RSNA: Vendor Neutral Archiving

One of the buzzwords on the RSNA that many companies are using is VNA (Vendor Neutral Archiving). With vendor neutral archiving, the storage is taken care off in a cloud oriented architecture. Any image can be stored into the VNA secure and consolidated regardless of the vendor of the data producing entity (e.g. A PACS).
Advantages can be found in easy sharing of images between healthcare institutes, but also in the fact that PACS replacement can be achieven easier since all data is available in the VNA.

A whitepaper on VNA is availble from Carestream Health

RSNA: iPad for review... But is it calibrated?

During this RSNA again a lot of vendors are showing iPad based viewing of medical imaging. In most cases advocated to be for review only and not for primary diagnosis. However, even for review the quality of the images displayed should be uncompromised. However, internal setting of the level of backlight of the iPad itself and external light sources heavily influence the quality of the image displayed.

BARCO has developed a calibration tool for the iPad called Medical QAWeb Mobile which allows a visual callibration and QA of tablets used for medical imaging viewing. A demo version can be downloaded from the Apple iTunes store. It basically involves tapping a couple of shapes on the screen to determine visibility of certain greylevels.

RSNA: IHE Image Sharing Demo

During RSNA, the IHE has an image sharing demo demonstrating the application of IHE profiles with a large number of different vendors that connect to each other and RSNA software.

In this demonstration they show how IHE can be employed to enhance clincal care by sharing information under patient control using personal health records. Doing this improves radiation safety and facilitates radiological research and aducation by appropriate sharing of images and related data.

Implementing the IHE profiles should also reduce costs by eliminating the need of publishing paper and CDs or DVDs both for patient care and clinical research.

For links to the documentation related to this demonstration see my earlier, pre-RSNA post on this topic.

RSNA: Radiology reporting

The RSNA informatics group is standardizing radiology reporting by making a report template library. this uses expert consensus, standard formats, rich functionality and all in XML. Their aim is to provide these templates on a webpage where a radiologist can visit an 'online shop' with macros, select the templates of interest and put them in a shopping cart. Subsequently, the templates can be downloaded and used in the local speach recognition system.

Using this a more consistent reporting can be achieved and reporting speed increases with effective macros.

The full database now contains over 140 templates that are freely available in text and XML.

RSNA: Decoding the Alphabet Soup

The RSNA is involved in many informatics activities and projects including IHE, MIRC, and RadLex. During this session more information on these activities is provided.

The tools are all developed part of the RSNA and freely available from the RSNA website.

MIRC is the RSNA teaching file system. Besides the system itself, the MIRC workgroup also developed other tools. CTP (clinical trial processor) can be used for data transfer for clinical trials including high level anonymization and firewall penetration.

A new, 2011, version of MIRC was shown which includes a rewrite of the software and also has a new and improved interface. One of the new possibilities are the 'shopping cart' to select cases for conferences.

RadLex is an encoding system which is complementing the existing coding systems including radiology oriented terms. In RadLex imaging methods (playbook) and diagnosis are included. The first version of the playbook for CT was launched this RSNA.

RSNA: Practical Informatics for the Practicing Radiologist

This session was organized in conjunction with the Society for Imaging Informatics in Medicine (SIIM).

Keith Dreyer presented on meaningful use where the transition has to be made from a department centered EHr to a patient centered EHR with acces to any information of a patient from any location. Driving forces are consumerism with technology advances and the informed patients, but also economics where the demand is on decrease of healthcare costs. In radiology this means either reducing the cost of imaging or reducing the amount of imaging. A third driving force is quality (image intepretation and report, image access).

The thing that is wrong with a RIS is that it is departmental centric, the RIS should be fully integrated with the EHR. Interaction with requesting physicians and patients must be improved.

In PACS the trends are towards Vendor Neutral Archive (VNA) with standards based archiving and cloud storage. Image display should move to storage independent web/mobile access. Image management should not focus on PACS or RIS based but patient centric.

