September 1998

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Telemedical Information Society in Future Generation Computer Systems
The scientific journal Future Generation Computer Systems , referred to as FGCS, has dedicated a special double issue to the subject of "The Telemedical Information Society". Guest editor and Euromed project manager, Dr. Andy Marsh, has selected a range of authors from all over Europe and the USA to offer a view on their research with relation to the technical implications of building a 21st century technological health care infrastructure. Eleven contributions shed a light on what telemedicine might look like in virtual reality as well as Web-based environments.

EU course teaches Slovenian nurses computer aided healthcare
In Slovenia, a major health care reform has been announced to provide excellent quality of care at reasonable costs for the whole of the population. Nurses are constantly being challenged to meet new tasks and responsibilities. This evolution has encouraged Professor Viljem Brumec, dean of the University College of Nursing and Professor Peter Kokol from the Faculty of Electrical Engineering and Computer Science at the University of Maribor, to start up a short cycle degree course for Nursing Informatics and Computer aided Education (NICE). The three year project resides under the European Commission's TEMPUS PHARE section. Results and achievements will be disseminated to interested parties in other European countries.

KISMET simulation software forms heart of the Karlsruhe Endoscopic Surgery Trainer
At the Forschungzentrum Karlsruhe, researchers have developed a virtual reality based training system for the simulation of diverse minimally invasive surgical tasks. This endoscopic surgery trainer consists of a high performance graphics workstation as a core unit, running on multipurpose KISMET software, which stands for Kinematic Simulation, Monitoring and Off-line Programming Environment for Telerobotics. The KISMET package has been extended for medical applications with haptic feedback interfaces, in order to calculate in real time the interaction between deformable objects and surgical instruments. In this way, the trainee is able to accurately track both the manipulations of the virtual tissues and the physical force feedback resulting from the object manipulation.

ATM turns SSM Health Businesses into fully distributed network
Large health care institutions increasingly rely on powerful and efficient computer networking to meet the strong demands for high qualitative patient care, accessible to every citizen at an affordable cost. SSM Health Care (SSMHC), as one of the biggest Catholic health care providers in the United States, has turned to the Asynchronous Transfer Mode (ATM) technology, provided by FORE Systems, to replace the existing T-1 lines, which transmitted administrative and medical data between six of its member hospitals in the St. Louis region, at a speed of 1.5 Mbps. SSM Health Businesses (SSMHB), an SSMHC division, is already making plans to extend the current services of the newly installed ATM network backbone, such as electronic file interchange (EFI), and both office and e-mail functions, to distance learning applications for remote training.

Valencia first to test low-cost tool for 3D visualization and segmentation
The Radiological Department of the Dr. Peset Aleixandre Hospital in Valencia will be the first user to test HIPERCIR, a new software package for 3D real time visualization and semi-automatic segmentation of medical images by means of high performance computing techniques. This helpful tool for both diagnosis and therapy has the great advantage of using low-cost parallel processing methods while running on standard Windows NT based PCs. The HIPERCIR (High Performance Computing Intergrated Radiology) project partners aim at offering an affordable but qualitative solution to small hospitals for easy to use 3D imagery without a need for expensive hardware.

CardiAssist to enable 3D ultrasound diagnosis, training and teleconsultation between cardiologists
Three hospitals, three industrial corporations specialized in ultrasound and echocardiography, and three research departments are gathered in a consortium, coordinated by GMD, the German National Research Centre for Information Technology to implement the CardiAssist project. This three year initiative, residing under the Health Telematics Programme of the European Union, has been set up to optimize the quality of 3D ultrasound images for more accurate cardiac diagnosis, and to design a system for both training and teleconsultation purposes, in order to improve the information exchange between physicians, attached to cardiological centres and peripheral hospitals in different countries.

Silicon Graphics boosts mid-range server to 225MHz
Silicon Graphics has introduced new 225 MHz models of its Origin200 server. The Origin200 225QC (Quick Cache) and the Origin200 GIGAchannel servers are both expandable from one to four 225 MHz MIPS R10000 processors. SGI claims these new models deliver increased processor speed for enterprise-caliber performance to the volume server market at aggressive entry-level price points.

SensiCath technology licensed to measure arterial blood gas of patients in shock
The Institute of Critical Care Medicine in Palm Springs, a not for profit institution founded to advance both life-saving and life-sustaining medical care, has decided to sign a license agreement with Optical Sensors, a designer of arterial blood gas (ABG) monitoring systems, which is based in Minnesota. This gives the company a right to commercialize all pending and issued patents of the Californian Institute with regard to the techniques of sub-lingual measuring of intra-mucosal CO2. This method is used to assess tissue perfusion, which is extremely valuable for the diagnosis and treatment of patients in shock.

