Friday, December 6, 2013

RSNA 2013 has finished

RSNA 2013 - RC725 - quantitative imaging: informatics

Radiology currently is primarily concerned with pattern recognition with some linear measurments. Therefore, the demand for quantitative tools is little in radiology. Residents should be trained in using 3d software and planning during their regular rotations. To determine the correct measurements validation datasets are needed. What is required:
1. Better tools to create measurements are required with integration into the PACS to integrate into the regular workflow.
2. Better tools for representing the results (DICOM SR and AIM are available but adoption by vendors is slow).
3. Education.
4. Validation datasets. How to use existing tools and how not to mis-use them.

The main immediate informatics challenge is that the workflow for 3D postprocessing is poor.

QIBA is trying to streamline the process of obtaining quantitative imaging biomarkers. Using standards is a prerequisite in this effort.

Wednesday, December 4, 2013

RSNA 2013 - SSM11 - Image Sharing

The RSNA Image Share Network: 20 Month Follow-up Results from a Pilot Site
An interesting presentation covered automatic rule-based deletion of data in PACS. Based on regulations and actual measurement of the use of older data (retrievel of data >1 yo was less then 5%) they deviced rule based deletion to free up space in PACS and reused the free space. This avoids vast  growth of the PACS database and saves money in the long run.

Strategies for Foreign Study Ingestion by a PACS Interfaced to a XDS Affinity Domain
Quebec (canada) has a regional XDS environment connecting all hospitals and clinics with a single registry for the whole province. There are three repositories with multiple hospitals pushing data to each of the repositories. The repositories take care of the central registration in the registry.
Problem they ran into was the lack of XDS-I consumer support by the PACS providers. Each hospital is fitted by a proxy which queries the registry and get the images from the repository. Subsequently data coercion (pat ID and acc nr correction) is performed and data stored in local PACS.

RSNA 2013 - RC526 - Cool technologies for radiologists

From the second presentation in this session the most usefull tools were:

Glassboard for a dedicated group to share information. It's a private form of Facebook with groups on invitation only. All communication stays within the private group.

Pdfpen scan+ allows taking a picture of a piece of text and it does OCR on it to use it on you device.

RSNA 2013 - RC526 - Cool technologies for radiologists

Tablet applications. 

- Pocket
Collecting bookmarks to websites into your pocket for later acces on any device.

- PDF readers
Examples are GoodReader, iAnnotate PDF, expert PDF. They allow reading and annotation of different files. However, they all are paid apps.

- Educational tools
Audience response apps are Poll everywhere (over 40 respondents requires a monthly payment), Poll runner ($10 per year), socrative (free and easy to use but a bit simple compared to others)

Baiboard collaborative whiteboard allowing multiple users that can join a board.

- technology tools is a website to cooperate on writing a paper. It includes a full version tracking. This is a free tool.

Udutu online course authoring tool. Pre designed course templates can be used to design and share courses. Sharing either by webpage or by building a zip.
Udemy has a simpler GUI with less style which is also free to use.

Dropbox alternatives that can be used are Spideroak. Drawback is that it does not provide sharing. However, the data security level is higher than when using dropbox.

Tuesday, December 3, 2013

RSNA 2013 - RC326 - Quantitative Imaging: A Revolution in Evolution (In Association with the Society for Imaging Informatics in Medicine)

Vendors provide easy tools to perform quantitative imaging but the question is how reliable and repeatable this quantification is. 
Many clinical examples can already be listed where quantitative imaging is used in clinical practice. Such as carotid stenosis, coronary artery stenosis, calcium scoring, pulmonary nodules, renal donor evaluation, liver and tumor volumetry, brain perfusion, emphysema quantification. 
Each of these show good results in literature and could be applied in clinical practice.
However, the question is whether the numbers we get out of the software are usefull and what is reality. Different vendors provide different results in the same patient and even within one software system measurements are influenced by postprocessing choices but also by decisions during the acquisiiton. 
One of the things that can be done to get proper quantification we should provide reference datasets.

QIBA is ran by a group of stakeholders to improve quantitative imaging. They define profiles to get precise, repeatable measurements. QIBA has setup a imaging data warehouse (QIDW) including standard datasets that can be used to validate quantitative imaging algorithm.
The QIDW is free, open source, modular software based on MIDAS.

In conclusion tagging of the image data in radiology is essential to allow computers to work with the information. The quantification is part of this tagging. Developments like AIM are trying to cover this and allow export in XML or DICOM SR, however current PACSs and EMRs do not yet support these kind of measurement. When the storage and data mining of all the information available in the images becomes possible it will provide the key information to get to personalized diagnosis and treatment.

RSNA 2013 - ICIA24 - using IHE profiles to plan for medical imaging

Top five forces to medical imaging are defined to be:

1. Cost reduction
2. Daunting PACS migration
3. Silos of imaging sources
4. Complexity of effective image sharing
5. Leverage health IT best practices

The road to effective image sharing by implementing Vendor Neutral Archive (VNA) taking care of access consolidation. Access consolidation requirements are:

1. Integrated clinical systems
2. Portability
3. Scalable
4. Extensible
5. Content accessible

IHE profiles are there to break the vendor neutral consolidation barriers.
IHE XDS provides the profiles to allow content (vendor) neutral archive. Several profiles are defined to describe the required capabilities within an XDS affinity domain such as PIX (patient identity cross referencing) , BPPC (basic patient privacy and concent) and XUA (cross enterprise user authentication).

The XDS environment can be setup as a federated, centralized or hybrid environment.

Monday, December 2, 2013

RSNA 2013 - ICII23 - 3D printing: bridging the gap between theory and practice

In an interesting session the prerequistes for 3D printing were shown as well as an overview of the available techniques for 3d printing. One clear message was that the integration into the normal workflow is not achieved as of yet. Furthermore, reimbursement of 3D printing is not available yet thus hampering its wide scale application.

Basically great potential was show for 3d printing in education, training, intervention planning, and evalution using patient specific phantoms for for example flow measurement. Although 3d printing is not yet into mainstream in radiology and medicine the near future will show an increased use of this new feature.

