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The HELIOS medical software engineering environment.

The aim of the HELIOS project is to create an integrated Software Engineering Environment (SEE) to facilitate the development and maintenance of medical applications. HELIOS is made of a set of software components, communicating through a software bus called the HELIOS Unification Bus. The object oriented paradigm is used both as the basic structure for building the software components and as the methodology for modelling, storing and retrieving the entities and procedures used in an application. Development standards include UNIX as operating system and X Window/MOTIF as windowing environment. One of the target applications for the HELIOS prototype is the development of a multimedia medical workstation as a front end to a hospital information system.

Computer Systems↗

A software program for exchanging MR data.

In an MR multicenter project, data exchange is a problem because most MR scanners do not use the same data format or have data export facilities. In the COMAC-BME Concerted Action on Tissue Characterization by MRS and MRI, a subgroup of seven MR centers had a need for data exchange in the form of digital MR images of the human brain. Because there was no common data format, software package was developed for data exchange. This article describes the basic features of the developed software. The software package was written in the language of C and was successfully tested on an IBM-6150 UNIX workstation. The software is currently being tested on the following series of UNIX workstations: SUN SPARC, IBM RS6000, and HP 9000/700.

Animals↗

Object-oriented design of medical imaging software.

A special software package for interactive display and manipulation of medical images was developed at the University Hospital of Geneva, as part of a hospital wide Picture Archiving and Communication System (PACS). This software package, called Osiris, was especially designed to be easily usable and adaptable to the needs of noncomputer-oriented physicians. The Osiris software has been developed to allow the visualization of medical images obtained from any imaging modality. It provides generic manipulation tools, processing tools, and analysis tools more specific to clinical applications. This software, based on an object-oriented paradigm, is portable and extensible. Osiris is available on two different operating systems: the Unix X-11/OSF-Motif based workstations, and the Macintosh family.

Computer Communication Networks↗

Software tools for interactive instruction in radiologic anatomy.

RATIONALE AND OBJECTIVES: To promote active learning in an introductory Radiologic Anatomy course through the use of computer-based exercises. MATERIALS AND METHODS: DICOM datasets from our hospital PACS system were transferred to a networked cluster of desktop computers in a medical school classroom. Medical students in the Radiologic Anatomy course were divided into four small groups and assigned to work on a clinical case for 45 minutes. The groups used iPACS viewer software, a free DICOM viewer, to view images and annotate anatomic structures. The classroom instructor monitored and displayed each group's work sequentially on the master screen by running SynchronEyes, a software tool for controlling PC desktops remotely. RESULTS: Students were able to execute the assigned tasks using the iPACS software with minimal oversight or instruction. Course instructors displayed each group's work on the main display screen of the classroom as the students presented the rationale for their decisions. The interactive component of the course received high ratings from the students and overall course ratings were higher than in prior years when the course was given solely in lecture format. CONCLUSIONS: DICOM viewing software is an excellent tool for enabling students to learn radiologic anatomy from real-life clinical datasets. Interactive exercises performed in groups can be powerful tools for stimulating students to learn radiologic anatomy.

Anatomy↗

The reliability of "Analyze" software in measuring orbital volume utilizing CT-derived data.

INTRODUCTION: Craniomaxillofacial surgeons require to estimate the orbital volume in a variety of clinical situations. This paper evaluates a new method based on software analysis of computerized tomography (CT) scan data. MATERIAL AND METHODS: Five dried skulls with prosthetic globes and periorbita were non-helically scanned in an Elscint 2400 CT scanner. Images obtained were processed using the "Analyze" software package and results compared to the volume of the intraorbital prosthesis as determined by a volume displacement gravimetric method. RESULTS: Estimates of volume produced by the software varied from the gold standard by 0.06-50.44%, with a mean error of 8.8%. CONCLUSION: Despite the use of a variety of scan protocols it was not possible to obtain results with "Analyze" software which were sufficiently accurate for clinical use.

Eye, Artificial↗

Automated software supported versus manual aorto-iliac diameter measurements in CT angiography of patients with abdominal aortic aneurysms: assessment of inter- and intraobserver variation.

