bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability of the Assessment of Appropriateness of Diagnostic Test Request Behavior
Authors: Bindels Rianne  , Winkens Ron A.G.  , van Wersch Jan W.J.  , Pop Peter  , Hasman Arie
Published: February 2025

We describe the reliability of the assessment of the appropriateness of requested diagnostic tests. We used a retrospective random selection of 253 request forms with in total1217 requested tests. Three experts made an independent assessment of each requested test. Interrater kappa values ranged from 0.33 to 0.44. The kappa values of intrarater agreement ranged from 0.65 to 0.68. The reliability coefficient for all three reviewers was 0.66. This reliability is not sufficient to make case-by-case decisions, for example to give individual feedback on the appropriateness of requested tests. Sixteen reviewers are necessary to obtain a reference with a reliability of 0.95.
Technology as an Aid to Coping with Caring: A Usability Evaluation of a Telematics Intervention
Authors: Chambers Mary  , Connor Samantha
Published: February 2025

This paper presents evaluation data for an interactive software program designed to provide family carers with information, advice and psychological support by way of feedback of their coping capacity. The multimedia program consists of an information-based package that provides carers with advice on health promotion and relaxation and offers them a range of coping strategies (for example, positive self-talk, assertiveness training and relaxation tapes and videos). The program also includes a carer's self-assessment instrument, designed to provide both family and professional carers with information to assess how family carers are coping with their care-giving role. As part of the usability evaluation, casual users (family carers, professional carers and older people) were invited to test the program and were administered a program evaluation questionnaire measuring quality and efficiency in utility and usability. Quantitative data were analysed by using the Statistical Package for the Social Sciences (SPSS) and qualitative data were analysed by content analysis. Findings indicated that the program is visually pleasant, easily understood, responds quickly and corresponds with user expectations. A number of recommendations are made for improvement of the navigation of the program.
An Information System to Improve Financial Management, Resource Allocation and Activity Planning: Evaluation Results
Authors: Ruland Cornelia M.  , Ravn Ingrid H.
Published: February 2025

An important strategy for improving resource management and cost containment in health care is to develop information systems that assist hospital managers in financial management, resource allocation, and activity planning. A crucial part of such development is a rigorous evaluation to assess whether the system accomplishes it's intended goals.
Development of an Evaluation System and Criteria for Health Related Web Sites
Authors: Park Hyeoun-Ae  , Chung Young Chul
Published: February 2025

The purpose of this study was to develop a health-related information evaluation system to assure the quality of health information on the Internet. Literature on information control and information appraisal on the Internet was reviewed. Based on the literature review a health information evaluation system consisting of an evaluation tool that includes 8 criteria that have 32 items was developed. The validity of the tool was tested via an email survey of 15 content and informatics experts.
Suggested Principles of Professional Ethics for the Online Provision of Mental Health Services
Authors: Hsiung Robert C.
Published: February 2025

The goal of this project was to suggest principles of professional ethics for the online provision of clinical mental health services that could guide both clinicians who provide and patients who receive such services. A joint committee of the International Society for Mental Health Online (ISMHO) and the Psychiatric Society for Informatics (PSI) was formed. Discussion and development of these principles took place online. A set of principles was produced and endorsed by ISMHO on January 9, 2000, and by PSI on May 13, 2000. The principles involve informed consent (about the process, the clinician, the potential risks and benefits, safeguards, and alternatives), standard operating procedure (competence, legal requirements, the structure of the services, evaluation, multiple treatment providers, confidentiality, records, and existing guidelines), and emergencies (procedures and local backup). This project demonstrates that traditional principles of professional ethics can be extended to online services, that comprehensive ethical principles can be developed by groups that cross disciplinary and national boundaries, and that productive collaboration can take place entirely online; and suggest that online clinicians have the potential to regulate themselves.
Issues Related to Online Internet Mortality Prediction
Authors: Albert Kircher
Published: February 2025

The Medical Informatics Division and the Hearth Centre at the Linköpings University Hospital are developing the AssistMe decision and information support system. It will aid physicians and patients in questions related to cardiac surgeries. One part of the system is able to provide predictions on operative mortality and morbidity based on entered or stored medical data. Scope of this poster is to outline ethical issues interconnected with use/abuse of computerised instruments with a partial ability to replace human medical experts.
Optimal Data Entry by Patients: Effects of Interface Structure and Design
Authors: Porter Stephen C.  , Kohane Isaac S.
Published: February 2025

