[Personalized medicine and individual healthcare : Medical and information technology aspects]. / Personalisierte Medizin und individuelle Gesundheitsversorgung : Medizin- und informationstechnische Aspekte.

The individualization of medicine and healthcare appears to be following a general societal trend. The terms "personalized medicine" and "personal health" are used to describe this process. Here it must be emphasized that personalized medicine is not limited to pharmacogenomics, but that the spectrum of personalized medicine is much broader. Applications range from individualized diagnostics, patient-specific pharmacological therapy, therapy with individual prostheses and implants to therapy approaches using autologous cells, and from patient model-based therapy in the operating room, electronic patient records through to the individual care of patients in their home environment with the use of technical systems and services. Although in some areas practical solutions have already been found, most applications will not be fully developed for many years to come. Medical and information technology are essential to personalized medicine and personal health, each driving the other forward.

[Workflow analysis to assess the efficiency of intraoperative technology using the example of functional endoscopic sinus surgery]. / Bestimmung der Effizienz von intraoperativer Technologie: Workflow-Analyse am Beispiel der endoskopischen Nasennebenhöhlenchirurgie.

Evaluation of the efficiency of surgical technology systems has to date been largely subjective. The aim of this study was to develop an ontology for surgical procedures usable workflow structures, and the evaluation of surgical workflow analysis using the example of functional endoscopic sinus surgery (FESS). A total of 38 procedures (20 patients) were included. Surgery was carried out by seven different surgeons with different degrees of training. Description of the surgical procedures and resources is based on the standard EN1828/2001 (Structure for Classification and Coding Systems for Surgical Procedures). In addition the requirements of the Workflow Reference Models (document no. Tc00-1003), Workflow Management Coalition (WfMC) were integrated. The workflow recorded the position, frequency of change of position, use time, cleaning time and concept based instrument changes. A total of 293 items were used to define FESS. A total of 1,029 different endoscopic positions were documented. These could be combined into five major endoscopic positions. The frequency of position changes was 27.1 per side, the period spent in an endoscopic position is about 1.31 min. Time for the concept-caused instrument changing was 6.44 min per side. This study demonstrates the need for assistance in guiding the endoscope in FESS. Using the workflow-data, the concept of an assistant system is possible. We offer a basis for discussion of the development of an ontology, recording and analysing surgical workflows and their practical application.

[Evaluation of PC-based radiologic diagnosis workstations]. / Evaluierung PC-basierter radiologischer Befundarbeitsplätze.

PURPOSE: Evaluation of PC based Radiology Diagnostic Workstations performed by medical users using detailed lists of functional requirements. MATERIAL AND METHODS: During February 1999 and September 1999 medical users at the hospital Dresden-Friedrichstadt Germany had tested 7 types of radiology diagnostic workstations. Two types of test methods were used: In test type 1 ergonomic and handling functions were evaluated impartial according to 78 selected user requirements. In test type 2 radiologists and radiographers (3 + 4) performed 23 work flow steps with a subjectively evaluation. RESULTS: By using a progressive rating no product could fully meet the user requirements. As a result of the summary evaluation for test 1 and test 2 the following compliance rating was calculated for the different products: Rad Works (66%), Magic View (63%), ID-Report (58%), Impax 3000 (53%), Medical Workstation (52%), Pathspeed (46%) and Autorad (39%). CONCLUSIONS: As a basis for a purchasing decision a detailed functional specification an importance rating is required. Especially industrial development effort for improving the workstations is required for DICOM Supplements 33, image printing, integration teleradiology functions for compatible interoperability between different workstations, support for classroom demonstrations, system administration and data security.

Development towards multimedia medical workstations.

In this paper, concepts and examples of medical workstations with multimedia and hypermedia capabilities will be presented. These workstations have special hardware and software requirements. Also described in the article are the developments in Europe (AIM project line) within this area.

Communication networks for medical image transmission.

Digital communication networks are of increasing importance for data exchange in health care environments. They may be used to transmit multi-media data, such as text, images, graphics, signals and sound. The essential characteristics of modern network technologies are summarized in this article and are seen in the context of local, metropolitan and wide area networks. Standardized technologies discussed are Ethernet, token oriented systems, FDDI, DQDB and ATM. Off-line communication media based on magnetic optical disk, such as IS&C, are briefly introduced. The conclusion reached is that therapy planning for radiation therapy or hyperthermia can make use of communication technologies, for example, to transmit patient images, modelling data and results of distribution calculations of physical phenomena.

