1995 IEEE-EMBC a d CMBEC Theme 3: Cliical Ehgineeringhledical Informatics

A NOVEL MEDICAL IMAGE P R O C E S S I N G

AND MANAGEMENT SYSTEM - ""NIA54"

S. Pavlopoulos, S. Dembeyiotis, G, Konnis and D. Koutsouris

Biome dic a1 Engineering Lab oratory, Dept. of Electrical & Clomput er Engineering ,

National Technical University of Athens (NTUA)

42 Patission Str., Athens 10682 Greece.

Abstract The introduction of information and telecommunication technologies into medicine and health care has improved the communication and exchange of data between different health care institutions. Along that direction we are developing a strategic plan for a countrywide infrastructure for exchanging medical imaging information in digital form, as well as providing for telemedicine and teleconsulting capabilities in rural areas. Two pilot networks will be implemented; the first will connect a number of primary health centers with a central hospital allowing for telemedicine and teleconsulting capabilities. The second will be implemented in a specialized cardiac center in Athens where a DICOM 3.0 based PACS system f o r cardiological applications will be installed. Preliminary results concerning ECG and real-time video signal transmission and processing are very promising and indicate the engineering basis for the final implementation of the NIM project.

Keywords : Telemedicine, PACS; DICOM

I'L? trodu c tion The main goal of modern health care systems is the improvement of health of the populations they serve. A t present, there is a trend for decentralization of health care institutions and for a move from institutional health care to primary and home care. In many countries, Greece being one of them, health care services are highly centralized. Despite the establishment of well-equipped rural health care centers during the past decade, personnel shortages still limit the quality of healthcare provided outside urban areas. In addition, there is a major increase in the volume of data generated by the use of modern imaging modalities (x-ray, CT. MRI. PET, SPECT. DSA, Ultrasound, etc.) This makes the management

of imaging data increasingly difficult, both for large and small health care centers, adds t o hospital costs, and makes the provision of telemedicine and t.eleconsulting services to smaller health care centers more difficult The result is that the gap in the quality of health care provided between rural health centers and larger urban centers is constantly widening with a large number of patients moving from the periphery to the center.

Considering all the (above, we have decided t o develop a countrywide strategic plan which will benefit both large and small health care centers. The system will be based on international standards and will be able t o accommodate older technology imaging equipment. The . network forming the backbone of the system will be based on open architectures so that additional imaging systems could be connected to the network with minimal interfacing problems. A n important factor in the network design is the provision for telemedicine and teleconsulting services t o rural health centers on demand, offered by specialized personnel in large medical centers. In addition to improving the level of the health care that is provided, an added benefit will be the reduction of patient traffic between rural and urban centers. The system will also enable the training of medical personnel using modern multimedia technologies.

Methods As previously described, the system consists of two main parts. The first part is the &'via network which connects seperal rural health centers in Evia island with the Chalkis General Hospital (Fig. 1). This network will provide telemedicine capabilities to the rural health centers. Both x-ray radiographs and ECG signals will be transmitted via normal telephone lines t o the central hospital where specialized physicians would proceed with the

0-7803-2475-7197 $1 0.00 0 1 997 IEEE 765

diagnosis. The central hospital is equipped with a dedicated distributed data-base where examinations from different health centers will be archived. Each health center is also equipped with a dedicated data-base for local archiving, and the required instrumentation for telemedicine applications, such as film- scanners, digital ECGs, etc.

Rura l Health Center Chalkis Hospital - 3 - - - - - . . - - - - - - - - - - - . . . I - - - - - - .

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Fig. 1 Schematic representation of the Evia network connecting several rural health centers with the Chalkis General Hospital.

The Onassio Cardiac Center in Athens will be the site f o r the second network (Fig. 2). I t consists of a high speed isochronous network

e of sustained high data transfer rates. etwork will be able to accommodate

DICOM 3.0 compatible medical imaging devices in a network plug-in mode. The storage subsystem utilizes a high capacity magneto- optical storage device with CD-ROM jukebox used f o r off-line storage. Several DICOM 3.0 image viewing stations utilizing high resolution monitors are installed in specifically selected sites throughout the hospital providing radiologists and other specialists access t o patient information. A major task in this project is the development of DICOM 3.0 network interfaces for systems which are not DICOM 3.0 compliant. The network can interface t o other HIS and PACS systems through appropriate gateways. In addition, the network design enables the use of video-conferencing using suitably equipped workstations. Finally the network can be linked t o wide area networks through high speed fixed o r wireless links (ISDN, ATM, satellite, et c .)

Results - Discussion Preliminary results of the NIKA project include ECG and real-time video processing and transmission. A dedicated ECG data card for use with personal computers has been developed and tested fo r telemedicine applications 9 [I-21. The data card will be

installed in rural centers in Evia and telemedicine application will be performed with the aid of the Chalkis Hospital.

Furthermore, we evaluated transmission of real-time video using the MPEG-1 algorithm. Preliminary results display acceptable. for diagnostic use, image quality with

ONASSlO CARDIAC CENTER

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Fig. 2 Schematic representation of the Onassio Cardiac Center fast hospital network linking several imaging modalities t o a central processing unit.

transmission rates of .IMbits/sec [3]. Further analysis is still in progress fo r a detailed determination of compression rates fo r different imaging modalities.

COR ChZSiORS

We are developing a strategic plan for a country-wide infrastructure for medical image data exchange. The initial implementation has two pilot stages, one connecting rural health centers with a general hospital, and the second linking a variety of imaging modalities within a specialized cardiac center with a centralized processing unit. Preliminary results are very promising for the successful completion of the project.

References [l] S. Tombros. G. Tselikis. S. Marakas. and D.

Koutsouris, "A Generic environment for linear and non-linedr ECG processing," TechoL and Health Care. Submitted 1995.

[ Z ] S. Tombros. G. Tselikis. E. Protonotarios and D. Koutsouris, "An optimized algorithm for R-R internal detection," IEZE Trans. Biomed Eng. Submitted 1995.

Dembeyiotis, and D. Koutsouris. "An integrated medical image processing and manage system." Proceedings of the 3rd European Conference on Engineerikig and Medicine Florence, April 1995.

[3] S. Pavlopoulos. N. Katevas. G. Konnis

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