Endovascular 3D imaging software treats aortic aneurysms
Patients suffering from Abdominal Aortic Aneurysms (AAA) are submitted to the innovative endoluminal stent graft procedure. Several medical centres throughout the USA are currently participating in Phase II for the Investigational Device Exemption (IDE) trial of the customized TALENT stent graft, developed by the World Medical Manufacturing Corporation. In order to offer the best conditions for the minimally invasive endovascular repair of aortic aneurysms, the Florida based company decided to close an agreement with Medical Media Systems to deliver the 3D Preview Surgery Planning Software. This valuable tool allows the clinical trial investigators to accurately plan the intervention, as well as to correctly size the endovascular stent grafts.

SGI's OpenGL Volumizer handles volumetric and surface data on equal basis
The medical, scientific, and energy visualization markets soon are to benefit from the tremendous potential that OpenGL Volumizer, the new Silicon Graphics application programming interface (API), is offering. The revolutionary graphics API will open commercial doors to new volume rendering capabilities in real time. For the first time, standard graphics applications will be activated to mix volume with geometric objects in the very same scene. A variety of sophisticated methods will be generated to provide scientists with immediate mode visualization and exploration tools to support their research.

New messaging framework is suited for remote medical monitoring
Specialist in reusable frameworks since 1993, Etsee Soft, Inc. has launched the brandnew DeCAF 1.2 release of its Java enterprise messaging framework after a large number of positive beta tests in the United States, Europe and the Pacific Rim. DeCAF, reffering to Distributed Command Architecture Framework, also constitutes the software basis for LifeConnect, a telemedicine system for remote patient monitoring, gathering information from distant locations in real time for dissemination, analysis and storage in the doctor's office, the hospital or at home. In Japan, LifeConnect has been implemented at Kurosawa Hospital in Nagano to monitor the patients' vital signs data from their homes or from clinics, situated throughout the islands.

Shared Medical Systems to acquire Pyrénées Informatique and sign marketing agreement with IBM
Shared Medical Systems (SMS) France, is a subsidiary of SMS Corporation. Together with IBM, the company has acquired the French provider Pyrénées Informatique S.A., specialized in the development, sales and installation of hospital information systems (HIS). At the same time, IBM and SMS Corporation have also signed a new European marketing agreement to sell and deliver complete Information Technology (IT) solutions to the health care community.

Telus to resell Tandberg healthcare videoconferencing solutions
Tandberg, a major designer of visual communications systems is partnering with Telus Corporation, one of the largest telecommunications service providers in Canada for both consumers and businesses. Prior satisfying experiences in the areas of distance education and telemedicine have convinced the Telus staff to select Tandberg as their videoconferencing supplier for the future.

Fakespace's Virtual Model Display systems demonstrated at SIGGRAPH'98
At the SIGGRAPH'98 Exhibition in Orlando, visitors

got an interactive taste of the 3D visualization potential offered by the Immersive WorkBench and VersaBench, two Virtual Model Display (VMD) systems that are developed by Fakespace. In collaboration with Sun Microsystems, the company showcased the Immersive WorkBench, using a beta version of the Java 3D programming environment. Second, the power of the new VersaBench was demonstrated in a range of scientific and practical applications.

Electronic Patient Record difficult to implement in Dutch Health Care
Two years ago, the project "Zorg2000" (= Care2000) has been launched by the Dutch National Programme Campaign Electronic Highways (NAP). The initial purpose was to supply the building blocks for an Electronic Patient Record (EPR), to be used by general practitioners (GPs), medical specialists and home care providers for mutual data exchange, in order to promote the concept of shared care. The plan hasn't worked out the way it should be, due to lack of streamlined communication between the various physician organizations, the hospital information systems vendors, and the project managers. In addition, the introduction of standards, codes, and definitions by the CSIZ centre for data standardization management also has failed. Today, new initiatives are undertaken to transform the Electronic Medical Record (EMR) into a real individualized EPR.

Interactive Simulation Models to guide medical students to real practice
Researchers at GMD, the German National Centre for Information Technology, have worked for two years on the InterSim project. This effort involved the building of a range of Interactive Simulation Models to support medical students in their learning process. These computer-based systems provide intelligent assistance to the user, so that he can gain a better understanding of the physiology and pathology of human organs, as well as learn to handle diagnostic technology in an efficient way. In fact, this kind of simulator has bridged the gap between the theoretical lectures of university professors and the practical skills of surgeons, allowing students to explore an object without any restriction and to undertake action according to their findings.

Voxel similarity measure for medical image registration
Dr. David Hawkes is director of the Image Processing Group in the Division of Radiological Sciences at the United Medical and Dental Schools (UMDS) of Guy's and St. Thomas' Hospitals in London. Together with his colleagues, he has been occupied since the early nineties with the complex study of automatic medical image registration, using the method of voxel similarity measures. During the annual conference of the Advanced School for Computing and Imaging (ASCI'98), last June at the Vossemeren in Lommel, he was invited to share the preliminary outcomes of his research with the participants of this three day event.