New technologies that are playing a major role in future radiology informatics are:

• Cloud computing
• Mobile computing
• Healthcare innovations (clinical decision support, personal health records)

RSNA: Improving resident report evaluation by web-based integration into the attending sign-off process

A group from New York presented on a system to improve the learning of residents. They stated that many times, the residents write a report, but one on one review with their supervisor is not always possible. The resident will see the supervisors corrections later on which decreases the learning value. They developed a seperatentool into their reading process adding a simple form for the supervisor to identify whether there were changes or not and somenmore details what was changed and what the consequences would be. This does not only provide more information for the residents but it also gives insight in the strengths and weaknesses of specific residents. A very interesting and valuable development.

Another group from Philadelphia did a similar study. However they provided the residents with a text changes comparison tool with their own report and the supervisors report. In these report the changes are marked. Residents can look at their last 100 report in a side by side comparison. This group also implemented a feedback form into thei PACS. This form is used by the supervisor to comment on a preliminary report of a resident using a guided form. The resident will receive an e-mail with the comments and links to the report and data through PACS and RIS webviewers.

RSNA: Informatics Education and Research

A mixed session with very different presentations on informatics.

First presentation from Leipzig, Germany about CT guided tumour ablation. A consortium of institutions developed a patient specific liver tumor ablation simulation. Clinical evaluation still has to be performed.

Next two presentations by our group from Groningen, the Netherlands on the use of the RSNA informatics tools in clinical studies and anonymization tools. One of these were also highlighted by AuntMinnie. Both studies show how to accurately implement anonymization into clinical setting.

Presentation four by a group from Baltimore, USA covered AIM and RadLex which should take care of standardization in clincal radiology reporting. Image base annotations are used to enable an intelligent atlas to facilitate the review of anatomy.

Other topics included were on reporting and e-learning. See the first link on this page for all presentations and abstracts of this session.

IHE Image sharing demonstration during RSNA

During RSNA from November 27 until December 2 of this year, the IHE organises several demonstrations on image sharing and other topics. The handout for the IHE image sharing demonstration can be found here. Detailed information about all the different demonstrations and activities on IHE and related initiativen from RSNA informatics can be found here.

German hospital achieves highest level of Electronic Patient Record according to HIMSS Analytics Europe

HIMSS Analytics Europe has granted level 7 of the european EMRAM (Electronic Medical Record Adoption Model) awards to the University Hospital Hamburg-Eppendorf in Germany. They are the first hospital in Europe to achieve this highest possible level. The hospital is running the electronic patient record Soarian of Siemens Healthcare. The European EMRAM model is a modified version of the American EMRAM adapted to the specific demands of European healthcare institutions. The German hospital achieved level 6 early 2011 and now they are at level 7. This level means that they not only work fully paperless internally, but that patient information is also exchanged digitally to other healthcare providers and insurance companies.

This achievement shows that the exchange of patient information is definately possible and should be advocated. Although a European report earlier this year showed that the exchange of data digitally between healthcare institutions is still far from widespread in the European Union, the trend is definately in this direction and hopefully examples like this will inspire decision makers and IT managers of other hospitals to 'dare' to go fully digital.

Also see the announcement in Zorgvisie (in Dutch): Zorgvisie - Duits ziekenhuis behaalt hoogste EPD-niveau met Soarian

TeraRecon introduces iNtuition on stereoscopic 3D

TeraRecon, Inc., (www.terarecon.com), showcased its powerful iNtuition™ advanced visualization tools to support physicians involved in TAVI and EVAR, at the 38th Annual VEITH Symposium held at the Hilton New York on November 16-20, 2011.
According to their published press release, they also demonstrated their new iNtuition support for stereoscopic 3D on affordable 3D television sets, providing an additional dimension of clarity and context, for visualization of vascular anatomy and morphology.

