1995 IEEE-EMBC a d CMBEC

Theme 3: Cliical Ehgineeringhledical Informatics

A NOVEL MEDICAL IMAGE P R O C E S S I N G

AND MANAGEMENT SYSTEM

S. Pavlopoulos,

""NIA54"

S. Dembeyiotis, G, Konnis and D. Koutsouris

Biome dic a1 Engineering Lab oratory, Dept. of Electrical & Clomput e r Engineering ,
National Technical University of Athens (NTUA)

42 Patission Str., Athens 10682 Greece.

Abstract
The
introduction
of
information
and
telecommunication
technologies
into
medicine and health care has improved the
communication and exchange of data between
different health care institutions. Along that
direction we a r e developing a strategic plan
for
a
countrywide
infrastructure
for
exchanging medical imaging information in
digital form, as well as providing for
telemedicine and teleconsulting capabilities in
rural areas. Two pilot networks will be
implemented; t h e first will connect a number
of primary health centers
with a central
hospital
allowing
for
telemedicine
and
teleconsulting capabilities. The second will be
implemented in a specialized cardiac center
in Athens where a DICOM 3.0 based PACS
system f o r cardiological applications will be
installed. Preliminary results concerning ECG
and real-time video signal transmission and
processing
are very promising and indicate
the
engineering
basis
for
the
final
implementation of the NIM project.
Keywords : Telemedicine, PACS; DICOM

I'L?troduction
The main goal of modern health care systems
is the
improvement of
health of
the
populations they serve. A t present, there is a
trend
for decentralization of health care
institutions
and
for
a
move
from
institutional health care to primary and
home care. In many countries, Greece being
one of them, health care services a r e highly
centralized. Despite the establishment of
well-equipped
rural health care centers
during the past decade, personnel shortages
still limit the quality of healthcare provided
outside urban areas. In addition, there is a
major increase in the
volume of data
generated by the use of modern imaging
modalities (x-ray, CT. MRI. PET, SPECT. DSA,
Ultrasound, etc.) This makes the management

0-7803-2475-7197
$1 0.000 1 997 IEEE

765

of imaging data increasingly difficult, both for

large and small health care centers, adds t o
hospital costs, and makes the provision of
telemedicine and t.eleconsulting services to
smaller health care centers more difficult
The result is that the gap in the quality of
health care provided between rural health
centers
and
larger
urban
centers
is
constantly widening with a large number of
patients moving from t h e periphery t o the
center.
Considering all the (above, we have decided t o
develop a countrywide strategic plan which
will benefit both large and small health care
centers. The system will be based on
international standards and will be able t o
accommodate
older
technology
imaging
equipment.
The . network
forming
the
backbone of t h e system will be based on
open architectures so t h a t additional imaging
systems could be connected to the network
with
minimal
interfacing
problems.
An
important factor in the network design is the
provision for telemedicine and teleconsulting
services t o rural health centers on demand,
offered by specialized personnel in large
medical centers. In addition t o improving the
level of t h e health care t h a t is provided, an
added benefit will be the reduction of patient
traffic between rural and urban centers. The
system will also enable the
training of
medical personnel using modern multimedia
technologies.

Methods
As previously described, the system consists
of two main parts. The first p a r t is the &'via
network which connects seperal rural health
centers in Evia island with the Chalkis
General Hospital (Fig. 1). This network will
provide telemedicine capabilities to the rural
health centers. Both x-ray radiographs and
ECG signals will be transmitted via normal
telephone lines t o t h e central hospital where
specialized physicians would proceed with the

diagnosis. The central hospital is equipped

with a dedicated distributed data-base where
examinations from different health centers
will be archived. Each health center is also
equipped with a dedicated data-base for local
archiving, and the required instrumentation
for telemedicine applications, such as filmscanners, digital ECGs, etc.

- - - - -Rural
. . -Health
- - -Center
- -- -- - - . . .Chalkis Hospital
.
I - - - - - -

ULTRASOUND

installed in rural centers in Evia and

telemedicine application will be performed
with the aid of the Chalkis Hospital.
Furthermore, we evaluated transmission of
real-time video using the MPEG-1 algorithm.
Preliminary results display acceptable. for
diagnostic
use,
image
quality
with
ONASSlO CARDIAC CENTER

SERVER

OTHERMEDIW
NETWOW

RAGE

I
I
I

STORAGESRVER

I
I

- - - _ _ _ _ _ _ _
1

I
I

(EYi$
NETWORKS

II
I

----..------------.

Fig. 1 Schematic representation of the Evia

network connecting several rural health centers
with the Chalkis General Hospital.
The Onassio Cardiac Center in Athens will be
the site f o r the second network (Fig. 2). I t
consists of a high speed isochronous network
e of sustained high data transfer rates.
etwork will be able t o accommodate
DICOM 3.0 compatible medical imaging devices
in a network plug-in
mode. The storage
subsystem utilizes a high capacity magnetooptical storage device with CD-ROM jukebox
used f o r off-line storage. Several DICOM 3.0
image
viewing
stations
utilizing
high
resolution
monitors
are
installed
in
specifically selected sites throughout the
hospital providing radiologists
and other
specialists access t o patient information. A
major task in this project is the development
of DICOM 3.0 network interfaces for systems
which are not DICOM 3.0 compliant. The
network can interface t o other HIS and PACS
systems through appropriate gateways. In
addition, the network design enables the use
of video-conferencing using suitably equipped
workstations. Finally the network can be
linked t o wide area networks through high
s p e e d fixed o r wireless links (ISDN, ATM,
satellite, et c .)

Results

y.XMER4

DM

CATSXNNER

FILMSCANNER

ULTPASXIND

- Discussion

Preliminary results of the NIKA project

include ECG and real-time video processing
and transmission. A dedicated ECG data card
for use with personal computers has been
developed
and
tested
for
telemedicine
applications [I-21. The data card will be
9

766

2 Schematic representation of the Onassio

Cardiac Center fast hospital network linking several
imaging modalities t o a central processing unit.
Fig.

transmission rates of .IMbits/sec [3]. Further

analysis is still in progress f o r a detailed
of
compression
rates
for
determination
different imaging modalities.
CORChZSiORS

We are developing a strategic plan

for a
country-wide
infrastructure
for
medical
image
data
exchange.
The
initial
implementation has two pilot stages, one
connecting rural health centers with a
general hospital, and the second linking a
variety of
imaging modalities
within
a
specialized cardiac center with a centralized
processing unit. Preliminary results are very
promising for the successful completion of
the project.

References
Tombros. G. Tselikis. S. Marakas. and D.
Koutsouris, "A Generic environment for linear
and non-linedr ECG processing," TechoL and
Health Care. Submitted 1995.
[ Z ] S. Tombros. G. Tselikis. E. Protonotarios and D.
Koutsouris, "An optimized algorithm for R-R
internal detection," IEZE Trans. Biomed Eng.
Submitted 1995.
[3] S. Pavlopoulos. N. Katevas.
G. Konnis
Dembeyiotis, and D. Koutsouris. "An integrated
medical image processing and manage
system." Proceedings of the 3rd European
[l] S.

Conference

on

Engineerikig

Florence, April 1995.

and

Medicine