bluuebunny/crossref_metadata_2025 huggingface dataset:
Spinal Surface Digitization Using ‘Metrecom’ in Scoliosis Screening
Authors: WONG Hee-Kit  , BALASUBRAMANIAM Ponnambalan  , RAJAN Uma
Published: February 2025

In this study, we evaluated the use of Metrecom, a surface digitizer, in scoliosis screening. 60 consecutive female subjects between 12 and 14 years old who were referred based on a scoliometer reading of 5 degrees or more on forward bending test (FBT) had second tier screening with surface digitization and moire contourgraphy. All patients had erect radiographs of the spine for confirmation of scoliosis. The FBT had a false positive rate of 23.3%. Moire contourgraphy did not improve the false positive rate and was associated with a false negative rate of 5.3%. Surface digitization of the spinous process curvature gave a false positive rate of 16.7% and a false negative rate of 1.7% taking a predictive spinous process angle of 5 degrees. Increasing this cutoff value to 7 and 10 degrees improved the false positive rate with little risk of missing significant scoliosis. Surface digitization of the spinous processes is an effective second tier screening tool for idiopathic scoliosis.
3-D Reconstruction of Vertebral Endplate Wedging
Authors: DANSEREAU J.  , CHABOT A.  , HUYNH N.T.  , LABELLE H.  , DE GUISE J.
Published: February 2025

A new method which allows the 3-D reconstruction of vertebral body endplates from biplanar radiographs was developed in order to evaluate the maximum wedge angulations of scoliotic vertebrae and their corresponding 3-D orientations. This new reconstruction technique, based on an iterative projectionretroprojection procedure which fits an ellipse on the real endplate contours, was applied on 10 adolescent idiopathic scoliotic patients. Results at thoracic apex show mean wedge angles of 9.1±4.5°. Wedging orientation values confirmed that scoliotic wedging is not a 2-D deformation but a 3-D phenomenon because it did not occurred in a plane parallel to the frontal X-ray plane. Preliminary validation showed maximum wedge angle errors less than 2.5°.
Three-Dimensional Analysis of Scoliosis Surgery Using Stereophotogrammetry
Authors: TREDWELL S.J.  , BOOTH K.S.  , REILLY C.W.  , SAWATZKY B.J.  , JANG S.B.
Published: February 2025

A method for scoliosis analysis using stereophotogrammetry has been developed. The technique involves intra-operative stereophotography using an overhead stereo camera system. Stereophoto pairs are taken at specific stages of spinal instrumentation procedures. In this way the effects of specific instrumentation maneuvers can be studied. Photo pairs are put onto Kodak PhotoCD’s and digitized to provide three-dimensional coordinate position for posterior element bony landmarks. Three-dimensional changes in position occurring after specific stages of surgical instrumentation are compared using a computer program developed for this project. Rotational and translational information is calculated for the entire visualized segment of the spine. Accurate results have been achieved with this technique and verified using appropriate statistical methods.
Disseminating Quality Care for Upper Gastrointestinal Cancer
Authors: de Dombal Tim  , Martin Iain
Published: February 2025

This presentation discusses the problem involved in providing quality care for patients with Upper GI Cancer throughout a healthcare delivery system. It is argued that appropriate telecommunications technology exists for widespread dissemination of “best clinical practice”, but that it cannot be used effectively at present because of some limiting factors. These include lack of precisely defined aims concerning use of technology, lack of interactive quality control, and insufficient involvement of end-users. Upper gastrointestinal cancer is selected as a model for discussion - since there is wide discrepancy between outcome of therapy in early and late cases, there is evidence that early diagnosis is possible - and there is substantial evidence that it does not take place widely in practice.
The Impact of Clinical Pilot Projects in R&D Programmes Supported by the EU
Authors: Beolchi Luciano
Published: February 2025

This chapter contains information and guidelines for scientists, researchers and medical professionals who intend to install a pilot in their ward, service or department within the framework of a R&D project co-funded by the European Union. It analysis requirements and cost-benefits in doing it.
Assessment and Evaluation of Knowledge-Based Expert Systems for Medical Diagnosis
Authors: Molino Gianpaolo  , Molino Francesca
Published: February 2025

This paper describes a well-assessed procedure for the validation of knowledge-based expert systems, as it results from recent authors' experience. The adopted strategy, including retrospective as well as prospective case samples and different groups of observers, fulfils the most important needs of expert system validation. The study describes an upgrading protocol based on the analysis of misclassification errors; a procedure for system verification; a detailed study design for laboratory validation considering diagnostic accuracy, diagnostic efficiency and advice analysis; and a section devoted to field testing. Relevance and limitations of the proposed evaluation protocol are discussed with respect to the complexity, inconveniences and thoroughness of the adapted procedure.
The Use of a Holographic Projection System (HOPROS) in Stereo Endoscopic Surgery and Telesurgery
Authors: Laurent Christophe R.  , Ysebaert Dirk K.  , Vanhoecke Eddy  , Van Hee Robrecht H.
Published: February 2025

