General Consumer Communication Tools for Improved Image Management and Communication in Medicine

We elected to explore new technologies emerging on the general consumer market that can improve and facilitate image and data communication in medical and clinical environment. These new technologies developed for communication and storage of data can improve the user convenience and facilitate the communication and transport of images and related data beyond the usual limits and restrictions of a traditional picture archiving and communication systems (PACS) network. We specifically tested and implemented three new technologies provided on Apple computer platforms. (1) We adopted the iPod, a MP3 portable player with a hard disk storage, to easily and quickly move large number of DICOM images. (2) We adopted iChat, a videoconference and instant-messaging software, to transmit DICOM images in real time to a distant computer for conferencing teleradiology. (3) Finally, we developed a direct secure interface to use the iDisk service, a file-sharing service based on the WebDAV technology, to send and share DICOM files between distant computers. These three technologies were integrated in a new open-source image navigation and display software called OsiriX allowing for manipulation and communication of multimodality and multidimensional DICOM image data sets. This software is freely available as an open-source project at http://homepage.mac.com/rossetantoine/OsiriX. Our experience showed that the implementation of these technologies allowed us to significantly enhance the existing PACS with valuable new features without any additional investment or the need for complex extensions of our infrastructure. The added features such as teleradiology, secure and convenient image and data communication, and the use of external data storage services open the gate to a much broader extension of our imaging infrastructure to the outside worl

Transforming healthcare with the synergy of biotechnology and information technology

We explore the integration of biotechnology and information technology in healthcare innovation. The convergence of these fields has revolutionized diagnostics, therapeutics and patient management. Biotechnology advancements, such as genomics and molecular diagnostics, enable personalized medicine, while information technology facilitates data management and analysis. The integration also extends healthcare access through telemedicine and remote patient monitoring, enhancing healthcare delivery in underserved areas. Challenges include data security and privacy concerns. Looking ahead, the integration of biotechnology and information technology holds immense potential for further healthcare innovation, transforming patient outcomes and healthcare delivery

Caracterização de defeitos ósseos maxilares: estudo imagiológico

Dissertação para obtenção do grau de Mestre no Instituto Superior de Ciências da Saúde Egas MonizEste estudo, de caráter retrospectivo, teve como objetivo avaliar, por meio da tomografia computadorizada (TC), a dimensão e volume dos defeitos ósseos maxilares, entre os dentes 15 e 25. Das TC disponíveis da consulta de implantologia da clínica dentária do Instituto Superior de Ciências da Saúde Egas Moniz, foram selecionados 36 pacientes com idades compreendidas entre os 32 a 76 anos. Destes pacientes isolou-se uma amostra total de 46 defeitos ósseos maxilares unitários. Os exames foram analisados no programa OsiriX. As medições obtidas foram analisadas estatisticamente por meio do teste “t”. Os dados foram considerados no nível de significância de 5%. A correlação efectuada, entre as medições obtidas, mostra que a comparação direta entre hemi-arcadas é uma metodologia viável para a análise de defeitos maxilares. O estudo demonstrou uma perda óssea horizontal de 17-33% (0,0718-0,2112 cm3, com média ponderada para o sector anterior de 0,1184 cm3); 2,46-3,48 mm (com média ponderada para o sector anterior de 2,91 mm), substancialmente superior à perda óssea vertical de 6-15 % (0,0291-0,0852 cm3, com média ponderada para o sector anterior de 0,0519 cm3); 2,09-2,72 mm (com média ponderada para o sector anterior de 2,27 mm). A tábua óssea vestibular apresenta a maior reabsorção. Não existe dimorfismo sexual nos defeitos ósseos maxilares neste estudo. Há uma maior prevalência de reabsorção óssea horizontal nos dentes 11/21. Na região anterior da maxila, a crista óssea de menores dimensões pós-extração corresponde à posição dentária 12/22. O dente 11/21 apresenta a maior quantidade de suporte ósseo. A porção óssea vertical de maior dimensão corresponde aos dentes 15/25. Há uma maior perda de altura óssea nos dentes 13/23. Observa-se a maior profundidade de perda óssea vestibular nos dentes 11/21. Há uma maior perda de dimensão horizontal óssea nos dentes 11/21. Existência um padrão morfológico para os defeitos ósseos

