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IS & C system and file protection mechanism.

This paper reports a new extension of IS & C (Image Save And Carry) project. Because IS & C is an off-line system and requires full compatibility so as to enable medical data interchange with ease among hospitals and clinics, specifications that are indispensable for compatibility have been standardized by the IS & C committee. The IS & C system is supposed to be used in medicine, so the file protection mechanism for the security of the recorded files has been also developed. The characteristics of IS & C volume and file structure and the second national project being carried out in National Cancer Center Hospital are briefly explained as well.

Computer Communication Networks

An introduction to fractal imaging technology.

In this article the author explains the basic theory and practical applications of the latest advancement in imaging technology called fractal imaging. Fractal imaging is a unique way of compressing and storing images which has unlocked the door to the restrictions imposed by conventional imaging technology as regards storage and transmission of high quality images. The article outlines how this technology has been successfully applied by the creation of the first and only fractal photographic archival and retrieval system in Scotland, in the form of the George Washington Wilson collection comprising 44,000 images and associated text in only 450 megabytes (Mb) of disc space.

Fractals

Uses and limitations of microcomputers for epidemiological research in occupational health.

The rapid improvements in microcomputer systems have contributed to ease of performance of epidemiological research in occupational health. Computers now available can aid in all stages of research- from the early stages of literature review to data collection, analysis and presentation. Optical storage devices now allow large occupational health data bases to be stored on a single compact disc, with the information accessible by microcomputer. Hand-held computers and optical scanners allow paperless collection of field data. Epidemiological analysis and data presentation is easily done with software packages, some of which are in the public domain. However, there are limitations in the use of computers for any epidemiological research. Investment of time is required to learn the use of a computer. Care needs to be taken to ensure accurate data entry, and correct choice has to be made of methods for subsequent statistical analysis. Microcomputers are valuable as labour saving devices, but cannot replace proper planning, execution and appropriate data analysis in epidemiological research in occupational health.

Health Services Research

Present status and performance of PACS at Kyoto University Hospital.

A pilot PACS project, named KIDS, has been running in Kyoto University Hospital. The purpose of the system is to establish a small PACS that includes all digital imaging modalities and to evaluate it. The project has been continued from the first phase (KIDS-1) to the second phase (KIDS-2). In the first phase, a small-scale PACS was developed. In the second phase, the expansion of coverage of modalities and completion of the image database was intended. At present, the database contains image data of 16264 patients amounting to 150 Gbytes. Simulation of the retrieval process to the database shows that 154.3 s per patient is required for retrieving his/her entire image data. This calculated value is close to the actual time.

Computer Communication Networks

Computer-monitored radionuclide tracking of three-dimensional mandibular movements. Part I: theoretical approach.

A new technique for the three-dimensional recording of a person's mandibular movement is described. A small and harmless radioactive source is fixed on the patient's skin at the point of interest or sealed in a tooth cavity. Using the proper collimation, the motion of the point source is recorded via a gamma camera and minicomputer. Long-term storage on a magnetic device offers playback, slow motion facilities, and data analysis through the use of sophisticated computer languages. Simultaneous recordings using two cameras, or postsynchronization of two different views of an experiment, enable the three-dimensional restitution of mandibular movements. Superimposition of a grid of radioactive spots spaced at measured intervals during the recording permits a straightforward calibration of the patient's motion. Multiple sources in a single experiment may be recorded to describe the displacement of several points of interest. This method, derived from nuclear medicine techniques, offers a powerful tool of general interest for the tracking of dynamic events in many fields of dentistry such as temporomandibular joint dysfunction and prosthetic restorative techniques. Further considerations on our experimental settings and results will be published in part II.

Analog-Digital Conversion

Neuropoiesis: proposal for a connectionistic neurobiology.

Given current assumptions about the biology of neural organization, some connectionists believe that it may not be possible to accurately model the brain's neural architecture. We have identified five restrictive neurobiological dogmas that we believe have limited the exploration of more fundamental correlations between computational and biological neural networks. We postulate that: 1) the dendritic tree serves as a synapse storage device rather than a simple summation device; 2) connection strength between neurons depends on the number and location of synapses of similar weight, not on synapses of variable weights; 3) axonal sprouting occurs regularly in adult organisms; 4) the postsynaptic genome directly controls the presynaptic cell via mRNA, rather than indirectly by the expression of NCAMs, reverse neurotransmitters, etc.; 5) dendritic spines serve a trophic function by controlling development of new sprouts via a process we term retroduction. We entertain an alternative formulation of a computational neural element that is fully consistent with modern neuroscience research. We then show how our model neuron can learn under Hebbian conditions, and extend the model to explain non-Hebbian, one-trial learning. This work is significant because by stretching the theoretical boundaries of modern neuroscience, we show how connectionists can potentially create new, more biologically-based neural elements which, when, interconnected into networks, exhibit not only properties of existing backpropagation networks, but other physiological properties as well.

