January 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.

HPCnet - Network of Excellence

ITIS '98 - The 21st century telemedical information society in conference
It appears 1998 will turn out to be a promising year for the 21st century telemedical information society. The new and actually first International Conference on the Telemedical Information Society (ITIS '98) will be organised during HPCN Europe in Amsterdam from the 21st until the 23th of April 1998. Several key figures in the world of telemedicine will present their expert view in a lecture or will actively attend the workshop.

The search for the way to your heart through the Virtual Medical World Personal Home Page
In the VMW November issue, we reported on the twenty building blocks of the Euromed framework as a guiding structure to create the telemedical information society. One of the main active components constitutes the navigation around the web to gather the required medical data related to a particular patient. Since these data are kept in several databases over the Internet, a time gaining procedure of methodical search has to be developed to reduce the burden of surfing the web. Responding to this need, Euromed has defined the concept of Virtual Medical Worlds. Basically, this is the electronic health card record for each patient, dispersed over the network but accessible from one initial html page: the Personal Home Page.

THESIS checks health of hospital management performance
Transformation of Healthcare for Excellence in Strategy, Information and Service: this is the mission of the Esprit supported THESIS project in a nutshell. THESIS emphasises the efficiency of the hospital management process rather than the organisation of the clinical workflow in order to gain competitive advantage through the implementation of information services. Thesis Health Check (THC) is a PC-based software tool which allows analysis and improvement of the hospital key indicators to match their strategic targets and to combine them with the stakeholders' objectives. Both the Athens Medical Centre and the UK Teddington Memorial Hospital serve as pilot sites for this Business Process Re-engineering program.

Accurate and affordable radiosurgery treatment through computer simulation
Cancer forms one of the major causes of death in Europe. Radiosurgery constitutes an important help in a great deal of cases but often treatments fail, either because the tumour's sensitivity is not always optimal with relationship to radiation or the tumour might become insensitive with radiotherapy after a long treatment period. In clinical practice, commercial treatment planning systems are used which do not fully take account of the patient's internal anatomical structure. On the other hand, the much more accurate Monte-Carlo simulation system is far too expensive and time-consuming. The RAPT project has addressed this problem by developing a low-cost parallel Monte-Carlo code where the individual patient data are captured from CT images using a graphical interface.

COBRA Elective Surgery Support System benefits from business process re-engineering
The COBRA project represents an exercise in Core Business Re-engineering for which it builds upon the RICHE IT Architecture. This approach offers considerable savings by reducing duplication of work in hospitals. The IT solutions transform the clinical and administrative procedures in theatre and day surgery into efficient processes enabling the staff to improve the general performance and make more effective use of the existing facilities in these areas.

WIDE workflow system streamlines Short Stay Surgery
At the Catalonian Hospital General de Manresa (HGM), a new procedure has been organised since 1996 to try and integrate the Short Stay Surgery process into a smooth running automated workflow system. The HGM staff is collaborating with the SEMA Group, provider of the FORO method which is dedicated to the definition and use of workflow engines. FORO is being implemented in the Esprit-supported WIDE-project dealing with workflow management of enterprise-wide processes in a cooperative, distributed environment. Manresa Hospital offers an ideal project embedded into everyday reality in order to prove the efficiency of the WIDE workflow tool.

CHILI organises medical images travel over ISDN lines
Physicians since a long time have made use of medical images on film, a rather slow and expensive way of image distribution. The Steinbeis Transferzentrum Medizinische Informatik (TZMI) in Heidelberg was selected among the European IT prize finalists 1997 because of their CHILI teleradiology system which offers a cost reducing and faster solution for medical image delivery over computer networks or ISDN lines. CHILI can improve the cooperation between radiologists and clinicians via teleconferencing and patients in rural areas suffering from complicated disease are able to get consultation from experts without having to face a dangerous transport. Additionally, CHILI can be enhanced with new functions for advanced image analysis tasks, such as 3-D reconstructions or operation planning.

