May 1998

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The Web-integration of a Computer Aided Medical Diagnosis tool for breast cancer
The Department of Electronics, Informatics and Systems (DEIS) at the University of Calabria in Italy has designed an integrated software system, called Computer Aided Medical Diagnosis or CAMD, as a partnering contribution within the Euromed project. Under the coordination of Professor Lucio Grandinetti, the team has developed an automatic classifier which discriminates between benign and malignant cells from a breast cancer. The CAMD tool has been embedded into a telemedicine system, based on two different functionalities, one using a Client/Server approach and the other relying on Web facilities. This implementation enables the physician to perform remote diagnostical consultations. In the future, the research team hopes to extend the application of the automatic diagnostic system to other types of cancers or diseases, such as brain and thyroid cancers.

The compromises of medical imaging compression and archival
Multimedia information, in particular medical imaging, consists of enormous quantities of data. No wonder, health care providers are submitted to the pressing constraint of keeping the medical image interchange and storage practicably manageable, without losing sight of legal requirements. Data compression offers a useful solution but always involves a certain amount of quality reduction due to irreversible loss of information or the possible introduction of artefacts. The required image quality depends on the context in which the data will be used and hence determines which kind or degree of compression has to be applied. In addition, hospitals deal with a serious archival problem and need to consider how to draw the line between on-line and off-line storage systems. Wavelet compression might offer an answer but legal implications have to be taken into account. Euromed project manager Andrew Marsh outlines the current situation.


Hospital strategy puts sharper focus on care management instead of cost reduction needs
Health providers and managed care organisations prefer to invest more resources in case management, inpatient protocols, community education and other related items, because they believe all these elements of care management provide a higher potential for saving costs while at the same time optimising the quality of health care. As a result, cost reduction measures have dropped by nearly ten percent. This is the overall image as presented by the 1998 Environmental Assessment, which is based on a number of primary and secondary sources. This report on the major trends in the American health care industry, appears for the eleventh time under the title "Setting Foundations for the Millennium ".

Conference attendants take part in remote interactive cardiac procedure
Over a thousand cardiovascular specialists, assembled in the 18th Annual Cardiothoracic Surgery Symposium in San Diego, were able to take part in a virtual, interactive cardiac surgical procedure, performed at a distance of about 5000 kilometers away, at University Medial Centre in Greenville, North Carolina. VTel Corporation, a telecom provider based in Austin, Texas, used its Digital Visual Communications technology, in collaboration with the Telemedicine Technologies Company of East Carolina University, to establish the link between San Diego and Greenville via three ISDN-lines. The symposium participants were offered a lively discussion forum with both the surgical team in Greenville and a panel of experts in San Diego.

Mozambique inaugurates one of the first telemedicine links in Africa
Between the central hospitals of Beira and Maputo in Mozambique, a telemedicine link, based on existing terrestrial and satellite telecommunications systems, recently has been set up by a multidisciplinary group of partners, including Telecomunicaçoes of Mozambique and WDS Technologies, a telemedicine equipment vendor from Geneva. This first pilot project in Africa has been launched by the Telecommunication Development Bureau (BDT) of the International Telecommunication Union (ITU) to assess the potential of information technology in order to more appropriately meet the various complications of health care organisation in the challenging environment of the developing world. The inauguration honours were fulfilled by H.Emr. Pascoal Mocumbi, Prime Minister of Mozambique.

"Telehealth in Africa" promotes telemedicine in developing countries
Since quite some time, several groups of intergovernmental and non-governmental organisations, as well as the private sector are uniting their forces to establish a telehealth link between European reference Hospital Centres in Milan, Paris and London, and a number of selected African Hospital Centres, connected with Peripheral Units of Assistance. This project, referred to as "Telehealth in Africa", initially was presented by Alberto Rovetta, Professor at the Telerobotics Laboratory of Politecnico di Milano at the UITA-UNESCO in Paris on April 7th 1995. Since then, the initiative has been extended to other developing countries as well, in co-operation with the European Collaboration Group for Telemedicine.

Intravenous Catheterisation Simulator helps nurses get the feel of venipuncture procedures
Virtual reality technology for the first time is proving its practical use in the everyday medical environment. HT Medical Systems, a company specialised in virtual reality medical simulation and visualisation technology, has developed an Intravenous Training System, called CathSim, to offer care providers a realistic means to practise invasive procedures before actually addressing themselves to the patient. The computer-based system constitutes an economically viable tool to award doctors and nurses the visual, physical and tactile experience of introducing a catheter needle into the veins of simulated patients.