Adult

Sorting efficiency.

Computers and the tasks they perform are becoming increasingly important in medicine. It behooves medical personnel to become familiar with some computer functions so that they may be in a better position to demand and evaluate a given implementation. One very basic computer task is sorting information. Some general principles of computing efficiency are discussed, as well as the standard "O" notation. A simple sort, bubblesort, is discussed and analyzed. A second elementary sort, insertionsort, is considered in relation to its more sophisticated descendant, shellsort. The most efficient in-memory sort, quicksort (and its various descendants), is likewise examined, and the advantages and disadvantages of each variant are discussed in some detail, as well as methods that may enhance speed and resource utilization. Finally, mergesort, which is used in sorting large files resident in mass-storage devices, is discussed, along with its particular advantages.

Algorithms

Clinical usefulness of the personal computer for equilibrium examinations.

A personal computer (PC) system and its usefulness for equilibrium examinations is reported. The system was introduced into clinical routine practice for the following purposes: i) Reduction of test result measurement troubles in clinical practice, ii) Clearer observation of eye movements and body sway, iii) Quantitative analysis of nystagmus responses or body sway, iv) Easy introduction into clinical practice of new parameters or new tests, v) Programmable arrangement of stimulating devices, and vi) Effective storage of test data. Our PC system has been successful for these purposes and provided many useful options in equilibrium examinations. Although computer systems for equilibrium examination have not been popular due to high costs, the PC system, which can be obtained at a reasonable price, has become as powerful a device as the conventional small computer, and is expected to become a popular method for both research and routine clinical practice in the near future.

Caloric Tests

Development and evaluation of oral reporting system for PACS.

Experimental workstations for oral reporting and synchronized image filing have been developed and evaluated by radiologists and referring physicians. The file media is a 5.25-inch rewritable magneto-optical disk of 600-Mb capacity whose file format is in accordance with the IS&C specification. The results of evaluation tell that this system is superior to other existing methods of the same kind such as transcribing, dictating, handwriting, typewriting and key selections. The most significant advantage of the system is that images and their interpretation are never separated. The first practical application to the teaching file and the teaching conference is contemplated in the Osaka University Hospital. This system is a complete digital system in terms of images, voices and demographic data, so that on-line transmission, off-line communication or filing to any database will be easily realized in a PACS environment. We are developing an integrated system of a speech recognizer connected to this digitized oral system.

Education, Medical

A proposal of an off-line PACS based on a personal database.

Problems with picture archiving and communication systems (PACS) are focused and an off-line PACS of practical value is proposed in this paper. This system is based on the personal database where each patient has his/her own recording medium. This medium files all medical information as well as images of value, and is carried with a patient through hospital. Advantages over the conventional or on-line PACS communicating through a network are discussed and a possibility of practical use is analysed showing a prototype system. The biggest advantage of this system is quick and easy access to the images of concern and a small amount of cost for initial investment. It is also pointed out that the format of the data recording on the disk has to be standardized so that this system could be used for a medical care system over a wide area.

Computer Systems

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

Analog and digital computer theory.

Analog signals abound in the natural world. With appropriate transducers these signals can be converted to continuous voltages and can be displayed, transmitted, stored, or copied. They can be processed by analog computers, the simplest of which is an audio amplifier. With analog signals, however, there can be errors because of signals loss, interference, and noise. Binary digital signals permit only two values, either 0 ('off' or 'low') or 1 ('on' or 'high'). These signals are much less susceptible to transmission problems. Binary signals are commonly organized into 8-bit groups which can represent 256 different numbers or meanings. These data can be transmitted in either serial or parallel fashion at high rates of speed. Analog-to-digital converters permit analog signals to be transformed to digital signals. A computer consists of the memory, the processor, and the input/output devices. Memory includes the fastest registers, the very fast core memory, the peripheral storage devices such as diskettes and disks, and the very slow peripheral devices such as magnetic tape. The processor can only load and store numbers in memory, add two numbers, test a number, and provide input and output. The program counter indicates the next computer instruction to be performed. Input/output devices allow communication with the outside world and may assume many forms. A computer by itself can do nothing. A program or series of instructions is required. The most simplistic program language is assembler or machine language. Most programming is done in more sophisticated languages, however.(ABSTRACT TRUNCATED AT 250 WORDS)

Analog-Digital Conversion

CD-ROM source data uploaded to the operating and storage devices of an IBM 3090 mainframe through a PC terminal.

