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Clinical application of a magneto-optical disk image filing system/image save and carry (ISAC) system.

We propose the utilization of portable magneto optical disks for image filing. The main problems in PACS are the need for a high-speed local area network (LAN) and a large mass storage device. An image filing system--image save and carry (ISAC)--is one solution for these problems in present PACS and requires minimal additional hardware and cost for the installation. Whenever a patient is examined, the clerk carries the medical record and the ISAC magneto-optical disk for recording image data, and after inspection records the image data into the magneto-optical disk. We investigated the number of image retrievals done for inpatients and outpatients in 1988 at our radiation therapy department. The data storage requirements were on the average 18.5 MB for outpatients and 173.9 MB for inpatients. An ISAC display console needs also an easy-to-use man/machine interface for specifying images and image display characteristics in order to realize the ISAC system.

Computer Systems

[Field localization and verification system for proton beam radiotherapy in deep-seated tumors].

It has been recognized that, for precise localization and verification of radiation fields, a marking drawn on the skin surface is not entirely reliable because its position relative to bony structures or internal organs is not stationary. This is especially true when treating deep-seated tumors located below the clavicle. In proton beam radiotherapy at the University of Tsukuba, we ristrict the margins around the target volume. Therefore, special care in field localization and verification is needed, and we make it a rule to take X-ray pictures on each treatment day. To accomplish this, we have developed a localize-and-verify system by using fluoroscopic techniques and combining it with a real-time digital image processing device. This allows for the formation of a digital image of the proton field and storage it in the optic disc. By using this system as well as verification films, filed placement errors were measured in 10 patients with deep-seated tumors. Out of a total of 190 localizations, 22% exhibited a field placement error of more than 5 mm, where patient positioning and field localization were done by using skin drawings aligned with laser beams. This result strongly suggests the necessity for daily localization and verification of radiation fields, as is being done by us, for precision in the execution of proton beam radiation therapy.

Adult

CD-ROM. A new advance in medical information retrieval.

The massive production of medical information is being met by new technologies for storing and retrieving knowledge. Recent years have witnessed the maturation of time-sharing information utilities into a full-blown industry. In medicine these services have provided bibliographic information but have recently expanded to full-text availability of journals and books. Now optical storage technology, most conspicuously the compact disk read only memory (CD-ROM), provides similar massive information storage and retrieval affordable to microcomputer users. Such devices might replace many of the functions of time-sharing.

Computers

X ray microscopy--state of the art and expected developments.

The Göttingen X ray microscope at the electron storage ring BESSY in Berlin and X ray microscopy experiments with biological specimens are described. A look ahead to future developments--optics for higher resolution and with better efficiency, detector devices with higher detective quantum efficiency, and the development of a laboratory X ray microscope with a plasma X ray source--is taken.

Electron Probe Microanalysis

Development of an integrated filing system for endoscopic images.

A new integrated filing system for endoscopic images has been developed, comprising a main image filing system and subsystems located at different stations. A hybrid filing system made up of both digital and analog filing devices was introduced to construct this system that combines the merits of the two filing methods. Each subsystem provided with a video processor, is equipped with a digital filing device, and routine images were recorded in the analog image filing device of the main system. The use of a multi-input adapter enabled simultaneous input of analog images from up to 8 video processors. Recorded magneto-optical disks make it possible to recall the digital images at any station in the hospital; the disks are copied without image degradation and also utilised for image processing. This system promises reliable storage and integrated, efficient management of endoscopic information. It also costs less to install than the so-called PACS (picture archiving and communication system), which connects all the stations of the hospital using optical fiber cables.

Analog-Digital Conversion

Two-dimensional, computer-controlled film scanner: quantitation of fluorescence from ethidium bromide-stained DNA gels.