BACKGROUND: Open surgical or endovascular abdominal aortic aneurysm (AAA) relies on precise preprocedual imaging. Purpose of this study was to assess inter- and intraobserver variation of software-supported automated and manual multi row detector CT angiography (MDCTA) in aortoiliac diameter measurements before AAA repair. PATIENTS AND METHODS: Thirty original MDCTA data sets (4 x 2mm collimation) of patients scheduled for endovascular AAA repair were studied on a dedicated software capable of creating two-dimensional reformatted planes orthogonal to the aortoiliac center-line. Measurements were performed twice with afour-week interval between readings. Data were analysed by two blinded readers at random order Two different measurement methods were performed: reader-assisted freehand wall-to-wall measurement and semi-automatic measurement. RESULTS: Aortoiliac diameters were significantly underestimated by the semi-automatic method as compared to reader-assisted measurements (p < 0.0031). Intraobserver variability of AAA diameter calculation was not significant (p > 0. 15) for reader-assisted measurements except for the diameter of the left common iliac artery in reader 2 (p = 0.0045) and it was not significant (p > 0. 14) using the semi-automatic method. Interobserver variability was not significant for AAA diameter measurements using the reader-assisted method and for proximal neck analysis with the semiautomatic method (p > 0.27). Relevant interobserver variation was observed for semi-automatic measurement of maximum AAA (p = 0.0007) and iliac artery diameters (p = 0.024). CONCLUSIONS: Dedicated MDCTA software provides a useful tool to minimize aortoiliac diameter measurement variation and to improve imaging precision before AAA repair. For reliable AAA diameter analysis the reader-assisted freehand measurement method is recommended to be applied to a set of reformatted CT data as provided by the software used in this study.

Aged↗

Development and evaluation of patient-centered software for a weight-management clinic.

OBJECTIVE: To describe a weight-management clinic software system and to report on its preliminary evaluation. RESEARCH METHODS AND PROCEDURES: The software system standardizes the collection of relevant patient information from an initial medical assessment, weekly clinic visits, and laboratory testing protocol of a medically supervised proprietary meal-replacement program in a university-based referral clinic. It then generates monthly patient feedback reports with graphs of clinical and laboratory parameters to support a patient-centered approach to weight management. After patients and clinic physicians review the data to ensure accuracy, the database is used for subsequent patient feedback reports, reports to referring physicians, quality assurance, and research. Clinic physicians and referring physicians were asked to rate their acceptance of the system. In addition, in a retrospective analysis of data generated by the system, outcomes for patients who received system-generated feedback (n = 620) were compared with those who participated in the program before the introduction of feedback (n = 130). RESULTS: Clinic and referring physicians reported that they had high overall satisfaction with the software and that the system saved them time, and the latter group reported that it decreased laboratory use. Regarding patients, the feedback group had lower dropout rates in the latter half of the program, better rates of attendance, completion of laboratory tests, and weight loss after 8 weeks. DISCUSSION: The software seems to facilitate the effectiveness of the treatment protocol for obesity and generates a high-quality database for patient care, clinic administration, quality assurance, and research purposes.

Ambulatory Care↗

On the use of error propagation for statistical validation of computer vision software.

Computer vision software is complex, involving many tens of thousands of lines of code. Coding mistakes are not uncommon. When the vision algorithms are run on controlled data which meet all the algorithm assumptions, the results are often statistically predictable. This renders it possible to statistically validate the computer vision software and its associated theoretical derivations. In this paper, we review the general theory for some relevant kinds of statistical testing and then illustrate this experimental methodology to validate our building parameter estimation software. This software estimates the 3D positions of buildings vertices based on the input data obtained from multi-image photogrammetric resection calculations and 3D geometric information relating some of the points, lines and planes of the buildings to each other.

Algorithms↗

Software design patterns for information visualization.

Despite a diversity of software architectures supporting information visualization, it is often difficult to identify, evaluate, and re-apply the design solutions implemented within such frameworks. One popular and effective approach for addressing such difficulties is to capture successful solutions in design patterns, abstract descriptions of interacting software components that can be customized to solve design problems within a particular context. Based upon a review of existing frameworks and our own experiences building visualization software, we present a series of design patterns for the domain of information visualization. We discuss the structure, context of use, and interrelations of patterns spanning data representation, graphics, and interaction. By representing design knowledge in a reusable form, these patterns can be used to facilitate software design, implementation, and evaluation, and improve developer education and communication.

