Construction of a system for the access, storage and exploitation of data and medical images generated in radiology information systems (RIS).

We present the analysis, design and implementation of a system that allows specialists at a medical centre to recuperate and manage information produced by computers that generate medical diagnosis images. The main objective of the system is to define an architecture that provides doctors with an easy and centralized access to any information they may need, and to allow users to access this information from the computers at the hospital itself as well as from remote locations, which then require telemedicine sessions. The architecture is built according to a layered and modular methodology, which provides high scalability and interoperability with other information systems (HIS, RIS, etc). All the information is stored in a database: not only the various image studies of the patient, but also all data concerning the diagnosis and any comments the specialist may have made. We have also incorporated tools that are not usually found in conventional systems (image segmentation, advanced visualization, etc), but that help the specialist with the decision-making process.

Real time monitoring and analysis via the medical information bus, Part I.

Because of the complexity of monitored data in modern intensive care units (ICUs), and the risk of information being overlooked if medical staff have to pay attention to a multiplicity of monitoring apparatuses and alarm signals, the data for each patient may well be best presented on a single bedside screen after digestion by expert system techniques. Such central units should be able to deal with data from any monitoring apparatus, not just a predefined set. Furthermore, relay of the information from each bed to a central control station (one per ICU) is desirable for the purposes of permanent storage and for in-depth analysis. The paper describes a comprehensive system for ICU monitoring management and patient data analysis that integrates multiple expert systems and computers. The basic difficulties in applying expert system techniques to monitoring are overcome with the shell OPS/83, which allows calls to sequential C routines and allows time-driven reasoning through appropriate design of the inference engine and rules. Flexibility as regards connectable monitoring apparatus is afforded by basing data acquisition mainly, though not exclusively, on the IEEE Medical Information Bus.

Real time monitoring and analysis via the medical information bus, Part II.

The complexity of the monitored data available in modern intensive care units suggests that they may be best processed, for presentation to medical staff, by expert system techniques. However, standard expert system shells are ill-fitted to either the basic sequential monitoring tasks of data acquisition and storage, or to handling the temporal considerations inherent in monitoring and in the recognition and processing of sporadic alarm signals. A solution to this dilemma is described: an expert system that has an appropriately designed inference engine and manages data acquisition via a medical information bus (MIB). Use of this MIB standard allows great flexibility as regards the monitoring apparatuses employed; in particular, the connection or disconnection of any apparatus is recognised and triggers the automatic reconfiguration of the network.

[Design of an expert system for decision-making in an emergency situation]. / Diseño de un sistema experto para toma de decisiones en situación de urgencia.

OBJECTIVES: To study the clinical applicability of the expert system URGSANT as a help in making up decisions in emergencies. MATERIAL AND METHODS: URGSANT is an expert system implemented in INSIGT 2+ which is structured in a modular and hierarchical form. It contemplates 44 urgent situations relating to the central nervous system, hematopoietic, cardiovascular, respiratory, gastrointestinal, genitourinary, endocrinological, and miscellaneous group. Validation of the program was made by four anesthesiologists who evaluated the performance of the program in 25 emergency cases and in 25 other situations that were treated by other specialists. RESULTS: The rationale of the system was basically correct. In most cases the program was considered efficient or very efficient during the different clinical situations and only in one case its guidance was wrong. CONCLUSIONS: The URGSANT expert system is an efficient and useful method for the clinician during emergency situations.