Distributed Network, Wireless and Cloud Computing Enabled 3-D Ultrasound; a New Medical Technology Paradigm

Medical technologies are indispensable to modern medicine. However, they have become exceedingly expensive and complex and are not available to the economically disadvantaged majority of the world population in underdeveloped as well as developed parts of the world. For example, according to the World Health Organization about two thirds of the world population does not have access to medical imaging. In this paper we introduce a new medical technology paradigm centered on wireless technology and cloud computing that was designed to overcome the problems of increasing health technology costs. We demonstrate the value of the concept with an example; the design of a wireless, distributed network and central (cloud) computing enabled three-dimensional (3-D) ultrasound system. Specifically, we demonstrate the feasibility of producing a 3-D high end ultrasound scan at a central computing facility using the raw data acquired at the remote patient site with an inexpensive low end ultrasound transducer designed for 2-D, through a mobile device and wireless connection link between them. Producing high-end 3D ultrasound images with simple low-end transducers reduces the cost of imaging by orders of magnitude. It also removes the requirement of having a highly trained imaging expert at the patient site, since the need for hand-eye coordination and the ability to reconstruct a 3-D mental image from 2-D scans, which is a necessity for high quality ultrasound imaging, is eliminated. This could enable relatively untrained medical workers in developing nations to administer imaging and a more accurate diagnosis, effectively saving the lives of people

Design and evaluation of echocardiograms codification and transmission for Teleradiology systems