Now that's something that could bring stereoscopic 3D into the clinical field. Up until now only very high-end systems were available but with this a standard TV from any TV shop could be used. Looking forward to having this demonstrated to me at RSNA!

The Conduit of Imaging Care

Just published in a November supplement to Health Imaging, once more showing the importance of Medical Imaging Informatics nowadays:

Advancements in image visualization and IT applications mirror those in the imaging modalities, all helping radiologists establish and solidify their central role in patient care and decision-making, while simultaneously boosting efficiency. Radiologists regularly confer real-time with one another both onsite and virtually, and increasingly with specialists and referring physicians, sharing opinions on specific images as well as effective interventional or patient care plans. Advanced tools enhance communication and colloboration and, improve patient care.

For full paper please click here.

Mixed Reality in the Operating Theater

This group from Japan uses Osirix and a projector in the operating theater to project the three dimensional images obtain by pre-operative Computed Tomography onto the patient abdomen.
The authors claim that the image overlay surgical navigation system using OsiriX provided accurate image guided navigation for minimally invasive surgery.

True 3D Technology Emits 50,000 Dots In 3D Space

Just released, a novel 3D display that can project 3D images in air or water by using laser beams. The researchers claim that they can improve the, now somewhat low, framerate and extend the system to color by using three lasers. One of the first applications they are thinking of is medical image visualization.

True 3D Technology Emits 50,000 Dots In 3D Space - DigInfo TV - Tech News Videos From Japan | The latest technology, products, gadgets and scientific research direct from Tokyo

Augmented reality Ultrasound

The future of ultrasound? An augmented reality Ultrasound training system. Instead of just looking on the screen you keep looking at and through the patient. In this case they do this using a phantom and preacquired datasets.

iPad not only beneficial for Healthcare but also infection risk??

Ingrid Spijkerman, microbiologist and director of the workgroup infection prevention warns in an interview with webwereld. She states that having iPad in hospitals both for healthcare providers and for patients is an infection risk which is not considered at the moment they are introduced. There are no guidelines yet that specify the use of tablets and the requirements on desinfecting them. Especially, because of the touch interface of tablets, cleaning and desinfecting them frequently is a very important issue.

An additional problem is that Apple states in their manual that the iPad should not be cleaned with alcohol since this would damage the top layer on the screen. This top layer (oleofobic coating) makes it easier to remove fingerprints from the screen. Furthermore, they state that the use of alcohol or other cleaning solutions on a regular basis could decrease the sensitivity of the touchscreen or damage the screen.

The workgroup infection prevention states that research should be conducted to determine the infection risk of tablets.

Augmented reality use for Medical Education

Augmented reality is really catching on with many applications arising in entertainment and commerce varying from TV show characters coming alive using a card in front of your webcam to augmented reality business cards. However, also in the field of medical imaging informatics, augmented reality could play a role.
This movie shows a nice application of augmented reality using gliphs for medical education.

Serious Games in Healhcare

We had a session on serious gaming at the UMCG. Below a short update.

There are three categories of users of serious gaming in healthcare:

• patients
• healthcare professionals
• researchers

Each of theses categories have their own interest, and different applications are surfacing that can be applied.

For patients, serious gaming can be used to inform, distract or motivate. An example for distraction is snow world, in which patient with severe burning are playing snow games during treatment, which has a beneficial effect and reduces the pain during this treatment. The re-mission game for children who are cancer patients improved their therapy loyalty.

Snowworld

 Re-mission

Examples of serious gaming for healthcare professionals are training games for minimally invasive surgery and teamtraining (e.g. burn center)

In the area of research, foldit is a prominent example in which gamers have helped (crowdsourcing) to determine protein structures to help medical research (www.fold.it)

Looks like serious gaming is really entering the healthcare enterprise at all levels and some good examples are shown. However, serious gaming should not be a goal in itself. It is important that a serious game really addresses an issue that could not be addressed otherwise or really has an impact on treatment effectiveness and/or quality.

