Social Media use in Healthcare

Use of social media by healthcare professionals is a matter of growing debate and concern. Discussions are on the way how healthcare professionals should behave themselves when using social media and several guidelines are proposed and published by different organisations in a variety of countries.

To provide insight in social media and what is involved, the US Centers for Disease Control and Prevention have published a document called "The Health Communicator's Social Media Toolkit".
This toolkit describes different social media tools and provides information on how to use them properly in a healthcare environment.

Publication: A Situational Aligment Framework for PACS

Last year we published this paper in Journal of Digital Imaging on the situational alignment framework for PACS. Using this framework, it is possible to determine the maturity level of a PACS implementation and to evaluate the current status of this implementation.


A situational alignment framework for PACS.
van de Wetering R, Batenburg R, Oudkerk M, van Ooijen P, Brinkkemper S, Scheper W.
J Digit Imaging. 2011 Dec;24(6):979-92.


Abstract
This paper reports the outcomes of a study on an integrated situational alignment framework for picture archiving and communication systems (PACS) labeled as PISA. Following the design research cycle, complementary validation methods and pilot cases were used to assess the proposed framework and its operationalized survey. In this paper, the authors outline (a) the process of the framework' development, (b) the validation process with its underlying iterative steps, (c) the outcomes of pilot cases, and (d) improvement opportunities to refine and further validate the PISA framework. Results of this study support empirical application of the framework to hospital enterprises in order to gain insights into their PACS maturity and alignment. We argue that the framework can be applied as a valuable tool for assessments, monitoring and benchmarking purposes and strategic PACS planning.

Publication: Postprocessing Pitfalls in Using CT for Global LV Function

This paper is a overview of the work we did on the evaluation of Left Ventricular (LV) function using Computed Tomography (CT). Earlier papers have already covered several aspects of this measurement. This paper, based on our poster presentation at RSNA 2010 provides a good overview of the problems that can arise in LV measurement.

Informatics in Radiology: Postprocessing Pitfalls in Using CT for Automatic and Semiautomatic Determination of Global Left Ventricular Function.
van Ooijen PM, de Jonge GJ, Oudkerk M.
Radiographics. 2012 Mar;32(2):589-99. 


Abstract
Recent advances in technical capabilities of computed tomographic (CT) scanners, including an increasing number of detector rows, improved spatial and temporal resolution, and the development of retrospective gating, have allowed the acquisition of four-dimensional (4D) datasets of the beating heart. As a result, the heart can be visualized in different phases and CT datasets can be used to assess cardiac function. Many software packages currently exist that allow automatic or semiautomatic evaluation of left ventricular function on the basis of 4D CT datasets. The level of automation varies from extensive, completely manual segmentation by the user to fully automatic evaluation of left ventricular function without any user interaction. Although the reproducibility of functional parameter assessment is reported to be high and intersoftware variability low for larger groups of patients, significant differences can exist among measurements obtained with different software tools from the same dataset. Thus, careful review of automatically or semiautomatically obtained results is required.

The Future of Integrated Health Care 2015

Check out this interesting movie on youtube. Is this where we are going??

The Future of Health Care is a subject that has been under intense speculation and debate in recent times across different forums. Several interesting prototypes and scenarios have been made by professionals and designers to give the World a glimpse of a fuzzy future.

Ergonomidesign have made it possible to actually experience the future of Health Care. Following their launch at the Medica/ Compamed trade fair (in Düsseldorf, Germany, Nov. 17-19), Ergonomidesign will present and demonstrate a future life science application that brings together 40 years of design experience for Ergonomidesign in the Life Science industry. This video is one of 2, that give an overview of the entire concept.

Publication: Implementation of an anonymisation tool for clinical trials

Since we do a lot of clinical research we are constantly working trying to facilitate the easy transfer of data from one hospital to the other. In this paper we presented the integration of the CTP tool from the RSNA, used for automated anonymization of imaging data, into an existing trial database that did not support imaging. The abstract is provided below along with a link to the open access paper.
 


Implementation of an anonymisation tool for clinical trials using a clinical trial processor integrated with an existing trial patient data information system.
Aryanto KY, Broekema A, Oudkerk M, van Ooijen PM.

Eur Radiol. 2012 Jan;22(1):144-51. Epub 2011 Aug 14. 