Las enfermedades cardiovasculares son la mayor causa de muerte en el mundo. Aunque la mayoría de muertes por cardiopatías se puede evitar, si las medidas preventivas no son las adecuadas el paciente puede fallecer. Es por esto, que el seguimiento y diagnóstico de pacientes con cardiopatías es muy importante. Numerosos son las pruebas médicas para el diagnostico y seguimiento de enfermedades cardiovasculares, siendo los ecocardiogramas una de las técnicas más ampliamente utilizada. Un ecocardiograma consiste en la adquisición de imágenes del corazón mediante ultrasonidos. Presenta varias ventajas con respecto otras pruebas de imagen: no es invasiva, no produce radiación ionizante y es barata. Por otra parte, los sistemas de telemedicina han crecido rápidamente ya que ofrecen beneficios de acceso a los servicios médicos, una reducción del coste y una mejora de la calidad de los servicios. La telemedicina proporciona servicios médicos a distancia. Estos servicios son de especial ayuda en casos de emergencia médica y para áreas aisladas donde los hospitales y centros de salud están alejados. Los sistemas de tele-cardiología pueden ser clasificados de acuerdo al tipo de pruebas. En esta Tesis nos hemos centrado en los sistemas de tele-ecocardiografia, ya que los ecocardiogramas son ampliamente usados y presentan el mayor reto al ser la prueba médica con mayor flujo de datos. Los mayores retos en los sistemas de tele-ecocardiografia son la compresión y la transmisión garantizando que el mismo diagnóstico es posible tanto en el ecocardiograma original como en el reproducido tras la compresión y transmisión. Los ecocardiogramas deben ser comprimidos tanto para su almacenamiento como para su transmisión ya que estos presentan un enorme flujo de datos que desbordaría el espacio de almacenamiento y no se podría transmitir eficientemente por las redes actuales. Sin embargo, la compresión produce pérdidas que pueden llevar a un diagnostico erróneo de los ecocardiogramas comprimidos. En el caso de que las pruebas ecocardiograficas quieran ser guardadas, una compresión clínica puede ser aplicada previa al almacenamiento. Esta compresión clínica consiste en guardar las partes del ecocardiograma que son importantes para el diagnóstico, es decir, ciertas imágenes y pequeños vídeos del corazón en movimiento que contienen de 1 a 3 ciclos cardiacos. Esta compresión clínica no puede ser aplicada en el caso de transmisión en tiempo real, ya que es el cardiólogo especialista quien debe realizar la compresión clínica y éste se encuentra en recepción, visualizando el echocardiograma transmitido. En cuanto a la transmisión, las redes sin cables presentan un mayor reto que las redes cableadas. Las redes sin cables tienen un ancho de banda limitado, son propensas a errores y son variantes en tiempo lo que puede resultar problemático cuando el ecocardiograma quiere ser transmitido en tiempo real. Además, las redes sin cables han experimentado un gran desarrollo gracias a que permiten un mejor acceso y movilidad, por lo que pueden ofrecer un mayor servicio que las redes cableadas. Dos tipos de sistemas se pueden distinguir acorde a los retos que presenta cada uno de ellos: los sistemas de almacenamiento y reenvió y los sistemas de tiempo real. Los sistemas de almacenamiento y reenvió consisten en la adquisición, almacenamiento y el posterior envió del ecocardiograma sin requerimientos temporales. Una compresión clínica puede ser llevada a cabo previa al almacenamiento. Además de la compresión clínica, una compresión con pérdidas es recomendada para reducir el espacio de almacenamiento y el tiempo de envío, pero sin perder l ainformación diagnóstica de la prueba. En cuanto a la transmisión, al no haber requerimientos temporales, la transmisión no presenta ninguna dificultad. Cualquier protocolo de transmisión fiable puede ser usado para no perder calidad en la imagen debido a la transmisión. Por lo tanto, para estos sistemas sólo nos hemos centrado en la codificación de los ecocardiogramas. Los sistemas de tiempo real consisten en la transmisión del ecocardiograma al mismo tiempo que éste es adquirido. Dado que el envío de video clínico es una de las aplicaciones con mayor demanda de ancho de banda, la compresión para la transmisión es requerida, pero manteniendo la calidad diagnóstica de la imagen. La transmisión en canales sin cables puede ser afectada por errores que distorsionan la calidad del ecocardiograma reconstruido en recepción. Por lo tanto, métodos de control de errores son requeridos para minimizar los errores de transmisión y el retardo introducido. Sin embargo, aunque el ecocardiograma sea visualizado con errores debido a la transmisión, esto no implica que el diagnóstico no sea posible. Dados los retos previamente descritos, las siguientes soluciones para la evaluación clínica, compresión y transmisión han sido propuestas: - Para garantizar que el ecocardiograma es visualizado sin perder información diagnóstica 2 tests han sido diseñados. El primer test define recomendaciones para la compresión de los