SMART BEAR: A large scale pilot supporting the independent living of the seniors in a smart environment

SMART BEAR is a multinational European research project implementing an innovative, secure and privacy-preserving platform with market available wearable and medical devices, along with smart home sensors. The solution will target the elderly population who suffer from Hearing Loss, Cardio Vascular Diseases, Cognitive Impairments, Mental Health Issues and Balance Disorders. The platform will be tested and validated in five large scale pilots, in six different countries and 5100 individuals, providing evidenced-based interventions on lifestyle, medical significant risk factors, and chronic disease management. The present work demonstrates the initial requirements collection and analysis, along with the architecture and the Decision Support System, which will provide the evidence on the recommendations to the individuals.

HOLOBALANCE: An Augmented Reality virtual trainer solution forbalance training and fall prevention

Balance disorders affect a large number of older people, leading to falls. To promote independence, self-care and the quality of living of the long-lived population, an innovative solution is devoped to act as a virtual trainer for people that suffer from vestibular dysfunction related balance disorders. Our solution offers a virtual balance therapy, supported by Information and Communication Technology devices, to monitor user's activity during the day and provide real time feedback for the correct execution of physiotherapy exercises. Wearable sensors are utilized to monitor user activity, while during the execution of exercises, cameras are used to track the body of the user. An Augmented Reality headset is used to project the virtual trainer's 3D avatar in front of the user, providing real time guidance for the correct execution of the exercises.

Monitoring of compliance on an individual treatment through mobile innovations

The present work examines the potential of smartphone usage for offering health services to elderly patients. The purpose of this work is the design, development, and implementation of a telemedicine application. This application aims to improve the monitoring mode and increase patient adherence to the instructions assigned by the medical staff. It consists of three parts: the doctor's application (Web Application), the patient's application (Android Application) and the Web Server of the platform, where the database is stored necessary for the smooth operation of the platform. Also the Web Server hosts the doctor's Web Application. The Web Application is based on web front-end technologies, providing the medical personnel with a variety of features and useful actions. These actions and capabilities are mainly relevant to the assignment of instructions to patients and the monitoring of their health progress. The Android Application has been implemented and validated for the Android-based mobile devices operating system and consists of a handy and user-friendly environment, equipped with the right tools so that the patient has the ability to update the system on the progress of his/her health by storing the appropriate measurements. Both applications also provide customization capabilities in regards to the patients' and doctors' profile.

ART-ML: a new markup language for modelling and representation of biological processes in cardiovascular diseases

BACKGROUND

With an ever increasing number of biological models available on the internet, a standardized modelling framework is required to allow information to be accessed and visualized.

OBJECTIVE

In this paper we propose a novel Extensible Markup Language (XML) based format called ART-ML that aims at supporting the interoperability and the reuse of models of geometry, blood flow, plaque progression and stent modelling, exported by any cardiovascular disease modelling software. ART-ML has been developed and tested using ARTool. ARTool is a platform for the automatic processing of various image modalities of coronary and carotid arteries.

METHODS

The images and their content are fused to develop morphological models of the arteries in 3D representations. All the above described procedures integrate disparate data formats, protocols and tools. ART-ML proposes a representation way, expanding ARTool, for interpretability of the individual resources, creating a standard unified model for the description of data and, consequently, a format for their exchange and representation that is machine independent. More specifically, ARTool platform incorporates efficient algorithms which are able to perform blood flow simulations and atherosclerotic plaque evolution modelling. Integration of data layers between different modules within ARTool are based upon the interchange of information included in the ART-ML model repository. ART-ML provides a markup representation that enables the representation and management of embedded models within the cardiovascular disease modelling platform, the storage and interchange of well-defined information.

RESULTS

The corresponding ART-ML model incorporates all relevant information regarding geometry, blood flow, plaque progression and stent modelling procedures. All created models are stored in a model repository database which is accessible to the research community using efficient web interfaces, enabling the interoperability of any cardiovascular disease modelling software models.

CONCLUSIONS

ART-ML can be used as a reference ML model in multiscale simulations of plaque formation and progression, incorporating all scales of the biological processes.

Integrating legacy medical data sensors in a wireless network infrastucture

In the process of developing a wireless networking solution to provide effective field-deployable communications and telemetry support for rescuers during major natural disasters, we are faced with the task of interfacing the multitude of medical and other legacy data collection sensors to the network grid. In this paper, we detail a number of solutions, with particular attention given to the issue of data security. The chosen implementation allows for sensor control and management from remote network locations, while the sensors can wirelessly transmit their data to nearby network nodes securely, utilizing the latest commercially available cryptography solutions. Initial testing validates the design choices, while the network-enabled sensors are being integrated in the overall wireless network security framework.