Mayo Clinic wins Webby Award for best Internet health site
Mayo Clinic has proven that hospitals can play a significant and useful role in health education on the World Wide Web. Its Health O@sis Web site was selected for the 1998 International Webby Award in the category "health care" and has been named a finalist in the Global Information Infrastructure (GII) Awards as well. In the past two years, Mayo Clinic Health O@sis has already won four international awards competitions. The winning site provides general information and specific answers to the medical concerns of the visiting public but in full respect of the ethical standards of the Health on the Net Foundation.


Flashscan 30 generates qualitative X-ray images
A new method has been developed for digital image-processing by dpiX, a company belonging to the Xerox New Enterprises Group. The innovative approach will turn the production of X-ray films into a superfluous step for the majority of radiographic applications in the near future. The Flashscan 30 system indeed generates grey-value images which possess a film-qualitative sharpness, displayed on a surface that is only a little smaller than the familiar foil used for traditional X-ray films.

Patent portfolio acquisition by Sun might give a dashing boost to virtual reality
After a four year trial in bankruptcy court, Walter Greenleaf, president of Greenleaf Medical Systems, initiated a four million dollar deal with Sun Microsystems to take over the patent portfolio of VPL Research Inc., the pioneer in virtual reality and networked 3D graphics, from Thomson CSF. From 1992 till 1997, Greenleaf Medical maintained the VPL intellectual property, together with other technical assets and as such, has developed various medical products based on virtual reality technology. The recent acquisition opens up new perspectives for the growth of industrial virtual reality applications, as well as for the establishment of hard- and software standards in this area.

Pen tablets handle high-density data traffic at University of Michigan Medical Centre
The Trauma, Burn and Emergency Surgery Division of the University of Michigan Medical Centre (UMMC) is a typical advanced health care environment with pressing workplace efficiency and mobility needs. The UMMC staff therefore has decided to provide all departments of the division with Point 510, RF-equipped, pen tablet computers, designed by Fujitsu Personal Systems, in order to enhance the accessibility to medical data for both physicians and nurses, while they keep interacting with their patients at the same time. The mobile computing system indeed offers a rich information display without disturbing the active communication between care provider and patient.

OEC Medical Systems acquires minority interest in Heartlab
Heartlab, a medical imaging software development company with a main interest in cardiology, has closed an alliance with OEC Medical Systems Company, headquartered in Salt Lake City. OEC holds a strong market position as a manufacturer of mobile fluoroscopic imaging systems for minimally invasive surgery. The two partners consider their technologies as being complementary to each other. For OEC, the agreement offers an opportunity to enter the cardiac imaging market whereas Heartlab hopes to reach a new community of health care professionals in other expert domains, besides cardiology, which also require high performance imaging.

Introduction of WatchMan enhances Personal Emergency Response System
Shahal, an Israelian company, has developed a user-friendly emergency and preventive homecare telemedicine system for worldwide distribution. The WatchMan constitutes the most recent extension of this personal emergency response system, referred to as PERS. Elderly or disabled individuals can subscribe to a tele-assistance service and benefit from the PERS communication system. This private Home Care Centre connects the subscribers to a remote emergency response service for hands-free, two-way voice communication. The new HCC model features the WatchMan, a multifunctional wristwatch provided with a panic button, sensitive microphone and RF transmitter to offer the patient a greater feeling of security and peace of mind.


EuroMed Net'98 Conference participants plan to actively engage in telemedicine initiatives
Countries in the Mediterranean region cherish the joint ambition to integrate the Internet and the World Wide Web in the development of a Euro-Mediterranean Information Society, covering areas such as culture and tourism; electronic commerce; education; and telemedical care. From March 4th to 7th, more than 350 delegates from both the European Union and the Mediterranean region gathered in Cyprus during the EuroMed Net'98 Conference, to discuss their general strategy and to propose or present several practical pilot projects in all of these fields. The initiatives share the common concern of awareness, training and sustainability and propagate the recognition of cultural diversity while uniting individual strengths and investing in potential synergies. Telemedicine is one of the major elements to be considered for the deployment of a fruitful Euro-Mediterranean co-operation between industry, research communities and governments, to the general benefit of the population in this region.

Surgeon navigates endoscope manipulating robot from operating cockpit
At the Fourth International Workshop on Rapid Prototyping in Medicine and Computer-Assisted Surgery, last autumn at the University of Erlangen, Dr. Volker Urban and his team announced the creation of a revolutionary prototype for robot assisted surgery. By the end of January, the first promising test outcomes were presented at this year's edition of the "Medicine Meets Virtual Reality" Conference in San Diego. Further trials, performed by experts from different medical disciplines, at the Dr. Horst-Schmidt-Kliniken in Wiesbaden, will have to prove whether the system is suited for actual use under real clinical circumstances in the operating theatre.