ecocardiogramas. Consiste en dos fases para un ahorro en el tiempo de realización, pero sin perder por ello exactitud en el proceso de evaluación. Gracias a este test el ecocardiograma puede ser comprimido al máximo sin perder calidad diagnóstica y utilizando así más eficientemente los recursos. El segundo test define recomendaciones para la visualización del ecocardiograma. Este test define rangos de tiempo en los que el ecocardiograma puede ser visualizado con inferior calidad a la establecida en el primer test. Gracias a este test se puede saber si el ecocardiograma es visualizado sin pérdida de calidad diagnóstica cuando se introducen errores en la visualización, sin la necesidad de realizar una evaluación para cada video transmitido o diferentes condiciones de canal. Además, esta metodología puede ser aplicada para la evaluación de otras técnicas de diagnóstico por imagen. - Para la compresión de ecocardiogramas dos métodos de compresión han sido diseñados, uno para el almacenamiento y otro para la transmisión. Diferentes propuestas son diseñadas, ya que los ecocardiogramas para los dos propósitos tienen características diferentes. Para ambos propósitos un método de compresión en la que las facilidades que incorporan los dispositivos de segmentar la imagen y en la que las características de visualización de los ecocardiogramas han sido tenidas en cuenta ha sido diseñado. Para la compresión del ecocardiograma con el propósito de almacenarlo un formato de almacenamiento fácilmente integrable con DICOM basado en regiones y en el que el tipo de datos y la importancia clínica de cada región es tenido en cuenta ha sido diseñado. DICOM es el formato para el almacenamiento y transmisión de imágenes más ampliamente utilizado actualmente. El formato de compresión propuesto supone un ahorra de hasta el 75 % del espacio de almacenamiento con respecto a la compresión con JPEG 2000, actualmente soportado por DICOM, sin perder calidad diagnostica de la imagen. Los ratios de compresión para el formato propuesto dependen de la distribución de la imagen, pero para una base de datos de 105 ecocardiogramas correspondientes a 4 ecógrafos los ratios obtenidos están comprendidos entre 19 y 41. Para la compresión del ecocardiograma con el propósito de la transmisión en tiempo real un método de compresión basado en regiones en el que el tipo de dato y el modo de visualización han sido tenidos en cuenta se ha diseñado. Dos modos de visualización son distinguidos para la compresión de la región con mayor importancia clínica (ultrasonido), los modos de barrido y los modos 2-D. La evaluación clínica diseñada para las recomendaciones de compresión fue llevada a cabo por 3 cardiologos, 9 ecocardiogramas correspondientes a diferentes pacientes y 3 diferentes ecógrafos. Los ratios de transmisión recomendados fueron de 200 kbps para los modos 2-D y de 40 kbps para los modos de barrido. Si se comparan estos resultados con previas soluciones en la literatura un ahorro mínimo de entre 5 % y el 78 % es obtenido dependiendo del modo. - Para la transmisión en tiempo real de ecocardiogramas un protocolo extremo a extremo basada en el método de compresión por regiones ha sido diseñado. Este protocolo llamado ETP de las siglas en inglés Echocardiogram Transmssion Protocol está diseñado para la compresión y transmisión de las regiones por separado, pudiendo así ofrecer diferentes ratios de compresión y protección de errores para las diferentes regiones de acuerdo a su importancia diagnostica. Por lo tanto, con ETP el ratio de transmisión mínimo recomendado para el método de compresión propuesto puede ser utilizado, usando así eficientemente el ancho de banda y siendo menos sensible a los errores introducidos por la red. ETP puede ser usado en cualquier red, sin embargo, en el caso de que la red introduzca errores se ha diseñado un método de corrección de errores llamado SECM, de las siglas en inglés State Error Control Method. SECM se adapta a las condiciones de canal usando más protección cuando las condiciones empeoran y usando así el ancho de banda eficientemente. Además, la evaluación clínica diseñada para las recomendaciones de visualización ha sido llevada a cabo con la base de datos de la evaluación previa. De esta forma se puede saber si el ecocardiograma es visualizado sin pérdida diagnostica aunque se produzcan errores de transmisión. En esta tesis, por lo tanto, se ha ofrecido una solución para la transmisión en tiempo real y el almacenamiento de ecocardiogramas preservando la información diagnóstica y usando eficientemente los recursos (disco de almacenamiento y ratio de transmisión). Especial soporte se da para la transmisión en redes sin cables, dando soluciones a las limitaciones que estas introducen. Además, las soluciones propuestas han sido probadas y comparadas con otras técnicas con una red de acceso móvil WiMAX, demostrando que el ancho de banda es eficientemente utilizado y que el ecocardiograma es correctamente visualizado de acuerdo con las recomendaciones de visualización dadas por la evaluación clínica