A Holographic Projection system is a light weight Head Mounted Display which can be used for viewing 3D images during stereo-endoscopy and tele-surgery in a more ergonomic and user friendly way than most shutter glass systems.
The Emotional Dimension of Experience in Information Environments
Authors: Manning Timothy R.
Published: February 2025

The emotional experience of persons engaged in computer-human interaction has scarcely been acknowledged. However, using current multimedia technologies, we are quite capable of having an impact on affective experience. In the use of interactive computer programs in patient education settings, emotions such as anxiety, sadness, and hopefulness may be exaggerated or moderated. If we are to sensitively create information environments for the benefit of patients involved in emotionally relevant situations, we must come to better understand the aspects of emotional experience within these systems. This paper reviews work on the creation and use of a multimedia program “Options for Treating Breast Cancer” that was produced under a grant from the Advanced Technology Program of the State of Texas. The program is being used in a two year trial in a clinical setting with patients who have just been diagnosed with Stage I or Stage II breast cancer. An attempt was made to decrease anxiety in two ways, by decreasing uncertainty and by providing non-cognitive queues for hopefulness. Our preliminary findings are reviewed and suggestions are made for how emotional response may be viewed as an important dimension of patient experience using interactive multimedia computer systems and how use of information systems in general may be viewed in terms of human experience within an environment.
Virtual Human™
Authors: Sellberg Michael  , Murray Daniel  , Knapp Darren  , Teske Todd  , Lattie Katherine  , Vanderploeg Martin
Published: February 2025

A comprehensive anatomical virtual environment (AVE) of the human musculoskeletal system has been created for both biomechanics and computer-aided instruction (CAI) applications. It has been developed on the Silicon Graphics family of workstations using the Open Inventor™ object-oriented programming environment.
Using Multimedia Computing To Help Patients Make Decisions for Treating Breast Cancer
Authors: Street Jr. Richard L.  , Manning Timothy
Published: February 2025

This investigation examined the effectiveness of two methods of preconsultation patient education, brochure vs. interactive, multimedia computer program, that were designed to help breast cancer patients (a) learn more about their treatment options, (b) become more optimistic about their futures, and (c) believe more strongly in the legitimacy of patient involvement in deciding treatment. A total of 50 patients with early breast cancer (stage I or II) were randomly assigned into either the brochure group or the multimedia group. Patients completed knowledge, optimism, and attitude toward decision-making measures prior to the education, immediately after the education, and after their consultations to decide treatment. Several results were noteworthy. First, patients knew more about breast cancer treatment (P < .001) immediately after the educational interventions and after the consultations than they did prior to the education. Second, there was a slight trend (P = .09) indicating that patients who used the multimedia program learned more about the treatment options than did patients reading the brochure. Third, after visiting with their doctors, patients believed more strongly in patient involvement in decision-making than they did prior to their consultations. Implications of these findings are discussed.
Using a Dataglove for the ergonomic Assessment of Instruments in Endoscopy
Authors: Bauer Wilhelm  , Breining Ralf  , Riedel Oliver
Published: February 2025

The ergonomic evaluation of instruments in endoscopy has developed into an important research area due to the many new operational procedures in minimal invasive surgery. The use of Virtual Reality (VR) elements and, especially in this case the Dataglove, as measuring tool; the generation of virtual infra-abdominal working areas; and the virtual design of the working side of the instruments offer distinct advantages and open up new possibilities with respect to the ergonomic evaluation of instruments. The paper describes the possibilities and experiences when using VR elements, such as the Dataglove, as a means of measurement and also how this device has been integrated in the assessment of the mechanical instruments used in minimal invasive surgery. In addition to the integration, the paper will conclude with a description of the plans to expand the system.
Project and Development of a Virtual Reality Microsurgical Simulator
Authors: Puzone R.  , Cervone E.  , Raposio E.  , Andreucci L.
Published: February 2025

We are developing a microsurgical simulator for surgeon's training. We simulate the operation of suturing small blood vessels under a stereo microscope. The apparatus is based on a UNIX workstation equipped with a Simsalabim Cyberscope stereo view adapter and Pholemus FASTRAK sensors applied on real surgical instruments. There is no force feedback. We want to use the simulator also as an analyzer of microsurgery manuality, and in the perspective of new tools for surgeons. The directions of the project and the actual status are described.
Using geometrical features to match CT and MR brain images
Authors: Maintz J.B. Antoine  , van den Elsen Petra A.  , Viergever Max A.
Published: February 2025

In this paper, we will show the feasibility of using ridgeness for rigid automatic matching of CT and MR brain images. Image ridgeness can be computed by convolving the image with derivatives of Gaussians. The specific derivatives involved are based on the local gradient and second order structure. The width of the used Gaussian determines the locality of the ridgeness computed.
Segmentation and Fusion of Multimodality and Multi-Subjects Data for the Preparation of Neurosurgical Procedures
Authors: Barillot C.  , Gibaud B.  , Gee J.C.  , Lemoine D.
Published: February 2025