Elastic models: a comparative study applied to retinal images

In this work various methods of parametric elastic models are compared, namely the classical snake, the gradient vector field snake (GVF snake) and the topology-adaptive snake (t-snake), as well as the method of self-affine mapping system as an alternative to elastic models. We also give a brief overview of the methods used. The self-affine mapping system is implemented using an adapting scheme and minimum distance as optimization criterion, which is more suitable for weak edges detection. All methods are applied to glaucomatic retinal images with the purpose of segmenting the optical disk. The methods are compared in terms of segmentation accuracy and speed, as these are derived from cross-correlation coefficients between real and algorithm extracted contours and segmentation time, respectively. As a result, the method of self-affine mapping system presents adequate segmentation time and segmentation accuracy, and significant independence from initialization.

Evaluating the effect of various background correction methods regarding noise reduction, in two-channel microarray data

In this work, two novel background correction (BC) methods, along with several commonly used ones, are evaluated regarding noise reduction in eleven two-channel self-versus-self (SVS) hybridizations. The evaluation of each BC method is investigated under the use of four statistical criteria combined into a single measure, the polygon area measure. Overall, our proposed BC approaches perform very well in terms of the proposed measure for most of the cases and provide an improved effect regarding technical noise reduction.

ISWLS: novel algorithm for image reconstruction in PET

The purpose of this study is to introduce a novel empirical iterative algorithm for medical image reconstruction, under the short name ISWLS (image space weighted least squares), which is expected to have image space reconstruction algorithm (ISRA) properties in noise manipulation and weighted least-squares (WLS) acceleration of the reconstruction process. We used phantom data from a prototype small-animal positron emission tomography system and the methods presented here are applied to 2-D sinograms. Further, we assess the performance of the new algorithm by comparing it to the simultaneous version of algebraic reconstruction technique (ART), simultaneous algebraic reconstruction technique (SART), to expectation maximization maximum likelihood (EM-ML), ISRA, and WLS. All algorithms are compared in terms of cross-correlation coefficient, reconstruction time, and contrast-to-noise ratios (CNRs). As it turns out, ISWLS presents higher CNRs than EM-ML, ISRA, and SART for objects of different sizes. Also, ISWLS shows similar performance to WLS during the first iterations but it has better noise manipulation. Finally, ordered subsets ISWLS (OS-ISWLS), the OS version of ISWLS, shows its best performance between the first six-nine iterations. Its behavior seems to be a compromise between OS-ISRA and OS-WLS.

A multiple watermarking scheme applied to medical image management

Digital watermarking is a recently emerged research area, which has the potential of providing alternative/complementary solutions for a number of issues relating to medical data management and distribution. The present paper aims to reveal the perspectives of digital watermarking in health information systems, and proposes a wavelet-based multiple watermarking scheme that addresses the issues of medical data protection, archiving, and retrieval, as well as of origin and data authentication. The scheme applies multiple watermarking in medical images, and embeds in them the physician's digital signature, patient's personal and examination data, keywords for image retrieval, and a reference watermark for the purpose of data integrity control. The experimental results demonstrate the efficiency and transparency of the watermarking scheme, which conforms to the strict limitations that apply to regions of diagnostic significance.

Energy-efficient MAC Protocol for Patient Personal Area Networks

The formulation of a Personal Area Network (PAN), consisting of a wireless infrastructure of medical sensors, attached to patient's body, and a supervising device carried by them, lays the path for continuous and real-time monitoring of vital signs without discomforting the person in question. This infrastructure enhances the context of remote healthcare services by supporting flexible acquisition of crucial vital signs, while at the same time it provides more convenience to the patient. Aiming at the exploitation of the inherent features and requirements of wireless medical sensor networks, in this paper we focus on the main design guidelines of a low power Medium Access Control (MAC) protocol, designated to support a patient PAN. The proposed protocol intends to improve energy efficiency in such applications and thus is oriented towards the prevention of main energy wastage sources, such as collision, idle listening and power outspending.