For more information on serious gaming visit umcgame.wikispaces.com (in Dutch!)

Personal Health Record - MIC 2011 Session

In session on Personal Health Records, the question was posed why we should need Personal Health Records. Generally, the trend seems to be that the most important issue of having a personal health record of some sort is that it provides control over your own health related information. However, big questions are concerning integrity, access, and availability of the data.

One suggestion was to just carry your own personal health information around using a USB stick or other portable device. That would provide a backup that will also be available when internet and or power fails or is not available. One difficult issue here is the limited storage capacity of such a device while the amount of data could run into the tens of gigabytes when multiple CT or MR examinations have to be stored onto it.

Furthermore, because the data on the device should be encrypted a password might be required which could be difficult to provide by the victim in an emergency case. Therefore, besides the device, one should somehow (on the device or in a cellphone entry) a ICE (In Case of Emergency) telephone number.
 

The nation wide patient information system was recently terminated by the government in the Netherlands, therefore initiatives are now arising to go from topdown to bottumup, so start with the patient.
A complication here is that the personal health record is intend for and maintained by the patient, but the information is delivered to the patient by healthcare providers, mainly used by the same or other health care providers, and the information is in most cases incomprehensible for patients. Therefore there should be fixed rules about logging, monitoring and maintainig the health information in a patient driven personal healthrecord to allow the patient to become in control of his/her own health record. When this issue is not considered, the information on the personal healthrecord could easily become corrupted.

Mirracle - Using Microsoft Kinect for interactive, augmented reality, anatomy education

Research groups at the technical university Munchen in Germany have developed an augmented reality system to study anatomy.

Their second version of the augmented reality magic mirror uses the Microsoft Kinect to detect a user standing in front of a screen. Subsequently, augmented reality is used to overlay a volume visualization of a CT onto the user. Using gestures the user can select 2D slices. The prototype was presented at the open day of Klinikum Ingolstadt. For more info see www.mirracle.de

Great development for education, but it also might find its way into clinical practice.

Education in eHealth - MIC 2001 session

Currently, education in information technology application in medicine is becoming of vital importance.
However, education at bachelors and masters level in medical informatics is extremely diverse with all kind of different educational programs that have their own curriculum and requirements. This is already demonstrated by the wide variety of terminology existing for such curricula such as medical informatics, clinical informatics, clinical information science, technical medicine, etc. Unfortunately, there also is no general list of end-points determining what students that completed one of these needs to know and be capable off.

However, people educated in IT in medicine are entering the clinical arena and work on improvement of healthcare and do research in this important area.

Another striking conclusion is that Medical education itself does not include any health informatics. They claim that this is not necessary since their students know how to use computers. Therefore, more education of medical students in the use of IT technology in day to day practice in modern healthcare institutions should be promoted.

Pie Medical showcases CT software

Pie Medical Imaging (Maastricht, the Netherlands) demonstrated their product showcase at our department. They acquired a software company also based in the Netherlands called 3Mensio which adds CT software to their already existing package of advance imaging applications.

Like with their earlier products, Pie Medical is not aiming at a general purpose workstation but at stand-alone, specialised, software tools for specific applications.
The CT applications currently focus on the evaluation and planning with respect to intravascular interventions such as abdominal aorta stent placement and aortic valve replacement.

 

Impressive software based on GPU processing which can be easily integrated into any PACS environment using a command-line interface.

Launch Center for Medical Imaging

Today the Center for Medical Imaging North East Netherlands (CMI-NEN) was launched. Presentations were given by representatives of government, industry, healthcare insurance companies and research groups providing a wide view on the possibilities and future perspectives of this Center of Research Excellence.
 
Within this CMI-NEN, Medical Imaging Informatics is a very prominent enabler and one of the discipline groups.