Data fusion in medical imaging encompasses both i) multisensor fusion of anatomical and functional information and ii) interpatient data fusion by means of warping models. These two aspects establish the methodological framework necessary to perform anatomical modeling especially those structures of the brain. The principal aim of the work presented here concerns the investigation of multimodal 3D neuroanatomical data.
Diastolic Function from Transmitral Flow
Authors: Kovács Sándor J.
Published: February 2025

Measurement of in-vivo diastolic function indexes has required cardiac catheterization. Analysis of Doppler echocardiographic transmitral flow contours using a kinematic paradigm holds promise in elimination of cardiac catheterization as a requirement for quantitative diastolic function characterization. The paradigm suggests that novel, kinematic indexes which characterize diastolic function can be extracted from the Doppler velocity profile (DVP). This article reviews the role of a kinematic modeling strategy. Topics covered include: the role of the heart as a suction pump, automated solution of the ‘inverse problem’ of diastole, the relationship of ‘dissynchronous relaxation’ of the ventricle to the Doppler waveform, prediction of LVEDP from the DVP and the causal relation of the third (S3) and fourth (S4) heart sounds to the Doppler E and A-waves.
Response of Left Ventricular Filling to Exercise before and after Heart Failure
Authors: Little William C.  , Cheng Che-Ping
Published: February 2025

During exercise, the peak LV filling rate in early diastole increases as the duration of diastole decreases with exercise induced tachycardia and stroke volume is maintained or increased. Our studies in conscious instrumented animals indicate that this increased rate of diastolic filling during exercise results from an increased mitral valve pressure gradient produced by a fall in LV early diastolic pressure. This fall in LV early diastolic pressure is associated with a downward shift of the early diastolic portion of the left ventricular pressure volume loop and enhanced rate of left ventricular relaxation during exercise. This is altered after the induction of pacing induced heart failure The early diastole filling rate still increases as does the early diastolic left atrial left ventricular pressure gradient during exercise after CHF. However, this increased pressure gradient results entirely from an increase in left atrial pressure after heart failure. In addition, left ventricular relaxation is not enhanced but in fact is slowed during exercise after heart failure because early diastolic left ventricular pressure does not fall during exercise but actually increases.
Determinants of Force Development and Shortening Velocity in Cardiac Muscle
Authors: ter Keurs Henk E. D. J.
Published: February 2025

The power of the heart is dictated by the force development and velocity of shortening (V) of the cardiac sarcomere. Both depend on the amount of Ca++released by the sarcoplasmic reticulum during the action potential. We have investigated the inter-relationship between force (F) sarcomere length (SL) and V and the intracellular Ca++concentration ([Ca++]i) in trabeculae isolated from the right ventricle of rat heart. Activation of the contractile filaments during a normal heartbeat requires approximately 30 μM Ca++ions. which rapidly bind to cytosolic ligands. Consequently the [Ca++]itransient detected by intracellular probes is less than 2 μM. Length dependent binding of Ca++to Troponin-C is responsible for the shape of the F-SL relationship. Ca++ions are long enough bound to Troponin-C to allow the F-SL relationship, and consequently the end-systolic pressure volume relationship in the intact ventricle, to be largely - but not completely- independent of the loading conditions. V during contraction against a load increases hyperbolically with decreasing load. Stiffness studies revealed that the number of attached cross bridges increases in linear proportion to an increase of the external load. At low external loads the V was large enough to induce a substantial visco-elastic load within the sarcomere itself. The F-V relationship of a single cross-bridge appeared to be linear after correction for the observed visco-elastic properties of the muscle and for load dependence of the number of cross-bridges. Maximal V of sarcomere shortening (Vo) without an external load, depends on the level of activation by Ca++ions because of the internal viscous load. Our studies of the rate of ATP hydrolysis by the actin-activated S1fragment of myosin suggest that Vois limited by the detachment rate of the cross bridge from actin. These studies also suggest that the difference between the fast (V1) and slow (V2) myosin isoenzyme can be explained by a difference in the amino acid domain on S1involved in binding of the cross bridge to the actin filament.
Time Scale and Oscillatory Features of Left Ventricular Step Response Originate from Multiple-Step Crossbridge Cycle
Authors: Campbell Kenneth B.
Published: February 2025

Step and frequency response behaviors of the constantly-activated isolated rabbit heart exhibit well-separated fast and slow dynamics and damped oscillations. These behaviors of the heart are also characteristic of constantlyactivated heart muscle which indicates that they originate from the actin-myosin cross-bridge cycle. Analysis of the dynamics of cyclic systems indicates that separate fast and slow behaviors and damped oscillations emerge and become pronounced only as the number of states in the cycle increases. A model of step and frequency response features of the constantly activated heart that incorporates cyclic cross-bridge activity will require multiple states.
Ventricular Twist and Its Relationship to Pressure Volume and Shortening
Authors: Beyar Rafael  , Kroecker Carol Gibbons  , Tyberg John
Published: February 2025

