Optically scannable form for documenting pharmacists' patient-care activities.
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Clinical Pharmacy Information Systems↗
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Fundamentals of image processing for personal computers.
Photographic images make an important contribution to medical education. Conventional means of display have included 35-mm projection, film, videotape, and more recently, analog videodiscs that accompany computer-based text. The availability of compact discs, with their enormous storage capacity, and of powerful central processing units now permits consideration of digital storage of visual images for display by the personal computer. The data processing required for the representation and transfer of high-quality images is forbidding, however, even with today's technology. The problem is compounded if one anticipates display of full-motion video. In this tutorial we first review the nature of analog signals and the process of capturing them in digital format. We then consider mass storage and the concept of compressing data into smaller amounts of information that can be processed and transferred by personal computers with the use of optical disc drives. A look into the future provides a vision of high-definition television-quality video in digital format.
Analog-Digital Conversion↗
Digital optical card. A promising technology for documentation and communication of images.
PURPOSE: To assess a patient-oriented digital optical card (OC) for documentation and communication of images using the analysis of breast microcalcifications to illustrate its resolution power. METHODS: Fifty film mammograms with histologically proved clustered microcalcifications were digitized using a 5 lp/mm CCD-scanner. A region of interest containing the cluster was selected for documentation on an OC as an overview OC-image and as a magnified OC-image (5 lp/mm). The shape (spherical/nonspherical) as well as the total number of microcalcifications were quantitatively analyzed by 2 radiologists. RESULTS: The detection rate for total number of overall and spherical microcalcifications using digital media was significantly reduced (p < 0.01) compared to analog mammography. There were no significant differences in the detection rate of nonspherical microcalcifications between film mammograms (100%) and magnified section OC-images (92.7%). The overview OC-image revealed 72% of those calcifications (p < 0.01). CONCLUSION: According to our results, this technology is not appropriate for diagnosis of breast microcalcifications, but may be a promising communication digital medium for transmitting an image/report unit to referring physicians.
Breast Neoplasms↗
[The Quick Return Service of electroencephalogram].
Because electroencephalography (EEG) examinations take time and numerous channels are used, they generate an enormous volume of data. Vast amounts of space would be required to store the data on shelves and in storage rooms, and a great deal of time and labor would be needed to retrieve the data and use it again. We developed an EEG optical disk filing system to solve such problems. With this system display terminals are set up in the various outpatient departments which often request EEG examinations, i.e., the neurology department, psychiatry department, and pediatric department, making it possible to search and display EEG waveforms, the content of EEG reports, etc., stored on the optical disks at any time. Using such functions patients can be examined without having to send for charts and EEG paper-output waveforms, which is troublesome and time-consuming, and contributes to shortening examination time.
Electroencephalography↗
Development of a personal computer's viewing station for the IS&C magneto-optical disk.
We developed a display station for the medical images stored in the IS&C (Image Save and Carry) magneto-optical disk. This station consisted of the personal computer and the magneto-optical disk drive. The performance of this system was evaluated and was compared with the Unix workstations. We found that the personal computer system had an adequate ability to display medical images. It provided, moreover, for portability and practical use of medical information.
Data Display↗
A visual telemedicine system: the integration of ordinary TV and HDTV still image transmission.
This paper describes a project to develop and test a new telemedicine system using image transmission. The system was implemented at Aomori prefecture, the northernmost prefecture of Japan, to provide medical consultation to remote hospitals from a medical center located in Aomori city, capital of the prefecture. The characteristics of the system are the combination of an HDTV still image transmission system and an ordinary tele-conference system using 65 kilobit telephone line i.e., an ordinary telephone line available in almost any part of Japan. We also developed a disk storage system that stores transmitted images automatically without human intervention. The system was assessed in real clinical settings and has proved to be effective in various areas of medical consultation, including radiology, pathology, dermatology, etc. We hope that this system becomes a standard telemedicine system in the future.
Computer Peripherals↗
Regional medical information network using optical memory cards and integrated services for digital network.
Since 1986, we have been developing a regional health and welfare system using optical memory cards. We have expanded the system and performed model experiments and evaluations this time. There are approximately 3000 card-holders and 23 card-reader terminals in use. They cover 50 percent of the medical facilities in the city of Isehara. Two medical clinics within neighboring cities have joined our project. Standard Deviation Index (SDI) has been introduced to standardize the numeric results of examinations. The terminals are connected with Integrated Services for Digital Network (ISDN) allowing remote access to the optical memory cards. This enhanced connectivity has allowed greater cooperation in delivering quality medical services.