Direct electronic acquisition of data from patients possesses accuracy and diagnostic value. The mechanics of how best to capture historical information from patients using electronic interfaces are not well studied. We undertook an iterative usability experiment to answer 2 questions: 1) How can maximal electronic data input from a patient be achieved, and 2) Do varying structures for data entry promote differential documentation of specified data elements? Methods: A series of four trials comprised the testing cycle. Unstructured text entry, directed text entry, and closed ended questions were tested in combination against outcomes of word count, time to task completion, and user preferences. Covariates of interest included participants ‘ technologic experience and ergonomic experience with keyboards, as well as self-report of educational status, literacy, and primary language. Results: Participants clearly preferred the order of initial closed-ended questions followed by unstructured text entry, and this ordering was not associated with decrements in word count or increase in time. When compared to unstructured text entry, directed text entry provided higher documentation of data for past medical history and questions which parents wished to discuss with the clinician. A closed-end question structure, when compared to directed text entry, provided higher capture of parents' questions for discussion. Conclusions: Optimal design of an electronic interview for the capture of medical histories will benefit from a mixed structure of directed text entry and closed-ended questions. For historical or clinically relevant items where maximal capture of data is desired, a structure with closed-ended questions would be preferred.
Applying Data Mining to Detection of Adverse Drug Reactions
Authors: Koide Daisuke  , Ohe Kazuhiko
Published: February 2025

To detect adverse drug reactions (ADRs) from a hospital information system efficiently, data mining was applied to prescription and laboratory data. From several techniques, market basket analysis was done. The association of targeted drugs and tests, which appeared on the Emergency Safety Information (ESI), were easily identified. (GPT vs. Benzbromarone, and PLTD vs. Ticlopidine) Further evaluation requires determining ADRs, however, data mining has a possibility to facilitate drug safety monitoring.
Analysis of the Pragmatic Use of EPR in General Practice
Authors: Beuscart-Zéphir Marie-Catherine  , Rajanoah Bako  , Anceaux Françoise  , Beuscart Régis
Published: February 2025

Some difficulties occur during the implementation of NIT in medicine. This may be due to an incomplete knowledge about the real activities of GPs and Hospital practitioners. We assume that medical activity must be considered to be devoted to the supervision of a dynamic process, the “PATIENT”, where the role of medical actors is to maintain the process “PATIENT” within an acceptable range of values. To validate this hypothesis we analyzed EPR from two physicians. The quantitative analysis demonstrated that the activities of GPs are not devoted only to diagnosis but more to gathering information and archiving traces of decisions and action, which is compatible with our general hypothesis. New EPR and NIT will have to take this dimension into account to design more usable and acceptable applications.
New Approaches To Evaluation: Alternatives To The Randomized Controlled Trial Quantitative Models for Evaluation
Authors: Kaplan Bonnie  , Anderson James G  , Jaffe Charles  , Leonard Kevin  , Zitner David  , Ellis Nikki  , Klecun-Dabrowska Ela
Published: February 2025

New information and communication technologies being used in health care are complex and diverse. This session provides an overview of a range of newer approaches by presenting examples of evaluations that have been conducted using quantitative methods, including simulation, modified randomized controlled clinical trials, business models, and data mining.
From Paper-Based to Electronic Guidelines: Application to French Guidelines
Authors: Gillois Pierre  , Chatellier Gilles  , Jaulent Marie Christine  , Colombet Isabelle  , Fieschi Marius  , Degoulet Patrice
Published: February 2025

In order to develop an Internet-based decision support system, making available for French general practitioners several prevention guidelines is was necessary to implement paper based guideline. We propose a framework allowing to transform paper based practice guideline into their electronic form. Three different problems were identified: computability (e.g. determinism of the eCPG), logic (e.g. ambiguities when combining Booleans operators) and external validity (i.e. stability of decision for variations around thresholds and proportion of subjects classified in the various terminal nodes). The last problem concerned documentation of evidence: the level of evidence was associated only with the terminal decision node and not with the pathway through the decision tree. We concluded that computerisation of guidelines is not possible without expertise or authors advices. To improve computability it is necessary to provide authors with a framework that checks ambiguities, and logical errors.
Aggregating UMLS Semantic Types for Reducing Conceptual Complexity
Authors: McCray Alexa T.  , Burgun Anita  , Bodenreider Olivier
Published: February 2025

The conceptual complexity of a domain can make it difficult for users of information systems to comprehend and interact with the knowledge embedded in those systems. The Unified Medical Language System ® (UMLS) currently integrates over 730, 000 biomedical concepts from more than fifty biomedical vocabularies. The UMLS semantic network reduces the complexity of this construct by grouping concepts according to the semantic types that have been assigned to them. For certain purposes, however, an even smaller and coarser-grained set of semantic type groupings may be desirable. In this paper, we discuss our approach to creating such a set. We present six basic principles, and then apply those principles in aggregating the existing 134 semantic types into a set of 15 groupings. We present some of the difficulties we encountered and the consequences of the decisions we have made. We discuss some possible uses of the semantic groups, and we conclude with implications for future work.
Building a Knowledge Base to Support a Digital Library
Authors: Mendonça Eneida A.  , Cimino James J.
Published: February 2025