Twist of the left ventricular (LV) apex relative to the base has been characterized by a variety of methods, both invasive and non-invasive. While the relationship between twist and volume changes or shortening have been shown to be fairly linear during systole, it has been shown that diastole is characterized by rapid twist recoil during the isovolumic relaxation (IVR) phase followed by relative little untwisting during ventricular filling. While it has been shown clearly that contractility effects twist, it has not been clear whether these changes are mediated through changes in volumes rather than a primary contractile effect. We have recently described a method to measure apex-rotation using an optical device in dogs. With base rotation of less than 2° apex-rotation becomes a reliable index of twist magnitude and dynamics. We have employed the device in a series of experiments in dogs where apex-rotation, LV pressure (Millar), ventricular dimensions (sonocrystals) and segment length were measured. Preload and volumes were changed with vena-cava occlusion and volume loading, afterload with 1-beat aortic occlusions and contractility using a paired pacing model, showing the following: a) There was a linear relationship between apex-rotation and LV volume at end diastole which was significantly different from the linear relationship at end systole; b) With increased preload or increased afterload, the amplitude of apex-rotation decreased slightly and maximal apex-rotation was delayed (into the IVR period) c) Increased contractility increased apex-rotation amplitude by 42% but did not alter the systolic twist volume relationship; d) The twist shortening relationship was steep during the IVR period relative to the systolic relationship, emphasizing the rapid twist recoil with minimal lengthening at that period. A mathematical model of the LV that accounts for the fiber angle distribution across the LV wall and the collagen mesh, and calculates the balance of moments between the endocardial and epicardial fibers is presented and discussed. The model supports the idea that the dynamics of twist, results from the dynamics of torsional moments across the LV wall.
COVIRA: Multimodality Medical Image Analysis for Diagnosis and Treatment Planning: COmputer VIsion in RAdiology
Authors: Kuhn M.H.
Published: February 2025

This paper presents an overview of the COVIRA project, AIM Project No. 2003. The COVIRA consortium has been performing research in the area of Multimodality Image Analysis, with a focus on. Registration and Segmentation. Together with results in the areas of Visualization, User Interface, Digital Anatomy Atlas, Conformal 3D Radiation Therapy Planning, and Cerebral Vessel Tree Reconstruction, COVIRA software has been clinically validated at six clinical sites in five European countries.
MILORD: Multimedia Interaction with Large Object- Oriented Radiological and Clinical Databases
Authors: D'Atri A.  , Di Stefano G.  , Fabrizi G.  , Montesanti A.  , Tarantino L.  , Zobel B.
Published: February 2025

The MILORD project concerns the implementation of an integrated developing environment to carry out medical applications (in particular clinical and radiological applications) dealing with multimedia information. The main goal of project was to facilitate the effective interaction of physicians with large amount of relevant multimedia data, through the use of an integrated set of tools to entry, to store, to process, and to communicate patient information. Advanced information technologies have been exploited: new knowledge representation languages and tools, friendly human-computer interaction, 3D graphical processing and displaying of medical images, high performance parallel architectures, large-scale distributed data storage, federated environments for clinical co-operation. The main results that have been obtained during the project and the plans for the future demonstration and exploitation activities are described.
SHINE: Strategic Health Informatics Networks for Europe
Authors: Cooper Paul  , van Wijnbergen Joke
Published: February 2025

The SHINE Project has constructed an open systems framework for the development of regional community healthcare telematic services that support and add value to the strategic business objectives of European healthcare providers and purchasers.
TELEGASTRO: Telematics Technology for Harmonising and Promoting Quality in Gastroenterology
Authors: Winding Ole  , Ohmann Christian  , de Dombal Tim
Published: February 2025

The Telegastro project objectives hag had the following objectives - (i) to develop a “consensus view” by which health care in specific gastroenterological areas may be measured in an agreed standardised and reproducible fashion; (ii) collate this consensus view into a Telematics product; and (iii) to distribute widely, and measure the reaction of potential end users to the Telematics product.
BEAM: Biomedical Equipment Assessment and Management
Authors: Pallikarakis Nicolas
Published: February 2025

The use of modern Biomedical Technology in hospitals today, imposes great demands for effective management and assessment. BEAM (Biomedical Equipment Assessment and Management) has actually developed informatics tools in order to assist Clinical Engineers in performing their tasks towards this direction. The system is able to exploit the enormous amount of information produced continuously in different countries, access and retrieve it from local and remote databases, introduce new standards and tools for the management of medical equipment in the hospital environment. It also provides communication means between clinical engineers and promotes Quality Assurance procedures. The outcome of the BEAM project, is a prototype system incorporating tools, supporting the clinical engineering department in all its functions as well as, databases and communication facilities for exchange and access of this information.
OBSQID: Continuous Quality Development in Perinatal Care through use of Quality Indicators
Authors: Stæhr Johansen Kirsten  , Langhoff Roos Jens
Published: February 2025