Giant Pentagon seduced by Dutch Dwarf Applicare's medical imaging software RadWorks
The US army constitutes the largest single care provider in the world and is aiming at implementing a network system through PACS in all its six hundred military hospitals in order to view, transport, archive and print medical images. The US Ministry of Defence selected Applicare Medical Imaging, a Dutch software company founded in 1987 and now forming part of an IBM consortium, to provide the workstations technology software for this huge project. Applicare's RadWorks visualisation package is the first one running under Windows NT. This is exactly the environment the Pentagon has chosen to standardise in all of its medical facilities. The multinational competitors still having to deal with their Unix past, the immediate availability of Applicare's technology formed a decisive factor for their final selection, according to the Dutch newspapers Automatisering Gids and de Volkskrant .

Luminescence spectroscopy optimises clinical blood gas analysis
Since quite some time, the Austrian biomedical research and development company AVL List GmbH has been focusing on the production of opto-chemical sensors. At present, AVL is selling a portable optical blood gas analyser, called OPTI 1, based on fluorescence intensity. Yet, AVL researcher Paul Hartmann recently has designed and tested within the Esprit funded QUANTUM project an imaging oxygen sensor based on luminescence lifetime or decay measurements. This new approach offers the possibility of non-invasive, quantitative and calibration-free imaging of the skin 'respiration'. The method may play an important role in the diagnosis of chronic venous insufficiency, ulcerations, wound healing, burns, amputations, micro-circulatory disturbances and the effects of drugs for improvement of circulation.

PHASE or a touch of metacomputing in the drug discovery process
The Esprit project PHASE aims at developing and implementing a distributed PHarmaceutical Applications SErver in order to deliver the power of high-performance computing onto the desks of small and medium sized industrial companies operating in the field of drug target identification and modelling. The main advantage for the users of leased high-performance processing lies in the easy access and the less prohibitive costs. PHASE not only provides the server architecture allowing introduction of job requirement specifications and submission to an automated load-balancing scheme that distributes the parallel tasks to the best suited hardware platform. It also offers a unified work-flow for the bio-informatics applications GeneQuiz, MaxHom, DRAGON and MSAP which all four contribute to the analysis of protein sequence and structure.

KneesUp lends a virtual hand to improve artificial finger joints implants
Patients suffering from rheumatoid arthritis or some kind of physical trauma often are faced with artificial finger joint implant's surgery. Most common used nowadays are one-piece silastic implants which unfortunately tend to fail within about five years. The HPCN-TTN organisation has engaged itself in the KneesUp-project to develop techniques simulating the movements of prostheses. In collaboration with the Sheffield University, the so-called SIGMA glove has been designed to output real-time kinematic data of the finger movements. Interfaced to a digitised skeleton of the hand on a PC, the 'virtual hand' on screen precisely indicates by means of finite element analysis techniques the critical stress-spots in silastic prostheses.

Blind may regain sight through optic nerve stimulation
The best way to rehabilitate blindness is to directly act upon a peripheral and passive neural structure instead of direct stimulation of the visual cortex or of the retina. This is only possible when the optic nerve fibres are electrically activated in a safe and selective manner. Researchers have developed a prototype of a Microsystems based Visual Prosthesis (MIVIP) interfaced with the optic nerve. This three years Esprit supported project might be able to help about 140.000 blind people in the industrialised countries.

The BARMINT demonstrator: a corner-stone in the development of microsystems
Under the wings of the Esprit program, researchers from various universities, institutes and laboratories throughout Europe since 1993 are engaged in a long term project called BARMINT. Together, they work on the identification of processes and tools needed for the development of microsystems. The results of their research form a substratum of elements to be used for the production of medical and other devices. Recently, a demonstrator has been finished which includes a micropump, a multisensor measuring chamber and the allied electronic technologies, the whole associated with 3-D assembly processes.