Glenoid failure in Total Shoulder Arthroplasty

Compared to hip and knee, anatomic shoulder arthroplasty is relatively poorly understood, underdeveloped and reported loosening rates are very high, the common cause of failure being glenoid aseptic loosening. The aim of this thesis was first to establish in-vitro and in-vivo CT protocols allowing direct monitoring of glenoid fixation and aseptic loosening and secondly to identify key elements of the procedure that could improve results of prosthetic surgery. First, in-vitro, the ASTM standard method for evaluating loosening of glenoid implants was modified, so that, with the use of CT-scans at regular interval basis, it allows the direct monitoring of the failure observed in the laboratory setting. The failure was observed at the cement-implant interface and progressed from the edges of the implants, both superior and inferior, towards the keel. Secondly, an in-vivo CT protocol was established that eliminates most of the metallic artefacts caused by the humeral head and consequently enhances the visualisation of the radiolucent lines and osteolysis around the glenoid. The link between radiological lucencies and aseptic loosening was confirmed first in a study including 68 cases using this CT protocol, which confirmed the progression of the lucencies over time, and secondly, by the use of Spect-CT. The 3-dimensional spatial (mal)position of the glenoid component and the resulting consequences were analysed in three additional studies. The effect of malposition on clinical results and radiological lucencies; the relationship to the preoperative eroded glenoid and the relationship to polyethylene wear were all investigated. These studies stressed how inaccurately the glenoid components are positioned in clinical practise and that this inaccuracy has a detrimental effect on polyethylene wear; aseptic loosening and ultimately on clinical outcome. Future work should focus on establishing the optimal position of the glenoid implant, and how to achieve this optimal placement in surgical practise

Διακαθετηριακή εμφύτευση τεχνητής αυτοεκπτυσσόμενης βιοπροσθετικής αορτικής βαλβίδας για την αντιμετώπιση συμπτωματικής σοβαρής αορτικής στένωσης: επίδραση στις μηχανικές ιδιότητες της αορτής.

Εισαγωγή: Προηγούμενες μελέτες έχουν δείξει μία παροδική επιδείνωση των μηχανικών ιδιοτήτων της αορτής μετά από χειρουργική αντικατάσταση αορτικής βαλβίδας (ή ρίζας) (ΑΒ). Η αορτική ελαστικότητα αποτελεί ανεξάρτητο προγνωστικό παράγοντα καρδιαγγειακού κινδύνου και θνησιμότητας. Στόχος: Να διερευνηθεί η επίδραση της διακαθετηριακής εμφύτευσης ΑΒ στην ελαστικότητα της αορτής. Μέθοδος: Η αορτική ελαστικότητα εκτιμήθηκε μη επεμβατικά (υπερηχογραφικά) πριν, 7 ημέρες και 1 μήνα μετεπεμβατικά. Οι αορτικές ελαστικές ιδιότητες μελετήθηκαν, επίσης, με επεμβατικό τρόπο (αγγειογραφικά) σε δύο επίπεδα (3 και 6 cm ύπερθεν της ΑΒ) αμέσως πριν και αμέσως μετά την επέμβαση. Αποτελέσματα: Μελετήθηκαν 30 ασθενείς (47% άνδρες) μέσης ηλικίας 79,9 ± 4,7 ετών. Δεν παρατηρήθηκαν σημαντικές μεταβολές των δεικτών ελαστικότητας που υπολογίστηκαν μετά την επέμβαση (αορτική διατασιμότητα, αορτική ενδοτικότητα, δείκτης αορτικής σκληρίας). Συγκεκριμένα, η αορτική διατασιμότητα παρέμεινε αμετάβλητη τόσο κατά την υπερηχογραφική αξιολόγηση: από 1,89 ± 1,11 (αρχικά), σε 2,05 ± 1,50 (7 ημέρες μετά) και 1,84 ± 1,34 cm^2/(dynes*10^6) (1 μήνα μετά) - p=0,497, όσο και κατά την αγγειογραφική αξιολόγηση. Ειδικότερα, στο επίπεδο των 3 cm ύπερθεν της ΑΒ, η αορτική διατασιμότητα παρέμεινε αμετάβλητη από 0,88 ± 0,44 (αμέσως πριν) σε 0,82 ± 0,47 cm^2/(dynes*10^6) (αμέσως μετά την επέμβαση), p=0,637. Αντίστοιχα ήταν τα αποτελέσματα για το επίπεδο των 6 cm ύπερθεν της ΑΒ. Συμπέρασμα: Η διακαθετηριακή εμφύτευση ΑΒ δεν επιδρά στις μηχανικές ιδιότητες της ανιούσας αορτής κατά την βραχυπρόθεσμη μετεπεμβατική περίοδο (1 μήνας).Introduction: Mechanical aortic properties have been shown to transiently deteriorate in the early post-operative after surgical interventions in the aortic valve (or root) replacement. Aortic stiffness is an independent predictor of cardiovascular risk and mortality. Aim: To evaluate the effect of Transcatheter Aortic Valve Implantation (TAVI) on ascending aorta's elasticity. Methods: Aortic stiffness indices were measured non-invasively (echocardiographically) at baseline, 7 days and 1 month post TAVI and invasively (angiographically) acutely pre- and post- TAVI. Invasive evaluation was conducted for two levels of the ascending aorta (3 cm and 6 cm above aortic valve). Results: A total of 30 patients (47% males) were studied with a mean age of 79.9 ± 4.7 years. No significant changes in aortic stiffness indices (aortic distensibility, aortic compliance, aortic stiffness index) were observed. In particular, aortic distensibility remained unchanged post-TAVI as evaluated both non-invasively (from 1.89 ± 1.11 at baseline, to 2.05 ± 1.50 at 7 days post-TAVI, to 1.84 ± 1.34 cm^2/(dynes*10^6); p=0.497) and invasively (at the 3 cm above aortic valve level: from 0.88 ± 0.44 pre- to 0.82 ± 0.47 cm^2/(dynes*10^6) post- TAVI, p=0.637. Results were similar at the 6 cm above aortic valve level. Conclusion: TAVI has no effect on mechanical properties of the ascending aorta in the early post-operative period (up to 1 month)