A two-dimensional scanner based on a digital plotter is described. The device is used to analyze photographic negatives of ethidium bromide-stained DNA-agarose gels. Scanning is controlled by and photometric data transferred to a computer for processing, storage, display, and analysis such as integration of the areas under bands and determination of the mean distances of migration of polydisperse samples. An integral light source and detector module designed for reading optical "bar-codes" is mounted in place of the pen of the plotter. Spatial resolution and reproducibility are about 0.2 and 0.005 mm, respectively. Photometric precision as good as one part per thousand is achieved by sinusoidal modulation of the intensity of the light source and synchronous, phase-sensitive detection of the signal from the detector by a lock-in amplifier. No part of the sensor assembly touches the surface of the negative. In contrast to a densitometer, the computer transforms photometric data to values directly proportional to the amount of DNA at given points on the original gel. The ability to move the sensor in two dimensions over the negative allows for the integration across the width of a lane correctly allowing for the nonuniform distribution of the DNA.

Computers

Confocal fluorescence microscopy and three-dimensional reconstruction.

Several recent technological advances have considerably improved the field of confocal fluorescence microscopy. Improvements in confocal microscope design, new fluorescent probes and indicators, more sensitive imaging devices, and computer advances which allow for data manipulation and storage provide a convenient method to acquire complex three-dimensional (3-D) architectural details which previously were difficult or impossible to obtain from biological specimens. Applications of the laser scanning and tandem scanning confocal microscopes offer the potential for gaining powerful insights into the complex relationship of cellular structure and function. Confocal microscopy generates optical sections free from out-of-focus blur. With the development of new visualization tools to render and display complex 3-D data, a set of optical sections taken at different focal planes can be three-dimensionally reconstructed to create an animated sequence which can reveal latent features of the specimen. The combination of confocal microscopy and 3-D reconstruction provides a powerful new imaging tool to advance knowledge about structural and functional cellular properties as they occur dynamically in three dimensions.

Animals

Manufacture of epikeratophakia lens.

Epikeratophakia lenses may be manufactured from donor cornea either with a lathe or using devices that make flat cuts on to previously deformed cornea. Details are given of a manufacturing technique using a cryolathe, including the storage and preparation of donor corneas and derivation of the formulae used to determine the radius of lathe cut.

Aphakia

Electronic system for digital acquisition of rotational panoramic radiographs.

A prototype system for digital panoramic imaging of the maxillofacial complex has been developed. In this system x-ray film is replaced by an electronic sensor that delivers the image information to a computer for storage in digital format. The images, which are similar to conventional panoramic radiographs, are displayed on a high-resolution video monitor and may be stored on optical disk for future use. Hard-copy output is also available. The present prototype system has been installed on an Orthopantomograph model OP10 panoramic x-ray machine is programmed for operation with this machine, but in principle the system can be installed on any such device. The system may be incorporated into the design of future panoramic x-ray systems or may be used to retrofit panoramic x-ray systems now using photographic film to record the radiographic image. Greater sensitivity of electronic sensors should make possible a reduction of x-ray dose to the patient, compared with film-based systems.

Analog-Digital Conversion

Improved control of image optical density with low-dose digital and conventional radiography in bedside imaging.

The technical and diagnostic performance of simultaneously acquired low-dose (44% of standard dose) storage-phosphor digital radiographs (system resolution = 0.2 mm, 10 bits) were compared with those of standard-dose conventional bedside radiographs of the chest in 32 patients. The mean optical density (OD) of the lungs (800 measurements) was closer to the ideal density with digital radiography (1.45 OD +/- 0.20 [standard deviation] vs 1.75 OD +/- 0.53) and was less often outside the usable range (2.5% vs 42.5%). Receiver operating characteristic analysis for detection of simulated nodules and monitoring devices (nine readers, 4,608 observations) showed that digital radiography was superior to conventional radiography (P less than .05) for four of the nine readers and equivalent to conventional radiography for five readers. The authors concluded that digital radiography produces more consistent and ideal image density and performs at least as well as conventional radiography under phantom test conditions.

Absorptiometry, Photon

Pseudo-outbreak of Bacillus species: related to fibreoptic bronchoscopy.