A Communication Platform for Tele-monitoring and Tele-management of Type 1 Diabetes

Type 1 diabetes mellitus is a chronic disease characterized by blood glucose levels out of normal range due to inability of insulin production. This dysfunction leads to many short- and long-term complications. In this paper, a system for tele-monitoring and tele-management of Type 1 diabetes patients is proposed, aiming at reducing the risk of diabetes complications and improving quality of life. The system integrates Wireless Personal Area Networks (WPAN), mobile infrastructure, and Internet technology along with commercially available and novel glucose measurement devices, advanced modeling techniques, and tools for the intelligent processing of the available diabetes patients information. The integration of the above technologies enables intensive monitoring of blood glucose levels, treatment optimisation, continuous medical care, and improvement of quality of life for Type 1 diabetes patients, without restrictions in everyday life activities.

The effect of color correction of endoscopy images for quantitative analysis in endometrium

The objective of this study was to develop a standardized protocol for the capturing and analysis of endoscopy digital images for subsequent use in a Computer Aided Diagnosis (CAD) system in gynaecological cancer. Images were captured at optimum illumination and focus at 720x576 pixels using 24 bits color in the following cases: (i) for a variety of testing targets from a color palette with known color distribution, (ii) different viewing angles and distances from calf endometrium, and (iii) images from the human endometrium. Images were then gamma corrected and their classification performance was compared against that of nonqamma corrected images. No significant difference in texture features was found between the close up and panoramic views, and between angles, either before or after gamma correction. There was significant difference in certain texture features between normal and abnormal endometrium, both before and after gamma correction. Our findings suggest that proper color correction can significantly impact CAD system performance, and we recommend its application prior to quantitative texture analysis in gynaecological endoscopy.

Healthcare services towards individualised wellness (i-wellness)

Information technology applications in medicine are rapidly expanding, and new methods and solutions are evolving since they are considered pivotal in the success of preventive medicine. In this paper two different concepts will be presented, the PANACEIA-iTV and the e-Vital concept. PANACEIA-iTV is a home care service provision system based on interactive TV technology and supported by the IST programme of the European Commission. The e-Vital service, supported by the eTEN programme of the European Commission, regards an integrated homecare and telemonitoring service chain aimed at large sensitive parts of the European population, the "at-risk" citizens. Both concepts developed a generic, flexible and adaptable framework for the combination of heterogeneous information sources and the creation of the individualised wellness (i-wellness) profile for prognostic purposes and early intervention.

Multiple digital watermarking applied to medical imaging

Beyond its already established wide range of applications, digital watermarking has recently started to gain a foothold in the healthcare sector. The paper discusses the potential of multiple watermarking to address a number of health information management issues, such as protection of sensitive data, origin and data authentication, image archiving and retrieval. A wavelet-based multiple watermarking scheme focusing on these medical-oriented applications is presented; the scheme allows the physician to define a Region of Interest, whose diagnostic value is explicitly protected throughout the embedding process, since the only additional information inserted therein is for the purpose of integrity control. The rest part of the image casts multiple watermarks conveying the physician's digital signature, patient's sensitive data, and keywords allowing image retrieval. In order to increase data robustness, a form of hybrid coding is applied, which includes repetitive embedding of BCH encoded watermarks.

A low power medium access control protocol for wireless medical sensor networks

The concept of a wireless integrated network of sensors, already applied in several sectors of our everyday life, such as security, transportation and environment monitoring, can as well provide an advanced monitor and control resource for healthcare services. By networking medical sensors wirelessly, attaching them in patient's body, we create the appropriate infrastructure for continuous and real-time monitoring of patient without discomforting him. This infrastructure can improve healthcare by providing the means for flexible acquisition of vital signs, while at the same time it provides more convenience to the patient. Given the type of wireless network, traditional medium access control (MAC) protocols cannot take advantage of the application specific requirements and information characteristics occurring in medical sensor networks, such as the demand for low power consumption and the rather limited and asymmetric data traffic. In this paper, we present the architecture of a low power MAC protocol, designated to support wireless networks of medical sensors. This protocol aims to improve energy efficiency by exploiting the inherent application features and requirements. It is oriented towards the avoidance of main energy wastage sources, such as idle listening, collision and power outspending.