RSNA 2013 - VSIN21 - radiology informatics series: mobile computing devices

Mobile is the single largest disruptive technology for the next decade. While desktop PCs are reducing in number the number of tablets is rising steadily. The number of smartphones is exploding right now showing an enormous increase (half of the facebook users are mobille only).
Eighty percent of smartphones shipped today are running android. This shows that android is starting to takeover apple iOS. This is also shown in tablets where android is also more sold nowadays than the iPad while the iPad currently still is the most used tablet based on network traffic measurements.
In terms of security, android shows a higher number of malware apps than apple iOS. Also in terms of enterprise security policies, VPN handling, etc, iOS is way ahead of android with for example enterprise single sign on and VPN per app.

The iOS first approach to develop an app seems to be the way to go in radiology because of the wider acceptance and use of apple devices.

To develop an app the steps to take are identify concept, user interface design, programming, construct app, and finally polish the app.

Sunday, December 1, 2013

RSNA 2013 - RC126 - Health IT tools to Improve quality and safety in radiology

A crucial point in quality metrics is the choice of the right measures. These measures should be selected such that they can be used to identify problems, not making the department look good. Metrics that are repeatedly in range should be droppen since they are not providing information to improven. The national quality forum can help to identify the radiology measures for quality. However they only include 2 dedicated radiology metrics.
Employee engagement is very important to succesfully improve quality. An example was given showing that metrics were used to stimulate radiologists to meet them by connecting the number of metrics met to a financial reward. This worked remarkably showing a much better quality performance after this reward was implemented.
Another vital part of quality improvement is root cause analysis. Just recording problems and fixing them does not improve quality, taking the time to get to the root cause and solving it does.

Wednesday, November 6, 2013

RSNA 2013 Preview

We are presenting a number of posters and orals from our group at the RSNA 2013 in Chicago later this year. Some of the topics made it to Auntminnie.

Check out the coverage at the AuntMinnie website:

Caution should be used with DICOM data deidentification


Before migrating your PACS, do a test run

Friday, November 1, 2013

HIMSS Europe 2013 Amsterdam - Closing Keynote: Assessing and AdvancingEHR System Usability

Zariukian stated usability to be an underexposed topic in HealthIT. Form, fit and function are important in usability. Form is the shape, size, mass, the 'look' of a product. Fit is ability physically interface, connect, integrate. Function is the action the product is designed to perform. Usability affects how we think, feel and act. By examples and backgrounds, Zaroukian clearly showed the importance of usability to get HealthIT accepted and used both by patients and professionals. With good usability It is easier to do the thing right and it is easier to do the right thing. The meaningfull use projects in he US has shown a struggle of physicians to use EHRs requiring extensive training. Specific problems were system wait times for busy clinicians and new abilities that seemed to be "bolted on" and not integrated properly. 

HIMSS published a document on usabilty of the EMR in 2009, accessible at

Below you can find the official information and abstract from the program

Closing Keynote: Assessing and Advancing EHR System Usability

Michael H. Zaroukian, MD, PhD, FACP, FHIMSS Vice President and CMIO, Sparrow Health System

Physicians, nurses and other clinicians are responsible for gathering, recording, analyzing and acting on health information in electronic health record (EHR) systems. Assessing and advancing EHR usability is important to clinician productivity, satisfaction and best use of clinical information systems to improve healthcare quality, safety, efficiency and value. In the closing keynote, a HIMSS Board member and practicing physician informaticist, will give his perspective on EHR usability challenges and opportunities, as well as strategies and tools for evaluating and improving the usability of EHR systems.

HIMSS Europe 2013 Amsterdam - SA7: Update and New Developments on IHE

Parisot presented in the update and new developments of IHE. One of the main messages from his presentation was that interoperability will never be turnkey magic, but always involve hard work. IHE is growing into new domains, new paradigms, adoption at national and regional level, enhancing deployment support, benefits for profile based interoperablity better understood. The challenge in getting IHE working is not in the writing of the profiles and produce the corresponding documents but in the deployment and use of the profiles. To support this open source test tooling (Gazelle) is available from IHE to test for IHE profiles and setup quality management for test plans. The tools are available for eHealth projects and vendors through IHE services.

Parisot also stated that the mobile world poses a large problem that every app is a silo on itself resulting in thousands of apps that can be used by the patient that are not connected and do not allow data sharing. Therefore, patients will have to use tens of apps to get all their required information. IHE is developing IHE profiles for mHealth to have app compatibility such that the user can choose te app and connect to required hospitals and other healthcare providers (IHE-MHD profile). Mhealth = IHE + HL7 + DICOM. A major challenge here is still authentication and determination of the identity of the user. 

 below you can find the official information and abstract from the programme

SA7: Update and New Developments on IHE

New Developments in IHE: Mobile Health, Device Connectivity and eHealth Projects Services

Charles Parisot, Manager Architecture and Standards, IHE Europe Stearing Committee, France

Integrating the Healthcare Enterprise has established a solid reputation in providing standards-based interoperability specification, IHE profiles that are proven, tested at Connectathon and widely adopted by the market and eHealth projects around the world. This presentation will provide an overall update of IHE profiles adoption world-wide, focusing on the recent profiles targeting specifically mobile Health, and home and hospital medical devices interoperability. It will conclude with the increased attention by IHE to offer its open interoperability test tools along with supporting services that greatly facilitate hospital and regional eHealth project deployment.

HIMSS Europe 2013 Amsterdam - SA6: Success Story from IHE Netherlands

Cross enterprise document sharing (XDS) in the Neterlands is discussed. Some exmples of possible pitfalls and problems based on experience in both regional and national (screening) infrastructures are:

Problem: lost documents because of discrepency in descriptions and lack of uniformity
Solution: standarization in coding (SNOMED, ICD-10) resulting in a Dutch standard metadataset. Role codes are also standardized.

Problem: security and privacy
Solution: ATNA secure node actor or secure application actor. Timestamp consistency

Problem: how to deal with patient consent?
Solution: no definite solution yet, ongoing discussion

Below the official information and abstracts are provided below

SA6: Success Story from IHE Netherlands

XDS in the Netherlands: Possibilities and Experiences of Implementing Cross-Institutional Collaboration

Piet-Hein Zwaal, Partner, Medical PHIT, The Netherlands

IHE Cross-Enterprise Document Sharing (XDS) allows authorized health care providers to electronically collect, store, manage, distribute and view patient documents, reports and images entirely in digital format. XDS networks are the building blocks that facilitate sharing and make the information an integral part of longitudinal patient records regardless of where the images or reports are acquired or created.