Abstract

OBJECTIVES:
To present an adapted Clinical Trial Processor (CTP) test set-up for receiving, anonymising and saving Digital Imaging and Communications in Medicine (DICOM) data using external input from the original database of an existing clinical study information system to guide the anonymisation process.
METHODS:
Two methods are presented for an adapted CTP test set-up. In the first method, images are pushed from the Picture Archiving and Communication System (PACS) using the DICOM protocol through a local network. In the second method, images are transferred through the internet using the HTTPS protocol.
RESULTS:
In total 25,000 images from 50 patients were moved from the PACS, anonymised and stored within roughly 2 h using the first method. In the second method, an average of 10 images per minute were transferred and processed over a residential connection. In both methods, no duplicated images were stored when previous images were retransferred. The anonymised images are stored in appropriate directories.
CONCLUSIONS:
The CTP can transfer and process DICOM images correctly in a very easy set-up providing a fast, secure and stable environment. The adapted CTP allows easy integration into an environment in which patient data are already included in an existing information system.

Publication: Design and Implementation of I2Vote

Below the abstract and a link to the full text of a recently published article by our group concerning I2Vote.

Design and implementation of I2Vote--an interactive image-based voting system using windows mobile devices. Int J Med Inform. 2011 Aug;80(8):562-9.

Abstract

PURPOSE:

To develop, implement and test a novel audience response system (ARS) that allows image based interaction for radiology education.

METHODS:

The ARS developed in this project is based on standard Personal Digital Assistants (PDAs) (HP iPAQ 114 classic handheld) running Microsoft® Windows Mobile® 6 Classic with a large 3.5 in. TFT touch screen (320×240 pixel resolution), high luminance and integrated IEEE 802.11b/g wireless. For software development Visual Studio 2008 professional (Microsoft) was used and all components were written in C#. Two test sessions were conducted to test the software technically followed by two real classroom tests in a radiology class for medical students on thoracic radiology.

RESULTS:

The novel ARS, called I2Vote, was successfully implemented and provided an easy to use, stable setup. The acceptance of both students and teachers was very high and the interaction with the students improved because of the anonymous interaction possibility.

CONCLUSION:

An easy to use handheld based ARS that enables interactive, image-based, teaching is achieved. The system effectively adds an extra dimension to the use of an ARS.

 

Health Affairs: Docs need to learn more health IT competency earlier

Quality improvement and patient-centered care—two concepts essential to the health reform effort—will require health IT. Current and future physicians must master the minimal competencies required to use health IT if the healthcare system is to reach its quality and cost containment goals, according to an article in the March edition ofHealth Affairs. Health Affairs: Docs need to learn more health IT competency earlier


Six near-term opportunities for integrating health IT training into educational and professional development programs are defined:


1. Improve integration of health IT into medical licensing board exams
2. Include health IT requirements in accreditation of curricula
3. Require meaningful use of health IT as a condition of licensure
4. Integrate assessment of health IT capabilities into board certification
5. Integrate use of health IT into continuing medical education: 
6. Use EHR-generated practice profiles to customize continuing medical education:

Another application of visualization: 3D animation to explain a procedural problem in court

In this, Dutch, video an interesting example is given of medical visualization. This forensic visualization was made to demonstrate the procedure in which a surgeon left a guidewire in the body of the patient. 

Kinect based medical image exploration

The author directed me to this movie in a comment on an earlier post on their previous system using the wii remote. Now they have a gesture based system using the kinect. Looks fantastic and very versatile.

Action Plan E-Health - results of public consultation published

A final report on the public consultation on the eHealth Action Plan 2012-2020 has been published. The four main objectives resulting from this consultation are:

1. Increase awareness of the benefits and opportunities of eHealth, and empower citizens, patients and healthcare professionals.
2. Address issues currently impeding eHealth interoperability
3. Improve legal certainty for eHealth
4. Support research and innovation in eHealth and development of a competitive European market

The consultation participants proposed that the European Commision should contribute to the plan by:

1. Supporting systematic evaluation of benefits, costs and usefulness of eHealth solutions
2. Providing guidance for achieving EU wide interoperability (e.g. the use of common standards, profiles, terminologies); and
3. Supporting deployment of eHealth services/solutions based on evidence facilitating cooperation between Member States and/or regions to address common challenges. 

The full report can be found here.

