes
Among the multiple medical simulation projects, set up at the Institute of Systems Science in Singapore, researchers have also developed an interactive simulator for visual navigation of a catheter insertion. A varied choice of patient models, lesions and interventional tools is provided to enhance the realistic impact of the performance. The 'da Vinci' project will support surgeons in their training efforts and their pre-operative planning, as well as designers in the building of appropriate devices for medical use.

Cath Works optimises interventional device design, testing and validation
Interventional device manufacturing has become a very lucrative business, emerging from the high-technology development in the medical field of minimal invasive surgery. Yet, designers face some serious problems which are causing development costs increase due to both faulty communication with physicians and the absence of a realistic environment to test and validate their concepts. In addition, new products are submitted to a long cycle of designing and testing before they can actually be used in the hospital. The Cath Works project, set up by the Institute of Systems Science in Singapore, therefore aims at improving the effectiveness of mechanical prototyping with the application of the advanced technologies of computer visualisation, engineering analysis as well as design and image processing.