Quantitative diagnosis of osteoporosis optimised through computerised trabecular and cortical analysis
A large percentage of the elderly population is suffering from osteoporosis, a disease which heightens the risk for fractures because of the growing loss of bone mass and structure. For diagnosis, Quantitative Computed Tomography (QCT) is used to generate cross-sectional images, allowing a separation of trabecular and cortical bone as well as a precise measurement of the bone mineral density (BMD). Simultaneously, the physician has to determine the trabecular structure of cancellous bone to evaluate the degree of osteoporosis according to a pre-set classification scheme. Since it is difficult to exclude subjective influences using this technique, the R&D team at the Centre for Medical Diagnostic Systems and Visualisation (MeVis) at the University of Bremen has developed an automated procedure to calculate the fractal dimension of the trabecular bone in combination with the BMD values in the cortical shell.

Comparing 3D medical imaging visualisation formats for educational purposes
Researchers of the Mednet Laboratory at the Medical Faculty of the Goteborg University have developed an educational software package, called 3D-Brain 2.0, which focuses on the anatomy and functionality of the human brain. Their major concern, expressed at the "Medicine Meets Virtual Reality" (MMVR) Conference in San Diego, last winter, was to create a platform independent learning and training tool for students, that is able to run on a basic personal computer with use of the latest visualisation technologies such as the CD-ROM based QuickTime VR 2.0 and VRML 2.0. Before the MMVR-audience, they offered a methodological and target-based comparison between the graphical capacities on both a high end workstation and a standard personal computer.


Dutch HPCN programme addition to fill-in white spots
The Dutch Foundation HPCN, who is administering the Dutch HPCN programme, has announced an addition to fill in some white spots. Application of many particle models, large databases, web technology and material and medical topics, are identified. Also diffusion of the results of the funded projects and investment in the infrastructure are planned.

Unique Virtual Environments Service Facility in Stuttgart
The Virtual Environments Lab (VELab) at the High Performance Computing Center Stuttgart (HLRS) will be inaugurated on 28 April 28. Together with the Visualization Lab and the Video Lab it is operated as a service facility. It is tightly connected to two other Virtual Reality Labs at the University of Stuttgart as well as to the Daimler Benz Virtual Reality Arbeitsplatz (DB-VIRA). This establishes a testbed for Distributed Virtual Environments applied to engineering sciences, that is unique in the world.

European release of ViewGate enterprise videocom system at CeBIT'98
Since early 1997, the ViewGate enterprise video comumnications system, developed by the Multimedia Access Corporation, has been a tremendous success in the United States. The system connects hundreds of users to frequently-used video-based applications, such as telemedicine, videoconferencing, and distance learning and training. At the CeBIT'98 Fair, VEBA's Raab Karcher Electronic Group launched the ViewGate PAL-version, especially designed for European customers.

Advanced medical telephony platform will support health care delivery
Since 1994, Endeavor Technologies has been building up a sound reputation as a cardiac event monitoring company, supplying Internet-based and diagnostic telemedicine products and services. In order to create an innovative medical telephony platform for the health care community, it now has closed a business alliance with Premiere Technologies, a major provider of enhanced communications services. Endeavor's health care industry distribution, various partnerships and provider programmes will be coupled with Premiere's Orchestrate design, a product which enables users to intelligently link their telephones, faxes, computers, pagers and voice mail.

Proceedings of Medicine Meets Virtual Reality 6: a review
From January 28th till 31st , the sixth edition of "Medicine Meets Virtual Reality" took place in San Diego. The proceedings of this conference are currently available and display a lavish image of virtual reality implementation in the telemedical field. From all over the world, no less than seventy-four contributions have been brought together for this publication by participants with an academic or an industrial background, and residing predominantly in the USA, Europe and Japan.

Cardiopulmonary exercise test avoids needless patient referral
Patients displaying symptoms like shortness of breath and chest pain, in most cases immediately are referred to a hospital for invasive testing, by the primary care physician. AccuMed Systems, an Atlanta-based mobile diagnostics telemedicine company, now has developed innovative equipment for a cardiopulmonary exercise test to help the practitioner in determining the exact causes of the emerging symptoms in order to make a correct diagnosis. The computerised diagnostics present a safe and cost-effective procedure to gain knowledge on the source of the symptoms, thus avoiding a possibly superfluous and expensive patient referral.

AltaVista Web search service inaugurates Health Zone in partnership with InteliHealth
Digital Equipment Corporation has extended its popular Web search engine AltaVista with a new health zone. As an expert provider of timely and qualitative health information, in association with the famous Johns Hopkins University and Health System in Baltimore, InteliHealth has been chosen as the ideal partner to provide the Web surfers with a useful and valuable health news resource.

