Interconnected living in a quarter for persons with dementia.

OBJECTIVE: In this work, we propose a new care concept for dementia patients in their own apartments: interconnected living in a quarter. We describe a technical setup that is comprised of a safety system and an activity detection system. The latter detects, processes and illustrates activities of daily living to help the quarter managers to provide appropriate interventions for persons with dementia in the quarter. PARTICIPANTS: The nine-month field study reported in this work was conducted in two quarters with eight participants. METHODS: We evaluated different possibilities to determine activity indicators with the aim of providing information that enables the quarter managers to offer exactly the level of support needed by each individual patient. To evaluate the usefulness and the perception of the technical infrastructure, qualitative interviews with the dementia patients and the quarter managers were conducted. RESULTS: The results indicate that the interconnected living concept helps to increase the safety of the dementia patients. Additionally, several activity indicators that help the quarter managers to offer the appropriate level of support to the dementia patients have been identified. CONCLUSION: The presented concept, which has been evaluated in a real-world-setting, constitutes a new holistic and cross-disciplinary dementia care approach.

[The DICOM-CD-Project of the German Radiology Association--an overview of the content and results of a pilot study in 2006]. / Das DICOM-CD-Projekt der Deutschen Röntgengesellschaft--eine Ubersicht über die Inhalte und Ergebnisse des Pilottests 2006.

DICOM-CDs are frequently used for medical image data transfer. Many different potential advantages are known, such as improved image quality, handling simplification, and cost optimization. However, there are numerous restrictions in the daily routine. While testing DICOM-CDs at the 2006 German Radiology Congress, we found that more than 70 % of CDs have discrepancies with respect to data structure or content. The German Radiological Association and OFFIS started an initiative to improve the quality of DICOM-CDs. There are three main objectives: To provide requirements for vendors of CD-writing systems, to establish user guidelines for the handling of DICOM-CDs, and to develop a test procedure for DICOM-CDs. Radiologists using such systems should be aware of these developments and use them for RFP's.

[Current developments in DICOM and IHE]. / Aktuelle Entwicklungen von DICOM und IHE.

The broadening use of imaging management systems in radiology and other disciplines is due in large part to the success of the DICOM standard (Digital Imaging and Communications in Medicine), which has been accepted worldwide for more than 10 years and meanwhile represents one of the most successful standards in medicine. The central intent of establishing the initiative "Integrating the Healthcare Enterprise" (IHE) was to ensure interoperability of different IT systems in medical processes. IHE is essentially based on widespread standards such as DICOM or HL7. This overview article briefly addresses the principles and organization of DICOM and IHE and describes the current developments in both domains.

[Standards for safe data exchange in teleradiology exemplified by image and report distribution]. / Standards für den sicheren Datenaustausch in der Teleradiologie am Beispiel der Bild- und Befundverteilung.

The use of telemedicine is becoming indispensable for a continuous and economical delivery of a high quality of care. However, data protection requirements have to be considered. For the selection of solutions, vendor-independent components based on standards are a prerequisite for a seamless integration into the existing, often heterogeneous, IT infrastructure. The "Internet protocol" TCP/IP and the DICOM standard with it's new security extensions form the basis for an internationally standardized and accepted procedure for a secure interchange of radiological images beyond platform boundaries.

Cardiac digital image loops and multimedia reports over the internet using DICOM.

The authors define an open, scaleable telemedicine architecture to reduce the time of reports delivery and consultation; increasing their simplicity via introducing common image presentation, storage and telecommunication formats and methods for telecardiology. They've developed a software application to implement it introducing the most appropriate digital imaging methods and formats using the latest available technology.

The RETAIN project: DICOM teleradiology over an ATM-based network. Radiological Examinations Transfer on an ATM Integrated Network.

The RETAIN project (Radiological Examinations Transfer on an ATM Integrated Network) has aimed at testing videoconferencing and DICOM image transfers to get advice about difficult radiological cases over an asynchronous transfer mode (ATM)-based network, which affords a more comfortable interface than narrow-band networks and allows exchange of complete image series using the DICOM format of studies. For this purpose, an experimental ATM network was applied between six university hospitals in four different countries. An assessment of the functionalities of the system was performed by means of log-file analysis, video recording of the sessions and forms filled out by the participants at the end of each session. Questionnaires were answered by the users at the end of the project to bring out perspectives of utilisation and added value. We discussed 43 cases during 20 sessions. For technical or organisational problems, only 20 of the 36 planned sessions took place. The throughput over ATM (10.5 Mbit/s, 20 times faster than six ISDN B-channels) was adequate. Despite the experimental configuration of the network, the system was considered as satisfactory by all the physicians. In 72 % of the sessions, the expected result (answer to the question) was gained. By common consent, videoconferencing was unanimously regarded as a prominent tool in improving the interaction quality. Asynchronous transfer mode is an efficient method for fast transferring of radiologic examinations in DICOM format and for discussing them through high-quality videoconferencing.

DICOM extensions for narrow-band networks.

DICOM is today's de-facto standard for exchanging medical images. Since new image acquisition devices produce more and more image and non-image data, image compression has become an important part of the standard. However, the compression of non-pixel data also stored in DICOM data sets has been disregarded up to now. In the scope of an EU research project we have examined a large amount of real-world DICOM images to test whether or not there is a potential for compressing the non-pixel attributes. Especially for use with narrow-band networks extensions as proposed in this paper could be a solution to save valuable bandwidth.

New DICOM extensions for softcopy and hardcopy display consistency.

The DICOM standard defines in detail how medical images can be communicated. However, the rules on how to interpret the parameters contained in a DICOM image which deal with the image presentation were either lacking or not well defined. As a result, the same image frequently looks different when displayed on different workstations or printed on a film from various printers. Three new DICOM extensions attempt to close this gap by defining a comprehensive model for the display of images on softcopy and hardcopy devices: Grayscale Standard Display Function, Grayscale Softcopy Presentation State and Presentation Look Up Table.

[Test of a teleradiology network based on ATM (asynchronous transfer mode)]. / Essai d'un réseau de téléradiologie basé sur ATM (asynchronous transfer mode).

The retain project (Radiological Examination Transfer on ATM Integrated Network) consisted in teleradiology trials focused on pediatric imaging between two university hospitals. Rennes (France) and Barcelona (Spain) using an integrated broadband communication network based on ATM (asynchronous transfer mode), as part of a European research program. The network used was a full 10 Mbits/s ATM network directly connected to local PACSs (medical imaging hospital networks). One important reason to explicitly consider ATM for medical imaging is that multimedia applications on such networks allow integration of digital data and person-to-person communication. The utility of broadband communication for teleradiology has been confirmed. High quality video and sound are important for both human communication and medical video transfer. The project led to guidelines regarding technical options still open to improvement.

RETAIN--an ATM pilot project for applications in health care.

The availability of ATM-based broadband wide-area networks facilitates a range of new applications in health care, especially the performance of videoconferences combined with software for computer-supported cooperative discussion and diagnosis of digital medical images. This report about a research project for applications of the 'European ATM pilot network' in radiology describes the technical, economic and structural framework for the application of broadband technology in health care.