As part of an effort to support searching of online medical literature according to individual needs, we have studied the possibility of using the co-occurrence of MeSH terms in MEDLINE citations to automate construction of a knowledge base of interrelated concepts. This study evaluates the relevance of the relationships between the semantic pairs generated by the extraction algorithm, and the clinical validity of the semantic types involved in the process. From the semantic pairs proposed by our method, a group of clinicians judged sixty percent to be relevant. The remaining forty percent were considered unimportant by clinicians. We believe our knowledge extraction method is appropriate for the task of retrieving information from the medical record in order to guide users during a search and retrieval process. Future directions include the validation of the knowledge, based on an evaluation of system performance.
An Automated Tool for an Analysis of Compliance to Evidence-based Clinical Guidelines
Authors: Metfessel Brent A.
Published: February 2025

Evidence-based clinical guidelines have been developed in an attempt to decrease practice variation and improve patient outcomes. Although a number of studies and a few commercial products have attempted to measure guideline compliance, there still exists a strong need for an automated product that can take as input large amounts of data and create systematic and detailed profiles of compliance to evidence-based guidelines. The Guideline Compliance Assessment Tool is a product presently under development in our group that will accept as input medical and pharmacy claims data and create a guideline compliance profile that assesses provider practice patterns as compared to evidence-based standards. The system components include an episode of care grouper to standardize classifications of illnesses, an evidence-based guideline knowledge base that potentially contains information on several hundred distinct conditions, a guideline compliance scoring system that emphasizes systematic guideline variance rather than random variances, and an advanced data warehouse that would allow drilling into specific areas of interest. As provider profiling begins to shift away from a primary emphasis on cost to an emphasis on quality, automated methods for measuring guideline compliance will become important in measuring provider performance and increasing guideline usage, consequently improving the standard of care and the potential for better patient outcomes.
HONselect: Multilingual Assistant Search Engine Operated by a Concept-based Interface System to Decentralized Heterogeneous Sources
Authors: Boyer Celia  , Baujard Vincent
Published: February 2025

Any new user to the Internet will think that to retrieve the relevant document is an easy task especially with the wealth of sources available on this medium, but this is not the case. Even experienced users have difficulty formulating the right query for making the most of a search tool in order to efficiently obtain an accurate result. The goal of this work is to reduce the time and the energy necessary in searching and locating medical and health information. To reach this goal we have developed HONselect [1]. The aim of HONselect is not only to improve efficiency in retrieving documents but to respond to an increased need for obtaining a selection of relevant and accurate documents from a breadth of various knowledge databases including scientific bibliographical references, clinical trials, daily news, multimedia illustrations, conferences, forum, Web sites, clinical cases, and others. The authors based their approach on the knowledge representation using the National Library of Medicine's Medical Subject Headings (NLM, MeSH) vocabulary and classification [2,3] . The innovation is to propose a multilingual “one-stop searching” (one Web interface to databases currently in English, French and German) with full navigational and connectivity capabilities. The user may choose from a given selection of related terms the one that best suit his search, navigate in the term's hierarchical tree, and access directly to a selection of documents from high quality knowledge suppliers such as the MEDLINE database, the NLM's ClinicalTrials.gov server, the NewsPage's daily news, the HON's media gallery, conference listings and MedHunt's Web sites [4, 5, 6, 7, 8, 9]. HONselect, developed by HON, a non-profit organisation [10], is a free online available multilingual tool based on the MeSH thesaurus to index, select, retrieve and display accurate, up to date, high-level and quality documents.
Characterization of Heart Atrial Fibrillation: Proposal for a Deterministic Model
Authors: Glace Christian  , Haton Jean-Paul  , Stoltz Jean-François  , Kohler François
Published: February 2025

Atrial Fibrillation (AFib) has been shown (e.g. Framingham Study) to increase stroke risk and to induce low cardiac output in patients. It is generally accepted that the mechanism of Atrial Fibrillation is reentry. In order to ease the study of AFib’s, we propose a deterministic model that could be used in the characterization cardiac signals. The model is based on a linear combination of several “Atrial Flutter”-like signals. We therefore obtained AFiblike aspects. To demonstrate its usefulness we performed a power spectrum transform (i.e. scalar Fast Fourier Transform) of this model. As a result we found that this transform could not be used as is, could lead to errors in the interpretation of results. We expect that this model will help us to evaluate the relevance of mathematical transforms. This may lead to new findings in the classification of AFib, as well as to improvements in patients treatment, follow-up and survival.
A Comprehensive Computerized Critical Laboratory Results Alerting System for Ambulatory and Hospitalized Patients
Authors: Iordache Sorin Daniel  , Orso David  , Zelingher Julian
Published: February 2025

Automatic alerting systems for key events in medical practice have been proven effective in improving the clinician’s response to the event. Most of the systems described in current literature are hospital based, some in intensive care units.
A Design and Prototype for a Decision-Support System in the Field of Urinary Tract Infections – Application of OpenGALEN Techniques for Indexing Medical Information
Authors: Karlsson Daniel
Published: February 2025