Future directions in electronic image handling.

After a relatively slow start compared with the United States and Japan, several projects are now being established in Europe that are aimed at the development of prototype systems for medical image processing and management. Frequently, this includes aspects of multimedia communication, as well as legal, ethical, and economic issues. Consideration is also often given to systems security, reliability, and data protection. All these projects are based on the application of modern computer and communication technologies. The following interesting conclusions can be drawn from these preliminary activities: 1. PACS and IMAC systems should not be regarded as products or devices, but as a means to improve the infrastructure in a given medical care environment. Sometimes this activity is also referred to as knowledge business. Individual components of these systems, for example image acquisition devices, networks, storage facilities, and medical workstations, should be provided with standard interfaces allowing a modular build-up and an easy adaptation to the specific conditions of clinical departments. 2. Digital luminescence radiography will further establish itself as a method for image acquisition and increasingly will replace analog radiologic methods. Consequently, digital processing, archiving, and communication will be a necessity for optimal patient care. 3. New network technologies and magnetic-optical storage media offer the possibility of an improved cost-effectiveness for communication and storage. They should therefore be considered an important factor in future economic considerations regarding health care services. 4. The practice of modern medicine is based on team-work; good communication among the parties concerned is a critical factor.(ABSTRACT TRUNCATED AT 250 WORDS)

European picture archiving and communication systems projects.

Picture archiving and communication systems (PACS) are among the most promising information technologies in health care. They are, however, still in the development phase, and their implementation is taking longer than was predicted in the 1980s. Evaluation of these PACS implementations is also much more difficult than was expected. Local, very specific settings and lack of standard methodology make a comparison of tangible and intangible factors very cumbersome. This difficulty has resulted in very divergent opinions in the literature regarding the objectives, realizations, and achievements of PACS. Different approaches for image acquisition, processing, communication, and display have been supported in a wide variety of conferences and in a few key publications. Different approaches are particularly noticeable in Europe and are exemplified by a spectrum of single and multivendor PACS realizations. Some of the most significant of these developments are reviewed.

[Computer-assisted radiology]. / Computergestützte Radiologie.

New digital imaging modalities and more sophisticated image processing systems will have a profound effect on those areas of medicine concerned with imaging. This mainly means computer-assisted radiology (CAR) and implies a transition from analog film systems to digital imaging systems, integration of digital imaging modalities through picture archiving and communication systems (PACS) and the graduated employment of image-oriented medical work stations (MWS) for computer-assisted representation, communication, diagnosis, and therapy planning.

[The PACS model plan at the Freiburg University Clinic. A first step toward a radiologic picture archiving and communication system]. / Das PACS-Modellvorhaben am Universitätsklinikum Freiburg. Ein erster Schritt zu einem radiologischen Bildarchivierungs- und Kommunikationssystem.

In a study performed at several clinical departments of the University of Freiburg, West Germany, it was found that approximately 180,000 patient examinations based on computed tomography, magnetic resonance, nuclear medicine, ultrasound as well as digital and conventional radiography, produce over 1,000,000 pictures. It was assumed that modern technologies can greatly facilitate the handling of such a quantity of images. This applies to diagnosis and therapy planning as well as to communication and archiving of this large amount of data. The study also assumes that the technologies to be considered, e.g. fiber optical networks, optical archives and medical work stations, which represent the main components of PACS, should be introduced in a stepwise manner following a clear overall conception. As the first step the implementation of a local area network (LAN) in the departments of radiology and general surgery is planned. Important criteria for the selection of these particular departments are improvements in health care for a maximum number of patients and in the working profiles for the greatest possible number of physicians and assistant personnel. A cost reduction as compared to the present system through more efficient communication and archiving of the digital images is expected. New perspectives for medical research as well as for medico-technical developments are also expected. Examples are the 3-D representations of human anatomy and the manufacturing of custom-designed prothetic devices. Scheduling and budgetary plans for equipment and manpower are further study results for the Freiburg PACS-Project.