Integration of monitoring devices in the e-Vital service

The continuous treatment of chronic diseases such as heart diseases, pulmonary disease and diabetes, relies on the patient's self-monitoring. The rapid advance in the development of telemedicine systems and monitoring devices during last years gave several solutions in continuous patient telemonitoring. However, in most of the cases, these systems work with only one or a few types of medical devices and, thus, the variety of diseases they can monitor is rather limited. One of the main reasons for this is the fact that medical device manufacturers usually develop their own proprietary communication protocols and data format for each device. Most of the existing telemonitoring systems support communication with limited medical device types and depend on the manufacturer of them. We describe a modular and ambulatory telemedicine platform, the e-Vital platform, where different monitoring devices are being integrated in homecare and telemonitoring service chain, in order to increase patients' quality of life and their feeling of safety concerning their health.

A novel communications network for the provision of medical care in disaster and emergency situations

We have designed and developed a novel data communications network targeted at the provision of Emergency Medical Care in disaster situations over wide areas. The network nodes can transmit essential biosignals and in addition, support video and diagnostic quality sound (auscultation) broadcasting for teleconsultation purposes, by using a variety of wireless transports. The medical data acquisition stations are networked dynamically and on demand, with no requirement for an existing communications infrastructure at the disaster sites. The network design allows for limited transmitting station mobility and support for software-based Voice over IP during station roaming. Initial test results, following the hardware and software integration, indicate that the chosen network design meets specifications, and a full-scale field test, utilizing a large number of wireless stations operating under realistic conditions is to take place.

Design of an interoperability framework in a regional healthcare system

The integration of information systems represents one of the most urgent priorities of a regional healthcare authority in order to meet its clinical, organizational and managerial needs. Current practice shows that the most promising approach to achieve a regional healthcare information system (RHIS) is to use a health level 7 (HL7) message-based communication system implemented by an asynchronous common communication infrastructure between healthcare sites. The RHIS is a complete and integrated information system at a regional level that comprises all types of healthcare levels, that includes interoperability issues, that covers most of the needed components, and that is able to work efficiently in a secure wide area network to ensure data privacy and confidentiality. Another important feature of the proposed solution is that it creates an interoperability framework that can be replicated from one healthcare institution to another. In that sense, common interoperability messages can be used to interconnect heterogeneous information systems. In response to this strategy, more than 10 different consortiums have submitted proposals to the Greek government and the proposed interoperability' framework seems to be widely accepted as a solution to enhance information and communication technologies developments in the healthcare sector in Greece.

Secure and efficient health data management through multiple watermarking on medical images

The landscape of healthcare delivery and medical data management has significantly changed over the last years, as a result of the significant advancements in information and communication technologies. Complementary and/or alternative solutions are needed to meet the new challenges, especially regarding security of the widely distributed sensitive medical information. Digital watermarking is a recently established research area with many applications; nevertheless, the potential of this technology to contribute value-added services to medical information management systems has only recently started to be realized by the research community. The paper presents a review of research efforts in the area of medical-oriented watermarking and proposes a wavelet-based multiple watermarking scheme; this scheme aims to address critical health information management issues, including origin and data authentication, protection of sensitive data, and image archiving and retrieval. In accordance with the strict limitations applying to medical images, the scheme allows the definition of a region of interest (ROI) whose diagnostic value is protected, since the only additional information embedded therein aims at integrity control. The robustness of the method is enhanced through a form of hybrid coding, which includes repetitive embedding of BCH encoded watermarks. The experimental results on different medical imaging modalities demonstrate the efficiency and transparency of the watermarking scheme.

Classification algorithms for microcalcifications in mammograms (Review)

Early detection is the key to improve breast cancer prognosis. The only proven effective method of breast cancer early detection is mammography. An early sign of 30-50% of breast cancer is the appearance of clusters of fine, granular microcalcifications and 60-80% of breast carcinomas reveal microcalcification clusters upon histological examination. The high correlation between the appearance of the microcalcification clusters and diseases, proves that computer aided diagnosis (CAD) systems for automated classification of microcalcification clusters will be very useful and helpful for breast cancer control. The fuzzy nature of microcalcification, the low contrast and the low ability of distinguishing them from their surroundings make automated characterization of them extremely difficult. In this study, we give an overview of the currently available literature on characterization of malignant and benign microcalcifications. We compare and evaluate some of the classification algorithms on microcalcifications in mammograms used in various CAD systems, which are separated into categories according to the method in use. Neural networks are used in applications where only a few decisions are required concerning an amount of data. The k-nearest neighbour classifier distinguishes unknown patterns based on the similarity to known samples and the decision tree approach is much simpler than neural networks and does not need extensive knowledge of the probability distribution of the features.