Volumetric Medical Images Visualization on Mobile Devices

Volumetric medical images visualization is an important tool in the diagnosis and treatment of diseases. Through history, one of the most dificult tasks for Medicine Specialists has been the accurate location of broken bones and of the damaged tissues during Chemotherapy treatment, among other applications; like techniques used in Neurological Studies. Thus these situations enhance the need of visualization in Medicine. New technologies, the improvement and development of new hardware as well as software and the updating of old ones for graphic applications have resulted in specialized systems for medical visualization. However the use of these techniques in mobile devices has been poor due to its low performance. In our work, we propose a client-server scheme, where the model is compressed in the server side and is reconstructed in a nal thin-client device. The technique restricts the natural density values to achieve good bone visualization in medical models, transforming the rest of the data to zero. Our proposal uses a tridimensional Haar Wavelet Function locally applied inside units blocks of 16x16x16, similar to the Wavelet Based 3D Compression Scheme for Interactive Visualization of Very Large Volume Data approach. We also implement a quantization algorithm which handles error coeficients according to the frequency distributions of these coe cients. Finally, we made an evaluation of the volume visualization; on current mobile devices .We present the speci cations for the implementation of our technique in the Nokia n900 Mobile Phone

Sistemas interativos e distribuídos para telemedicina

doutoramento Ciências da ComputaçãoDurante as últimas décadas, as organizações de saúde têm vindo a adotar continuadamente as tecnologias de informação para melhorar o funcionamento dos seus serviços. Recentemente, em parte devido à crise financeira, algumas reformas no sector de saúde incentivaram o aparecimento de novas soluções de telemedicina para otimizar a utilização de recursos humanos e de equipamentos. Algumas tecnologias como a computação em nuvem, a computação móvel e os sistemas Web, têm sido importantes para o sucesso destas novas aplicações de telemedicina. As funcionalidades emergentes de computação distribuída facilitam a ligação de comunidades médicas, promovem serviços de telemedicina e a colaboração em tempo real. Também são evidentes algumas vantagens que os dispositivos móveis podem introduzir, tais como facilitar o trabalho remoto a qualquer hora e em qualquer lugar. Por outro lado, muitas funcionalidades que se tornaram comuns nas redes sociais, tais como a partilha de dados, a troca de mensagens, os fóruns de discussão e a videoconferência, têm o potencial para promover a colaboração no sector da saúde. Esta tese teve como objetivo principal investigar soluções computacionais mais ágeis que permitam promover a partilha de dados clínicos e facilitar a criação de fluxos de trabalho colaborativos em radiologia. Através da exploração das atuais tecnologias Web e de computação móvel, concebemos uma solução ubíqua para a visualização de imagens médicas e desenvolvemos um sistema colaborativo para a área de radiologia, baseado na tecnologia da computação em nuvem. Neste percurso, foram investigadas metodologias de mineração de texto, de representação semântica e de recuperação de informação baseada no conteúdo da imagem. Para garantir a privacidade dos pacientes e agilizar o processo de partilha de dados em ambientes colaborativos, propomos ainda uma metodologia que usa aprendizagem automática para anonimizar as imagens médicasDuring the last decades, healthcare organizations have been increasingly relying on information technologies to improve their services. At the same time, the optimization of resources, both professionals and equipment, have promoted the emergence of telemedicine solutions. Some technologies including cloud computing, mobile computing, web systems and distributed computing can be used to facilitate the creation of medical communities, and the promotion of telemedicine services and real-time collaboration. On the other hand, many features that have become commonplace in social networks, such as data sharing, message exchange, discussion forums, and a videoconference, have also the potential to foster collaboration in the health sector. The main objective of this research work was to investigate computational solutions that allow us to promote the sharing of clinical data and to facilitate the creation of collaborative workflows in radiology. By exploring computing and mobile computing technologies, we have designed a solution for medical imaging visualization, and developed a collaborative system for radiology, based on cloud computing technology. To extract more information from data, we investigated several methodologies such as text mining, semantic representation, content-based information retrieval. Finally, to ensure patient privacy and to streamline the data sharing in collaborative environments, we propose a machine learning methodology to anonymize medical images

Innovative ICT solutions in telemedicine to support clinical practice and research in hospitals

