KEYWORDS: Display technology, Mobile devices, Computed tomography, Visualization, Radiology, Diagnostics, Medical imaging, 3D visualizations, Brain, Imaging systems
When a patient is accepted in the emergency room suspected of stroke, time is of the utmost importance. The infarct
brain area suffers irreparable damage as soon as three hours after the onset of stroke symptoms. A CT scan is one of
standard first line of investigations with imaging and is crucial to identify and properly triage stroke cases. The
availability of an expert Radiologist in the emergency environment to diagnose the stroke patient in a timely manner
only increases the challenges within the clinical workflow. Therefore, a truly zero-footprint web-based system with
powerful advanced visualization tools for volumetric imaging including 2D. MIP/MPR, 3D display can greatly
facilitate this dynamic clinical workflow for stroke patients. Together with mobile technology, the proper
visualization tools can be delivered at the point of decision anywhere and anytime. We will present a small pilot
project to evaluate the use of mobile technologies using devices such as iPhones in evaluating stroke patients. The
results of the evaluation as well as any challenges in setting up the system will also be discussed.
Multiple sclerosis (MS) is a progressive neurological disease affecting myelin pathways. MRI has become the
medical imaging study of choice both for the diagnosis and for the follow-up and monitoring of multiple sclerosis.
The progression of the disease is variable, and requires routine follow-up to document disease exacerbation,
improvement, or stability of the characteristic MS lesions or plaques. The difficulties with using MRI as a
monitoring tool are the significant quantities of time needed by the radiologist to actually measure the size of the
lesions, and the poor reproducibility of these manual measurements. A CAD system for automatic image analysis
improves clinical efficiency and standardizes the lesion measurements. Multiple sclerosis is a disease well suited
for automated analysis. The segmentation algorithm devised classifies normal and abnormal brain structures
and measures the volume of multiple sclerosis lesions using fuzzy c-means clustering with incorporated spatial
(sFCM) information. First, an intracranial structures mask in T1 image data is localized and then superimposed
in FLAIR image data. Next, MS lesions are identified by sFCM and quantified within a predefined volume. The
initial validation process confirms a satisfactory comparison of automatic segmentation to manual outline by a
neuroradiologist and the results will be presented.
As clinical imaging and informatics systems continue to integrate the healthcare enterprise, the need to
prevent patient mis-identification and unauthorized access to clinical data becomes more apparent
especially under the Health Insurance Portability and Accountability Act (HIPAA) mandate. Last year, we
presented a system to track and verify patients and staff within a clinical environment. This year, we
further address the biometric verification component in order to determine which Biometric system is the
optimal solution for given applications in the complex clinical environment. We install two biometric
identification systems including fingerprint and facial recognition systems at an outpatient imaging facility,
Healthcare Consultation Center II (HCCII). We evaluated each solution and documented the advantages
and pitfalls of each biometric technology in this clinical environment.
KEYWORDS: Picture Archiving and Communication System, Image processing, Computer security, Databases, Medical imaging, Medicine, Device simulation, Control systems, Defense and security, Biometrics
The deadline of HIPAA (Health Insurance Portability and Accountability Act) Security Rules has passed on February
2005; therefore being HIPAA compliant becomes extremely critical to healthcare providers. HIPAA mandates
healthcare providers to protect the privacy and integrity of the health data and have the ability to demonstrate examples
of mechanisms that can be used to accomplish this task. It is also required that a healthcare institution must be able to
provide audit trails on image data access on demand for a specific patient. For these reasons, we have developed a
HIPAA compliant auditing system (HCAS) for image data security in a PACS by auditing every image data access. The
HCAS was presented in 2005 SPIE. This year, two new components, LDSE (Lossless Digital Signature Embedding) and
LTVS (Patient Location Tracking and Verification System) logs, have been added to the HCAS. The LDSE can assure
medical image integrity in a PACS, while the LTVS can provide access control for a PACS by creating a security zone
in the clinical environment. By integrating the LDSE and LTVS logs with the HCAS, the privacy and integrity of image
data can be audited as well. Thus, a PACS with the HCAS installed can become HIPAA compliant in image data privacy
and integrity, access control, and audit control.
By implementing a tracking and verification system, clinical facilities can effectively monitor workflow and heighten information security in today's growing demand towards digital imaging informatics. This paper presents the technical design and implementation experiences encountered during the development of a Location Tracking and Verification System (LTVS) for a clinical environment. LTVS integrates facial biometrics with wireless tracking so that administrators can manage and monitor patient and staff through a web-based application. Implementation challenges fall into three main areas: 1) Development and Integration, 2) Calibration and Optimization of Wi-Fi Tracking System, and 3) Clinical Implementation. An initial prototype LTVS has been implemented within USC's Healthcare Consultation Center II Outpatient Facility, which currently has a fully digital imaging department environment with integrated HIS/RIS/PACS/VR (Voice Recognition).