Advanced image fusion algorithms for Gamma Knife treatment planning. Evaluation and proposal for clinical use

Image fusion is a process of combining information from multiple sensors. It is a useful tool implemented in the treatment planning programme of Gamma Knife Radiosurgery. In this paper we evaluate advanced image fusion algorithms for Matlab platform and head images. We develop nine level grayscale image fusion methods: average, principal component analysis (PCA), discrete wavelet transform (DWT) and Laplacian, filter - subtract - decimate (FSD), contrast, gradient, morphological pyramid and a shift invariant discrete wavelet transform (SIDWT) method in Matlab platform. We test these methods qualitatively and quantitatively. The quantitative criteria we use are the Root Mean Square Error (RMSE), the Mutual Information (MI), the Standard Deviation (STD), the Entropy (H), the Difference Entropy (DH) and the Cross Entropy (CEN). The qualitative are: natural appearance, brilliance contrast, presence of complementary features and enhancement of common features. Finally we make clinically useful suggestions.

An integrated computer supported acquisition, handling, and characterization system for pigmented skin lesions in dermatological images

This paper describes an integrated prototype computer-based system for the characterization of skin digital images. The first stage includes an image acquisition arrangement designed for capturing skin images, under reproducible conditions. The system processes the captured images and performs unsupervised image segmentation and image registration utilizing an efficient algorithm based on the log-polar transform of the images' Fourier spectrum. Border- and color-based features, extracted from the digital images of skin lesions, were used to construct a classification module for the recognition of malignant melanoma versus dysplastic nevus. Different methods, drawn from the fields of artificial intelligence (neural networks) and statistical modeling (discriminant analysis), were used in order to find the best classification rules and to compare the results of different approaches to the problem.

Interoperability among healthcare organizations acting as certification authorities

One of the main problems in public key infrastructures (PKI) is currently the lack of interoperability at international level, which is greatly dependent on the automation of the cross-certification procedure using certificate policies (CP). This paper addresses the aforementioned need by presenting a method for the automated development and comparison of CPs, with main emphasis on healthcare environments. The basic elements of this method include standardization of the CP content for healthcare, a prototype decision-making algorithm for CPs comparison, representation of CPs in extensible markup language, as well as a JAVA-based CP comparison tool. The final aim of the paper is to contribute toward the technical implementation of an on-line automated cross-certification service, yielding PKI interoperability and promoting information exchange between healthcare establishments.

Multi-purpose HealthCare Telemedicine Systems with mobile communication link support

The provision of effective emergency telemedicine and home monitoring solutions are the major fields of interest discussed in this study. Ambulances, Rural Health Centers (RHC) or other remote health location such as Ships navigating in wide seas are common examples of possible emergency sites, while critical care telemetry and telemedicine home follow-ups are important issues of telemonitoring. In order to support the above different growing application fields we created a combined real-time and store and forward facility that consists of a base unit and a telemedicine (mobile) unit. This integrated system: can be used when handling emergency cases in ambulances, RHC or ships by using a mobile telemedicine unit at the emergency site and a base unit at the hospital-expert's site, enhances intensive health care provision by giving a mobile base unit to the ICU doctor while the telemedicine unit remains at the ICU patient site and enables home telemonitoring, by installing the telemedicine unit at the patient's home while the base unit remains at the physician's office or hospital. The system allows the transmission of vital biosignals (3-12 lead ECG, SPO2, NIBP, IBP, Temp) and still images of the patient. The transmission is performed through GSM mobile telecommunication network, through satellite links (where GSM is not available) or through Plain Old Telephony Systems (POTS) where available. Using this device a specialist doctor can telematically "move" to the patient's site and instruct unspecialized personnel when handling an emergency or telemonitoring case. Due to the need of storing and archiving of all data interchanged during the telemedicine sessions, we have equipped the consultation site with a multimedia database able to store and manage the data collected by the system. The performance of the system has been technically tested over several telecommunication means; in addition the system has been clinically validated in three different countries using a standardized medical protocol.

Computerised intrapartum diagnosis of fetal hypoxia based on fetal heart rate monitoring and fetal pulse oximetry recordings utilising wavelet analysis and neural networks

OBJECTIVE

To develop a computerised system that will assist the early diagnosis of fetal hypoxia and to investigate the relationship between the fetal heart rate variability and the fetal pulse oximetry recordings.

DESIGN

Retrospective off-line analysis of cardiotocogram and FSpO2 recordings.