Differences in expert and end-user contexts may be detrimental to the use of decision-support systems. A way to attend to this problem is to triangulate decision-support methods and information sources such as in the case of the expertext system model. To organize the information contained in the system, a common domain model is suggested as a instrument for annotating information. In this paper, a design and a prototype for a decision-support system in the field of urinary tract infections using techniques and methods developed in the GALEN projects is presented.
Survival and Viral Load in Four Groups of HIV-1 Infected Hemophiliacs Compared by Three-way Data Clustering
Authors: Tatsunami Shinobu  , Kuwabara Rie  , Hiroi Tomoko  , Matsui Hiroaki  , Fukutake Katsuyuki  , Mimaya Junichi  , Yamada Kaneo  , Sato Mika
Published: February 2025

We assigned a total of 131 hemophiliacs infected with HIV- 1 into four clusters by applying a 3-way data analysis method. Sequentially acquired CD4+ and CD8+ cell counts obtained longitudinally over an observation period from 1986 to 1992 were analyzed. During the successive observation in this interval, a clustering of patients is not always coincident over all the times, because the cell counts vary with time. Therefore, the 3-way data clustering is to obtain the optimal result of the classification of patients through all the interval of observation. Examining patients' survival after that period, the cumulative mortality rate was highest among the 36 hemophiliacs in Cluster 1. Less mortality was found in Cluster 2, consisting of 49 hemophiliacs and none was reported in Clusters 3 and 4, which included 33 and 13 hemophiliacs, respectively. However, a significantly lower blood viral copy number was found in Cluster 3 than in Cluster 4. A total of six long-term non-progressors was found, five in Cluster 3 and one in Cluster 4, while none was found in Cluster 1 or 2. As demonstrated in this analysis, 3-way data clustering may represent a good data mining technique for handling various types of clinical data.
End-user Support: A Necessary Issue in the Implementation and Use of EPR Systems
Authors: Bygholm Ann
Published: February 2025

A successful integration of an IT-system is dependent not only of the quality of the information and the user interface features of the system but also of the organizations ability to support the users learning process. As IT is becoming more and more pervasive in the Health Care sector as such there is a need for a systematic approach to the question on how to support end-users. Based on an empirical study of an implementation process in a Danish Primary Health Care Services the concept of end-user support is discussed and it is argued that there is a need for a distinction between different kinds of support depending of the type of activity involved. First the organizations strategy for learning when the system was implemented is described. The evaluation of the learning strategy revealed that there was a need for different kinds of knowledge involving qualitatively different kinds of learning. Second the area of end-user support is discussed and it is argued that the common understanding of end-user support as something provided by DP staff vendors or manuals are to narrow. Third a more differentiated way of thinking of support that link the need for different kind of knowledge and learning processes to different kinds of support is proposed. Finally Activity Theory is put forward as a possible basis that provide the opportunity of discussing issues belonging to different kinds of end-user support within an integrated framework.
Paragraph-oriented Structure for Narratives in Medical Documentation
Authors: Lovis Christian  , Baud Robert H  , Revillard Claude  , Pult Laura  , Borst François  , Geissbuhler Antoine
Published: February 2025

The authors present a 6 years experiment using a document-centered electronic patient record, based on a central document repository. The document management system is paragraph oriented and all documents are built automatically before editing using predefined ordered sets of paragraphs. Paragraphs can be preloaded with templates, text or images. Once edited, signed and printed, documents are again decomposed in paragraphs and permanently stored. This system, though the compositional aspect of paragraphs is limited and their semantic content wide, offers numerous advantages. The typology is easy to build and to maintain, it has been implemented widely in our hospitals without need for any natural language processing techniques and is used daily within commercially available text editors. The actual state of the system is discussed, emphasizing the structure of the documents, the various attributes and properties that have been needed in order to meet user’s needs.
Shared Experience in 13 Local Danish EPR Projects: The Danish EPR Observatory
Authors: Nøhr Christian  , Kristensen Margit  , Andersen Stig Kjær  , Vingtoft Søren  , Lippert Søren  , Bernstein Knut  , Bruun-Rasmussen Morten
Published: February 2025

In 1996 a national strategy for the development of electronic patient records (EPR) for the Danish hospitals and primary care was launched. An element in the strategy was to support a number of regional EPR development projects. The EPR-Observatory has in the two recent years collected data from the regional projects, dealing with the expectations in four areas: 1) Impact on organisational issues, 2) Benefits of EPR, 3) Integration of EPR with other information systems and 4) security aspects of EPR.
Electronic Commerce in the Health Sector Applying the National Smartcard System
Authors: Marcun Tomaz  , Groznik Ana  , Mursa Martin  , Suselj Marjan
Published: February 2025

Since autumn 1999 to summer 2000, Slovenia introduced its health insurance card at the national scale, with a highly affirmative acceptance among both providers and beneficiaries of health care services. The card has provided technological and data infrastructure for a national level management of the health sector and expansion of electronic commerce in the medical field.
Use of Handheld Computers as Bedside Information Providers
Authors: Tschopp Mathias  , Geissbuhler Antoine
Published: February 2025