Several diagnostic imaging & document XDS deployments has been carried out in the Netherlands. These networks are separated into two different groups. The first group is the regional sharing of documents and images for patients between hospitals. The second group is the XDS infrastructures, which support the Dutch screening operations. Experiences of setting up 4 networks will be discussed.

All the Dutch projects involved the integration of different EHR, Picture Archiving and Communication Systems.

In implementing the different XDS networks, obstacles were found along the way. Some of them were technological in nature, and could be addressed directly. However, it was found that many obstacles are a mix of organisational and technical reasons.

This talk will explain the implementation outcomes and successful steps in realising XDS networks. One of those steps can be lowering the technical barriers and organisational barriers to starting with a focused use-case. Another could be starting with less interoperability from the beginning only to facilitate the organisational cooperation. Also new re-use and possibilities of combining XDS networks will be discussed.

HIMSS Europe 2013 Amsterdam - SA5: Success Story IHE France

The presentation showed that getting to a national personal health record is a long term project that took years of preparation and experimenting (started in 2002). The health records is nationwide and products can obtain a compatibility certificate when they are proven to connect to the central system properly. The architecture of the personal health record is based on IHE profiles. 
The compatibilty certification has three levels: create, read and write. 123 IT products are already compatible with the system (including EMR, IHE interface, ambulatory physician softwares, lab information systems).

Both patients and healthcare providers have a smartcard allowing access to the sytem for identification and authentication. Patients have an internet account with a single use password deliverd to their mobile phone to access their own data.

In France, the DMP account is optional for the patient. It will be created together with a healthcare provider. The patient grants permission for access by physicians, departments or institutions. All information is available to the patient but it is possible to lock certain information until after a certain event. For example, if bad news is included in a report, the report can be blocked until after a personal consult with the patient.

By now about 380,000 patients have a record which is still modest but shows a steady growth. This modest usage is partly explained by the fact that no public marketing campain was undertaken yet.

Below, the official information and abstract from the program are provided

SA5: Success Story IHE France

The French PHR: The Creation, Usage and Lessons Learnt With a National e-Health Record

Francois Macary, Responsible for Semantic Interoperability, ASIP Santé, France

This presentation summarizes the different steps in the national Personal Health Record project (DMP in French stands for PHR): regulation and legal adaptations, standardization activities, design of the framework, build of the solution, promotion and support towards healthcare providers and health IT vendors, certification of the interoperability of Health IT solutions. The presentation shows the interactions that this project has had back and forth with IHE all along the way, and draws some lessons and perspectives for the future.

Thursday, October 31, 2013

1st Annual Netherlands eScience Symposium - eScience Center

1st Annual Netherlands eScience Symposium - eScience Center

Free symposium about big data at which the winners of the Enlighten Your Research 4 contest will be announced. Our project on LungCAVE, a european database on lungcancer screening is one of the finalists. More information about our and the other finalist projects on the contest BLOG.

HIMSS Europe 2013 Amsterdam - Plenary Session: “Patient Safety and IT”

Vesseur indicated that IT can be both beneficial to patient safety but also a hazard. Two of the top ten health technology hazards as reported by the ECRI are IT related (numbers 4 and 5). Patient safety is compromized when information in healthcare is not available, lacks integrity, or is not confidential. Information has to be safe and information exchange has to be safe. Important in these issues is compliance to standards like ISO/IEC 27001 or NEN 7510. 

Vesseur stated in his conclusion that IT will not automatically solve these problems but an approach is required that also involves the healthcare professional, the standards organisation, and hospital management.

Marinka de Jong-Fintelman presented on patient empowerment which, according to her is not possible without patient enabling. She showed that patients have to be an active partner in their own healthcare. Using an illustration by a personal experience story, she clearly demonstrated that currently the patient is not empowered and definitely not in control of their healthcare process resulting in many problems with respect to work and social activities and causing much stress and waiting. She recommends to make patients more aware of the possibilities of eHealth and have the ability to digitally access their records. Nictiz has a platform patient & eHealth to improve the patient empowerment. The platform provides a lot of information on how to develop and implement eHealth through their website (in Dutch). 

Plenary Session: “Patient Safety and IT”

Moderator: Michiel Sprenger
Jan Vesseur, Chief Inspector Patient Safety and Health IT, Dutch Health Care Inspectorate (IGZ), The Netherlands
Marinka de Jong-Fintelman, Program Manager Patient and Self Management, NICTIZ

The assumption is that IT contributes to the quality and the safety of health care. The delivery of care should have profits through the use of IT. The availability, the accuracy of information gains enormous with the help of IT. No one will ignore that. But there is another point of view. IT can also threat the quality and safety of health care. When information and the technology that handles information is not safe, it can harm the patient or even causes his death. The Dutch Health Care Inspectorate (IGZ) received several examples of failing information and failing IT with harm to the patient. For that reason IGZ started investigations in hospitals about the way they secure the patient information along the directives from the information security standards. Beside that they looked at the contribution of IT to information exchange. The conclusions were that IT does not contribute to the solving of the problems in information exchange as long as there will be different systems and different standards. IGZ asked for more standardization. New developments are the EU directive MEDDEV 2.1/6 about the software as a medical device and the way the IGZ will use this directive and the way electronic prescription of medication will be enforced. The aim of IGZ is that patient safety and IT are friends.

HIMSS Europe 2013 Amsterdam - SA4: Mobile Devices in Hospital Settings:Real World Strategies for Now and the Future

Session on mobile devices. Some remarks are that WIFI still poses a challenge in hospitals. There are no problems at the user side in terms of adaptation, but getting apps and mobile devices running in the supported environment of the hospital IT still is challenging.
Concrete examples were given in this session, e.g. Medimapp which provides the patient with an app that give all information about the medical traject including what was done and will be done based on a disease driven approach. This in contrary with traditional portals and information that are mostly specialty based and sometimes incomplete or contradictory.

SA4: Mobile Devices in Hospital Settings: Real World Strategies for Now and the Future

Maarten Winkelman, ICT Manager St. Jansdal Hospital Harderwijk, The Netherlands

mHealth for Nurses on the Ward of UMC Utrecht: A Pilot, Plans and Lessons Learned

Jan Christiaan Huysman, Program Manager ICT, CIO, University Medical Center Utrecht, The Netherlands

Mobile Health applications and platforms are being piloted at the academic medical centre in Utrecht. An example is the NurseMapp, a smartphone based application that enables nurses to register vital signs at the patient bed in realtime, integrated with the hospital information system. In another setup, a proof-of-concept mHealth app on a tablet is developed for patients in a diagnostic pathway for oncology. The patient can check all process information, interact with the physician and see the same information at home via a patient portal.

