Peeter Ross

Understanding drug uptake and binding within targeted disease micro-environments in patients: a new tool for translational medicine.

BackgroundFor many common global diseases, such as cancer, diabetes, neurodegenerative and cardiovascular diseases there is an unmet need for diagnosing early indications of disease that could enable medical intervention and early treatment. The treatment of these diseases will require detailed knowledge of targeted pathways involved in disease pathogenesis but also the mode of drug actions at the biological location on these targets. Translational medicine is a new area of research where expert from different disciplines involved in basic science and clinical disciplines meet and join forces. Mode-of-drug-action mechanisms elucidation is key in the characterization of drugs that can relate to both efficacy and safety.MethodsMatrix assisted laser desorption/ionization mass spectrometry imaging (MALDI-MSI) was used providing evidence into the fate (destinations and distributions) of administered drugs within tumor regions of lung compartments.ResultsWe hereby present a pulmonary study in which we have isolated lung tissue after inhaled drug administration and then localized the drug within airway wall compartments. The histology also provides evidence of drug binding to smooth muscle cell microenvironments. We also identified lung tissue regions with tumor cell invasion in these COPD patients.ConclusionsThe ultimate goal is to identify bridging comprehension that forms a knowledge base that can be used by society to develop a better treatment and medicine for patients. Our results demonstrated that robust imaging data could be generated confirming drug localization in pulmonary regions of COPD patients with tumor pathology.Trial registrationTallinn Medical Research Ethical Committee decision #1724, 18.06.2009

Pervasive Access to Images and Data—The Use of Computing Grids and Mobile/Wireless Devices Across Healthcare Enterprises

Emerging technologies are transforming the workflows in healthcare enterprises. Computing grids and handheld mobile/wireless devices are providing clinicians with enterprise-wide access to all patient data and analysis tools on a pervasive basis. In this paper, emerging technologies are presented that provide computing grids and streaming-based access to image and data management functions, and system architectures that enable pervasive computing on a cost-effective basis. Finally, the implications of such technologies are investigated regarding the positive impacts on clinical workflows

Low cost anatomically realistic renal biopsy phantoms for interventional radiology trainees

This paper describes manufacturing of economically affordable renal biopsy phantoms for radiology residents and practicing radiologists. We reconstructed a realistic 3-dimensional patient-specific kidney model from CT data, manufactured an organ mould and casted the kidney phantoms. Using gelatin gel materials with calibrated parameters allowed making phantoms with realistic mechanical, ultrasound and CT properties including various pathologies. The organ phantoms with cysts included were further casted into gelatin gel medium. They were validated by radiology residents in biopsy training and compared against self-made phantoms traditionally used in the curriculum of interventional radiology. The realism, durability, price and suitability for training were evaluated. The results showed that our phantoms are more realistic and easier to use than the traditional ones. Our proposed technology allows creating a low-cost (50

Nationwide Health Data Management System: a novel approach for integrating biomarker measurements with comprehensive health records in large populations studies.

/kg) alternative to the pricy commercial training phantoms available today.

Images crossing borders: image and workflow sharing on multiple levels

The nation-wide electronic health record database acts as an interoperable repository of health data obtained throughout citizen contacts with health care providers. This system improves accessibility for citizens and researchers to health data with the ability to assign context to disease development. In that system, individual patients who are members of the large population-based health database can be assessed as individuals or as a population in prospective studies of prospective diseases.

An evaluation of e-prescribing at a national level

Digitalisation of medical data makes it possible to share images and workflows between related parties. In addition to linear data flow where healthcare professionals or patients are the information carriers, a new type of matrix of many-to-many connections is emerging. Implementation of shared workflow brings challenges of interoperability and legal clarity. Sharing images or workflows can be implemented on different levels with different challenges: inside the organisation, between organisations, across country borders, or between healthcare institutions and citizens. Interoperability issues vary according to the level of sharing and are either technical or semantic, including language. Legal uncertainty increases when crossing national borders. Teleradiology is regulated by multiple European Union (EU) directives and legal documents, which makes interpretation of the legal system complex. To achieve wider use of eHealth and teleradiology several strategic documents were published recently by the EU. Despite EU activities, responsibility for organising, providing and funding healthcare systems remains with the Member States. Therefore, the implementation of new solutions requires strong co-operation between radiologists, societies of radiology, healthcare administrators, politicians and relevant EU authorities. The aim of this article is to describe different dimensions of image and workflow sharing and to analyse legal acts concerning teleradiology in the EU.