In July and August 1980, Bacillus spp. were isolated with unusual frequency from bronchial washings obtained during bronchoscopy performed with fibreoptic equipment. Clinical disease in culture-positive patients was not apparent; but Bacillus spp. were recovered from one component of the bronchoscope, the automatic suction valve. It appeared that secretions became contaminated during passage through the valve en route to a collection device. After institution of controls directed primarily at proper storage and maintenance, the number of isolations of Bacillus spp. decreased significantly. Thus, investigation revealed a site for contamination not previously described and the results suggest that in future outbreaks, cultures of the component parts may permit localization of the site of contamination which may help focus control measures.

Bacillus

A high-resolution digital dosimetric system for spatial characterization of radiation fields using a thermoluminescent CaF2:Dy crystal.

A high-resolution digital dosimetric system has been developed for the spatial characterization of radiation fields. The system comprises the following: 0.5-mm-thick, 25-mm-diam CaF2:Dy thermoluminescent crystal; intensified charge coupled device video camera; video cassette recorder; and a computerized image processing subsystem. The optically flat single crystal is used as a radiation imaging device and the subsequent thermally stimulated phosphorescence is viewed by the intensified camera for further processing and analysis. Parameters governing the performance characteristics of the system were measured. A spatial resolution limit of 31 +/- 2 microns (1 sigma) corresponding to 16 +/- 1 line pairs/mm measured at the 4% level of the modulation transfer function has been achieved. The full width at half maximum of the line spread function measured independently by the slit method or derived from the edge response function was found to be 69 +/- 4 microns (1 sigma). The high resolving power, speed of readout, good precision, wide dynamic range, and the large image storage capacity make the system suitable for the digital mapping of the relative distribution of absorbed doses for various small radiation fields and the edges of larger fields.

Health Physics

Network system: the integrated picture archiving and communication system with the hospital information system.

We describe the outline of Hokkaido University picture archiving and communication system (HU-PACS) and its network functions. HU-PACS processes 0.5 Gbytes of images daily through 10 acquisition devices. Functional integration of hospital information system (HIS) and PACS has been implemented. The HU-PACS can access common data base with HIS. Multi-image data-base systems provide fast throughput of image retrieval. The system is composed of 4 modules: (1) 2 image data-base systems (IDS), (2) 1 image management system (IMS), (3) image display terminals (IDT), and (4) 8 image acquisition nodes interfaced to 10 modalities and 1 film scanner. These 4 modules are connected by branch and loop type local area networks (LAN). HU-PACS has functions other than basic PACS functions. Images in optical disk library (ODL) are loaded onto magnetic disks (MD) in advance according to patient booking information, the images expected to be viewed are transferred to the local storage automatically, and the desired images can be pre-downloaded into local storage by instruction through HIS terminals.

Computer Communication Networks

[Experience in application of electronic data processing in routine medical microbiology (author's transl)].

Experiences in a two years application of electronic data processing in medical routine microbiology are reported. Optical mark reader forms serve as request forms as well as workprotocol. On the left two thirds of these forms (Fig. 1 and 2) the patients data including clinical statements, and the kind of specimen to be investigated (sputum, smear etc.) as well as results not essential for the printout of laboratory reports are filled in. On the right third of the optical mark reader form, in which area the Bell & Howell document reader can read pencil marks, the patients identification number, the tests requested and all results are marked right at the work bench. As shown in the flow diagram (Fig. 3) after completion of the investigation the date on the mark reader forms are read mechanically and the test results are printed (Fig. 5) by means of the computer. In addition, the data processing system, which proved to be very flexible, performs all necessary types of administrative work as filing of laboratory data in a coded form on cards for permanent storage (Fig. 7) statistics and the printout of bills (Fig. 6). The processing of routine microbiology date is achieved by a Siemens DVA 404/3 (64 kbt) connected for magnetic disc device (2993 Mio bytes), and a line printer (60,000 lines per hour) and dialog display monitors, which are used simultaneously for the on line and off line handling of all the data in clinical chemistry-, serology- and hematology-departments of the same institute.

Computers

Electronic imaging in endoscopy.