A powerful method of processing MEDLINE and CINAHL source data uploaded to the IBM 3090 mainframe computer through an IBM/PC is described. Data are first downloaded from the CD-ROM's PC devices to floppy disks. These disks then are uploaded to the mainframe computer through an IBM/PC equipped with WordPerfect text editor and computer network connection (SONNGATE). Before downloading, keywords specifying the information to be accessed are typed at the FIND prompt of the CD-ROM station. The resulting abstracts are downloaded into a file called DOWNLOAD.DOC. The floppy disks containing the information are simply carried to an IBM/PC which has a terminal emulation (TELNET) connection to the university-wide computer network (SONNET) at the Ohio State University Academic Computing Services (OSU ACS). The WordPerfect (5.1) processes and saves the text into DOS format. Using the File Transfer Protocol (FTP, 130,000 bytes/s) of SONNET, the entire text containing the information obtained through the MEDLINE and CINAHL search is transferred to the remote mainframe computer for further processing. At this point, abstracts in the specified area are ready for immediate access and multiple retrieval by any PC having network switch or dial-in connection after the USER ID, PASSWORD and ACCOUNT NUMBER are specified by the user. The system provides the user an on-line, very powerful and quick method of searching for words specifying: diseases, agents, experimental methods, animals, authors, and journals in the research area downloaded. The user can also copy the TItles, AUthors and SOurce with optional parts of abstracts into papers under edition. This arrangement serves the special demands of a research laboratory by handling MEDLINE and CINAHL source data resulting after a search is performed with keywords specified for ongoing projects. Since the Ohio State University has a centrally founded mainframe system, the data upload, storage and mainframe operations are free.

CD-ROM

Data acquisition and analysis system for intracellular neuronal signals.

A comprehensive system for the acquisition and analysis of neurophysiological data is described, with a focus on intracellular data. The software comprising the system will evaluate a number of neuronal signals, including intracellular as well as extracellular recordings from neurons, evoked potentials and computer simulation data. Significant enhancements enable sampling at high resolution (50 kHz throughput to disk; +/- 15 bit or 96 db), concurrent with extensive on-line analysis capabilities and display. Modifications of existing software and development of new types of input and output devices and analysis can be incorporated as needed, using a binary digital database as the primary storage for the experimental signals and device-independent graphics.

Cell Communication

A peripheralized digital image management system: prospectus.

The number of diagnostic radiology examinations being performed on digitally formatted imaging equipment is continually increasing. However, most digital data are recorded as analogue images and the films stored in a central file. The dynamic range of raw digital data is lost. Currently, the space and cost requirements for storage of all digital data have discouraged most users from attempting it. This article presents the concepts and describes the requirements and initial fabrication of a system that will capture and retain all digital data using a network of peripheralized image acquisition, display, and storage devices. Any piece of digitally formatted equipment can be interfaced into the system. A real-time computer capability provides that any digital examination can be reviewed at any display station for up to 10 days.

Computers

Basics of computer hardware and software.

The basics of computer hardware and software are presented. A computer is a general-purpose electronic counting device used in data processing because of its accuracy and high speed. The physical components of a computer system are called the hardware, which includes the central processing unit and peripheral equipment for data input, output, and storage. Computer capacity is measured by the amount of data that can be stored in main memory and by the computer word size. Performance is indicated by the speed with which instructions are executed. Input devices (e.g., keyboard-type terminals) are the components that accept raw data and convert it into electronic form, and output devices (e.g., video display terminals) present the results of data processing in human-readable form. System software is the set of instructions that facilitate hardware use and allow the application software, which solves specific user problems, to run efficiently. System and application software is written by using various machine and symbolic languages. Milestones in software-development techniques include program subroutine use, modular programming, functional decomposition, structured programming, and structured analysis. Objectives in improving software quality are reducing development costs, making maintenance easier, and making development results more predictable. Because software development has lagged behind revolutionary advances in hardware, the full potential of computers has yet to be realized.

Computer Literacy

An interactive microcomputer program for calculation of combined parenteral and enteral nutrition for neonates.

A responsive, iterating program is described (available on diskette from first author), which enables the physician to formulate a balanced, total parenteral nutrition (TPN) for low-birth-weight and sick newborns. The program allows for the possibility of TPN or simultaneous intravenous, intraarterial, and oral feeding. It calculates the overall balance of fluids, nutrients, calories, electrolytes, minerals, trace elements, and vitamins. It features the integration of algorithms and limit tests of nutritional balance, to produce a feeding program that can be modified by clinical considerations of the physician, specific for each patient. The entire procedure can be accomplished, and a record of the entries and orders to the pharmacy and to the ward staff printed, within about 4-5 min. The program, which is written in BASIC, can be accommodated within and operated with a 16K byte microcomputer, equipped with a monitor, a printer, and a diskette or other program storage device.

Computers