WebCDs and Push technologies lined up against breast cancer to try and "Break IT"
Interactive Labs, part of the Italian Giunti Publishing Group, is concentrating on hybrid solutions to bring together the communication effectiveness of CD bandwidth and the information updating capability of Web based systems. The WebCD concept is used for several different integration levels which are now being implemented on the marketplace. In collaboration with leading European medical content providers such as the British and Italian Cancer Research Institutes and the European Working Group on Breast Cancer Screening, Interactive Labs has launched the Break IT project as a case study to tackle both target training and informative needs applying WebCD and Web Push technologies on the highest level to deal with breast cancer detection and pathology.

RICHE accomodates Hospital Information Systems to the latest IT needs
The hierarchical health care system depends on profound mutual collaboration between general, specialised and local hospitals. Additionally, it has to offer an ever growing range of services without any supplementary budget being provided. Group Riche, a non-profit making organisation, has acknowledged this need since 1989 by promoting an open approach to Information Technology in order to transform the Hospital Information System (HIS) into a smooth running organisational tool.

Flat panel sensors generate digital real time X-ray images
Conventional methods of X-raying rely on photographic film technology which is quite expensive, time-consuming and inconvenient because of the necessarily applied radiation doses. Among the results of the Esprit program, the MEDID project offers an efficient alternative for digital radiography in the shape of a non-chemical flat panel detector. This solid-state device is based upon silicon technology and digital signal processing to convert X-rays into a high-quality digital image. As a major advantage, the system provides real time performance with low radiation doses. The digital images can also easily be stored and retrieved, visually enhanced as well as transmitted to other locations for remote consultation.

NICE endeavours 3-D ultrasound heart scan
During the European IT Conference and Exhibition which took place in November 1997, the people responsible for NICE, one of the Esprit projects devoted to medicine, showed a video presentation of 3-D ultrasound scanning on the human body and on the human heart in particular. The realisation of real-time volumetric imaging will mean no less than a breakthrough in clinical diagnostics since conventional ultrasound systems only use linear, one-dimensional arrays.

Advanced Spectral Bio-Imaging System SpectraCube wins European IT prize
At the European Information Technology Conference, the jury of this year's European IT competition, organised by the Esprit program in collaboration with the European Council of Applied Sciences and Engineering, Euro-CASE, awarded a prize to the SpectraCube based on a new modality of imaging. This intensive technology system using SKY or Spectral Karyotyping is capable of precise location and characterising of genetic aberrations in chromosomes in order to enable better diagnosis and therapy of cancer and genetic abnormalities.

FORE's ATM technology offers a cost saving quantum leap in performance for PSS/World Medical
The old ways of using dial-up modems to transfer data are past history for Physician Sales & Service/World Medical Inc. A new Wide Area Network (WAN) based on Asynchronous Transfer Mode (ATM) technology supplied by FORE Systems, largely improves the performance of a variety of applications between PSS/World Medical's headquarters and its 87 branch locations. Additionally, the moving of its voice traffic over ATM is trimming the monthly long distance costs by 30% for this distributor of medical, diagnostic and imaging equipment and products. Remote training facilities and teleconferencing for companywide meetings are future implementing tools of this high-performance network.

Telemicroscopy reveals the origins of Alzheimer and Parkinson
Neurological diseases such as Parkison's and Alzheimer's are associated with the breakdown of components of the nervous system. The cellular and molecular basis for this degeneration has been extremely difficult to visualise in the past. A high-resolution 400.000 volt electron microscope is able to obtain images from much thicker specimens than conventional instruments can, thus allowing examination of 3-D biological structure and discovery of cellular changes that may result in disease. To promote remote access to such scarcely found high powered microscopes like the one residing at the San Diego National Centre for Microscopy and Imaging Research (NCMIR), a plan has been developed to build a "Collaboratory for Microscopy and Digital Anatomy" (CMDA), using Internet and high performance computing to support biomedical researchers.