Algorithms↗

Recommendations for responsible monitoring and regulation of clinical software systems. American Medical Informatics Association, Computer-based Patient Record Institute, Medical Library Association, Association of Academic Health Science Libraries, American Health Information Management Association, American Nurses Association.

In mid-1996, the FDA called for discussions on regulation of clinical software programs as medical devices. In response, a consortium of organizations dedicated to improving health care through information technology has developed recommendations for the responsible regulation and monitoring of clinical software systems by users, vendors, and regulatory agencies. Organizations assisting in development of recommendations, or endorsing the consortium position include the American Medical Informatics Association, the Computer-based Patient Record Institute, the Medical Library Association, the Association of Academic Health Sciences Libraries, the American Health Information Management Association, the American Nurses Association, the Center for Healthcare Information Management, and the American College of Physicians. The consortium proposes four categories of clinical system risks and four classes of measured monitoring and regulatory actions that can be applied strategically based on the level of risk in a given setting. The consortium recommends local oversight of clinical software systems, and adoption by healthcare information system developers of a code of good business practices. Budgetary and other constraints limit the type and number of systems that the FDA can regulate effectively. FDA regulation should exempt most clinical software systems and focus on those systems posing highest clinical risk, with limited opportunities for competent human intervention.

Clinical Medicine↗

cPath: open source software for collecting, storing, and querying biological pathways.

BACKGROUND: Biological pathways, including metabolic pathways, protein interaction networks, signal transduction pathways, and gene regulatory networks, are currently represented in over 220 diverse databases. These data are crucial for the study of specific biological processes, including human diseases. Standard exchange formats for pathway information, such as BioPAX, CellML, SBML and PSI-MI, enable convenient collection of this data for biological research, but mechanisms for common storage and communication are required. RESULTS: We have developed cPath, an open source database and web application for collecting, storing, and querying biological pathway data. cPath makes it easy to aggregate custom pathway data sets available in standard exchange formats from multiple databases, present pathway data to biologists via a customizable web interface, and export pathway data via a web service to third-party software, such as Cytoscape, for visualization and analysis. cPath is software only, and does not include new pathway information. Key features include: a built-in identifier mapping service for linking identical interactors and linking to external resources; built-in support for PSI-MI and BioPAX standard pathway exchange formats; a web service interface for searching and retrieving pathway data sets; and thorough documentation. The cPath software is freely available under the LGPL open source license for academic and commercial use. CONCLUSION: cPath is a robust, scalable, modular, professional-grade software platform for collecting, storing, and querying biological pathways. It can serve as the core data handling component in information systems for pathway visualization, analysis and modeling.

Computational Biology↗

Random allocation software for parallel group randomized trials.

BACKGROUND: Typically, randomization software should allow users to exert control over the different aspects of randomization including block design, provision of unique identifiers and control over the format and type of program output. While some of these characteristics have been addressed by available software, none of them have all of these capabilities integrated into one package. The main objective of the Random Allocation Software project was to enhance the user's control over different aspects of randomization in parallel group trials, including output type and format, structure and ordering of generated unique identifiers and enabling users to specify group names for more than two groups. RESULTS: The program has different settings for: simple and blocked randomizations; length, format and ordering of generated unique identifiers; type and format of program output; and saving sessions for future use. A formatted random list generated by this program can be used directly (without further formatting) by the coordinator of the research team to prepare and encode different drugs or instruments necessary for the parallel group trial. CONCLUSIONS: Random Allocation Software enables users to control different attributes of the random allocation sequence and produce qualified lists for parallel group trials.

Algorithms↗

ScanImage: flexible software for operating laser scanning microscopes.

BACKGROUND: Laser scanning microscopy is a powerful tool for analyzing the structure and function of biological specimens. Although numerous commercial laser scanning microscopes exist, some of the more interesting and challenging applications demand custom design. A major impediment to custom design is the difficulty of building custom data acquisition hardware and writing the complex software required to run the laser scanning microscope. RESULTS: We describe a simple, software-based approach to operating a laser scanning microscope without the need for custom data acquisition hardware. Data acquisition and control of laser scanning are achieved through standard data acquisition boards. The entire burden of signal integration and image processing is placed on the CPU of the computer. We quantitate the effectiveness of our data acquisition and signal conditioning algorithm under a variety of conditions. We implement our approach in an open source software package (ScanImage) and describe its functionality. CONCLUSIONS: We present ScanImage, software to run a flexible laser scanning microscope that allows easy custom design.