Data from 1993 on a set of essential quality indicators on perinatal care identified and validated as part of the OBSQID project were collected from 29 countries in the European region. Regional differences between NIS, CCEE and Western European countries in indicators on fetal death during delivery, eclampsia, caesarean section, early neonatal mortality and preterm birth are presented and discussed.
Workshop on Primary Care: Perspectives on Telematics for Primary Care
Authors: Boydell Leslie  , Sosa-Iudicissa Marcelo
Published: February 2025

Workshop Aims
The Curriculum for Medical Informatics at the University of Heidelberg/School of Technology Heilbronn
Authors: LEVEN F. J.
Published: February 2025

The specialized university curriculum for medical informatics at the University of Heidelberg/School of Technology Heilbronn described in this paper is one of the oldest educational approaches in the field of medical informatics, and has been successful for more than 20 years with more than 600 graduates (Diplom-Informatiker der Medizin). It is based on the concept of medical informatics as an independent medical discipline of its own, and covers the total spectrum ranging from health care economics, biosignal and medical image processing, model building in medicine, to information and knowledge processing in medicine. It is a program of 4.5 years duration with a strong emphasis on the methodological foundations of medical informatics and on practical education in a number of specific laboratories. Thirty-five students are admitted each semester, and in total about 390 students enrolled. The faculty consists of 17 full-time members and about 25 part-time lecturers.
Courses on Health Informatics for Professionals in Healthcare
Authors: van der KOOIJ W.
Published: February 2025

The paper describes a new four year curriculum of information technology for healthcare on higher educational level. The curriculum was developed under the “Dutch Informatics Stimulation Plan” and stimulated by a rising demand for education and training in health informatics in The Netherlands. The content of the programme is described in detail.
SANTAL - An Advanced Smart Health Card Application for France
Authors: Badiali M.H.  , Aranda A.
Published: February 2025

SANTAL is an innovative French health care project using highly secure multiapplication smart cards for the decentralized storage of the patient’s data and the secure communication between patients and health care professionals using the portable file capability of the smart card as a secure communication vehicle. The benefits of the secure communication allowed by the smart card are a simpler and more comprehensive exchange of health care information on the one side and a simplification of the administrative procedures (paperwork) on the other side. The SANTAL patient’s card contains patient’s administrative data, a portable file with patient’s medical data, a portable file with biological data, and pharmacy’s data. A very selective access to the patient’s card data is controlled by SANTAL professional cards, used by health care professionals (doctors, nurses, pharmacists, analysts) as well as administrative personnel. Each type of professional card has access to only one particular area of the patient’s card. The access rights are controlled by keys that are cryptographically secure. In order to avoid illegal use of the professional card, PIN presentation by the professional is mandatory. Special care has been taken to link the SANTAL cards to the French national health care system.
Regional Review: Italian Condition
Authors: Sicurello F.
Published: February 2025

In this paper we describe the Italian reality of the use and diffusion of Health Cards or Patient Data Cards (PDC). The computerisation of Medical Record is becoming now a necessity, and the role of a portable medical record by means of Patient Card is very important and useful to integrate the Health Information Systems. We will briefly illustrate the history and the present Italian situation on the cards applications in health care. Experiences, projects and pilot experiments will be listed. A lot of these initiatives present a lack of harmonisation and coordination aspects. The proposal is to create national and regional plans in order to increase the diffusion of the electronic data cards applications in social and health care, and, in this context, to involve the Public Administration offices, (at national, regional and local levels), the health services operators and also the companies of medical informatics sector.
Experiences with the Dental Information Card
Authors: Sillmanns H.
Published: February 2025

In recent years need for improvement of medical services and especially for medical documentation in the dental office has increased. These needs are caused due to trends and changes in the participants groups within the ‘dental care system’ in Germany to be explained in the following. On the patients’ side, reasons for the need of documentation are the increased mobility of patients not only concerning travelling but also more than 800.000 movings per year. In most of these cases no documentation of the dental status of the person is available and necessary information for a medical effective and cost-efficient dental treatment is lost. This is also the case, if paper-material documentation is lost within a long period of time and the dentists-office papers are lost. Also the needs of dentists (aspects of quality management, integration, and binding of the patient, patient information and patient involvement etc.), of suppliers and laboratories and of the insurances and health authorities, must be investigated.
Towards a Generalized Patient Card in France - The Contributive Strategy of Complementary Health Insurers
Authors: Millot R.
Published: February 2025

The principle of a generalised patient card in France was announced in 1978 for the first time at a meeting of the Board of the Caisse Nationale d’Assurance Maladie. At that time, associating complementary health insurers to this project was not really part of the program. The promoters of Vitale Card have now theoretically in mind to elaborate a system covering simultaneously compulsory and complementary health insurance. Nobody can object against this fundamental objective as regards the service of the insured as well as of the health professional. A notable approach is already noticeable owed to the good will of the concerned partners as well as to some recent recommendations of the Ministry of Social Affairs. But there is still much to be done to change minds and to build up what should be the future common tools. The objective of the following communication is to provide some guidelines concerning the present situation and its possible evolution for the middle term, from a complementary health insurer’s point of view.
The Health Information System of PANEM
Authors: Picas J.  , Vilalta J.
Published: February 2025