ITIS'98 - Seeds for the new telemedical information society
Challenging, colourful, exploratory, fascinating, humorous, matter-of-fact, multi-faceted, outspoken, realistic, visionary: all these somewhat contradictory qualities apply to the ITIS'98 conference, a three-day full immersion into the realms of the Telemedical Information Society. East met west, south met north in lively discussions, assessing the current telemedical potential of the World Wide Web. Some speakers amazed their colleagues with state-of-the-art applications, already implemented in day-to-day health care. Others warned the audience not to loose sight of the various obstacles yet to overcome, especially with regard to high-speed networking and permanent funding. The overall impression however, left plenty of room for a message of hope and trust. Chairman Andy Marsh properly concluded: "We can do it, so why don't we?"

VRML strategy meets growing 3D-needs on the Internet
The Virtual Reality Modelling Language (VRML) is a language for describing multi-participant interactive simulations, which generates virtual worlds that are being networked via the global Internet and hyperlinked with the World Wide Web. The VRML Consortium as a non-profit organisation has received a mandate to develop and promote VRML as the open, ubiquitous standard for 3D content on the Web. A new Executive Committee has just been elected to form Task Groups within the Consortium in order to lead the marketing and specification initiatives offering appropriate support for the continuing growth of 3D on the Internet.


Prisoners and their doctors welcome teleconsultative health care network in West Texas
Prisoners' transport between the correctional facility and the medical specialist requires a careful but expensive preparation. The Texas Department of Criminal Justice (TDCJ) therefore has investigated the possibility of setting up a remote medical consulting service to provide convicts with the community standard of health care while reducing both the risks and the costs. As a result, in 1994, Dr. William Gonzalez and his team, at the Texas Tech University Health Sciences Centre (TTUHSC), created a teleconsultation clinic whereas HealthNet, the university telecommunications department, in collaboration with NEC, manufactured the TeleDoc 5000 system, a portable videoconferencing tool for medical examination, consultation and education. Gradually, this procedure has turned into a success, as stated by ReLinda Longan during the " Medicine Meets Virtual Reality" Conference in San Diego, earlier this year.

Virtual Retinal Display forms ideal solution for low vision disability and surgical application
The Virtual Retinal Display (VRD) constitutes an innovative technology to create images by scanning modulated laser light directly onto the retina of the viewer's eye. This method has been developed by Dr. Thomas A. Furness III in the Human Interface Technology (HIT) Laboratory at the University of Washington. In contrast with a conventional display, no real image is produced. Instead, a very small spot is focused onto the retina while scanned light beams are swept over it in a raster pattern. Despite the low power laser source, bright images with high contrast and resolution are generated to be readily seen in ambient room- and even daylight. Since the power levels recorded from the system remain way below those prescribed by the American National Standard, VRD reveals itself as a safe alternative for use in a surgical display and as an ideal visualisation technology for patients with low vision.

Supercomputer engineered antitumour agents aid cancer therapy
At the 89th Annual Meeting of the American Association for Cancer Research, BioNumerik Pharmaceuticals, a company based in San Antonio, Texas, presented the promising results of its preclinical studies on the antitumour activity of two supercomputer engineered small molecule agents, referred to as Karenitecins and BNP7787. The strong correlation between actual experimental observations and the computational simulations, performed through innovative supercomputer programming and mechanism based approach, are paving the way to creative and inspiring pharmaceutical discovery and development.

STACK database of gene sequences goes live
From now on, scientists who are trying to establish a unified view of all the genes to be discovered in the human genome and their possible relationship to disease, are able to benefit from the public use of an exciting and useful tool, called STACK. The National Centre for Genome Resources (NCGR) and the South African National Bioinformatics Institute (SANBI), based at the University of the Western Cape, near Cape Town, have been closely working together to launch the Sequence Tag Alignment and Consensus Knowledgebase (STACK), a unique DNA sequence database. STACK is being made publicly available through NCGR's Genome Sequence DataBase (GSDB), which is hosted in Santa Fe. Pangea Systems Company is offering a commercial version of the data.

Paving the way to the overall health information systems integration
The Radiological Society of North America (RSNA) and the Health care Information and Management Systems Society (HIMSS) have united their forces to set up a new initiative to stimulate the integration of the different information systems, imaging resources and other software components for health care. Both partners intend to sponsor the organisation of a series of public demonstrations that will provide a showcase for the increasing connectivity between health information systems. A team of experts, ranging from providers and equipment manufacturers to standards developers and information specialists, will try to build a consensus on the capabilities to be supported and demonstrated at the RSNA and HIMSS annual meetings over the years to come.