Access to clinical reference information at the point-of-care is a goal that is difficult to achieve by lack of really portable reference material. Handheld computers have matured to the point where they are powerful enough to be used as clients of a distributed knowledge system serving reference information and decision-aid applications in a highly portable form factor. We describe a pilot project launched at the Geneva University Hospital studying the use of handhelds and associated clinical applications in two internal medicine clinics. Results garnered by this study will help answer the many questions raised by the use of handhelds in medical practice, in term of cost, benefits, risk and change in workflow.
IP Videoconferencing using a Quality of Service Public Network
Authors: Crudele Michele  , Cinque Giuseppe  , Neglia Giovanni  , Razzicchia Giuliano  , Venditti Marco
Published: February 2025

Videoconferencing in the medical world has been successfully used for quite a few years. Nevertheless it has not spread significantly in daily use. Some of the problems rely on the infrastructure needed to set up a video session: one or more ISDN lines or a fast Internet connection. The first is not easily available everywhere in a building; the latter is rarely so fast to allow for a smooth operation with no quality drops. The use of Videonet, the first European commercial public Internet link with guaranteed Quality of Service (QoS), has the potential to be a breakthrough in videoconferencing. We describe this new system and its applications, with the first tests in a hospital environment. Our results show that there are still problems to be solved in order to achieve a quality comparable to ISDN.
PACS Linked to EPR
Authors: Kondoh Hiroshi  , Takeda Hiroshi  , Matsumura Yasushi  , Kuwata Shigeki  , Yoshimura Hideaki  , Narumi Yoshifumi  , Nakamura Hironobu  , Okura Yasuhiko  , Inamura Kiyonari  , Washiashi Takeshi  , Okada Shinichi
Published: February 2025

We developed a new PACS linked to Electronic Patient Record system (EPR). It was a hospital-wide PACS storing all the radiological examinations. The images and reports were linked on EPR. The concept of navigation servers and segment servers was introduced for prefetchig and quick displaying. After the start of operation, increasing retrieval indicated its effectiveness on practical work in spite of remaining delivery of radiographs.
The Creation of an Ontology of Clinical Document Names
Authors: Frazier Pavla  , Rossi-Mori Angelo  , Dolin Robert H.  , Alschuler Liora  , Huff Stanley M.
Published: February 2025

The efficient use of documents from heterogeneous computer systems is hampered by differences in documentnaming practices across organizations. Using an openconsensus method, the Document Ontology Task Force’, with support from the Veterans Health Administration, addressed this pervasive problem by developing a clinical document ontology. Based on the analysis of over 2000 clinical document names, the ontology was used to formulate a terminology model which is currently being used to guide the creation of fully-specified document names in LOINC (Logical Observations, Identifiers, Names & Codes). Incorporation into LOINC will enable homogenous management of documents in a widely distributed environment and will also give rise to a rich polyhierarchy of document names.
Protein Structural Domain Parsing by Consensus Reasoning over Multiple Knowledge Sources and Methods
Authors: Kulikowski Casimir A.  , Muchnik Ilya  , Yun HwaSeob J.  , Dayanik Aynur A.  , Zhang Deyou  , Song Yueyue  , Montelione Gaetano T.
Published: February 2025

Domain parsing, or the detection of signals of protein structural domains from sequence data, is a complex and difficult problem. If carried out reliably it would be a powerful interpretive and predictive tool for genomic and proteomic studies. We report on a novel approach to domain parsing using consensus techniques based on Hidden Markov Models (HMMs) and BLAST searches built from a training set of 1471 continuous structural domains from the Dali Domain Dictionary (DDD). Validation on an independent test sample of family-matched structural domain sequences from the Scop database yields a consensus prediction performance rate of 75.5%, well above the 58% obtained by simple agreement of methods.
Virtual Reality System using Force Feedback Device for Molecular Modeling
Authors: Mizushima Hiroshi  , Nagata Hiroshi  , Tanaka Eriko  , Hatsuta Masaaki  , Tanaka Hiroshi
Published: February 2025

We designed two new concept of computer aided molecular modeling system using virtual reality technologies. Although it is still a prototype, the most characteristic function of the system is enabling its user to “touch” and feel the electrostatic potential field of a protein or a drug molecule. User can scan surface of a protein using a globular probe, which is given an electrostatic charge, controlled by a force feedback devise. The electrostatic force between the protein and the probe is calculated in real time, and immediately fed back into the force feedback device. The user can easily search interactively for positions where the probe is strongly attracted to the force field. Such positions can be regarded as candidate sites where small chemical groups corresponding to the probe, functional parts of lead compounds, can bind to the target protein. We also developed a binding simulator which we can bind a small molecule (drug) to a large molecule (protein). In this system, we placed a camera, so that we can not only “feel” but also “see” how drug fits into the binding site. Our prototype system has the potential to serve as a new application method as well as being applicable to conventional VR technologies, especially to force feedback technologies.
Creating a statistical atlas of the cranium
Authors: Däuber Sascha  , Krempien R.  , Krätz Michael  , Welzel Thomas  , Wörn Heinz
Published: February 2025