The aim of our communication is to introduce a project that is being developed on the information generated by 40 primary care physicians, 20 nurses, and 30 consultant specialists, these health providers cover the primary and outpatient care of a population that totals 70.000 people in the city of Barcelona.
Issues of Security and Network Security in Health Care Information Systems
Authors: Patel Ahmed  , Kantzavelou Ioanna
Published: February 2025

A Health Care Establishment (HCE) is an establishment where medical services are rendered. The above services are provided by the health care personnel. The infrastructure of a HCE may include Information Technology (IT) equipment that stores and processes HC information. Previously, IT equipment consisted solely of stand-alone systems, whereas in recent years, the trend has been towards computer networks and distributed systems in HCEs. The spread of distributed information technology in HCEs have necessitated the implementation of Security in HCISs, to assure confidentiality, integrity and availability of HCE information. This paper discusses the issues of Security and Network Security in Health Care Information Systems (HCISs). It also suggests a method in establishing Network Security Guidelines and describes Principles for the provision of Network Security in HCEs.
The Netherlands' Competent Authority Activities
Authors: de Vries Ancko
Published: February 2025

An overview of the Dutch competent authority activities and measurers in the area of medical devices directives, is presented in this paper and covers the following topics: the transposition of the directives into national legislation, the notification of manufacturers, the postmarket surveillance system and the implementation of the vigilance system.
Medical Devices Vigilance: The European Approach
Authors: Freeman Maurice F.
Published: February 2025

Post market procedures have been foreseen within the medical device directives. This in turn, led to the preparation of the guidelines on a medical device vigilance system, which is actually the establishment of a recommended procedure to deal with reported adverse incidents. The medical device vigilance system provided a most valuable service to enhance safety of medical devices in the EU. However, a number of potential problems can arise during its implementation. Proper use of the vigilance system improves the protection of health, by reducing the likelihood of repeating the same type of incident.
The European Legislation on Medical Devices
Authors: Anselmann Norbert
Published: February 2025

The protection of health and safety of patients and users, is the main objective of the comprehensive, harmonised legislation created in the EU, in the area of medical devices. In this paper, a brief description of the legislative programme is presented, giving details on the three medical device directives, as well as their transposition. A detailed analysis of the directives context follows, with the steps and actions that all involved parties have followed or need to follow to ensure their uniform application.
Finland's Competent Authority Initiatives
Authors: Pommelin Petri
Published: February 2025

Finland, as a member state of the European Union, has taken all necessary actions to implement the medical device directives. This paper presents the current situation in the area of manufacturers' registration as well as adverse incident notification. The establishment of a trans-european network between member states is strongly supported, as it could provide an efficient tool for the information exchange.
Geometric and Physical Representations for a Simulator of Hepatic Surgery
Authors: Cotin S.  , Delingette H.  , Bro-Nielsen M.  , Ayache N.  , Clément J.M.  , Tassetti V.  , Marescaux J.
Published: February 2025

Despite the large interest in simulators of minimally invasive surgery, it is still unclear to what extent simulators can achieve the task of training medical students in surgical procedures. The answer to that question is certainly linked to the realism of displays and force-feedback systems and to the level of interaction provided by the computer system.
Primary Care and Hemodialysis Monitoring through Telemedicine
Authors: Moncrief Jack W.  , Sorrels Poppy A.J.
Published: February 2025

Telemedicine offers the primary care physician an opportunity to improve time management while continuing to provide optimal, cost efficient care. The following paper offers a means with which to deliver such care and describes the relationship required between physician and patient to deliver optimal telemedical care.
A System for the Delivery of Remote Obstetrical Care by Telepresence
Authors: Brennan John P.  , Brennan Jais A.
Published: February 2025

This paper describes the development of a system to provide obstetrical care to remote and/or medically underserved areas. The ROC project is an attempt to develop new telemedicine hardware and software which will enable the provision of high quality obstetric care to individuals who are normally denied access to this care by reasons of distance, handicap, economics, or other causes. As broadband data communications links and increasingly powerful and affordable computing resources become widely available, the barriers of distance and economics will no longer prevent the provision of this care. Increased efficiency and access may also meet society’s requirements for cost containment and productivity.
Volume Rendering of Visible Human Data for an Anatomical Virtual Environment
Authors: Kerr John  , Ratiu Peter  , Sellberg Mike
Published: February 2025

In this work, we utilize the axial anatomical human male sections from the National Library of Medicine’s Visible Human Project to generate three-dimensional (3-D) volume representations of the human male subject. The two-dimensional (2-D) projection images were produced by combining ray tracing techniques with automated image segmentation routines. The resultant images provide accurate and realistic volumetric representations of the Visible Human data set which is ultimately needed in medical virtual environment simulation.
A Virtual Reality Interface to an Intelligent Dental Care System
Authors: Herder Jens  , Myszkowski Karol  , Kunii Tosiyasu L.  , Ibusuki Masumi
Published: February 2025