2010/2011The scope of this study was to examine ICT telemedicine innovations and potentialities in web-portals, intranet services and tele-radiology topics respectively, in order to design, develop and, possibly, realize apposite telemedicine systems and solutions for healthcare and in particular for the hospitals. ICT techniques and technologies are nowadays applied in every area of our common living from work places to our homes, our free-time, schools, universities and so on. The healthcare services offered by hospitals are heavily supported by technologies and, behind them, by a wide research both in ICT and biomedical sciences. Thanks to these advances telemedicine is now becoming a fundamental part of services offered by hospitals and healthcare structures. The healthcare management, the doctors and the common people are now experimenting how telemedicine is an added value to all the services offered in terms of the quality of care, the patient follow up, the early diagnose and treatment of pathologies and diseases. In this research is presented an all-inclusive approach to telemedicine problems and challenges in particular studying, developing and proposing ICT methods and technologies in the above mentioned three areas of interest: •innovative healthcare and telemedicine-ready hospital website or portal design and development; •analysis and study of models for the realization of intranet healthcare services to enhance both quality of care and the management of healthcare personnel evaluation; •tele-radiology and some of its actual new perspectives as the study and the evaluation of the “mobile” tele-radiology approach using commercial tablets (and what it could mean).For the first topic the results may be summarized in the development of a more interactive and “social” hospital web-portal offering original solutions and services to all the categories of users (audience, professionals, researchers), allowing them – through the use of advanced tools - to configure and select their own pages and interests. The originality of this approach consists in a good cost/effective result in the respect of the last and worldwide accepted Internet regulations and policies too. A similar approach regarded the intranet services and the design of web interfaces for the clinical practice and the executive evaluation. These kind of innovative systems regard a limited and selected number of more skilled users, typically belonging to a corporation or to specific offices. As above the approach is important: interactive services, innovative tools and affordable instruments are the keywords of the systems designed or proposed to solve specific problems or needs. The last research topic concerned the proposal of a protocol for the assessment of medical images on commercial displays, interesting the stakeholders and the groups involved in medical images treatment, visualization and communication. The potentialities of the mobile tablet devices improve day after day and new devices are marketed every week and the innovation is round the corner. These potentialities must encounter the medical diagnostics world and meet the standards and the regulations the international community established. It will be difficult for a commercial tablet to obtain the medical device CE mark not only for commercial reasons, but the technical limits may be reached and even surpassed adopting objective measures and evaluations. This study demonstrates that commercial tablets may be used in clinical practice for the correct visualization and diagnose of medical images. The measures of some display characteristics may be considered acceptable for mobile interpretation (even report?) of medical images, but if and only if the ambient lighting conditions are under objective control and integrated automated systems in tablets warns physicians about bad or borderline technical and ambient restrictions or bonds.XXIII Ciclo197

Ubiquitous volume rendering in the web platform

176 p.The main thesis hypothesis is that ubiquitous volume rendering can be achieved using WebGL. The thesis enumerates the challenges that should be met to achieve that goal. The results allow web content developers the integration of interactive volume rendering within standard HTML5 web pages. Content developers only need to declare the X3D nodes that provide the rendering characteristics they desire. In contrast to the systems that provide specific GPU programs, the presented architecture creates automatically the GPU code required by the WebGL graphics pipeline. This code is generated directly from the X3D nodes declared in the virtual scene. Therefore, content developers do not need to know about the GPU.The thesis extends previous research on web compatible volume data structures for WebGL, ray-casting hybrid surface and volumetric rendering, progressive volume rendering and some specific problems related to the visualization of medical datasets. Finally, the thesis contributes to the X3D standard with some proposals to extend and improve the volume rendering component. The proposals are in an advance stage towards their acceptance by the Web3D Consortium

IoT-Enabled Smart Cities: A Review of Concepts, Frameworks and Key Technologies

In recent years, smart cities have been significantly developed and have greatly expanded their potential. In fact, novel advancements to the Internet of things (IoT) have paved the way for new possibilities, representing a set of key enabling technologies for smart cities and allowing the production and automation of innovative services and advanced applications for the different city stakeholders. This paper presents a review of the research literature on IoT-enabled smart cities, with the aim of highlighting the main trends and open challenges of adopting IoT technologies for the development of sustainable and efficient smart cities. This work first provides a survey on the key technologies proposed in the literature for the implementation of IoT frameworks, and then a review of the main smart city approaches and frameworks, based on classification into eight domains, which extends the traditional six domain classification that is typically adopted in most of the related works