One of the main issues presented by several of the stakeholders is that cooperation between public and private entities is essential. Within CMI a large amount of companies, of which many are working in the area of medical imaging informatics, are cooperating with the university medical center groningen and the technical university twente.

Furthermore, medical imaging informatics is regarded one of the possible solutions to reduce the cost of healthcare in an ageing society and to increase productivity.

The digital imaging infrastructure is an important project of CMI-NEN which will be starting soon and aims to setup a unique and high-end multi-site digital medical research infrastructure.

Study shows cost of not turning off workstations after working hours

In a study published in the November issue of the Journal of the American College of Radiologythe authors demonstrated that the increased IT usage within radiology departments may benefit the patient, but puts a large burden on the energy consumption and thus on the environment. Especially because in many cases, radiology workstations tend to be switched on 24/7.
The authors demonstrated that shutting down equipment after an eight-hour day and on weekends would cut electricity consumption 76 percent, the researchers estimated, saving $9,225. The paper concludes that:

“Radiologist have the unique opportunity, as technological leaders, to direct energy efficiency measures as a means of cost savings and the reduction of airborne by-products from energy production to improve patients’ lives."

Wii Remote-enhanced Hand-Computer Interaction for 3D Medical Image Analysis

Look at this movie for a more serious application of the wii remote using a very simple glove with some IR LEDs attached to it.

RSNA 2011 - Pre-meeting Glance at the schedule

During the RSNA, the largest radiology conference in the world running from November 27 to December 2, many sessions will focus on medical imaging informatics. Topics included into the programme are for example:

1. Informatics (Education and Research) in room S403A on Sunday
2. Informatics support for Quantitative Imaging in room E353A on Sunday
3. Advanced Image Analysis in room S401CD on Monday
4. Practical Informatics for the Practicing Radiologist: Part One in room S501ABC on Monday
5. Decoding the Alphabet Soup (IHE, MIRC, RADLEX, Reporting): Worldwind Tour on RSNA Informatics Projects in room S401AB on Monday
6. Standardized Terminology in Radiology: Applications and New Developments in room S403A on Tuesday
7. Virtualization and remote rendering for Medical Imaging in room E263 on Friday

Besides these scientific sessions, the technical exhibit includes virtually all major players in the field of Medical Imaging Informatics and in many cases the RSNA is used to launch and introduce new developments.

I will be attending RSNA and use this blog during the meeting to report on the scientific sessions I attend and to share news from the technical exhibit.

Holodesk by Microsoft - real interaction with 3D objects

They are just showing this now with some balls and cubes, but Microsoft really made the next step with their Holodesk as demonstrated in the youtube movie shown below.

In my opinion these kind of technologies should also be explored for the medical field. How about serious gaming using a system like this to practice surgery for example.. Or just using it to display patient data for diagnosis and follow-up. It's technologies like this that could really change the way we interact with data and information nowadays and to get away from the standard desktop.

Enhanced four-dimensional presentation of cardiac CT data

Demonstrated again at the ESCR 2011 in Amsterdam last week, the PhyZiodynamic software of Ziosoft Inc. Incredible what they can do based on 4D imaging data obtained from CT. With advanced computing techniques they compute a fluent 4D moving heart with increased temporal and spatial resolution. Technically it is possible, as they demonstrate, and now they are looking for the clinical applications.

PhyZiodynamic solutions are based on uncompressed imaging data, using off-the-shelf hardware. Ziosoft's revolutionary PhyZiodynamic algorithms utilizes non-rigid (deformable) registration on lossless temporal images to reduce noise, improve motion coherence, and enable functional analytics.
 
Look at their website for some example movies.

New version of the NEN 7510 available

A new version of the NEN 7510 standard of the Dutch standards institute (NEN) is available as of today. NEN 7510 concerns Information protection in healthcare. The new version is easier to read and contains all national and international requirements for information protection in healthcare into one single document.

See more information on the Zorgvisie website.