Operation iPad – a Mobile Strategy for the Years to Come

Werner Zuurbier, Head of Information Management, Antonius Zorggroep, The Netherlands

Recent years brought us a mobile IT-revolution with the iPad as one of its contributors. Healthcare is quickly embracing these innovations but many healthcare organizations struggle to define a useful and comprehensive strategy to fit this in the overall IT and business strategy. The opportunities are promising: Healthcare will be organized more and more outside of the hospital itself. This can be leveraged with a mobile and flexible infrastructure. But this also creates new problems and challenges. Are handheld devices the ultimate solution or is it just the beginning of a mobile health era? And what about sensor health or nano health?

HIMSS Europe 2013 Amsterdam - SB3: Clinical Decision Support: ChangeManagement and Protocol Maintenance

Process mining focuses in the data generated during the daily activities. Based on these data, processes are automatically constructed using process mining. The clinical paths of different patients are used to construct a general process. The results can be used to determine bottlenecks or to check on compliance to guidelines.

Process mining:
- unveils healthcare processes
- automates discovery of objective insights
- case: performance and guidelines adherence

The other presenter used a different approach that was based on the user knowledge to implement guidelines.

Below you will find the official information of the session including the abstracts

SB3: Clinical Decision Support: Change Management and Protocol Maintenance

Philippe Kolh, Professor and CIO at University of Liege, Belgium

Process Mining in Hospitals

Prof. Hajo Reijers, Full Professor, Eindhoven University of Technology, The Netherlands

Process mining is an analytical technique that can be used to exploit the vast amounts of data that become available through the use of information systems in contemporary organizations, such as hospitals. The technique provides a distinctive process perspective in comparison to other data analysis techniques. This is useful to unveil performance information that is of interest to management, medical specialists and patients. In this talk, the speaker will reflect on the experiences of using process mining in healthcare settings and present findings from these projects. The take-home message is: Process mining is available, applicable, and beneficial to healthcare.

100% Adherence to Guidelines: an Expert System for Preoperative Screening

Martijn Mertens, Anesthesiologist, Spaarne Ziekenhuis, The Netherlands

Smart configuration of the Anesthesia module of the EPIC® electronic medical record, resulted in an expert system that can guarantee 100% adherence to guidelines. Prior to a live demonstration of the system, its background, its objectives and its configuration will be discussed.

HIMSS Europe 2013 Amsterdam - SA2: Creating the Continuity of CareRecord (CCR) – An Interoperability Initiative of Eight UniversityMedical Centers Sharing EMRs

Although a country like Estonia is able to provide a full medical records to each healthcare provider and patient (Continuity of Care Record), the Netherlands is still not there with fragmented information and a lack of interoperability. A problem still is introduced by the lack of semantic ineroperability, requiring uniformity of language. Eight university hospitals in the Netherlands have started cooperation to introduce standardization and build the patient record. In this endeavour the patient is central. Getting to semantic interoperability is a long road with several problems on the way including standards, legislation, etc. Nictiz developed an interoperability model showing the different topics that need to be addressed to achieve interoperability.

Below you will find the official information and abstracts of the programme.

Jan Christiaan Huysman, Program Manager at UMC Utrecht, The Netherlands

A Core Data Set for Every Citizen

Jan Hazelzet, Pediatric Intensivist and CMIO, Erasmus Medical Center, The Netherlands

A patient when travelling through healthcare needs to pass his medical information to each caregiver over and over again. During this journey the caregivers store this information in different systems, using different terminology and in a different contextual perspective. This situation is a burden for patients and caregivers, can lead to incomplete information and is a risk for patient safety. It is time we change this situation from a caregiver focus to a patient centered focus. This means that caregivers all look at the same patient health information. For this concept to work we need one individual core dataset suitable in every healthcare situation. In the Dutch University Hospitals we have selected such an (international) dataset and the terminology to be used.

The Long and Winding Road to Interoperability

Sjaak Gondelach, Information Architect, University Medical Center Utrecht, The Netherlands

This presentation focuses on the more practical side of the exchange of patient records between hospitals, and the work of the eight UMC’s in the Netherlands to create a core dataset for semantical interoperability. We will look at the core dataset (the ‘Generieke Overdrachtsgegevens’) and the work that is done in the project, in some more detail. The presentation will also pay attention to other essential technical, organizational and legal aspects that must be addressed on the road to information exchange and semantical interoperabily between hospitals.

HIMSS Europe 2013 Amsterdam - SB1: Benchmarking eHealth and EMRAdoption in Europe

HIMSS started to develop EMR adoption models also for primary care (PC-EMRAM). It can be used to determine the interoperability of the General Practitioner. Two dutch GPs introduced an ICT ladder for the GP developed specifically for the Netherlands.

Krijgsman from Nictiz intriduced the eHealth monitor 2013. The report can be obtained by download from or where and infographic can also be obtained. The field consultation showed good progress but still a long way to go. The Netherlands is at the forefront when looking at a global scale. The use of self management of health information by patients is still very low and also the demand for it is very low. Four steps should be made to increase eHeatlh in the Netherlands:

Create greater awareness of options
Encourage electronic exchange of information
Provide access to medication records to patients
Increase eHealth awareness and enhance skills of professionals

Below this you will find the official session information and abstracts.

Rachelle Blake, PA (Physician Assistant), MHA, CEO and President of Omni Micro/Omni Med Solutions, Clinical Informatics, Data Analytics and Healthcare Technology Specialist

Establishing Benchmarks for EMR Adoption with the PC – EMRAM and ICT Ladder Models: The Only Way is Up!

Uwe Buddrus, Managing Director, HIMSS Analytics Europe, Germany
Bart van Pinxteren, General Practitioner, Huisartsen Oog in Al, The Netherlands
Hans Peucker, General Practitioner, SpinDok, Medisch Centrum Dorp, Houten, Netherlands

European healthcare delivery organizations are being pushed to do more with less and a major movement is brewing to push healthcare outside of the home. This session offers a unique opportunity to influence the standard for IT adoption in outpatient settings by engaging in a discussion on the PC-EMRAM. The PC-EMRAM is the next generation tool to drive IT adoption in primary care and out-patient settings. This new evaluation model creates a framework for building the healthcare settings of the future. The PC-EMRAM focuses on key IT systems and health information exchange (HIE) capabilities that need to be implemented for achieving higher levels of patient access, quality, efficiency and safety. Two General Practitioners and an IT specialist from The Netherlands have adapted and transformed the model to make it more comprehensive and promote its acceptance among the Dutch GPs. They advise their regional branch of the Dutch Association of General Practitioners to implement the so-called ‘ICT-ladder’. Presented by Uwe Buddrus, Hans Peucker and Bart van Pinxteren.