SETTING

The Maternity Unit of the 2nd Department of Obstetrics and Gynaecology, Aretaieion Hospital, University of Athens.

POPULATION

Sixty-one women of more than 37 weeks of gestation were monitored throughout labour.

METHODS

Multiresolution wavelet analysis was applied in each 10-minute period of second stage of labour focussing on long term variability changes in different frequency ranges and statistical analysis was performed in the associated 10-minute FSpO2 recordings. Self-organising map neural network was used to categorise the different 10-minute fetal heart rate patterns and the associated 10-minute FSpO2 recordings.

MAIN OUTCOME MEASURES

Umbilical artery pH of < or = 7.20 and Apgar score at 5 minutes of < or = 7 formed the inclusion criteria of the risk group.

RESULTS

After using k-means clustering algorithm, the two-dimensional output layer of the self-organising map neural network was divided into three distinct clusters. All the cases that mapped in cluster 3 belonged in the risk group except one. The sensitivity of the system was 83.3% and the specificity 97.9% for the detection of risk group cases.

CONCLUSIONS

A relationship between the fetal heart rate variability in different frequency ranges and the time in which FSpO2 is less than 30% was noticed. Fetal pulse oximetry seems to be an important additional source of information. Computerised analysis of the fetal heart rate monitoring and pulse oximetry recordings is a promising technique in objective intrapartum diagnosis of fetal hypoxia. Further evaluation of this technique is mandatory to evaluate its efficacy and reliability in interpreting fetal heart rate recordings.

An overview in healthcare information systems security

The scope of this paper is to present the current needs and trends in the field of healthcare systems security. The approach applied within the described review was based on three major steps. The first step was to define the point and ways of penetration and integration of security services in current healthcare related applications addressing technical, organisational and legal/regulatory issues. The second step was to specify and evaluate common security technologies applied in healthcare information systems pointing out gaps and efficient solutions, whereas the third was to draw conclusions for the present conditions and identify the future trends of healthcare information security. A number of EU RTD Projects were selected, categorised, analysed and comparatively evaluated in terms of security. The technical focus was on key security technologies, like Public Key Infrastructures (PKIs) based on Trusted Third Parties (TTPs) in conjunction with other state-of-the-art security components (programming tools, data representation formats, security standards and protocols, security policies and risk assessment techniques). The experience gained within this review will provide valuable input for future security applications in the healthcare sector, solving existing problems and addressing real user needs.

Effect of wavelet compression on data transmission in a multipurpose wireless telemedicine system

We have developed a novel emergency telemedicine system which allows the transmission of physiological data (electrocardiogram, oximetry, blood pressure and temperature) and still images of the patient. The transmission is performed through wireless links using either GSM mobile phones or satellite. Because of the low bandwidth available through these links, data compression is required to allow realtime transmission of electrocardiographic (ECG) data. A new integrated design approach for an optimal zonal wavelet compression (OZWC) method was implemented for the ECG data. The performance of the mobile system with compressed ECG data segments was evaluated in terms of the percentage root-mean-square difference and visual inspection. The optimum wavelet algorithm achieved a maximum compression ratio of 18:1 with low distortion.

XML and the VITAL standard: the document-oriented approach for open telemedicine applications

This paper describes an effort to create a common, document-oriented architecture for the interchange of medical data in healthcare telemedicine applications. Key components are: The VITAL standard specifying a common (medical device independent) representation of Vital Signs Information and the Extensible Markup Language (XML) specifying the document specifications form, an architecture that, in aggregate, define the semantics and structural constraints necessary for the exchange of vital signs and related medical data. The modelling and design technique for the described application has been the Unified Modelling Language (UML). The XMI (XML Metadata Interchange Format) of the Object Management Group (OMG) provided the meta-model for this application, for sharing objects using XML, via the transfer of the application's UML model to XML documents and DTDs.

Medical support system for continuation of care based on XML web technology

In this paper, the implementation of an Internet-based telematic service for medical support is presented, which was developed and operated in pilot form within the INTRANET HEALTH CLINIC project--a 2-year project supported by the European Commission under the Health Telematics Programme. The aim of the application is to offer high quality care to users of health services over inexpensive communication pathways, using Internet-based, interactive communication tools, like remote access to medical records and transmission of multimedia information. The XML technology was employed to achieve customised views on patient data, according to the access rights of different user profiles. Strict security and access control policy were implemented to ensure secure transmission of medical data through the Internet. The system was designed to collaborate with existing clinical patient record systems and to be adjustable to different medical applications. Current implementations include the fields of Oncology, Lupus Erythrematosis, Obstetrics and Chronic Obstructive Pulmonary disease. The results of the pilot operation with oncological patients in Greece were encouraging, so that the refining of the system and its expansion to a large number of patients is already in progress.