Promising IT companies welcome at IST 98 Investment Forum
Selected companies seeking investment or equity finance are invited to present their business cases and Information Technology related products to venture capitalists, and both institutional and industrial investors at the IST 98 Investment Forum. This initiative forms an integral part of the Information Society Technologies Conference and Exhibition 1998 , which will take place in Vienna from November 30th to December 2nd. Organizers are the European Commission and a pan-European consortium of partners.

DiabCare Q-Net to improve quality in diabetes care and disease management
Started off in February 1996, DiabCare Q-Net, as a three year initiative, forms part of the European Commission's Telematics Applications Programme. The project's goal is threefold and consists in the development of a European quality network for diabetes benchmarking, the improvement of diabetes care and prevention, and the application of telemedicine in the form of image and video information to detect retinopathy and to remotely examine foot and leg ulcers. For this purpose, a telemedicine demonstrator has been designed. The project partners hope to achieve on all national, regional and local levels within Europe, the efficient functioning of a service centres' network for the evaluation and optimization of diabetes care. Health providers will be able to access and link the latest guidelines to their own data.

Speech recognition medical specialists work more efficiently
Are we about to move towards keyboardless hospital information systems (HIS) in the years to come? Speech recognition systems for English speaking health care professionals are already conquering the markets. The Dutch company, MDT Information Division BV, has now designed the first speech recognition software package for Dutch medical terminology. Other versions are being prepared for Germany, Belgium, and France. Italy and Spain soon will follow. MDT is working together with native speakers who are familiar with the vocabulary of the various medical specialities in the different countries. The Clinical Reporter system has been developed for use in orthopaedics, surgery, radiology and gynaecology. Managing Director, Dion Janssen, has set his mind on teaching European doctors to talk with the computer.

Endoscopic surgery simulator Virgy interconnects distant doctors and students for training
For a few years, researchers of the VRAI (Virtual Reality and Active Interface) Group at the Swiss Federal Institute of Technology, have been working on the development of a laparoscopic surgery training system. The project, called Virgy, consists of two complementary design phases. The first one relates to the creation of a virtual environment by means of the Libptk, a 3D graphic sensor engine which generates the population of all the objects in the simulation. A so-called surgical ghost provides the physician with force feedback through the endoscopic tools, that are used for manipulation of the virtual organs. The second phase involves a multimedia communication platform, allowing surgeons at remote locations to co-operate and offering students an opportunity for distant learning.

Multi-regional pilot project TEMeTeN to promote advanced telemedicine and teleworking
The regions of Crete in Greece, the Balearics in Spain, Sardegna in Italy and Tampere in Finland have set up a telematics applications and services initiative within the European Programme for International Co-operation and Regional Economic Innovation, in order to move " Towards a European Medical and Teleworking Network" (TEMeTeN). Rather than aiming to develop new technologies, the project partners prefer to use the already existing infrastructure of terrestrial, mobile and satellite communications, interoperable portable devices, multimedia information systems and computer supported co-operative worksystems to demonstrate what a future information society may look like in isolated areas, which are nevertheless becoming very attractive for tourists.

HPCnet winds up
HPCnet, the Network of Excellence managed by PAC in Southampton, stops after four years of serving the European HPCN community especially with their high-quality workshops. Although there was a strong increase in number of members during the past year, efforts to attract funding to continue the network failed. The HPCnet web site will close down end of September.

Soft second quarter for Lumisys but positive signs ahead
The Californian developer of fully integrated soft- and hardware product suites for Picture Archiving and Communications Systems (PACS), Lumisys, has issued its second quarter results for 1998. Compared to the turnover in 1997 for the same period, sales and earnings have slightly come down but there is no reason to get pessimistic, since six supplementary system integrators have signed up during the second quarter, including an important telemedicine provider in Canada. As such, they complete the success of the first quarter, in which eight new contracts were signed.

New ChartMailer software sends medical files over the web
Children and adults in developing regions who are isolated from medical services, far too often can only rely on care and relief workers sent by humanitarian organizations, international care agencies or foreign governments. The PhysiTel company is trying to meet pressing health care needs in these areas through the One World programme. The Texas based manufacturer of telemedicine products wants to provide health care groups offering medical aid in developing and war-torn countries, with its ChartMailer software at little or no cost at all. The application has been designed to combine medical images and paper-based patient records into a single, streamlined electronic patient chart for transmission over the Internet by means of conventional telephone lines.