Aged↗
A multimedia-based histology laboratory course: elimination of the traditional microscope laboratory.
UNLABELLED: We have developed a multimedia-based laboratory course which has enabled us to eliminate the microscope and traditional microscope laboratory that have been mainstays of our histology course and histology courses at almost all institutions where histology is taught. The multimedia laboratory uses a library of histology images (approximately 24,000) stored on videodisc ( HISTOLOGY: A Photographic Atlas, by S. Downing) as its microscope slide collection and accesses those images through barcode and computer interfaces. The laboratory workstations consist of a videodisc player, videodisc monitor, computer, and computer monitor. One workstation is available for every 4-students, and our students are encouraged to work together in groups of four or five. In our current set-up, the students are introduced to and instructed in the basic principles of histology using a computer program that interfaces with the videodisc images. The computer program is divided into 19 chapters (the chapters are typical of the chapters found in a normal histology textbook) and has: (1) a laboratory component that covers the material traditionally covered in the microscope laboratory, and (2) a lecture component that enables the students to evaluate their understanding of the lecture material in a non-punishing way. The laboratory section of each chapter is divided into a "MicroLab" section, an "InFo Time" section, and a "Quiz Time" section. Each of these sections interfaces with histological images stored on the videodisc. The students are encouraged to work through the "MicroLab" section of each chapter before moving on to the "InFo Time" and "Quiz Time" sections. The "MicroLab" sections introduce the students to the various tissues and organs of the body and is interfaced with the videodisc player and the histology images stored on the videodisc. These sections describe the basic histological features of the various tissues and organs and give the students access to multiple examples of what they are studying. The "InFo Time" sections bring up specific images and ask the students to think about the images. Information about the images being observed is available if the students want it and the students can flag those images that they found difficult. The Quiz Time section of the program is also interfaced with the videodisc player and provides access to a large number of histology images stored on the videodisc. The "Quiz Time" sections provide non-punishing review questions that the students can study after she has worked her way through the "MicroLab" and "InFo Time" sections. In addition to the use of a computer program to access the histology images stored on videodisc, we use barcodes that address specific images on the histology videodisc in a variety of ways to augment the students' laboratory and lecture experience. The benefits of using multimedia in place of the traditional microscope and microscope slide collection are numerous and include the speed at which specific histological images can be accessed and reviewed (when compared to finding a structure on a glass slide), a significant reduction in the amount of laboratory time needed by the student to learn the same amount of information, the ease of tutoring on a large monitor screen (when compared to trying to discuss a histological structure with a student through the eyepiece of a microscope), the encouragement of group study (which is difficult to do when a student is working 1-on-with a microscope), and the reduction of the number of faculty necessary to cover a typical histology laboratory session. The use of barcodes that address specific videodisc histology images has greatly changed our examination procedures and has significantly expanded the usefulness of the traditional lecture note handouts given to our students.
Computer-Assisted Instruction↗
An interactive histology image-barcode manual for a videodisc image library.
UNLABELLED: Cell Biology and HISTOLOGY (alias Microanatomy, alias Microscopic Anatomy) is a required course for first-year medical and dental students in most health science centers. The traditional approach used in teaching this discipline is to present photomicrographic images of structures to students in lecture using 35 mm slides of fields seen through the microscope. The students then spend many hours viewing and studying specimens of tissues using a light microscope in a laboratory setting. Students in traditional courses of histology spend an inordinate amount of time learning the component structures by attempting to find and identify them in tissue sections using a microscope, where the structure being sought is surrounded by a multitude of other structures with which they are also not familiar. With the recent availability of videodisc stored image libraries of histological samples, it is now possible to study histological principles without the use of the microscope as the primary learning tool. A videodisc entitled " HISTOLOGY: A Photographic Atlas" by S. Downing (published by Image Premastering Services Limited, Minneapolis, MN, 1991) has been incorporated into our histology course. Fifteen videodisc player stations are provided for 150 students. Images are retrieved by students using a bar code scanner attached to a videodisc player (Pioneer CLD-2400). Using this kind of image library, students can now learn basic histological structure, such as cell and tissue types, without the use of a microscope or as a tool for facilitating microscopy. The use of a videodisc library of randomly accessible images simplifies learning the basic components which all organs are composed of by presenting the learner with clear-cut examples to avoid