The design and fabrication of teeth restorations in dentistry rely increasingly on CAD/CAM techniques. We present an approach for interactive design of the occlusal surface of teeth based on simulation of jaw articulation and computer-aided diagnosis of occlusal disorders. To bridge the cognitive gap between the dentist and the computer system, we propose a virtual reality user interface, which applies the metaphors of tools and techniques known in dentistry. This makes the restoration design more intuitive for dentists. The system uses Virtual Reality Modeling Language (VRML) and HTML standards to generate a treatment report and exchange data in an electronic form.
Wideband Holographic Three-Dimensional Ultrasonic Imaging of Breast and Liver Phantoms
Authors: Sheen D.M.  , Collins H.D.  , Gribble R.P.
Published: February 2025

Wideband ultrasonic 3-D holography is a unique technique for volumetric imaging with extremely high lateral and depth resolution. The large frequency bandwidth, which is typically 25% to 100%, provides excellent depth resolution. The synthetic aperture provides optimum lateral resolution of one-half wavelength at the pulse center frequency. Wideband impulse holography is a multi-frequency detection and imaging technique where the reflected target’s broadband time waveform signals are recorded over a defined aperture. The signals are then decomposed into their discrete frequency components as single frequency holograms, combined in the spatial frequency domain, and reconstructed into a 3-D composite image. The composite image may then be viewed with stereo glasses in 3-D. Recent 3-D holographic images of human female breast and liver phantoms with internal cysts (5 to 10 mm) at 5 MHz illustrate the efficacy of this technique for medical ultrasound 3-D volumetric imaging. A video of the breast and liver phantoms may be presented at the meeting.
Distributed Medical Intelligence
Authors: Warner Dave  , Sale Jeff  , Viirre Erik
Published: February 2025

Recent trends in healthcare informatics and telemedicine indicate that systems are being developed with a primary focus on technology and business, not on the process of medicine itself. Distributed Medical Intelligence promotes the development of an integrative medical communication system which addresses the process of providing expert medical knowledge to the point of need.
Annex: Guideline for Cryptographic Mechanisms for Health Care Management
Authors: Bleumer G.
Published: February 2025

The comprehensive objective of SEISMED (a \underbar{S}ecure \underbar{E}nvironment for \underbar{I}nformation \underbar{S}ystems in \underline{MED}icine) was to elaborate a consistent, harmonized framework for medical data protection throughout Europe. The specific technical proposals of SEISMED are thus accompanied by a high level security policy which presents the underlying principles. This approach is consistent with the forthcoming European ITSEC activity.
Baseline Security Guidelines for Health Care IT and Security Personnel
Authors: Sanders P.  , Furnell S.  , Warren M.
Published: February 2025

The overall objective of the SEISMED (a Secure Environment for Information Systems in MEDicine) project was to develop a consistent, harmonised framework for the protection of medical data throughout Europe. This document presents guidelines for the security of existing European health care systems based upon work conducted by SEISMED workpackage SP07 (Security in Existing Systems).
Annex: Technical Recommendations on Cryptographic Mechanisms IT and Security Personnel
Authors: Bleumer G.
Published: February 2025

The comprehensive objective of SEISMED (a $\underbar{{\rm S}}$ecure $\underbar{{\rm E}}$nvironment for $\underbar{{\rm I}}$nformation $\underbar{{\rm S}}$ystems in $\underline{{\rm MED}}$icine) was to elaborate a consistent, harmonized framework for medical data protection throughout Europe. The specific technical proposals of SEISMED are thus accompanied by a high level security policy which presents the underlying principles. This approach is consistent with the forthcoming European ITSEC activity.
Network Security Guidelines for Health Care System Users
Authors: Patel A.  , Kantzavelou I.  , Clissman C.  , Maroulis D.
Published: February 2025

This document includes two parts. The scope of Part I is to accomplish the final set of Network Security guidelines that aim at providing a secure environment in European Health Care networking information systems. These guidelines will be used by Reference Centres to implement security mechanisms and protocols for the provision of network security in Health Care Establishments in EC member countries.
Baseline Security Guidelines for Health Care System Users
Authors: Sanders P.  , Furnell S.  , Warren M.
Published: February 2025

The overall objective of the SEISMED (a Secure Environment for Information Systems in MEDicine) project was to develop a consistent, harmonised framework for the protection of medical data throughout Europe. This document presents guidelines for the security of existing European health care systems based upon work conducted by SEISMED workpackage SP07 (Security in Existing Systems).
European Distributed Information Technology for Healthcare, Real Open Healthcare Information Systems: Now a Reality in Europe
Authors: van der Werff A  , Ferrara FM  , Mobilia G
Published: February 2025