The Dutch National eHealth Monitor: Benchmarking eHealth in the Netherlands – by Nictiz and NIVEL

Johan Krijgsman, Senior Consultant, Nictiz, The Netherlands

Judith de Jong, Program Coordinator, NIVEL

The Netherlands, like other European countries, are confronted with rising costs of healthcare, an ageing population and rising prevalence of chronic illness. This creates challenges with regards to ensuring access to affordable, high quality health care in the future. There are high expectations of the possible contribution of eHealth to these issues. For instance, eHealth may support patient empowerment and self management, which eventually may lead to cost reductions. This is why it is important to monitor the adoption of eHealth by healthcare professionals and patients . Nictiz and NIVEL have started a yearly eHealth benchmark and present their first results.

HIMSS Europe 2013 Amsterdam - Opening Keynote

Opening remarks and keynote
Prof. Schrijvers presented on the fact that Dutch hospitals are still far from paperless. About 50% of Dutch hospitals are at stage 2 of the EMR adoption model. About 36% is at stage 5, and 9% at stage 6. No hospitals are in stage 7 yet. Although in Europe over 30% is still at level zero, in the Netherlands all hospitals are at level 1 or higher. Problems in theNetherland are still the nursing and clinical information, closed loop medication and intelligent pathways. In HIT science we should use routine outcome measurement since in other ways publications will come to late because of the delay in publication of one to two years.

The three main goals for HIT are Adoption, change management and interoperability

The opening keynote addressed reflective comments on US healthcare initiatives by Bert Reese, Kirk Heath and Betsy Rosenfield from Sentera Healthcare. Their institution has been EMRAM level 7 for five years. They described the US approach to interoperability, EMR adoption, the journey to analytics, the emergence of the mobile computing and the value proposition for technology investments. A main issue of interest is currently telemedicine.

Intelligent Health Agent
Aid to the patient to go through their complete treatment. Information about the intervention, the follow-up and revalidation. It really will allow the patient to be guided, to get information, and to provide information. The patient can be guided in what to do at what moment, when to do the excercises, etcetera.

Keys to succes
Keys to success for adopting an EMR are: Shared vision, avoid early skeppticism, realistic plans and goals, it is not an IT project, engage experienced help and support.

Wednesday, October 30, 2013

HIMSS Europe

Starting October 31, the first HIMSS Europe in Amsterdam. A two day event on advancing innovation and and best practice in European Health IT.

Visit the website at for more information.

Monday, October 28, 2013

Realview - Holographic Visualization in the OR during heart surgery

Check out this video from Realview. They developed a holographic visualization system that was actually used in the Operating Theatre.
This really looks like a breakthrough technology that could have major impact on the way three-dimensional imaging data of patients is used in the operating room. Their current hardware looks a bit bulky for the already crowded OR, but this might become smaller in the future to allow real integration. Big advantage is the ability to have touch-less interaction with the 3D holographic image which is a huge benefit in the OR.
Also check-out their website at

Friday, October 18, 2013

Hiding sensitive patient data in the information stream

RMIT University from Melbourne, Australia, has developed a method to hide sensitive information about patients inside the normal data stream using steganography, the practice of embedding secret information inside a larger bit of data without noticeably affecting the size or character of the larger data.

Check out the IEEE Spectrum coverage at:

Hiding Data in a Heartbeat

Tiny Wireless Pacemaker

New development by a start-up company called Nanostim that was recently acquired by st. Jude Medical of a pacemaker about the size of a AAA battery that can be inserted into the heart using a catheter and will last for 9 to 13 years without any leads or wires required.

Check out the coverage on: Teeny Tiny Pacemaker Fits Inside the Heart

Wednesday, September 18, 2013

HAT - role of the medical engineer

The role of medical engineers is growing in the Netherlands, this varies from clinical informatics, clinical physics, to technical medicine. According to the presenters at the HAT the exact placement and positioning of these engineers is not yet fully clear. However, it is generally accepted that these medical engineers are crucial in modern day healthcare. The important role is to implement products into medical practice which requires knowledge of the whole clinical process in which the new product should be integrated. Important steps and issues for the medical engineer are:
- problem definition
   - Understand what clinicians do and why they do it.
- model optimization
- from model to personalization
   - model uncertainty
- model corroboration
   - models choice versus expert choice
- practical implementation

HAT 2013 - Diabeter

Diabeter has developed seperate institutions for diabetes type 1 patients. One of the main reasons for developing these new institutions was the rigidness of hospitals when implementing dedicated IT systems to treat disease oriented populations not targeted at the local region of the hospital.

In the diabeter centers everything is centralized around technology IT with a high level of medical specialization. Because the patients are not close to the hospital, IT infrastructure is also very important for distance communication with the patient (tele-medicine).

Example innovation: 
Patients are provided with a USB enabled blood sugar measurement device which is coupled to the computer by the patient at home and the data is transferred to the hospital. Users of this USB device are more inclined to often upload their data and include questions about their data and thus are more engaged in their own clinical process.

They developed a very dedicated, specialized electronic patient record system in which analysis of collected patient data, feedback to the patient, etc is automated. 

SSL is used to safeguard the security of the communication as well as avoiding the sending of the identifying information of a patient.

Thursday, September 5, 2013

Infographic Health Informatics

This infographics by the University of Illinois at Chicago gives details on what Health Informatics is and which role it will play in healthcare in the future. They state that the future is in desperate need of a large number of health IT professionals that will help to keep the healthcare system affordable.
This link will give you access to the original on the website of the University of Illinois:

Friday, August 23, 2013

Health & Technology 2013 » HAT Event

Mainly for the Dutch readers of my blog, but perhaps also interesting for others. The Health and Technology 2013 event is to be held in Arnhem on September 17 and 18. The HAT tries to bring together the technical, commercial and medical professionals in the area of Healtcare Technology/Medical Devices in order to stimulate innovation and research. Go to the website through the link below, registration is free.