confusion with other structures. However, videodisc players and TV monitors are still not appropriately priced for every student to own. This presents a problem in that the same images studied in class are not available to study and review outside of class. There is a need for resources for additional study outside of the institutional setting, for students to have and interact with to reinforce the learning experience in the teaching laboratory. A hard copy manual was created and is being used in our course; it incorporates photos captured from the videodisc. The images displayed in the manual are chosen to give the student one example of each histological component. Additional labeling is added to the images, and each image is accompanied by a bar code that may be used at a videodisc player with a bar code reader to retrieve the same color image from the disc displayed in larger format on a TV monitor. Each topic in the manual is accompanied by learning objectives and a statement of clinical relevance. Following the presentation of the images in each section of the manual, the students are encouraged to practice by viewing multiple examples of each structural component presented in the lesson. They can do this by using the bar-coded catalog supplied with each disc. The presentation of each topic concludes with a quiz composed of questions about images that the student can retrieve from the videodisc using barcodes in the text of the manual. Some of the images on the quiz are printed in miniature in the manual to provide the student with an opportunity for personal review at home when hardware to obtain and display images from a video disc is not available. This manual provides an answer to the dilemma faced by the learner when access to hardware is not available; reinforcement is therefore facilitated outside the teaching laboratory. This allows learning to continue outside of the classroom, using the same materials. (abstract truncated)
Computer-Assisted Instruction↗
Digital optical archiving of medical records in hospital information systems--a practical approach towards the computer-based patient record?
The large number of inpatients and outpatients in university hospitals leads to high costs of medical documentation and to an increasing number of medical documents. Due to legal regulations, these medical records have to be stored for 30 years. This implies spatial, organizational, and economical problems. At present, conventional archiving in hospitals often does not satisfy the need to make medical records available for health-care professionals in a systematic and timely manner. From 1989 to 1993 a pilot study on "digital optical archiving of medical records" was carried out at Heidelberg University Hospital. The study has shown the feasibility of digital optical archiving in hospital s if done under certain conditions. In 1995, Heidelberg University Hospital adopted a procedure for "digital optical archiving of medical records". The digital optical archive will first be filled with the medical records of the department of neurosurgery and the endoscopic and echographic images and reports of the department of internal medicine. It is to be expected that this procedure will gradually lead to an integrated functionality on health-care professional workstations, to a hospital-wide use of an electronic patient record, and to media-independent document management systems. The paper focuses on the potentials of digital optical archiving as an integral part of hospital information systems, and on the requirements for the systematic managements of hospital information systems with respect to digital optical archives.
Archives↗
Multiple sclerosis in India: A.I.I.M.S. experience.
Fifty patients of multiple sclerosis were reviewed. The commonest initial neurologic symptom was motor weakness (30%) followed by visual impairment (26%). Absence of internuclear opthalmoplegia was noted in addition to the infrequent occurrence of optic nerve involvement and Devic's disease. Evoked potential studies and radiological investigations were in agreement with others series reported.
Adolescent↗
Documenting resident procedure and diagnostic experience: simplifying the process.
BACKGROUND AND OBJECTIVES: The Residency Review Committee (RRC) requires documentation of family practice residents' procedural and diagnostic experiences. Further, hospital privileging is frequently based on documentation of prior clinical experience. Residency programs need a user-friendly (ie, resident-friendly) mechanism for collecting data and generating reports to document these experiences. This paper outlines a simplified, user-friendly method of documenting resident procedural and diagnostic experiences. METHODS: We developed a pocket-sized, optically scannable card for data input. This is coupled with a computerized database with report generation capability. The system is based on diagnostic clusters to further simplify the data input process. RESULTS: The system's setup costs are about $10,000. Annual maintenance and operational fees are about $5,000. After instituting the system, the number of residents submitting documentation information increased substantially. CONCLUSIONS: This system meets both RRC and potential clinical privileging requirements and provides a useful tool for guiding resident evaluation and developing appropriate training opportunities during the latter half of the residency. Simplified, accurate documentation may allow for comparisons among residents at various levels--program, state, and national.
Clinical Competence↗
[Medical information network with optical memory card system].
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Computer Communication Networks↗
A retrospective review of patients with clinically definite multiple sclerosis.