Normative data is very important for simulation procedures in craniofacial surgery [1]. While treating e.g. a malformed skull the surgeon seeks to reconstruct its natural and harmonic shape. Atlas or normative data of the skull could support the surgeon in this effort [2], as it would provide a standard model of the skull which gives an idea of the natural shape. We create a standard skull by averaging regularly formed skulls in a shape space spanned by spherical harmonics. While state-of-the-art methods use landmarks to define the shape and mean shapes [4,5,6,14], this method is deterministic, i.e. it manages averaging without landmarks and it provides a complete description of the shape. In addition the shape space can be used to classify shapes to identify different types of an anatomy.
Mastoidectomy Simulation with Combined Visual and Haptic Feedback
Authors: Agus Marco  , Giachetti Andrea  , Gobbetti Enrico  , Zanetti Gianluigi  , Zorcolo Antonio  , John Nigel W.  , Stone Robert J.
Published: February 2025

Mastoidectomy is one of the most common surgical procedures relating to the petrous bone. In this paper we describe our preliminary results in the realization of a virtual reality mastoidectomy simulator. Our system is designed to work on patient-specific volumetric object models directly derived from 3D, CT and MRI images. The paper summarizes the detailed task analysis performed in order to define the system requirements, introduces the architecture of the prototype simulator, and discusses the initial feedback received from selected end users.
Tele-Immersive Medical Educational Environment
Authors: Ai Zhuming  , Dech Fred  , Silverstein Jonathan  , Rasmussen Mary
Published: February 2025

By combining teleconferencing, tele-presence, and Virtual Reality, the Tele-Immersive environment enables master surgeons to teach residents in remote locations. The design and implementation of a Tele-Immersive medical educational environment, Teledu, is presented in this paper. Teledu defines a set of Tele-Immersive user interfaces for medical education. In addition, an Application Programming Interface (API) is provided so that developers can easily develop different applications with different requirements in this environment. With the help of this API, programmers only need to design a plug-in to load their application specific data set. The plug-in is an object-oriented data set loader. Methods for rendering, handling, and interacting with the data set for each application can be programmed in the plug-in. The environment has a teacher mode and a student mode. The teacher and the students can interact with the same medical models, point, gesture, converse, and see each other.
Shared Virtual Environments for Telerehabilitation
Authors: Popescu George V.  , Burdea Grigore  , Boian Rares
Published: February 2025

Current VR telerehabilitation systems use offline remote monitoring from the clinic and patient-therapist videoconferencing. Such “store and forward” and video-based systems cannot implement medical services involving patient therapist direct interaction. Real-time telerehabilitation applications (including remote therapy) can be developed using a shared Virtual Environment (VE) architecture. We developed a two-user shared VE for hand telerehabilitation. Each site has a telerehabilitation workstation with a videocamera and a Rutgers Master II (RMII) force feedback glove. Each user can control a virtual hand and interact hapticly with virtual objects. Simulated physical interactions between therapist and patient are implemented using hand force feedback. The therapist’s graphic interface contains several virtual panels, which allow control over the rehabilitation process. These controls start a videoconferencing session, collect patient data, or apply therapy. Several experimental telerehabilitation scenarios were successfully tested on a LAN. A Webbased approach to “real-time” patient telemonitoring - the monitoring portal for hand telerehabilitation – was also developed. The therapist interface is implemented as a Java3D applet that monitors patient hand movement. The monitoring portal gives real-time performance on off-the-shelf desktop workstations.
A New Approach for the Synthesis of Glistening Effect in Deformable Anatomical Objects Displayed with Haptic Feedback
Authors: Prakash C.E.  , Kim Jung  , Manivannan M.  , Srinivasan M.A.
Published: February 2025

An environment mapping approach for texture mapping of anatomical objects with glistening was studied and implemented in surgical simulation. A classifier based on the generalized goal of achieving glistening effect, which depends on the underlying physics and the mapped data, was used as a visual metric and shown to be realistic in the presence of achieving the desired quality in real time in the presence of haptic feedback. The proposed approach was compared with the standard texture mapping approaches used in existing surgical simulation methods that generally suffer from texture stretching and with little or no glistening effect. In our work, we have successfully applied environment mapping techniques for realistic real-time rendering of anatomical objects. We also show several examples of anatomical objects with glistening effects that mimic real anatomical objects.
FIRST CLINICAL TRIALS FOR NEUROMOTOR ANALYSIS
Authors: Rovetta A.  , Antonini A.  , Pignatelli F.  , Ragone V.A.
Published: February 2025

This paper deals with a first test model of DAPHNE system, called DDX, which may measure the reaction time, the velocity of a finger, the force exerted on a button, the tremor of the person, and also the time delay on pronouncing a word which appears in the screen of the display. The system is made by a button and a spring, with sensors which detect all the parameters. Tests on healthy and unhealthy people have been performed to check the validity of the instrument and the possibility to use the results in diagnosis and in therapy.
A new approach for modelling kinematic dependencies for monitoring locations of objects in closed kinematic chains (Part 2)
Authors: Stien Malte  , Hein Andreas  , Szymanski Daniel  , Lueth Tim
Published: February 2025