Study: iPads boost residents' efficiency

Providing personal mobile computers to medical residents increases their efficiency, reduces delays in patient care and enhances continuity of care, according to a research letter in the March 12 issue of the Archives of Internal Medicine. Read more about this in the HealthImaging coverage: Study: iPads boost residents' efficiency

Is the end of the CD era approaching?

The distribution of patient imaging data on CDs and DVDs is commonplace in almost every hospital in developed countries. However, with the increasing demand on imaging and the increase in the amount of data generated at each acquisition, the number of CDs and DVDs is increasing dramatically and the flood of portable media is almost impossible to handle. Network based sharing over the internet using secure protocols and profiles such as XDS(i) could solve the problem. Read the story from the HIMSS by Healthcare Technology Management for more information. HIMSS: Is the end of the CD era approaching?

Introduction into PACS movie

A non-branded short presentation on the basics of PACS. Already somewhat older, but the basics stay the same.

Gesture based control of AquariusNET using Kinect

Using the Kinect with the TeraRecon AquariusNET software. I'm only wondering how they change between the different operations since they do not show that. Probably they change the function using the mouse and then interact again with gestures.

Hand Tracking

Little bit older already, but still a very good handtracking that might be beneficial in manipulation of medical data since they capture a lot of different gestures with only a simple webcam.

IHE Europe Introduction Video

IHE Europe has launched a video to give a general introduction to IHE and to explain the tasks and goals of IHE Europe.

ECR 2012 - SS505/B0376 - Semantic navigation in radiology

In this presentation (abstract here) a method was proposed that links semantic information from the radiology report directly to images. Additional value of the methodology would be the capability to auto compare what is written in the radiology report to the pathology reports that are constructed later in the diagnostic process. To achieve their objective the researchers developed tools to analyze and automatically index text to include them into a search engine. They suspect possible applications in clinical, research and teaching environments.

Clinical:

• Validate diagnosis
• Looking for best-practice reports
• Mobile app for clinicians
• Integration in referring physician portal

Research:

• Collecting patient cohorts

Teaching:

• Database for teaching cases
• Prepare lectures and talks

The concluded that their analysis shows that comprehensive syntactic and semantic text analysis is required to achieve high-quality information extraction from radiology reports. This could be the basis for a number of value-added applications in clinic, research and teaching.

ECR 2012 - SS505/B0375 - Towards efficient simultaneous multi-patient annotation of 3D imaging data.

In this presentation the authors described their method to segment a stack of similar images from different patients using a basic segmentation of one sample. They do this based on a weakly supervised classification algorithm to segment the complete set. Examples were shown to demonstrate the process where only a small amount of user interaction was required to achieve the segmentation.
They conclude that using over-segmentation through superpixels combined with local descriptors makes the labelling problem in multi-patient segmentations tractable.
One question after this presentation was about the clinical application of this kind of method. Most probably the highest value application will be in (retrospective) clinical research where often large sets of data from different patients have to be segmented to segment certain anatomical or pathological structures.

ECR 2012 - SF12 - Radiology on the road: working when you are away from home

In the session entitled 'Radiology on the road: working when you are away from home' after the introduction of the chairman (dr. Donoso from Spain), three presenters shared their thoughts on this issue.

First up was dr. Ranschaert on 'Teleradiology in 2012: growing or shrinking in importance'. In a European survey it was shown that 35% of the respondents used teleradiology for outsourcing of which 65% was sent to commercial reading companies. It was clear that teleradiology is already frequently used although there still remain a lot of issues concerning practical and legal issues. Regulation and reimbursements are often mentioned as being important issues still to solve. Main reasons for Teleradiology are:

• shortage of radiologists


• need for oncall readings


• need for subspecialty advise

Also opportinities for further growth are identified.

Driving factors of Teleradiology are:

• Demand for Tele Radiology


• Infrastructure


• Political climate


• Cost of healthcare


• Acceptance by radiological communitee

Key issues to be solved for even more widespread introduction and growth of Tele Radiology are quality assurance, privacy and security, standards (IHE), legal, financial, language.
Transition to mobile radiology is regarded to be the main future development in Tele Radiology. Dr. Ranschaert stated that a paradigm shift is required with a more patient centered radiology where patients are managers of their own data with new services for patients using websites and apps.