Multiple sclerosis (MS) is an uncommon disease in Singapore. We retrospectively reviewed our experience from a large single medical institution to identify prominent clinical features and forms of this disease. Of the 21 patients entered into the study, 10 patients developed optic-spinal symptoms over the course of their illness. None of these patients with optic-spinal symptoms had Devic's disease. Unusual clinical manifestations included paroxysmal symptoms either at presentation or during the course of their illness in 3 patients. While cerebrospinal fluid oligoclonal bands were present in only 4 patients, the majority of patients had abnormal neurophysiology and neuroimaging studies. Due to the presence of autoimmune markers in a significant number of cases, we recommend that as part of the initial evaluation for MS, an underlying collagen vascular disorder should be excluded.
Adolescent↗
A microscopic, continuous, optical monitor for interstitial electrolytes and glucose.
Ions, such as hydrogen (pH), sodium, or potassium, as well as metabolites, such as glucose or lactate, diffuse easily between blood in the capillaries and the interstitial fluid (ISF) residing between cells, and tissues. This work represents a synthesis of several unique concepts to achieve accurate, continuous, in vivo monitoring of critical ions and glucose in the ISF under the human skin. Ionic levels are monitored using optode technology that translates the respective concentrations into variable colors of ionophore/dye/polymeric liquid membranes. Glucose is monitored indirectly, by coupling through immobilized glucose oxidase with pH, that is then detected using a similar color scheme. The monitor consists of a tiny plastic bar ("sliver sensor"), 100-300 microns wide and 1-15 mm long, placed just under the skin, with optical spots or stripes for each analyte as well as blanks for calibration. The colors are read and translated into concentration values by a watchlike device placed above the skin. Direct optical coupling between the in vivo sensing bar and the ex vivo detector device requires negligible power, and eliminates the need for wires or optical fibers crossing the skin. The microminiature sliver penetrates the skin easily and painlessly, so that the user could insert it him- or herself. No risk of track infection exists. We are reporting here on the first successful in vitro tests of this approach.
Animals↗
[MRI safety aspects and artifacts of atrial septal defect and patent foramen ovale occluders at 1.5 tesla: a phantom study].
PURPOSE: To investigate the magnetic resonance safety and magnetic resonance artifact intensities of patent foramen ovale and atrial septal occluders in a phantom study. MATERIALS AND METHODS: Seven different commercial occluder models (Amplatzer ASD, Angel Wing ASD, Helex Septal Occluder, Cardia PFO-Star Generation I & III, Sideris Buttoned Device, Starflex ASD) were tested in a 1.5 Tesla whole-body MR scanner. Following a deflection test, the non-magnetic devices were imaged using different MRI pulse sequences including conventional spin echo, spoiled gradient echo as well as fast refocused steady-state pulse sequences (trueFISP) commonly used for cardiac MRI. Additionally, device temperatures were measured in the MR scanner during two imaging protocols (trueFISP, HASTE) with an MR-compatible fiber-optical thermometer. RESULTS: One ferromagnetic device (Sideris Buttoned Device) did not pass the deflection test and was excluded from further experiments. For typical cardiac imaging protocols, the remaining non-ferromagnetic devices showed only minor image artifacts with artifact sizes not exceeding 2 mm next to a strut. Heating was not observed in the devices. CONCLUSION: Non-ferromagnetic occluder models used in this study can safely be imaged with typical cardiac MRI protocols at 1.5 Tesla. The device artifact sizes are small enough to allow anatomical and functional MRI even in the immediate vicinity of the occluders.
Artifacts↗
All-optical flip-flop based on an active Mach-Zehnder interferometer with a feedback loop.
A novel architecture for an all-optical flip-flop is validated experimentally. The architecture comprises a single semiconductor optical amplifier-based Mach-Zehnder interferometer with an external feedback loop. The experimental results show optical bistable operation for a latching device with an on-off contrast ratio of 11 dB that employs set and reset pulses of less than 250 pJ, although the energy of these pulses could be greatly reduced by optical integration of the whole device.
Journal Article↗
Fiber-optic power limiter based on photothermal defocusing in an optical polymer.
We describe the performance of a fiber-optic power-limiting component. The passive device is dynamically responsive to the input signal and has been shown to attenuate continuous-wave power with a dynamic range of up to 9 dB at 150 mW of input power at 1550 nm. The limiting threshold is approximately 30 mW from 1530 to 1565 nm and less than 10 mW at 1430 nm. The device is activated by a photothermal defocusing mechanism in an optical polymer fixed between two expanded core fibers that collimate light through the material. The magitude and threshold of the limiting response is dependent on the absorption properties of the polymer and the size of the gap between the two fiber endfaces. Simple model calculations have been made to predict the limiting response, and they agree reasonably well with the performance of the actual device.
Journal Article↗