The paper describes the methodology for the clinical design and implementation of a Location Tracking and Verification System (LTVS) that has distinct benefits for the Imaging Department at the Healthcare Consultation Center II (HCCII), an outpatient imaging facility located on the USC Health Science Campus. A novel system for tracking and verification of patients and staff in a clinical environment using wireless and facial biometric technology to monitor and automatically identify patients and staff was developed in order to streamline patient workflow, protect against erroneous examinations and create a security zone to prevent and audit unauthorized access to patient healthcare data under the HIPAA mandate. This paper describes the system design and integration methodology based on initial clinical workflow studies within a clinical environment. An outpatient center was chosen as an initial first step for the development and implementation of this system.
A 2003 report in the Journal of Annual Surgery predicted an increase in demand for surgical services to be as high as 14 to 47% in the workload of all surgical fields by 2020. Medical difficulties which are already now apparent in the surgical OR (Operation Room) will be amplified in the near future and it is necessary to address this problem and develop strategies to handle the workload. Workflow issues are central to the efficiency of the OR and in response to today's continuing workforce shortages and escalating costs. Among them include: Inefficient and redundant processes, System Inflexibility, Ergonomic deficiencies, Scattered Data, Lack of Guidelines, Standards, and Organization. The objective of this research is to validate the hypothesis that a workflow model does improve the efficiency and quality of surgical procedure. We chose to study the image-guided surgical workflow for US as a first proof of concept by minimizing the OR workflow issues. We developed, and implemented deformable workflow models using existing and projected future clinical environment data as well as a customized ICT system with seamless integration and real-time availability. An ultrasound (US) image-guided surgical workflow (IG SWF) for a specific surgical procedure, the US IG Liver Biopsy, was researched to find out the inefficient and redundant processes, scattered data in clinical systems, and improve the overall quality of surgical procedures to the patient.
Nanoparticle phosphors made of lanthanide oxides are a promising new class of tags in biochemistry because of their large Stokes shift, sharp emission spectra, long luminescence lifetime, and good photostability. We demonstrate the application of these nanoparticles to the visualization of protein micropatterns. Luminescent europium-doped gadolinium oxide (Eu:Gd2O3) nanoparticles are synthesized by spray pyrolysis. The size distribution is from 5 to 200 nm. The particles are characterized by means of laser-induced fluorescent spectroscopy and transmission electron microscopy (TEM). The main emission peak is at 612 nm. The nanoparticles are coated with avidin through physical adsorption. biotinylated bovine serum albumin (BSA-b) is patterned on a silicon wafer using a microcontact printing technique. The wafer is then incubated in a solution of avidin-coated nanoparticles. Fluorescent microscopic images reveal that the nanoparticles are organized onto designated area, as defined by the microcontact printing process. The luminescent nanoparticles do not suffer photobleaching during the observation, which demonstrates their suitability as luminescent labels for fluorescence microscopy studies. More detailed studies are preformed using atomic-force microscopy (AFM) at a single nanoparticle level. The specific and the nonspecific binding densities of the particles are qualitatively evaluated.
Nanoparticles made of lanthanide oxides are promising fluorophores as a new class of tags in biochemistry because of their large Stokes shift, sharp emission spectra, long lifetime and lack of photobleaching. We demonstrate for first time the application of these nanoparticles to the visualization of protein micropatterns. Europium-doped gadolinium oxide (Eu:Gd2O3) nanoparticles were synthesized by spray pyrolysis and were characterized by means of laser-induced fluorescent spectroscopy and TEM. Their main emission peak is at 612 nm. And their size distribution is from 5 nm to 500 nm. The nanoparticles were coated with avidin through physical adsorption. Biotinylated Bovine Serum Albumin (BSA-b) was patterned on a silicon wafer using a micro-contact printing technique. The BSA-b - patterned wafer was incubated in a solution containing the avidin-coated nanoparticles. The specific interaction between biotin and avidin was studied by means of fluorescent microscopy and atomic-force microscopy (AFM). The fluorescent microscopic images revealed that the nanoparticles were organized into designated structures as defined by the microcontact printing process - non-specific binding of the avidin-coated nanoparticles to bare substrate was negligible. The fluorescent pattern did not suffer any photobleaching during the observation process which demonstrates the suitability of Eu:Gd2O3 nanoparticles as fluorescent labels with extended excitation periods - organic dyes, including chelates, suffer bleaching over the same period. More detailed studies were preformed using AFM at a single nanoparticle level. The specific and the non-specific binding densities of the particles were qualitatively evaluated.
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