February 1998

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. Virtual Medical Worlds Magazine is sponsored by HPCnet and 4S.

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

ITIS'98 - Conference and Speaker's corner: the sequel
From April 21st till 23rd 1998, ITIS'98 or the First International Conference on the Telemedical Information Society is welcoming speakers from around the globe at the RAI Conference Centre in Amsterdam. They will talk about their experiences and offer their expert opinions on the role of telemedicine in the future world of health care. The Virtual Medical Worlds Magazine will cover the event and is hosting both the official ITIS'98 Conference site and the discussion platform.

Virtual Reality merges with Euromed's Virtual Medical Worlds through supercomputing
One of the important goals Euromed is striving at is to introduce Virtual Reality within the concept of Virtual Medical Worlds. This integration requires a vast amount of computing which has to be achieved by building up a meta-centre, similar to what is currently being developed in the USA through several initiatives such as the CASA Gigabit network. Euromed's collaborative network, consisting of the Universities of Calabria, Amsterdam, Joensuu and Athens and connected by the Internet, already has realised this Hierarchical Computing Facilities Infrastructure (HCFI) offering a virtual computing centre supplying heterogeneous computing platforms. At present, this meta-centre is creating complex VRML medical models to support activities such as the medical imaging requirements of the Virtual Assisted surgery. In this regard, Euromed is focusing on the ANALYZE project lead by the Mayo Clinic in Rochester to serve as a model.

Sick children learn and play through hospital intranet
The London St Bartholomew's Hospital recently has been provided with an internal network of multimedia PCs at its children's unit. According to The Times, the children's charity, Express Link, has invited a group of IT suppliers including Microsoft, Gremlin, Mind Kind and BT Syntegra to set up this intranet in order to run interactive software for education and entertainment as well as e-mail. The possibility of communication between St Bartholomew's intranet and similar projects in Derby and Sheffield already has been envisaged.

Mayo Clinic still going strong after ten years of intranet pioneering
The Mayo Clinic has built up a unique experience in the use of intranet for effective health care management. Treatment protocols and information transfer between individual caregivers are no longer organised in physical meetings but through computer communication which saves printing and distribution costs. Since most intranet applications involve the handling of confidential patient records, the security issue has been taking very seriously during the past decade. A separately installed data security department is dealing with the huge technical problems of safe intranet data traffic. The greatest challenge of all lies however in the delicate human factor to make the Mayo health care colleagues, spread over the different departments, aware of the importance of mutual information exchange.

Telemedicine technology connects North Dakota nursing homes to distant health care resources
The Rural Utilities Service of the U.S. Department of Agriculture has awarded the Evangelical Lutheran Good Samaritan Society and the National Institute for Long Term Care with a grant through its Distance Learning and Telemedicine Grant Program to support a growing telemedicine network in western North Dakota. The Society selected the Californian systems integration company CyberOptions, Inc. to install its Integrated Telemedicine Workstations (ITW) into the first three sites at the long term care centres in Crosby and Noonan and at the Crosby Clinic. Other sites will soon follow. Frail elderly people in remote areas thus will benefit from the critical health care resources in distant hospitals and clinics.

For your ears only: eavesdropping with Hearmaster
Two Danish companies have worked together within the Esprit Hearmaster project to set up promising techniques of mixed-signal testing for the new generation of hearing aids using Digital Signal Processing (DSP). Oticon A/S, a hearing-aid manufacturer founded in 1904, introduced the world's first digital hearing-aid, DigiFocus, in 1995. The test system vendor, MicroLEX Systems A/S, has managed to develop a new method for qualifying DSP features so the DigiFocus product can adapt better than earlier models to the surrounding sound environment, providing maximum speech recognition and avoiding unpleasant sound distortions.