Vital signs monitoring from home with open systems

This study investigates the applicability of a novel codification scheme based on two healthcare informatics standards (namely the VITAL (ENV 13734) and DICOM Sup. 30 Waveform Interchange) in addressing the robust interchange of waveform and medical data in remote healthcare applications. To further address system validation and clinical acceptance issues, pilots were set-up between home-monitoring stations and a hospital-based telemedicine consultation center. The pilots focused in assessing applicability, technical feasibility and performance of the proposed codification scheme based on the two standards. This paper presents the system and services requirements as studied for a home-care application, the design goals for the preservation of security stature, the practical issues of validation and the results of integrating these codification schemes into a commercial patient connected device.

Intranet health clinic: Web-based medical support services employing XML

In this paper, the implementation of an Internet-based telematic service for medical support is presented, which operates in pilot form within the INTRANET HEALTH CLINIC project--a two-year project supported by the European Commission under the Health Telematics Programme. The aim of the application is to offer high quality care to users of health services over inexpensive communication pathways, using Internet-based, interactive communication tools, like remote access to medical records and transmission of multimedia information. The XML technology was employed to achieve customised views on patient data, according to the access rights of different users. Strict security and access control policy were implemented to ensure secure transmission of medical data through the Internet. The system is designed to collaborate with existing clinical patient record systems and to be adjustable to different medical applications. Current pilot implementations are under clinical evaluation and include oncological patients (Greece), Lupus Erythrematosis (Canada), Obstetrics (Belgium) and Chronic Obstructive Pulmonary disease (Spain).

Mobile Medical Data (MOMEDA)--a Personalized Medical Information System

MOMEDA is a two-years project supported by the European Commission (Telematics Applications Programme of DGXIII--Health Care Sector). The main objectives of the project are the development of a compact personal information terminal for hospital and home care environments that could be used by patients and a demonstrator that allows the consulting physician to access electronic patient record data from outside the hospital, using a hand held companion device connected to GSM network. Special attention is paid to a Personalized Medical Information System (PMIS) which will allow patients to access customized disease-specific information material that will enable them to fully understand in a simple and constructive form what their medical problem is, what the planned procedures are, what lifestyle they should follow during and after their hospitalization, thus becoming more qualified partners in the recovery process. Considering the fact that in most cases informed and educated patients are usually satisfied patients when the treatment is finished, patient satisfaction can be also accomplished. The design considerations for the PMIS system are presented and the implementation is discussed.

Education and training in the MEDICOM system

MEDICOM system is a world wide telematics application for electronic commerce of medical devices. It has been designed so as to provide the health care professionals with a central Internet access to up-to-date information about medical equipment from multiple manufacturers, in a particular easy and friendly way. Moreover, the Medicom system will serve the health care professionals' requirements for high-quality information about specific products in a form of multimedia presentations and that of a secure communication channel with the community of manufacturers, especially for post marketing surveillance. The system will provide the medical staff (physicians and technicians) with demonstrations of the operation procedures and the functioning of high-tech equipment in a form of virtual models. Moreover, through the medicom system the end users of medical devices can have access to on line libraries and participate in special newsgroups. This paper discusses the architectural structure of the MEDICOM system with emphasis to its educational and training functionality.

Simulated generation of evoked potentials components using networks with distinct excitatory and inhibitory neurons

Long latency evoked potentials (EP's) are electrical potentials related to brain information processing mechanisms. In this paper, three-layered neurophysiologically based artificial neural network model is presented whose neurons obey to Dale's law. The first two layers of the network can memorize and recall sparsely coded patterns, oscillating at biologically plausible frequencies. Excitatory low-pass filtering synapses, from the second to the third layer, create evoked current dipoles, when the network retrieves memories related to stimuli. Based on psychophysiological indications, simulated intracranial dipoles are straightforwardly transformed into long latency EP components such as N100 and P300 that match laboratory-measured scalp EP's.