Location monitoring systems for surgical applications are getting more and more common in clinical daily life. Navigation treatment systems are also a form of a location monitoring system. These systems always consist of an optical, US-, electromagnetic or mechanical navigation system. If two or more navigation systems are combined or one navigations system is combined with a robot system the kinematic model of the entire system consists of closed kinematic loops. In this paper, an approach is presented to gain more information from the closed kinematic chains instead of breaking the kinematic loops. This is the second part of [1].
Measurement of In-vivo Force Response of Intra-abdominal Soft Tissues for Surgical Simulation
Authors: Tay B.K.  , Stylopoulos N.  , De S.  , Rattner D.W.  , Srinivasan M.A.
Published: February 2025

The lack of data on in-vivo material properties of soft tissues has been a significant impediment in the development of virtual reality based surgical simulators that can provide the user with realistic visual and haptic feedback. As a first step towards characterizing the mechanical behavior of organs, this work presents in-vivo force response of the liver and lower esophagus of pigs when subjected to ramp and hold, and sinusoidal indentations delivered using a haptic feedback device, Phantom, employed as a mechanical stimulator. The results show that pulse significantly affects the reaction forces and that the lower esophagus is 2 to 2.5 times stiffer than the liver.
Estimation of Soft-Tissue Model Parameters Using Registered Pre- and Postoperative Facial Surface Scans
Authors: Teschner Matthias  , Girod Sabine
Published: February 2025

Computer–based techniques for the simulation of craniofacial surgical procedures and for the prediction of the surgical outcome have been shown to be very useful. However, the assessment of the accuracy of the simulated surgical outcome is difficult. In this paper, a technique is described which allows to compare the simulated surgical outcome and the actual surgical result. The simulated postoperative patient’s appearance is compared to a second surface scan which is obtained postoperatively. The pre- and postoperative surface scans, which are different due to the surgery, are registered employing a robust registration method which minimizes distances of corresponding points. Parameters of the soft–tissue model can be adapted with respect to minimized differences of corresponding points of the simulated postoperative and the actual postoperative surface of a patient’s face.
Moore's Law, Disruptive Technologies, and the Clinician
Authors: Vosburgh Kirby G.  , Newbower Ronald S.
Published: February 2025

The advancement of technical power described by Moore’s Law offers great potential for enabling more cost-effective medical devices and systems. However, progress has been slow. Many factors for this failure have been cited, including the anti-rational economic structure of healthcare and the complexity and long time scale of medical development. Christensen et al. suggest that “disruptive technologies” may circumvent some of these difficulties. “Disruptive Technologies” are defined as those that are established in one market, but then penetrate and overwhelm another market. These incursions are accelerated by economic factors, and capitalize on functionality, reliability, and advancements supported by the original market. Christensen has cited many examples from industrial and service businesses, but few examples can be found yet in healthcare.
Sharing clinical information. Principles and task-oriented solutions
Authors: Mori Angelo Rossi  , Consorti Fabrizio  , Ricci Fabrizio L.
Published: February 2025

Increasing cooperation among health professionals — within and across organizations — require a suitable sharing of clinical information from heterogeneous (electronic) documentation. Information originates from healthcare activities and may be organized within record systems in relation to health issues, episodes of care, episodes of illness, etc. Implementation of record systems depends on tasks and attitudes within each particular healthcare environment, that determine (i) the balance among functions of the record system, e.g. supporting human memory and decision making, supporting workflow management, recording circumstances about stored data, (ii) the particular organization of a record, (iii) the details of clinical statements that should be explicit or understood.
User Friendly Computer Profilormetry
Authors: Kozlowski Janusz  , Merolli Antonio  , Monni Gianstefano
Published: February 2025

Portable optical profilometer for measurement and analysis of the human back shape has been developed. The driving user friendly software includes correction of distortion of the observation lens, data calibration, three-dimensional Z-axis rotation of the patient normalizing his position, calculus of the curvature map (second derivative), and precise indication of different characteristic points of the back including the spinous processes line. This instrument enables the examination of the back in both erected and bent positions.
Evaluation of the Efficiency of Patient Stabilization Devices for 3D X-ray Reconstruction of the Spine and Rib Cage
Authors: Bellefleur C.  , Dansereau  , Koller A.  , Labelle H.
Published: February 2025

Four devices designed to stabilize the patient’s position and/or posture between X-ray exposures were investigated in order to obtain accurate 3-D reconstruction of their spine: a pelvis support, two elbow supports with handlebars, a back neck contact system and a device with three divergent laser beams pointing on subject body targets. Stability and the bearing of natural posture on a group of 10 adults without scoliosis was evaluated for the different devices using a statistical experimental design (Plackett-Burman plan of resolution IV). Small displacements of subjects were obtained by an Optotrak system with 11 infrared diodes placed on the subject’s back. Results showed that the elbow supports with handlebars and pelvis support improved the subject’s stability while the pelvis support was the device that produces more changes in the subject’s natural posture. The elbow and back neck supports were retained for further evaluation.
Correlation Study between Indices Describing the Scoliotic Spine
Authors: Godillon Maquinghen A.P.  , Ouverlot V.  , Aubin C.E.  , Villemure I.  , Labelle H.
Published: February 2025