HIPOCRAT hybrid circuit turns the new pacemaker generation into smaller yet more powerful prostheses
Four companies are working together in the Esprit supported project HIPOCRAT to develop a miniature low power hybrid circuit devoted to human implantable cardiac prostheses such as pacemakers and defibrillators. The overall aim is to design a family of three integrated circuits (ASICs) using technologies based on submicronic mixed Analog/Digital CMOS and high voltage protection processes. The new hybrid circuit is intended to be half size and three times less consuming than its predecessors. Since this kind of prostheses lasts longer, the cost savings for health care systems are considerable.

Smart blood micro-pumps improve cirrhotic liver perfusion
Although alcohol abuse is the major cause of liver cirrhosis in the western world, infection with hepatitis B and C viruses affect the livers of about 800 million patients in the underdeveloped countries. This development of fibrous tissue in the liver causes an important decrease of portal blood flow amounting to portal hypertension. Thus, an unstable network of blood vessels is created. These varices in turn are the cause of uncontrollable bleeding from which a patient can die without swift intervention. Researchers have now designed an implantable blood micro-pump to go inside the hepatic portal veins and by driving blood through the liver reduce the intra-portal pressure. The people responsible for this IMALP project hope to prolong the active lives of liver patients until a transplantation can be offered.

Virtual environment trains surgeons
The Department of Computer Science at the University of Hull and the Orthopaedic Department of the Hull Royal Infirmary and Castle Hill Hospital are currently developing a Virtual Environment Knee Arthroscopy Training System (VEKATS) offering trainee surgeons an effective environment to acquire skills such as triangulation, orientation and dexterity, necessary to perform an arthroscopic procedure. VEKATS is trying to integrate the advantages of both video-disc based and computer graphics based surgical simulators in order to serve diagnostic as well as operative purposes. Deformable objects are introduced permitting the trainee to interact in real-time with soft tissue. At present, the research team is working on a prototype force feedback device allowing the student to get a feel for the hardness of the bone and the flexibility of the soft tissues.

Five telematical ways of introducing telemedicine in the surgery room
There must be fifty ways to leave your lover but only five suffice to get a taste of computer assisted surgical intervention in the operating room. Michael Nord, a surgeon and telemedical expert from Strasbourg, guided the audience at the International Symposium on Telemedicine, organised last October at the Brussels Military Hospital, through the five high-tech gateways leading up to laparoscopic surgery. This new approach invites the surgeon to collect information through databases and guidelines in order to simulate procedures on a graphic station by using adequate patient data and by requesting interactive support from a distant expert.

The teleradiology think tank of the Dutch Armed Forces
Surgeon captain H.J. Prins was invited at the International Symposium on Telemedicine in the Brussels Military Hospital to give a short account of the telemedicine project within the Dutch Armed Forces. This expert, based at the Central Military Hospital in Utrecht, first offered a brief, yet interesting history of the general subject before entering into the specific details of the telemedical efforts in the Dutch Army, which are being focused on teleradiology. A story full of challenges to accept and difficulties to overcome with the aim of delivering optimised medical care and education for the soldiers and their families in times of war and peace.

Reconciling ethics with electronics: a telemedical challenge
A sensible use of the various telemedical resources to enhance the common welfare implies a sound philosophical consideration with regard to the ethical consequences of the new technological developments in health care. Dr. Koen Raes, professor at the University of Ghent, highlighted the most critical and moral aspects in telesurgery and telediagnostics at the International Symposium on Telemedicine, last October in Brussels. His final conclusions can be summarised in the general creed: patients before technology. A not so commonplace statement as one perhaps might be inclined to think...

CHARMing 3-D simulation of the musculoskeletal structure will lead to promising applications
Many separate research fields would certainly profit by an information database as a comprehensive resource on the human body and its dynamics. Starting from medical data out of the Visible Human Database (VHD), the CHARM project, supported by Esprit, is developing a Comprehensive Human Animation Resource Model to generate a 3-D computer model of the human body including bones and soft tissue structures in order to define associated simulation procedures for finite element deformation. Initially, the project has been focusing on the shoulder-arm complex which constitutes one of the most complex articulations in the body.