Health & Technology 2013 » HAT Event

Thursday, August 22, 2013

Robotic Surgery Assistant

A group of Purdue University, in West Lafayette, Ind. developed a robotic system that acts as a surgery assistant providing the surgeon with the correct tools using gesture and voice commands. Starting as a 'joke' during a brainstorm to build a robotic nurse, but now an international research project. 
Check it out on youtube:

Also check out the coverage on IEEE Spectrum: Profile: Juan Wachs

Wednesday, July 17, 2013

Glass Up

Some entrepeneurs from Italy are working on a similar device as the Google Glass. They decided to compete with Google and not stop their work. Check out the movie below to see what they are working on.

Monday, July 15, 2013

Nomination for Innovation Award of the Hanze Institute of Technology for Kinect project

One of the students working on an assignment in my group to evaluate the use of the MS Kinect for use in the operating theatre has been nominated for the innovation award of the Hanze Institute of Technology based on this thesis work. The official press release can be found here.

Just a short demonstration video:

The student used the Kinect to allow a surgeon to walk through the data available for a patient using minimal gestures using an easy and intuitive user interface. We are currently trying to arrange the continuation of his project.

New page on my Blog on Free DICOM Tools

It's always difficult trying to find a free DICOM software tool to do the work you need done. Therefore, I just started a new page on my blog where I will keep a collection of possibly usefull DICOM tools with their corresponding links. Most of them I do use myself in day to day work and educational setting, but I did not test them all thoroughly so if you have any remarks, please leave them at the bottom of the DICOM Tools page. The first tools are already included. Just take a look!

Friday, June 28, 2013

CARS 2013 - OR Systems Design and Applications

Ratib and Amato discussed about intelligent design in the OR. They state that intelligence in workflow and data management will drive future diagnostic and treatment platforms...from Patient models... To intelligent patient models. They stated that in intelligent design the BIM (building intelligent model) should be used allowing integration of simulation into a 3D model. This concept is already used in other areas and should be introduced in the design of facilities in healthcare integrating the patient specific model into the design. There is too much technology in the OR, the future paradigm should be to move the technical stuff outside the OR. On the other side, imaging is entering the OR and new technologies are coming fast.

Five other presentations were given touching different aspects of developments in the OR. Generally it was discussed that a lot of information is available during surgery from different systems on different computer screens and that intelligent systems are required to optimalize the data rich OR environment.
This requires a new vision on how the data should be presented to the surgeon. Decreasing the number of screens by integration of the sources on one switchable display is one of the presented solutions. A group from Leipzig showed how they perform this switching automatically using a roadmap of the OR workflow for the procedure currently performed. Huang discussed a currently running and tested integrated OR setup. Other topics covered were the standardization of robotic interfaces for image guided surgery using OpenIGTLink, and experiences with IP based systems in the OR.

The main direction presented by most is to move to more intelligent systems and infrastructures. Possible direction is by employing machine learning.

CARS 2013 - Cardiovascular and Angiographic Imaging

The first presentation in this session was by Tuncay on segmentation of the aortic valve area on CT. They have deviced a novel method to semi automatically segment the opening area of the aortic valve. They created an adaptive grayscale image to get the boundaries more clear and an adaptive algorithm to remove the calcium from the image. The technique proved effective and more reproducible in 21 patient datasets.

The second presentation by Haase was on Model based 3D registration of a CS catheter: application to single X-ray projections from a rotational angiographic sequence. They use a model of the catheter and combine this with the recorded Xray data to obtainna 3D representation of the orientation and movement of the catheter in 3D. They showed high accracy in the tracking in a simulated phantom setup. In clinical datasets also a high accuracy was obtained. Overall accuracy was 0.33 mm in 2D and 2.04 mm in 3D.

The third and final presentation by Masuda was on full automatic calculation of ejection fraction of left ventricle from either of short-axis view by processing succesive ultrasound images. The aim of their study was to design a method that does not require any initial input of the user. They envision to include this algorithm into a portable echography device for use in emergency situations. They demonstrate an interactive real-time detection of the LV cavity during the acquisition of the ultrasound. A subjective scoring by sonographers showed a high level of correct segmentation. Their algortihm was succesfull both in two and four chamber view. Good correlation was shown of the EF based on the new and conventional method.

Thursday, June 27, 2013

CARS 2013 - Image Processing Workflow and Management in Clinical Practice

Regge gave an interesting presentation on getting from bench to desktop with image processing illustrated with his own example on CT colonography. His take home points are that an Imaging lab should be embedded in a cliinical unit, should be cautious with industrial partners, and must start from a clinical problem and build the software on that problem.

Glinkowski presented about what information the clinician really needs. The questions a clinician asks are: what? Where? How? Decision making - what to do? In answering these question the clinicians are heavily depending on imaging an Radiology is essential in answering many of the questions a clinician may have in a muti disciplinary collaborative effort to get the optimal outcome for the patient.

Where we stand on costs and reimbursements of image processing was the topic of a presentation by Turchetti. He started to show that the total healthcare expenditure in Europe and the US is increasing. First cause of this increase is innovation because of growing indications and applications of the innovations, growing area of treatable conditions, increasing use of technologies for the same conditions with less discomfort, broadening definition of diseases and life extending effects. Note that all issues are positive: we live longer and better... Most countries try to tackle these issues with increasing efficiency, redesign of the supply side (closing hospitals, reducing beds, etc), regulation of price and/or quantity of services, and the reduction of the services granted for free and introduction of higher level of co-payment.
The reimbursement mechanism could stimulate efficiency and reduce the opportunistic behavior of hospitals. But if not used properly it could impede the transfer of innovation to the clinical practice.
Studies to calculate real cost of procedures should be promoted and reimbursement should be defined accordingly. Define for which indications the image processing is approriate from a clinical point of view and from a cost effectiveness point of view. Cost and reimbursement should be properly aligned.

In the next presentation Fatehi discussed the composition of the image processing research team including the clinician, radiologist, radiographer, computer scientist, biomedical engineers, and ... He stated that image processing reeserach is done to answer a clinical need, to refine engineering methods and to support management. As stated already many times during the conference he also stresses that imaging research should be a multi-disciplinary effort. The cooperation should include the following topics.