In this document an overview is provided of the major developments and achievements in the field of distributed information technology for healthcare. This activity has been supported and co-funded by the Commission of the European Union since 1988, and concrete, generally applicable results are now available for Europe. The technology can be applied in healthcare at institutional-, local- (district-) or regional level, but in this document a restriction is made to hospitals where at this stage an urgent need exists for affordable open information systems.
A New Approach for Hypermedia Medical Records Management
Authors: Laforest F.  , Frénot S.  , Flory A.
Published: February 2025

With the advent of information society, medical systems have to use integrated new technologies such as hyperdocuments, multimedia documents : texts, images and sound. In this paper we show how we can build a new generation of medical information systems based on the functionalities given by the World-Wide Web (W3).
Modeling x-ray imaging procedures: A tool for generating learning tasks
Authors: Costaridou L.  , Papanikolaou C.  , Efstratiou C.  , Hatzis K.  , Pallikarakis N.  , Panayiotakis G.
Published: February 2025

A tool is reported in support of learning tasks pertaining to imaging procedures, defined on the basis of specific x-ray imaging apparatus. The tool assists the function of a radiographic process simulator, by allowing the definition of learning tasks, by an imaging expert, without employing of a programming language. The simulator is based on an object-oriented adaptive hypermedia model, which structures information in three layers. The tool allows the definition of learning tasks and their association to predefined machine abstraction objects. This tool allows the acquisition of procedural knowledge from an expert and its subsequent use for learning simulations sessions.
Test of EDI Prescriptions
Authors: Sørensen Svend  , Korsgaard Stig
Published: February 2025

Test of EDI-presciptions has been introduced in Denmark as a local test procedure carried out by the vendors. The test procedure is supported by a software programme called the EDI-tutor. The EDI-tutor test is followed by a pilot test. Transcription from the EDI-tutor and tables from the pilot test are sent to the EDIsecretariat for certification. The results have been a lift in the technical quality of the communication systems and a feed-back to the EDI secretariat about several semantic shortcomings.
Steps towards Integration of Knowledge Based Functions into a Hospital Information System
Authors: Bürkle T  , Prokosch H-U  , Dudeck J
Published: February 2025

This paper demonstrates a stepwise practice-oriented approach to introduce knowledge based functions into a hospital information system. The analysis of the specific architecture of the hospital information system is followed by the description how main components of the knowledge based system were mapped into this environment. Every step is exemplarily discussed on the base of a current research project performed at the medical intensive care unit of the Gießen University Hospital. One of the aims of this project is the introduction of knowledge based functions into daily routine use in an “intelligent” drug order entry program.
Aspects of Integrating a Disease Specific System into a Hospital Information System
Authors: Altmann Udo  , Katz Frank  , Tafazzoli Ali  , Haeberlin Volker  , Dudeck Joachim
Published: February 2025

During the last four years a new documentation system for tumor diseases has been developed and was implemented at 29 hospital tumor registries by the “Arbeitsgruppe zur Koordination Klinischer Krebsregister”. Although the so-called “Gießener Tumordokumentationssystem” GTDS has primarily been implemented for the use in registries, from the beginning many functions and services have been integrated to fulfil specific clinical requirements in order to support the individual treatment of oncologic patients. The physicians’ interest in a direct on-line use of such systems is increasing. Specific impediments like the registry specific user interface, the need for entering partially redundant data, and the restriction to oncologic patients stand in the way of a wide spread on-line use. Support of data exchange, graphical user interface, and availability of services which can be called from other systems are the key developments which will help to integrate GTDS into a hospital information system.
FRAME: a framework for the development of GUI-based Hospital Information System applications
Authors: Perinati L.  , Tangenti A.  , Di Cesare A.  , Cagnoni L.  , Pinna G.D.
Published: February 2025

This paper presents FRAME (FRamework for Applications in the Medical Environment), an object-oriented framework designed for the development of integrated and GUI-based applications in Hospital Information System environments. The project has given special attention both to an object-oriented approach and to the compliance with design principles and standards of Microsoft Windows, that are considered crucial steps toward the development of more reliable, consistent and integrated applications. A further purpose of the FRAME project was to build an efficient software engineering environment that improved quality and productivity during the whole software life-cycle. After a summary of the main characteristics of the development process and the description of some standards employed in designing FRAME's user interface, FRAME's architecture is described and some fundamental software components are presented.
Setting and evaluating an inter-hospital network: a user's perspective
Authors: Fay AF  , Fery-Lemonnier E  , Charpentier E  , David Ph  , Marsault Cl  , Viens-Bitker C
Published: February 2025

The Comité d'Evaluation et de Diffusion des Innovations Technologiques (CEDIT) of Assistance Publique - Hôpitaux de Paris is assessing the impact of inter-hospital image transmission on the management of neurosurgical and neuromedical emergencies. This study demonstrated that image transmission was indeed a medically acceptable way to improve the management of patients with a potential neurosurgical emergency. It also demonstrated that a simple use of everyday's informatics and telecommunication techniques could be effective in the solution of this problem.