Battlefield Medical Information System-Tactical (BMIST): the application of mobile computing technologies to support health surveillance in the Department of Defense.

This paper discusses the innovation process of the Battlefield Medical Information System- Tactical (BMIST), a point-of-care mobile computing solution for reducing medical errors and improving the quality of care provided to our military personnel in the field. In such remote environments, medical providers have traditionally had limited access to medical information, a situation quite analogous to that in remote areas of underdeveloped or developing countries. BMIST provides an all-in-one suite of mobile applications that empowers providers via access to critical medical information and powerful clinical decision support tools to accurately create an electronic health record (EHR). This record is synchronized with Department of Defense (DOD) joint health surveillance and medical information systems from the earliest echelons of care through chronic care provided by the Veterans Administration. Specific goals met in the initial phase were: integration of the PDA and wireless interface; development of the local application and user interface; development of a communications infrastructure and development of a data storage and retrieval system. The system had been used extensively in the field to create an EHR far forward that supports a longitudinal medical record across time and across all elements of the Military Healthcare System.

Effects of scintillator on the detective quantum efficiency (DQE) of a digital imaging system.

OBJECTIVE: To compare the effects of scintillator on the detective quantum efficiency (DQE) of a charge-coupled device (CCD) digital intraoral radiographic system. STUDY DESIGN: Three screens composed of 3 different scintillator materials, namely europium-doped lutetium oxide (Lu2(O3):Eu3+), transparent optical ceramic (TOC), thallium-doped cesium iodide (CsI:Tl; CsI), and terbium-doped gadolinium oxysulfide (Gd2(O2)S:Tb; GOS) were compared, in turn, in combination with a CCD detector having square pixels with height and width dimensions of 19.5 microm. DQE was investigated using the slanted-slit-derived MTF and surrogate signal-to-noise ratio (SNR) measurements derived from calculations of the mean and standard deviations from the mean pixel values of multiple random patches from various uniform exposures. An Irix x-ray generator operated at 70 kVp and 8 mA, with a nominal focal spot size of 0.7 mm and 2.5 mm Al equivalent filtration, was used in making all exposures. RESULTS: Using TOC, the peak DQE was 62% at 5 cycles/mm. For CsI, the peak DQE was 22% at 2 cycles/mm. With GOS, the peak DQE was 10% at 1 cycle/mm. CONCLUSION: Under identical experimental settings, TOC consistently resulted in higher DQE than CsI and commercially available GOS scintillators combined with the same high-resolution solid-state detector.

Effects of scintillator on the modulation transfer function (MTF) of a digital imaging system.

OBJECTIVE: To investigate the effects of 2 components (scintillator and x-ray generator) in the imaging chain on the modulation transfer function (MTF) of a charge-coupled device (CCD) digital intraoral radiographic system. STUDY DESIGN: Three screens composed of 3 different scintillator materials, namely europium-doped lutetium oxide transparent optical ceramic (TOC), thallium-doped cesium iodide (CsI), and terbium-doped gadolinium oxysulfide (GOS), were compared. Each was used, in turn, in conjunction with a CCD detector having a pixel dimension of 19.5 mum. Two different x-ray generators were also used to evaluate this variable. MTF was investigated using the slanted slit method. RESULTS: The TOC provided a good modulation response for low and middle frequencies, reducing to 0 only at a high cutoff frequency. With CsI and GOS, the system MTF dropped to 0 at a lower cutoff frequency than was the case with TOC. Hence, TOC provided higher spatial resolution than the other 2 scintillators tested under the experimental conditions applied. The differences in MTF attributed to the scintillator type were proportional and consistent. CONCLUSIONS: Despite constant pixel dimensions, MTF was affected to a considerable degree by the scintillator applied and the x-ray generator used in conjunction with the same CCD imaging device. TOC shows potential as a possible replacement for CsI and GOS as a scintillator screen material for intraoral digital x-ray imaging using a solid-state detector, providing higher spatial resolution under the given experimental conditions.

A wireless diabetes management and communication system.

Current diabetes management requires the collection of a large volume of data by the patient for analysis by his or her provider. There are numerous practical and technical barriers to doing this effectively and efficiently. In addition, the calculation of the correct insulin dose is complex because it requires considering anticipated carbohydrate consumption and exercise in addition to the current blood glucose level. A Diabetes Management and Communication System (DMCS) has been developed using a Compaq iPAQ Pocket PC with a Sprint PCS wireless AirCard. This system circumvents the problem of multiple proprietary programs for each brand of meter and permits the accurate determination of the proper insulin dose. Privacy is maintained by using only the iPAQ serial number as the patient identifier with access to the website protected by unique patient and provider passwords. The iPAQ was programmed with formulas that included: insulin sensitivity factor, current glucose level, amount of carbohydrates, appropriate carbohydrate:insulin ratio for that meal, and duration/intensity of exercise. Once the information is entered, an insulin dose is calculated, although an alternative dose can be selected. The data are downloaded to http://www.HealthSentry.net, where they are displayed in both tabular and graphic form. The patient may view the glucose data in both tabular and graphic form on the iPAQ. Thus a DMCS has been developed to assist patients and providers in improving glycemic control. A proof-of-concept study is underway to determine the effectiveness of the DMCS in patients with Type 1 diabetes mellitus who are currently using insulin pumps.