A comparative study of ultrasound image segmentation algorithms for segmenting kidney tumors

Objective: The aim of the article is to describe the process of implementing the Estonian national second generation electronic prescription service (e-prescription) and determine if the objectives set by the Estonian government were fulfilled. Materials and methods: The study presents an analysis of both retrospective and current data in the evaluation phase of a design research project. Sources include, among others, publicly available documents and previous evaluation studies. Results: According to all of the major stakeholders, the Estonian e-prescription service has very high usability and user satisfaction scores have been high. There is only little empirical evidence available to confirm if the benefits aimed for in the creation of the service were achieved. From a public administration viewpoint, the implementation of e-prescription has led to potential efficiency gains. Conclusion: The Estonian second-generation e-prescription system is widely used by citizens, healthcare providers and administrators alike. However, there are gaps in measuring the impact of the service, especially with respect to time savings and enhanced healthcare quality. Additional functionalities will be key drivers in creating benefits for all stakeholders. Future nationwide e-health services should have a more rigorous evaluation process carried out during the design and implementation stages.

Economically affordable anatomical kidney phantom with calyxes for puncture and drainage training in interventional urology and radiology

In this paper we introduce an ultrasound image segmentation evaluation framework for kidney tumor. Ultrasound image segmentation algorithms can be divided into edge based, region based, texture based, active contour and model base technique. We tested the performance of algorithms in each category using a kidney phantom and kidney cyst ultrasound image. We found that the algorithms we implemented are more suitable for relatively homogeneous kidney tumors. For more heterogeneous tumors we should use more complicated segmentation techniques and some of these advanced techniques are discussed in this paper.

Shielding static magnetic fields from Magnetic Resonance Imaging units by ferromagnetic material

Background Trends in interventional radiology and urology training are orientated towards reducing costs and increasing efficiency. In order to comply with the trends, we propose training on inexpensive patient-specific kidney phantoms. Purpose To develop a new kidney phantom for puncture and drainage training in interventional urology and radiology, and to evaluate their anatomical correctness and suitability for training compared to the traditional way of training on home-made phantoms. Material and Methods A case study for validation of kidney phantoms was conducted with nine radiology students divided into two groups: one trained on standard home-made training phantom (n = 4) and the other on our kidney phantoms (n = 5). Another test phantom was used to evaluate the effectiveness of the training of the two groups. The tests were video recorded and analyzed. Duration of the procedure was used as the primary indicator of procedure’s quality. Comparison tests were also conducted with professional radiologists. Anatomical correctness of the kidney phantom was evaluated by comparing the post mortem kidney scans with reconstructed models from CT scans. Subjective feedback was also collected from the participants. Wider use of kidney phantoms was analyzed. Results The average volumetric difference between post mortem kidney scans and reconstructed CT kidney models was 4.70 ± 3.25%. All five students practicing on the kidney phantom improved their performance and the results were almost equal to the results of the professional radiologist while in the other group two students out of four trained on standard home-made training phantoms failed to improve their performance. However, the small number of test subjects prevents us from drawing general conclusions about the efficiency of the new practice. The kidney phantoms were found usable also for nephrostomy catheter placement training under fluoroscopy. Conclusion The feedback from radiologists showed that the anatomically correct features of the phantom is an added value for the training and has a potential to increase the quality of minimally invasive procedures in general.

Eesti terviseinfosüsteemi majandusmõju/puhastulu hindamine. TOF-DIGIMÕJU projekti lõpparuanne

This study investigated the effectiveness of iron sheets in shielding static magnetic fields from MRI units. The neighbouring rooms of two 3T MRI units were measured, located in different healthcare facilities, one fully shielded and the other only partially shielded (only the ceiling was shielded) from static magnetic fields. In order to achieve a significant shielding effectiveness from the MRI static magnetic field, the examination room should be fully shielded, including the walls, ceiling and the floor. The MRI unit with only partially shielded room allowed ten times more static magnetic field to propagate into the premises one floor below. The average static magnetic field below partially shielded MRI unit was 1.178 mT, whereas below fully shielded MRI unit 0.176 mT.