Medi-Monitor helps forgetful patients take their pills on time
Next October, a voluntary programme will start to encourage patients suffering from congestive heart failure (CHF), to take their prescriptions at regular times. The initiative is a joint effort between the Mid Atlantic Medical Services Inc. (MAMSI), one of the leading managed care organizations in the United States, and InforMedix Inc., a developer of interactive telemedicine devices and the inventor of the Medi-Monitor unit. This little portable data-collector alerts the patient when it is time to take his medication and assesses both his general health status and quality of life. Every night, the information is electronically being transmitted to the patient's physician for review and analysis.

Trimension showcases interactive virtual solutions at SIGGRAPH'98
During the SIGGHRAPH'98 Exhibition in Orlando, Trimension Systems presented the largest interactive computer workstation. This V-DESK10, a visualization system for collaborative real time design, enables immersive virtual reality viewing in high ambient light. In the expo's Digital Pavilion, the company provided the Enhanced Realities section with the Relocatable Reality Room, a self contained and portable Reality Centre to simultaneously immerse fairly large groups of people into a virtual reality environment.

Mercury invests $100 million in signal and image technology
Mercury Computer Systems plans to invest more than $100 million over the next five years as part of the company's strategy to stream computing in the digital signal and image processing markets. Today Mercury is already delivering systems with nearly 1000 compute elements. Projections anticipate the achievement of more than 100 Gflops/cubic foot in the near term, en route to 1 Tflop/cubic foot early in the new century.

US National Center for genome research selects Starfire
The National Center for Genome Resources (NCGR) has selected a Sun HPC 10000 server to provide improved performance and reliability for users of bioinformatics software and genomic databases. NCGR is one of four international centers providing central organization and analysis of genetic information flowing in from all parts of the globe, including the Human Genome Project.

Abdominal Trauma Simulator probes frontiers of realistic modelling
The major challenge for virtual reality simulation of surgical procedures lies in the realistic rendering of organ deformation when touched by medical instruments, and the resulting degree of haptic feedback experienced by the surgeon. This is especially true in the delicate case of abdominal trauma, where open surgery is required. At HT Medical, based in Maryland, Dr. Morten Bro-Nielsen and his team have developed a testbed for simulation of open surgery from the front to remove a shattered kidney. The experimental approach involved the most innovative technologies to generate deformable organ models and a lot of high performance computational power to simulate complex actions, like cutting, bleeding, and force feedback. Fully realistic virtual scenes are impossible to create at present, so some of the surgical steps have to be substituted or suggested with a set of multimedia interfaces.

Silicon Graphics launches Virtual Reality Initiative at SIGGRAPH '98
There is more to virtual reality (VR) than games and science projects. In the past years, it has become a business tool in order to enhance productivity, reduce industrial costs, and increase the customer's satisfaction. This evolution has caught the attention of the Silicon Graphics experts. As a result, the company has taken up the idea to promote the adoption of virtual reality technology in a broader commercial range.

Students take virtual trip into the inner ear with networking technology
At the University of Illinois, the team of Dr. Mary Rasmussen has designed a three-dimensional model of the inner ear from serial histologic sections. A powerful ImmersaDesk system, which is normally used in CAVE technology, displays the complicated interrelationships of the vital anatomic structures, embedded within the dense temporal bone, by means of true stereoscopic visualization. Surgeons and students can use a wand to make an extensive tour within the virtual temporal bone. This is done either in the same room or through networking with multiple interlinked ImmersaDesks between remote sites. In the latter case, the participants communicate by voice over standard telephone lines. The virtual temporal bone provides a time and cost saving learning tool for students as well as an ideal means for physicians to plan surgical approaches and procedures.

MCell and NetSolve to simulate brain cell activity
At the Computational Neuroscience Laboratory (CNL) of Dr. Terry Sejnowski at the Salk Institute for Biological Studies in San Diego and at the University of Tennessee Computer Science Department, participants in the National Partnership for Advanced Computational Infrastructure (NPACI) have united forces to combine two innovative computer applications to conduct extremely powerful simulations of microscopic cellular processes. With the assistance of the MCell and NetSolve systems, it could even be possible to simulate the functions of an entire organism, as stated by neurobiologists in the recent issue of the enVision magazine. If simulation techniques are integrated with distributed processing workload methods, scientists are able to study in detail what exactly is happening at the level of the various brain synapses.

Electronic patient records through speech recognition
The recent development of advanced speech recognition systems is starting to obtain a serious foothold in health care environments. IBM, Philips and Kurzweil are already designing specific medical application packages, while other companies, like Voice Input Technologies and Voice Activated Systems Technologies, have adapted existing speech recognition software for practical use in Hospital Information Systems (HIS). The physician will soon be able to create a fully computerized patient record (CPR) by simple and direct dictation of the right data into the system for seamless transcription into an online chart. In the June 1998 issue of the Physicians and Computers Journal , Dr. John Leipsic presents a survey of the speech recognition tools, currently available.