Equipment Design↗

Software packages for quantitative microarray-based gene expression analysis.

Microarray technology enables researchers to investigate the expression of several thousand genes simultaneously. The whole transcriptional response of these genes in normal cells or tissue, in disease condition, as an response to biological, genetical or chemical stimuli or during normal biological processes such as cell cycle or embryonic development can be investigated. This leads to a huge amount of data, from which the relevant information has to be extracted by statistical and computational methods. Several software packages for the analysis of gene expression data are available, both commercially and freely. They differ particularly with regard to the implemented analytical methods, the graphical display and the manageability. In this paper the commercial software packages arraySCOUT, GeneSpring and Spotfire DecisionSite for Functional Genomics are compared and their applicability for analysis of gene expression data is studied. Small artificial and application test datasets are used to compare the computational results of the software packages. As far as possible results are verified with standard statistical software package SAS.

Algorithms↗

An institution-based process to ensure clinical software quality.

Clinical software can have a major impact on the delivery of care. It is imperative that clinical software undergo regular quality review, to evaluate the clinical correctness of the specification, the technical correctness of the software, problems that have arisen, and maintenance of the software as conditions change. We have developed a process using existing hospital review groups to perform clinical review, and using a project specification form and analysis of likely problem areas to effect technical review.

Hospital Information Systems↗

How the open-source development model can improve medical software.

The current system of proprietary software development for healthcare applications is inadequate to meet the needs of providers, administrators, and patients. A recent advance in the field of Internet programming is the release of large-scale software projects as "open-source". The advantages of this method of development include higher quality, lower cost, and increased adherence to established standards. There are several hurdles to be overcome before the healthcare field can take full advantage of this development model. The implementation of open-source development of medical software could greatly improve clinical and research software and elevate the academic standards of the field of medical informatics.

Copyright↗

Evidence-based development of a diagnosis-dependent therapy planning system and its implementation in modern diagnostic software.

The prerequisite for structured individual therapy of craniomandibular dysfunctions is differential diagnostics. Suggestions for the structured recording of findings and their structured evaluation beyond the global diagnosis of "craniomandibular disorders" have been published. Only this structured approach enables computerization of the diagnostic process. The respective software is available for use in practice (CMDcheck for CMD screening, CMDfact for the differential diagnostics). Based on this structured diagnostics, knowledge-based therapy planning is also conceivable. The prerequisite for this would be a model of achieving consensus on the indicated forms of therapy related to the diagnosis. Therefore, a procedure for evidence-based achievement of consensus on suitable forms of therapy in CMD was developed first in multicentric cooperation, and then implemented in corresponding software. The clinical knowledge of experienced specialists was included consciously for the consensus achievement process. At the same time, anonymized mathematical statistical evaluations were used for control and objectification. Different examiners form different departments of several universities working independently of one another assigned the theoretically conceiveable therapeutic alternatives to the already published diagnostic scheme. After anonymization, the correlation of these assignments was then calculated mathematically. For achieving consensus in those cases for which no agreement initally existed, agreement was subsequently arrived at in the course of a consensus conference on the basis of literature evaluations and the discussion of clinical case examples. This consensus in turn finally served as the basis of a therapy planner implemented in the above-mentioned diagnostic software CMDfact. Contributing to quality assurance, the principles of programming this assistant as well as the interface for linking into the diagnostic software are documented and also published here.

Clinical Protocols↗

Software engineering education in medical informatics.

Requirements and approaches of Software Engineering education in the field of Medical Informatics are described with respect to the impact of (1) experiences characterizing the "software misery", (2) status and tendencies in software methodology, and (3) educational status and needs in computer science education influenced by the controversy "theoretical versus practical education". Special attention is directed toward the growing importance of analysis, design methods, and techniques in the professional spectrum of Medical Informatics, the relevance of general principles of systems engineering in health care, the potential of non-procedural programming paradigms, and the intersection of Artificial Intelligence and education. Realizations of and experiences with programs in the field of Software Engineering are reported with respect to special requirements in Medical Informatics.

Artificial Intelligence↗