CITATION Computer Systems releases new radiology software
CITATION Computer Systems, Inc., a company based in Saint Louis, has developed a Microsoft Windows NT radiology software, called C-RIS. The installation at several sites is being undertaken at present. C-RIS is bound to pay great services in multi-site and integrated environments, according to John Selestak, Vice President, Marketing of the Missouri company.

Norwegian hospitals communicate through ATM-based network
Dagens Telecom has announced the installation of an ATM-based network at Ullevl hospital in Oslo by Telenor. Transmission of high-speed voice and image data will soon be established between Ullevl and other hospitals in Oslo, Akershus, Hedmark and Oppland by using Asynchronous Transfer Mode (ATM) technology. According to Telenor, Norway outperforms the USA when it comes to telemedicine.

Medical students get audio-visual training through ATM
The Times announced the installation of an Asynchronous Transfer Mode (ATM) network at the United Leeds Teaching Hospital in the UK. This technology offers students audio-visual teaching directly from the operating room.

Neural networks that cure, whatever you do
The medical field is presenting itself as an ideal implementation environment for research and development into neural networks. Physicians have discovered the useful assistance neural networks can deliver in various therapeutic and diagnostic decisions. Their precise and rapid data analysis reduces a meaningful part of the human workload.

English patients will get on-line within five years
The English government has invested #150 million in telemedicine. Recently, The Financial Times reported on the initiatives which Alan Milburn, minister of health, has taken to offer patients an on-line health care service in the next five years.

FORE ATM to build high performance network for Gen-Probe
Gen-Probe, a developer of advanced genetic probe diagnostic tests for human health care, recently opened a public bid for the installation of a high-performance network in its new corporate headquarters. The price/performance objectives were kept within strict limitations leaving the vendors with the challenge to offer the highest quality for an edged price. FORE ATM was the only one to meet these severe demands without cutting down on service and technical support.

The new age of Telemedicine, Telesurgery and Virtual Reality
During the International Symposium on Telemedicine, organised by the Belgian Armed Forces in Brussels on October 8th 1997, retired Colonel Richard M. Satava, Professor of Surgery at Yale University, used the Gulf War as an example to illustrate the impressive power of modern information technology and its implementation on military medicine. New approaches in health and trauma care slowly are breaking through. Medical care takers are forced to adapt to thinking in Information Age terms instead of clinging to traditional Industrial Age definitions.

Scientists in Singapore develop Virtual Brain Bench for stereotactic frame neurosurgery
Brain surgery involves the adjustment of a stereotactic frame attached to a fixation device which is rigidly screwed to the skull. Scanning always precedes the actual intervention in order to precisely locate the patient's target lesions. Up till now, no software has assisted in the initial placement of the fixation device which holds fiducial localiser markers during scan as well as the stereotactic frame during surgery afterwards. At the National University of Singapore (NUS), Dr. Luis Serra is currently leading a project to develop a Virtual Brain Bench in which the user can manipulate a computer model of the stereotactic frame to plan against registered brain structures from both the Electronic Brain Atlas and the patient's individual data. Last december, Tomorrow's World , a scientific BBC TV broadcast, reported on the latest results of brain surgery rehearsal at the NUS-based Institute of System Science (ISS).

Towards telepsychiatry as a value-added business
John Bennett, member of the Administrators in Academic Psychiatry (AAP) and working at the Michigan University, on several occasions has reported on the development of telepsychiatry as an application of telemedicine. In the AAP Magazine Grapevine, he clarifies his viewpoints on what role technology can play with relationship to telepsychiatry as to reduce costs in patient treatment while at the same time adding value to the psychiatric health care. Bennett suggests we should have a look at the commercial business experiences of the eighties where downsizing had to be reconciled with process re-engineering in order to stay alive and competitive.