A method for viewing and interacting with medical volumes in virtual reality

The medical field has long benefited from advancements in diagnostic imaging technology. Medical images created through methods such as Computed Tomography (CT) and Magnetic Resonance Imaging (MRI) are used by medical professionals to non-intrusively peer into the body to make decisions about surgeries. Over time, the viewing medium of medical images has evolved from X-ray film negatives to stereoscopic 3D displays, with each new development enhancing the viewer’s ability to discern detail or decreasing the time needed to produce and render a body scan. Though doctors and surgeons are trained to view medical images in 2D, some are choosing to view body scans in 3D through volume rendering. While traditional 2D displays can be used to display 3D data, a viewing method that incorporates depth would convey more information to the viewer. One device that has shown promise in medical image viewing applications is the Virtual Reality Head Mounted Display (VR HMD). VR HMDs have recently increased in popularity, with several commodity devices being released within the last few years. The Oculus Rift, HTC Vive, and Windows Mixed Reality HMDs like the Samsung Odyssey offer higher resolution screens, more accurate motion tracking, and lower prices than earlier HMDs. They also include motion-tracked handheld controllers meant for navigation and interaction in video games. Because of their popularity and low cost, medical volume viewing software that is compatible with these headsets would be accessible to a wide audience. However, the introduction of VR to medical volume rendering presents difficulties in implementing consistent user interactions and ensuring performance. Though all three headsets require unique driver software, they are compatible with OpenVR, a middleware that standardizes communication between the HMD, the HMD’s controllers, and VR software. However, the controllers included with the HMDs each has a slightly different control layout. Furthermore, buttons, triggers, touchpads, and joysticks that share the same hand position between devices do not report values to OpenVR in the same way. Implementing volume rendering functions like clipping and tissue density windowing on VR controllers could improve the user’s experience over mouse-and-keyboard schemes through the use of tracked hand and finger movements. To create a control scheme that is compatible with multiple HMD’s A way of mapping controls differently depending on the device was developed. Additionally, volume rendering is a computationally intensive process, and even more so when rendering for an HMD. By using techniques like GPU raytracing with modern GPUs, real-time framerates are achievable on desktop computers with traditional displays. However, the importance of achieving high framerates is even greater when viewing with a VR HMD due to its higher level of immersion. Because the 3D scene occupies most of the user’s field of view, low or choppy framerates contribute to feelings of motion sickness. This was mitigated through a decrease in volume rendering quality in situations where the framerate drops below acceptable levels. The volume rendering and VR interaction methods described in this thesis were demonstrated in an application developed for immersive viewing of medical volumes. This application places the user and a medical volume in a 3D VR environment, allowing the user to manually place clipping planes, adjust the tissue density window, and move the volume to achieve different viewing angles with handheld motion tracked controllers. The result shows that GPU raytraced medical volumes can be viewed and interacted with in VR using commodity hardware, and that a control scheme can be mapped to allow the same functions on different HMD controllers despite differences in layout

Augmented Reality in Forensics and Forensic Medicine - Current Status and Future Prospects

Forensic investigations require a vast variety of knowledge and expertise of each specialist involved. With the increase in digitization and advanced technical possibilities, the traditional use of a computer with a screen for visualization and a mouse and keyboard for interactions has limitations, especially when visualizing the content in relation to the real world. Augmented reality (AR) can be used in such instances to support investigators in various tasks at the scene as well as later in the investigation process. In this article, we present current applications of AR in forensics and forensic medicine, the technological basics of AR, and the advantages that AR brings for forensic investigations. Furthermore, we will have a brief look at other fields of application and at future developments of AR in forensics

Ubiquitous volume rendering in the web platform

176 p.The main thesis hypothesis is that ubiquitous volume rendering can be achieved using WebGL. The thesis enumerates the challenges that should be met to achieve that goal. The results allow web content developers the integration of interactive volume rendering within standard HTML5 web pages. Content developers only need to declare the X3D nodes that provide the rendering characteristics they desire. In contrast to the systems that provide specific GPU programs, the presented architecture creates automatically the GPU code required by the WebGL graphics pipeline. This code is generated directly from the X3D nodes declared in the virtual scene. Therefore, content developers do not need to know about the GPU.The thesis extends previous research on web compatible volume data structures for WebGL, ray-casting hybrid surface and volumetric rendering, progressive volume rendering and some specific problems related to the visualization of medical datasets. Finally, the thesis contributes to the X3D standard with some proposals to extend and improve the volume rendering component. The proposals are in an advance stage towards their acceptance by the Web3D Consortium