Clinical to Technical:

  • Defining the clinical question

  • Defining the components of the applications

  • Providing the most relevant datatsets

  • Defining the workflow before and after the image processing

  • Validating the test protocol

  • Improving the user interface

Technical to clinical:

  • Specify potential methods to achieve the clinical goal

  • Specify technical limitations of implementing the application development

  • Provide a comparative list of already tested methods in the literature

  • Translating the clinical workflow into an engineering language with technical block diagrams

  • Keeping engineering standards in the final product/application

  • Taking care of the integration issues

  • Taking care of the licensing issues

  • Providing information about open source to avoid high costs.

Finally, Schilling presented on bridging the radiology/surgery gap. He advocated the introduction of new visualization protocols with higer dimension imaging with direct interaction with the data using easy to use devices. They want to have intuitive 2D and true 3D. Clinical efficacy and worflow can both be optimal using true 3D.

CARS 2013 - PACS Workflow

In a presentation from the Neterlands, Jorritsma discussed the necessity to introduce usability to the PACS selection process. He stated that in PACS replacement functionality is regarded but not usability, while this should be a major criterion in the PACS selection process. Subjective measures should be complemented with objective usability data to be valuable in the selection process.

Next, Procida from Italy presented on 'PACS independent and IHE-like approach method for the analysis of PACS in a healthcare enterprise'. they noticed that the hospital had over 100, high cost, workstations connected to the PACS. However, the usage of these systems is unknown and many of them might be used only for a small part of the time. The display on/off status was recorded in a database and provided the possibility to record system usage. This method was limited by the fact that the displays had a delay of 10 min inactivity before they turned off automatically. The IHE ATNA (Audit Trail Node Authentication) profile was utilized to determine the exact use of the workstations since information about each exam view was recorded with the user information. A more accurate status was obtained with this second method about the workstation usage per workstation. This allowed reallocation and discontinuation of underused, high cost, workstations. Proposals are made to the IHE to adopt the ATNA profile to fully support this non-intended but very interesting use.

Final presentation was from Japan, presented by Ito on the improvement of clinical workflow of thoracic surgeons in distant hospitals by interactive teleconference using open source software. They used Osirix, VNC, Voice Chatter (voice communication software) and Wireshark (packet analyzer) to setup teleconference with only open source software. Using this they setup a four hospital teleconference system using VPN connection. Instead of travelling up and down they now upload anonymized DICOM data to the university hospital and do the consultation using the teleconference method saving hours of travelling time.

CARS 2013 - Image Distribution and Cloud Computing

Aryanto presented on an institutional DICOM data distribution system called RadTransceiver. They have built an environment to distribute DICOM data throughout the health enterprise using a webbased, standards based, environment. The setup allows easy distribution using different protocols either with or without anonymization.

Mahmoudi touched the topic of medical image annotation and retrieval. This group from Belgium uses CBIR to support a decision support system by providing similar previous exams based on a query image.

A zero footprint application of mobile devices in radiolgy was presented by dr. Engelmann. He showed that starting early this century the developments of mobile devices for medical image review has progressed steps until their now marketed product that is device independent and available from CHILI as CHILI/Mobile.

Final presentation by Kondoh on development of hybrid medical record sharing system, EPR and PACS of each hospital on cloud technology plus XDS and XDS-I on cloud technology.

CARS 2013 - Content based retrieval from DICOM images

In a very interesting presentation, dr. Caramella stated that making full use of PACS content goes beyond the images and involves teaching files, content based retrieval, dose information extraction both regarding radiation and contrast media use, and proactive quality assurance.

Dr. Kozuka showed image based retrieval in a clinical database of lung CT images. They defined image features in the lung CT scans with a new approach to dynamically assign weights to image features for each query by also using written findings descriptions to extract information from the database. They showed higher succes rates with their weighted method (71%) when compared to the conventional method (61%).

The next presentation was about user interface design to enhance human interpretation of content based image retrieval by dr. Kubar. Using 8 literature based UI requirements and recommendations. Their novel approach is a graph showing a representation of the data by providing anatomical region nodes and tumour region nodes and the connection between the node that define their relationship. The nodes are linked to the images allow the user to utilize the nodes to jump to the correct image. A full paper on the presenation can be found in the Int. journal of CARS.

Bastião from Portugal presented on analyzing of efficiency and service quality of digital imaging laboratories. They use DICOM (meta)data to perform knowledge extraction to get quality indicators and evaluate performance. They used a DICOM data mining tool called dicoogle available at which permits extraction of DICOM meta data allowing a variety of analyses based on the DICOM header information.

CARS 2013 - PACS-CAD Integration

This session contained four presentations on PACS-CAD integration.

Dr. Regge gave an outlook of a radiologist on how to use the CAD in the clinical workflow. He discussed the problems with double reading with increased recall rate of patients for biopsy and the cost involved in requiring two experts to review all datasets. This provides a good incentive to start using CAD as a second reader. Studies have shown similar performance with increased recall rates but also with reduced cost of the diagnostic process because of having only one reader and the decrease in reading time. Controversies are that radiologists might reject true positive polyps defined by CAD and the influence of CAD on the reading process. Inconclusion CAD is coming to maturity and can be used but still is controversial and the clinical value still needs to be assessed.

Dr. Suárez Cuenca presented on an integration of CAD into the PACS environment using a wide computing infrastructure. They aim to build a sytem for a whole region in Spain to make CAD assessable for multiple hosptials utilizing different PACSs and clinical workstations. They build a standards based platform with which users can request a CAD service and receive the results in their local PACS. The process is running through a webinterface that allows sending their (anonymized) data to the CAD service and receiving a DICOM object with the result.

Next a presentation on Enhancing clinical use of CAD systems in PACS with automation and open-source tools by dr. Summers. They built a system that allows a better integration of CAD into the normal workflow utilizing the clinical information already available in the PACS to automate the utilization of CAD in three different scenario's. Either all studies are processed automatically based on their properties (8 minutes per case), a radiologist selects a specific case and requests processing (6 min per case), or a list of cases is predefined in PACS and processed automatically with notification of completion to the radiologist by email or text message (9 min per case). This method allows non disruptive integration with the ability to utilize the full capabilities of the PACS workstation, such as direct comparison with older data.

The final presentation by dr. Behlen was entitled 'an unexamined assumptionnis not worth assuming: imaging data quality exposed in data migration'. this talk was about PACS data migration by Laitek, a company specializing in this area. They presented figures showing exceptions ranging from almost 0 to 35%. Majority of the migrations will only have 1-2% of exceptions. Many problems occur related to interpretation of the DICOM standard. One of the problems is the utilization of annotations, where everybody is implementing in a different way resulting in difficulties to transfer them from one to another PACS environment.