Next dr. Ratib presented on 'Use of PDAs and other hand held devices in radiology: beyond the head?' to demonstrate his point dr. Ratib presented using his iPad. Tablet are changing the way we do things and penetrate our world through the consumer market. Also in the medical field the use of tablets has shown a rapid adoption. Webbased extensions of the current systems can already be used on mobile devices and are available from many vendors. Furthermore, low cost apps are becoming available. The quality of the images still has to be proven but is increasing in resolution rapidly. One of the main area where the disruptive technology is gaining interest is the use of tablets in the OR for direct imaging. Another application area is to have an app companion to a textbook with more interactive material.

Finally, dr. Fitzgerald presented on 'Legal issue of teleradiology and portable reporting'. He stated explicitly that (medical) regulation is a barier of defense against the 'bad'. However regulation is going slowly and has problems to keep up with the novel possibilities in healthcare such as Tele Radiology. Directives and legislation is being developed to address issues of cross border wokring including Tele Radiology.
He summarized three critical issues when starting to use mobile devices:

• Don't let standards slip


• Documentation


• Patient confidentiality

For Teleradiology these are:

• Check indemnity cover


• Don't let standards slip


• Less tolerance from strangers


• Fatigue


• PACS audit trail

ECR - MIR@ECR - Managing Radiology

Three presentations were given in this session.

The first one was on the implications for radiology of Imaging and benchmarking by dr. Schouman. Benchmarking is the comparison to best practices based on measurements. She promoted benchmarking to achieve improvement of the productivity and performance of a radiology department. The current situation with EHR, RIS and PACS starts to enable efficient benchmarking. Problems are
- Cumbersome data capture
- Poor data quality
- Lack of standardization
- Reductive analysis
- Meaningless comparisons
One of the key points is the assurance that manual data entry is done correctly. For example the information going into the RIS.

Second was the added value of in-house radiological IT by dr. Jakobsen. He showed, based on examples, that IT is crucial for the operation of a radiology department and that the absence of IT would take down that complete radiology department. The in-house IT support is critical to keep the IT up and running since they can either solve the problem or knows who to contact. Concluding in-house radiology IT can effectively prevent a stop in workflow.

Finally, dr. Senol talked about Risk management in radiology. As definition of risk he gave: The potential that an chosen action or inaction leads to a negative outcome. Risks in radiology are:
- related to reporting
- direct harm to the patient
- related to decision making
Risks related to reporting are:
- delay
- errors in reporting (up to 4% of reports)
- false positive or negative errors
- incorrect diagnosis
When an error occured patient and hospital should be informed and the root cause of the error should be assessed.

ECR 2012 - MIR@ECR - Communication with our Partners

Three presentations were given in this session.

First dr. Kahn talked about computerized physician order entry and decision support. He approached this from the side of the appropriateness criteria. He stated that those criteria are not meant for the radiologist but for the referring physicians. However, delivering it to them in an enormous pdf file is not very efficient. It should be integrated into the exam ordering process using computerized systems inside the electronic health record. By doing this the referring physician can enter the properties of the patients and get decision support on their order. This should reduce the number of wrong diagnostic tests or may even reduce the number of diagnostic tests. Kahn remarked that we should be talking about a radiology examination request and not an order. Furthermore he stated that decision support should be regarded as advise and not the law and that a physician should be able to reject the advice.

Next, dr. Centoze gave a presentation about communication of urgent and unexpected findings. He started to state that efficient and correct communication is crucial. ESR has release guideliness on communication of urgent and unexpected findings published in insights in imaging. Ideally an automatic alert and feedback system should be implemented. Urgent information should always be communicated directly with the referring physician. Unexpected findings could be communicated with other methods like e-mail .

Finally, a presentation on implications of reporting infrastructure - general reading room vs. Individual office was given by dr. Strickland. She presented her personal preference of a general reporting room and discussed pros and cons of that choice against private offices. The pros are:
- less costs because of maximum use of the workstations
- optimized ergonomics in the central reading rooms
- camaraderie: reporting is a social activity/teambuilding
- facilitates clinician access
- enhances inter-radiologist consultation
The perceived cons are
- noise
- personalized workstation settings lost
- pre-existing building architecture
Extra small reporting rooms could be beneficial to have. But they should not be personal.

ECR 2012 - SS505/B0373 - Automated semantic navigation and synchronized alignment

Semantic navigation is used to synchronize baseline and follow-up CT examinations. The algorithm detects words from the radiology report and puts links on it to automatically travel to the proper region in the images. To achieve this the software automatically detects landmarks in the anatomy and connects this to semantic information using rekationships like 'close to', 'above', 'to the right of', etcetera. this method allows matching of non-corresponding exams and provides clinically sufficient automatic alignment of corresponding findings in consecutive examinations.