A new method for measuring red blood cell aggregation using pattern recognition techniques on backscattered ultrasound Doppler signals

In order to study the important phenomenon of aggregation of red blood cell in vitro, an original ultrasound Doppler in vitro technique has been designed and developed in our laboratory. In the experiments held with this new technique, erythrocyte aggregation was examined by adding dextrans of different molecular weights and concentrations for a wide range of hematocrit values. Consequently, a large data base of backscattered ultrasound Doppler signals is created. In these signals, various pattern recognition methods have been applied, mainly morphological and statistical ones. It results from the employed analysis that the envelope, energy and area characteristics of the obtained backscattered signals are quite good indicators of the degree of RBCs aggregation. In this way, we have been able to: (a) Establish a quantitative relation between the presence of various dextrans and the degree of aggregation. (b) Determine the distribution of the size of the formed aggregates in the various experimental solutions. (c) Obtain a most accurate relation between ultrasound backscattering and actual size of the corresponding observed aggregates.

A novel emergency telemedicine system based on wireless communication technology--AMBULANCE

Recent studies conclude that early and specialized prehospital management contributes to emergency case survival. We have developed a portable medical device that allows telediagnosis, long distance support, and teleconsultation of mobile healthcare providers by expert physicians. The device allows the transmission of vital biosignals and still images of the patient from the emergency site to the consultation site using the GSM mobile telephony network. The device can telematically "bring" an expert specialist doctor at the site of the medical emergency, allow him/her to evaluate patient data, and issue directions to the emergency personnel on treatment procedures until the patient is brought to be hospital. Legal reasons mandated the inclusion at the consultation site of a multimedia database able to store and manage the data collected by the system. The performance of the system has been validated in four different countries using a controlled medical protocol and a set of 100 patients per country treated has been collected and analyzed.

Loading of intact rabbit erythrocytes with fluorophores and the enzyme pronase by means of electroporation

The application of electric field pulses in cell suspensions is known to alter membrane integrity, resulting in increased membrane permeabilization. This field-induced membrane poration provides the means to load cells with a variety of external substances, useful for clinical applications. In this work, intact rabbit erythrocytes were successfully loaded with low molecular weight fluorescent probes and with the high molecular weight enzyme pronase, which has been shown to mimic the effects of insulin. Attachment of the enzyme onto the cell surface was also achieved by modifying the applied pulse parameters. Both applications were efficient and accompanied by high cell survival rates. In this way, biological carriers loaded with active substances were produced, offering the potentials for useful clinical applications, either for diagnostic or therapeutic purposes.

Design and development of a multimedia database for emergency telemedicine

Recent studies conclude that early and specialised pre-hospital patient management contributes to emergency cases survival. Recent developments in telecommunication and medical informatics by means of telemedicine can be extremely useful to accomplish such tasks in a cost-effective manner. Along that direction, we have designed a portable device for emergency telemedicine. This device is able to telematically "bring" the expert doctor at the emergency site, have him perform an accurate diagnosis, and subsequently direct the Emergency Medical Technicians on how to treat the patient until he arrives to the hospital. The need for storing and archiving all data being interchanged during the telemedicine sessions is very crucial for clinical, legal and administrative purposes. For this, we have developed a multimedia database able to store and manage the data collected by the AMBULANCE system. The database was equipped with a user-friendly graphical interface to enable use from computer naive users. Furthermore, the database has the possibility to display, in an standard way, ECG's, X-ray, CT and MRI images. The application is password protected with a three-level hierarchy access for users with different privileges. The scope of this application is to enhance the capabilities of the doctor on duty for a more precise and prompt diagnosis. The application has the ability to store audio files related to each emergency case and still images of the scene. Finally, this database can become a useful multimedia tool which will work together with the AMBULANCE portable device, the HIS and the PACS of the hospital. The system has been validated in selected non-critical cases and proved to be functional and successful in enhancing the ability of the doctor's on duty for prompt and accurate diagnosis and specialised pre-hospital treatment.

CT-based software for 3-D localization and reconstruction in stepping source brachytherapy

This paper describes innovative software for catheter localization and three-dimensional (3-D) reconstruction in stepping source brachytherapy applications. Patient information is a set of computed tomography (CT) slices scanned during the implantation of brachytherapy catheters. Catheter geometry and patient anatomy are exported for use with dose calculation software modules. The errors produced by the system are also encouragingly low. Time saving was achieved, in terms of other traditional reconstruction techniques. Various automated procedures, 3-D graphics and a user-friendly GUI, have contributed to providing a powerful, comprehensive software tool, directly useable in the clinical practice.