CARS 2013 - Medical Imaging Informatics Simulators

After a short introduction and welcome by prof. Neri, prof. Huang presented a tutorial on Medical Imaging Informatics Simulators. In this tutorial a Medical Imaging Informatics Infrastructure was introduced together with its simulator environment. The simulators are plugged into the MIII layers which integrates with PACS/RIS/ePR/HIS/etc. The simulators can be built in different forms for a variety of applications utilizing different components. They use the actual 'live' information to provide a simulated environment for training and testing. The other simulators described by prof Huang are systems setup to achieve the standards based integration of different components within one single workflow enabling easy acces to and deployment of those different components. After a proven implementation in the simulator environment, the simulators can be moved into patient care.

Wednesday, June 26, 2013

IHE for Dummies - Free eBook NOW available!!!

Interoperability for Dummies, IHE Edition provides practical advice for understanding the ins and outs of healthcare interoperability! This helpful book tells you what you need to know about leveraging IHE to improve your organization’s ability to share patient information—securely and efficiently. Topics discussed in this eBook include:

IHE Basics: find out how IHE can help you meet your interoperability goals.
Secure Document Sharing: examine the current state of document exchange, look at some different scenarios for exchanging information, and find out how IHE is improving the process.
Get Involved: Discover the many opportunities IHE offers for stakeholders and clinicians to work together.
The complimentary eBook is now available!

Follow this link

CARS 2013 - Opening Lectures

Three keynotes were presented during the opening ceremony.

Dr. Ringertz presented about histopathology using integrated diagnostics where many modalities are used to gather diagnostic data. The emergence of molecular imaging has reduced the impact of imaging scale. Knowledge from radiology resulted in a study on workflow and IT solutions for efficient digital pathology. The main goal is to Design the optimal workflow of a digital pathology department utilizing the synergies between the imaging modalities in radiology and pathology. Dr. Ringertz showed that although many actions in pathology are still done manually and non-digital this will move to a more digital environment using IT possibilities based on the experience already gained in Radiology. A major problem is the data explosion when digitizing imaging modalities in pathology where a multitude of the data of radiological modalities like CT is produced. He concluded that digitization has started in pathology and that radiology can help the process. Furthermore, the role of pathology in the diagnosis will increase. This requires standardized referral, computerized order entry and structured reporting.

Dr. Satava presented on 'how much radiology do you need in surgery'. He stressed that this requires disruptive visions because we went from the industrial to the information age. He showed an increase of the use of different tools in treatment (ablation) and robotics. This requires a combination of radiology and surgery and the need for these new techniques will increase to about 90% of the surgeries within 25 years. The Interventional Radiology and non-invasive surgery are moving into a new dimension where surgeons need to move towards radiology or cooperate, which also holds for the digital operating room. The fundamental change is from tissue and instruments to information and energy. Its about exploiting the electromagnetic spectrum (energy) and utilizing the information flow. Dr. Satava stated that it is all about controlling energy and building intelligent sytems.

Finally, dr. Fenster presented on 'Dynamics of medical and technical disciplines towards a multi-disciplinary approach to digital driven healthcare and research'. He presented on the way they setup a small lab which developed into a leading center in Canada. One of the priorities he defined is a multi-disciplinary approach is crucial within a lab although many barriers may exist. Another priority is the focus on diseases and translation instead of on technology, which in itself also helps the creation of a multi-disciplinary approach.

Tuesday, June 25, 2013

CARS 2013

The coming days I will be attending the CARS 2013 in Heidelberg, Germany. I will mainly focus my attendence of scientific sessions to the EuroPACS part and the digital OR developments. For more information keep a look on this blog for the coming days.

CARS is running from June 26-29, 2013. For more information visit their website.

Tuesday, June 11, 2013

Microsoft's Robot Touch Screen Lets You Palpate a Brain

Microsoft is working on haptic feedback integrated into a touch display. So when going to a stack of slices from a CT or MR haptic feedback can be provided based on the image displayed.

Microsoft's Robot Touch Screen Lets You Palpate a Brain

Wednesday, May 22, 2013

Ode to Electronic Health Records - Not everybody is happy with them...

Drs Ken Roberts and Jim Granfortuna on problems with electronic health records (from a debate on whether EHRs enhance patient care and education or not, 5/5/2013)

Tuesday, May 21, 2013

TED: Printing human organs

And at TED there was a presentation on actually printing human organs:

3D printing is really entering the medical arena

Some hospitals are now moving to really using 3D printing in day-to-day practice. 3D printing is used to print a model of complex anatomy to help surgeons in planning their interventions. Read more at the Health&Science webpage of theWashington Post.

Tuesday, March 19, 2013

Kinect Brain Scan = Augmented Reality for Neurosurgeons

Fantastic Development of using Kinect to look inside the patient. Apparently, the SDK will become available soon. See the IEEE coverage or check-out the youtube movie.
Kinect Brain Scan = Augmented Reality for Neurosurgeons

Monday, March 4, 2013

Normal video to detect subtle medical measures

This is fantastic! Researchers from MIT use normal video input to detect subtle changes in the video showing pulsation of vessels and breathing motion. This is really applicable!

Thursday, February 28, 2013

New advances in speech recognition and translation

Demonstration of new technology developments in speech recognition and transcription combined with translation that even allows voice translation. Very promising example and perhaps the future in tele-radiology allowing radiologists all over the world to dictate in their own language and having automatic translation of their report into the language of the requesting party.

Tuesday, February 5, 2013

New and improved gesture based interaction for medical data using MS Kinect

The guys at iHealthLab in Italy further improved their gesture based interaction system for medical data using the Kinect. They have included interaction with 3D visualizations and all kinds of other cool features. Check it out at their website.

Thursday, January 10, 2013

Preliminary version of e-book on Medical Visualization published

I've just published a preliminary version of my e-book on medical visualization at this blog. It is far from complete and some whole chapters are still unfinished or even empty, but I wanted to put out this priliminary version out for my students in the Biomedical Engineering course that I am teaching. So please download the e-book and give me your comments. Do you like it or not? What should be changed or added? Any comments are most welcome. New versions will appear in the near future on this page.

Just go to the e-books and whitepapers tab on this blog to get to the download location.