ECR 2012 - SS505/B0372 - Digital Perfusion Phantoms for software validation

Digital perfusion phantoms and their use in perfusion validation.
The researchers showed comparable perfusion maps with totally diffferent definition of artery and vein location. Even completely misplaced locations resulted in an acceptable looking perfusion map using commercial software.
To allow calibration of perfusion software they developed the digital perfusion phantom. They start from the wanted perfusion map and produce the DICOM images that correspond to this map.
The presenter showed that the patterns generated in the simulated, simple DICOM images are not exactly right and very different when comparing different software packages. In an example where they overlapped their simulated map on the anatomical image strange highlighted regions appeared in one software system that should not be there. They also tested some freeware from the web and those packages provided even worse results.
The authors concluded that 'processing DPP perfusion sequence with any perfusion software of choice, and comparing the results to the expected DPP patterns provide a robust and straightforward way to control the quality of perfusion analysis, software, and protocols'

ECR 2012 - workstation face-off

This year the face-off session at ECR for the fifth time with 6 participating companies. Aycan, GE Healthcare, Philips Healthcare, Siemens Healthcare, TeraRecon, and Vital Images.
The cases presented were prepared for four weeks preceding the conference. Two cases were presented with five minutes per company per case.
The first case was a cardiac case.
First task was to assess a four dimensional CT dataset. 3D visualization and assessment of the grafts in this patient was requested. Next analysis of the original RCA was requested with plaque analysis. Finally, LV function was performed.
Aycan, like all companies, showed automated segmentation of the heart.
The lima graft posed a bigger problem with full manual segmentation by Aycan. Overall the Aycan system proved to be less automated overall and required a lot of manual interaction and ran out of time.
Philips uses a model based approach where all 'components' are automatically segmented and colour coded. Suprisingly end systolic and end diastolic phases were selected manually while all phases were already segmented and thus this could be easily automated.
Terarecon also demonstrated their iPad integration that can be used for the communication with referring physicians. Their process is fast and automatic and they had 30 seconds left.
Siemens demonstrated the preprocessed workflow of syngo.via. Very automatic too with everything segmented and labelled. As an extra they showed the ability to do right ventricular analysis and had 20 seconds left.
Vital Images showed one click segmentation of the LIMA graft. The segmentation of the LV was a more manual process of defining the location of the axis of the LV after which the ejection fraction is computed.
GE Healthcare was the last to present the cardiac case. Heart segmentation contained a lot of remaining parts of the thorax and was not complete. Segmentation of the LIMA and RCA was manual and rather time consuming. The LV volume segmentation was automatic but required some manual adjustment to delete certain cavities from the volume. They managed to finish right in time.
Not supprisingly it was demonstrated, as always, that the LV function quantification varied between the different vendors.
The second case was an oncological case.
The tasks were to analyse a baseline and two followup CT scans. Specifically they were asked to define response, show simultaneous view of all timepoints and measure mass volume over different timepoints.
All workstations were up to this task, but the interesting thing was the variety of segmentation methods used.
Region growing segmentaion was shown by Terarecon which is a very straightforward way but requires more manual interaction.
Diameter definition segmentation was shown by Siemens that allows defining a rough centerline through the lesion with manual adjustment after the initial first segmentation.
A mouse over segmentation was shown by Vital Images which allowed the fastest segmentation with just a couple of mouse clicks.
Segmentation by GE was made using a edge based segmentation using a livewire which has to be performed at multiple levels to get the volume segmentation by interpolation.
Aycan required fully manual, polynomial segmentation of the lesion by defining a number of point on the borders in 2D at multiple slices. This required a lot of clicks and was the most manual way of all software companies. They were the only one running into time problems again.
Philips showed a new segmentation they call smart ROI which looks similar to the region growing algorithm but seems to be faster to operate.
Here also, the volume measurements were, off course, varying a lot. However, it was shown that the response reported by the different systems were similar.

There is no way to define a clear winner from sessions like this. All worstations perform their task and many issues are user and preference dependent. I would say though that based on what was demonstrated Aycan was the 'looser' however this might change when the price of the solutions is taken into account.