Uma proposta de arquitetura de alto desempenho para sistemas PACS baseada em extensões de banco de dados

Orientador : Prof. Dr. Aldo Von WangenheimTese (doutorado) - Universidade Federal do Paraná, Setor de Ciências Exatas, Programa de Pós-Graduação em Informática. Defesa: Curitiba, 25/07/2014Inclui referênciasResumo: O uso de imagens digitais no processo de diagnóstico médico é observável em diferentes escalas e cenários de aplicação, tendo evoluído em termos de volume de dados adquiridos e número de modalidades de exame atendidas. A organização desse conteúdo digital, comumente representado por conjuntos de imagens no pa-drão DICOM (Digital Imaging and Communications in Medicine), costuma ser dele-gada a sistemas PACS (Picture Archiving and Communication System) baseados na agregação de componentes heterogêneos de hardware e software. Parte desses componentes interage de forma a compor a camada de armazenamento do PACS, responsável pela persistência de toda e qualquer imagem digital que, em algum momento, foi adquirida ou visualizada/manipulada via sistema. Apesar de emprega-rem recursos altamente especializados como SGBDs (Sistemas Gerenciadores de Banco de Dados), as camadas de armazenamento PACS atuais são visualizadas e utilizadas como simples repositórios de dados, assumindo um comportamento pas-sivo (ou seja, sem a agregação de regras de negócio) quando comparadas a outros componentes do sistema. Neste trabalho, propõe-se uma nova arquitetura PACS simplificada baseada em alterações na sua camada de armazenamento. As alterações previstas baseiam-se na troca do perfil passivo assumido atualmente por essa camada por um perfil ativo, utilizando-se de recursos de extensibilidade e de distribuição de dados (hoje não empregados) disponibilizados por seus componentes. A arquitetura proposta concentra-se na comunicação e no armazenamento de dados, utilizando-se de ex-tensões de SGBDs e de estruturas heterogêneas para armazenamento de dados convencionais e não convencionais, provendo alto desempenho em termos de es-calabilidade, suporte a grandes volumes de conteúdo e processamento descentrali-zado de consultas. Estruturalmente, a arquitetura proposta é formada por um con-junto de módulos projetados de forma a explorar as opções de extensibilidade pre-sentes em SGBDs, incorporando características e funcionalidades originalmente dis-tribuídas entre outros componentes do PACS (na forma de regras de negócio). Em nível de protótipo, resultados obtidos a partir de experimentos indicam a viabilidade de uso da arquitetura proposta, explicitando ganhos de desempenho na pesquisa de metadados e na recuperação de imagens DICOM quando comparados a arquiteturas PACS convencionais. A flexibilidade da proposta quanto à adoção de tecnologias de armazenamento heterogêneas também é avaliada positivamente, permitindo estender a camada de armazenamento PACS em termos de escalabili-dade, poder de processamento, tolerância a falhas e representação de conteúdo. Palavras-chave: PACS, DICOM, SGBD, extensibilidade, alto desempenho.Abstract: The use of digital images on medical diagnosis is observable in a number of application scenarios and in different scales, growing in terms of volume of data and contemplated medical specialties. To organize this digital content composed by image datasets in DICOM (Digital Imaging and Communications in Medicine), it is usual to adopt PACS (Picture Archiving and Communication System), an architecture built as an aggregation of hardware and software components. Some of these components compose the so-called PACS's storage layer, responsible for the persistence of every digital image acquired or visualized/manipulated through the system. Despite their high-specialized components (e.g., DBMS - Database Management System), PACS storage layers used today are visualized as simple data repositories, assuming a passive role (i.e., without the implementation of business rules) when compared to other components. In this work, a simplified, new architecture is proposed for PACS, based in modifications on its storage layer. The modifications are based in the replacement of the current passive role by an active one, using extensibility and data distribution resources available on its components. The proposed architecture focuses on communication and data storage, using DBMS extensions and heterogeneous structures for the storage of conventional and non-conventional data, providing high-performance in terms of scalability, support to large volumes of data and decentralized query processing. Structurally, the proposed architecture is composed by a set of modules designed to explore extensibility options available in DBMSs, incorporating characteristics and functionalities originally distributed as business rules among other components of PACS. At prototype level, results obtained through experiments indicate the viability of the proposal, making explicit the performance gains in the search for metadata and image retrieval when compared to conventional PACS architectures. The flexibility of the proposal regarding the adoption of heterogeneous storage technologies is also positively evaluated, allowing the extension of the PACS storage layer in terms of scalability, processing power, fault tolerance and content representation. Keywords: PACS, DICOM, DBMS, extensibility, High-Performance Computing