Endoscopy evolved from a hollow tube view of visually restricted areas into an expansive, distal representation of the anatomy. Rod lens telescopes, improved coherent imaging bundles, superior light sources, and other optical advances enhanced endoscopic observations. Yet complicated endoscopic procedures remained visible to the endoscopist alone, relegating assistance and consultation to verbal description of sophisticated visual observation. Instrumentational advances alone did not promote three crucial elements: participation, cooperation and documentation. The importance of these elements has increased with the need for coordinated assistance in complex operative endoscopic manipulations, as well as in a visual record for improved documentation and consultation. New imaging technologies are supplanting the unwieldy, often daunting equipment once required for photodocumentation. The charged couple device (CCD) 2/3 and 1/2 in. "chip" video camera miniaturization provides nearly weightless TV coobservation. Distal chip placement has created the "video endoscope". Combined with the 8 mm tape format, the chip has created a lightweight, single unit camera, monitor, and recorder. A recent advantage, magnetic disc recording, permits still video storage of up to 25 images. An electronic printer produces a hard color copy (4 x 5), which is inserted in the chart before the patient leaves the endoscopy room. The cost of the equipment can be shared in multidisciplinary institutions.

Costs and Cost Analysis

Quantitative optical determination of the viability of platelet concentrates.

An optical method to assess platelet viability in platelet transfusion concentrates has been developed which is based on the observation that healthy, discoid platelets transmit more light in shear flow than aged, spherical cells. Using a specially designed glass channel, the rise in transmission of light through platelet samples with agitation is referenced against a measurement of transmission without flow. Referencing the measurements may minimize the effects of red blood cell contamination, as well as other variations among platelet packs such as plasma characteristics and plastic container variability. At an optimal frequency of agitation, the ratio of the transmission of light with agitation to that of the sample at rest is found to correlate highly with the concentration of discoid platelets, r = 0.92 to 0.95 (P less than 0.001), for light sources including a HeNe laser and two LEDs. Using this index, the discoid platelet counts of twelve platelet packs are estimated and compared with manual counts. The mean difference between the two methods was 0.009 x 10(9) discoid platelets ml-1 with a standard deviation of 0.11 x 10(9) cells ml-1. We conclude that the method may be applied to the development of a non-invasive device to monitor the concentration of viable, discoid platelets in storage.

Blood Platelets

[Automated and semiautomated perimetry. Comparative trial of 3 devices (Baylor programmer, Friedmann Mark II campimeter, Octopus 2000 R.)].

Modern perimetry involves automated or semi-automated procedures, this computer assisted perimetry (CAP) providing results independent of the examiner, and with marked discrimination of light sensibility through quantification of points tested. A wide variety of CAP devices are available, and a comparative study was conducted in 50 patients using 3 perimetric apparatuses with similar supraliminal static techniques but with variable automated potentials: The Goldman perimeter modified by "Baylor visual fields programmer": static technique for the middle area and kinetic for the peripheral area. The Friedmann Mark II Visual Fields Analyser with a multiple stimulus static technique for the middle area. The Fankhauser Octopus 2000 R perimeter with a precise static technique for middle and peripheral areas. This perimeter, highly automated, also allows statistical evaluation of defects changes, owing to storage of results on magnetic discs. Patients studied had either: glaucoma (25 cases) or neuro-ophthalmologic and retinal disorders (24 cases). Conclusions drawn from the experience acquired by the authors during more than one year of use of the 3 devices were: Rate of detection of defects is excellent with the Octopus and quite good with the Friedmann MKII, but limited in the middle area. The Baylor program does not allow quantification of defects. The image is clear with the Octopus as far as the gray scale is concerned, and more exact as far as the comparative tables are concerned; is not clear with the Friedmann MKII; is typical and clear with the Baylor. The length of examination (which varies with the programs used as far as the Octopus is concerned, and with the patient's reaction time) is usually long with the Octopus and the Friedmann, but short with the Baylor. Time and energy can be gained by the use of the Octopus, since it supplies data obtained from use of the Baylor program associated with that of the Friedmann MKII. The authors prefer to follow up campimetric evolution of glaucomatous patients with the Octopus because it offers more sensibility and precision in quantifying losses. The application of the statistical evaluation delta program on the 2000 R device, which will soon be tested in the Ophthalmological Department, could in an objective way indicate whether there is stabilization or a real progression of glaucomatous defects.

Adenoma