This study intended to investigate the correlations between different geometrical indices in order to assess their usefulness in the characterization of scoliotic deformities. Analytical evaluation of indices was obtained from 3D reconstruction of vertebrae. Scoliotic indices included the Cobb angle, the Cobb angle in the plane of maximum curvature, the angular orientation of the plane of maximum curvature, the kyphosis and the maximal axial rotation. This analysis was applied to the thoracic curve of 100 scoliotic adolescents. The correlations between these five indices were separately investigated for the RT and RTLL curve types. A statistical correlation was found between the angular orientation of the plane of maximum curvature and the kyphosis. The results indicate a relative independence between most indices. Hence, an evaluation of several complementary indices is required to provide a more complete description of 3D scoliotic deformities.
Three-dimensional Action of Chêneau Brace on Thoracolumbar Scoliosis
Authors: Kotwicki Tomasz  , Pietrzak Szymon  , Szulc Andrzej
Published: February 2025

We treated 18 girls for idiopathic thoracolumbar scoliosis with Chêneau brace. The apex of the curve was at Th 12 or at LI or at the disc Thl2/Ll. The initial Cobb angle varied from 21 to 42 degrees, mean 28. The follow up period was of 2 years and 6 months on the average. We noted the rib hump height on Adams' forward bending test. We measured Cobb angle, apical vertebra transposition and apical vertebra rotation (according to Perdriolle method) on antero-posterior standing radiograms before the treatment had started and at the moment of the best correction. We digitized antero-posterior and lateral standing radiograms with sonic digitizer GP-9 and we prepared computed reconstruction of the transversal plane of the spine with Hecquet and Grafs software RACHIS 91TM. The best clinical and radiological correction was achieved after 3 to 8 months of treatment (mean 5,5 months). We considered it as the fitting period and we analysed the correction achieved at that moment and at last follow-up. Cobb angle in brace ranged from 0 to 18 degrees, mean 9 degrees. The correction of apical vertebra transposition ranged from 51 % to 100%, mean 80%. The correction of apical vertebra rotation ranged from 0% to 100%, mean 52%. The correction of rib hump ranged from 0 to 100%, mean 42%. Normal sagittal contour was established in 15 patients. Conclusion: important correction was present in each of the three planes.
Rotation of the Atlantico-Axial Joint, Investigated Using CT and MRI
Authors: Dangerfield Peter H.  , Roche Clare J.  , King Susan E.  , CARTY Helen M.  , Dorgan John C.
Published: February 2025

The vertebral column is composed of a series of joints, each capable of a specific range of movement. To investigate these movements, a study into the physiological range of rotation at the atlanto-axial joint has been undertaken. The movements and their interpretation under imaging conditions are crucial if any underlying spinal deformity or the consequences of trauma are present in an individual. 28 healthy volunteers were examined using dynamic Magnetic Resonance Imaging with maximum head rotation to the right and left sides in turn. An anatomical specimen of the atlanto- occipital joint was imaged using Computed Tomography with the specimen fixed in varying degrees of rotation. The results indicate that there is a significant but incomplete loss of contact between the articular surfaces of CI (atlas) and C2 (axis). The range of motion to the right was between 20 and 48.5 degrees (mean 32.4 degrees) and to the left was between 13 and 52.75 degrees (mean 3.2 degrees). Statistical significance between left and right movement was not demonstrated. The instantaneous axis of rotation was examined for the joint and was found to be located within the odontoid peg (dens). These findings indicated that a wide range of movement occurs within the atlanto-axial joint in normal subjects. Furthermore, the appearances under imaging could be misinterpreted as a pathological subluxation. This has implications if the subject with a spinal deformity also has a dysplasia associated with a potential subluxation. The siting of the instantaneous axis of rotation within the odontoid is also important in furthering the understanding of the movement of this joint.
Examination of Relative Movement between the Back and Lower Limb
Authors: Chockalingam Nachiappan  , Dangerfield Peter H.  , Giakas Giannis  , Dorgan John  , Cochrane Tom
Published: February 2025

The importance of trunk movement in human gait has been established by many studies. However, these investigations have examined trunk/pelvis motion or the pelvic/thoracic motion in isolation to lower limb kinematics. Studies quantifying spinal deformities and the range of spinal and trunkal movement have concentrated on spinal/back movement, with the subject performing tasks, such as flexion, while maintaining a static position. There is also a paucity of data detailing the real relative motion between the back and lower limb during gait, an important consideration when testing the Nottingham ‘flag-pole’hypothesis for spinal curvature generation.