Stefan Rakowsky

Interactive telemedicine in the operating theatre of the future

An experimental stereoscopic system has been established in the Robert-Rössle-Klinik, including four operating theatres and the surgical research unit OP 2000. The system allows local three-dimensional image acquisition, local stereoscopic video display, in-house stereoscopic video transmission and stereoscopic links to external partners. The goal is to make high-quality patient data available in a medical centre or over a collaborative network of medical experts. In future the requirements of teleconsultation in terms of image quality and bandwidth will be heterogeneous. A sophisticated medical telecommunication system for second opinions is needed that can take advantage of intelligent compression approaches (e.g. wavelet compression) to archive, to search for image content and to transmit medical data such as images.

GALENOS as interactive telemedical network via satellite

In GALENOS (Generic Advanced Low-cost trans-European Network Over Satellite) a trans-European competence network via satellite, dedicated to telemedical applications, has been realized. Using off-the-shelf hardware components and a specially developed high-end software communication system (WinVicos) various telemedical applications, like teleteaching, intraoperative teleconsultation, have been realized.

Broadband networks for interactive telemedical applications

Using off-the-shelf hardware components and a specially developed high-end software communication system (WinVicos) satellite networks for interactive telemedicine have been designed and developed. These networks allow for various telemedical applications, like intraoperative teleconsultation, second opinioning, teleteaching, telementoring, etc.. Based on the successful GALENOS network, several projects are currently being realized: MEDASHIP (Medical Assistance for Ships); DELTASS (Disaster Emergency Logistic Telemedicine Advanced Satellites Systems) and EMISPHER (Euro-Mediterranean Internet-Satellite Platform for Health, medical Education and Research).

Multiphoton excitation and photodynamic activity of macromolecular derivatized mTHPC

Multiphoton excitation of photosensitizers in photodynamic therapy constitutes a promising approach, because of the increasing tissue penetration for longer wavelength of illumination. In this contribution the photodynamic activity of polyethylene glycol macromolecular derivatized mTHPC upon two-photon excitation is established. To test the photo- activity of the photosensitizer, human colon carcinoma cells, HCT-116, were incubated with 2 (mu) g/ml of mTHPC- CMPEG4 in the nutrition medium. Subsequent pulsed laser irradiation at 784 nm focused down on growing cell monolayers restricts cell vitality clearly within 24 hours after irradiation. To investigate whether an anoxic or euoxic energy transfer mechanism is involved, a uric acid assay was performed to test for the generation of singlet oxygen. Upon single-photon excitation mTHPC-CMPEG4 in TriPEG decomposed uric acid via the generation of singlet oxygen. Using femtosecond pulsed laser irradiation no decomposition of the uric acid was found, implying an anoxic energy transfer mechanism after tow-photon excitation. However, at present, we cannot exclude local hyperthermic effects in the cells containing the photosensitizer to contribute to the photodynamic activity upon two-photon excitation.

Telekonferenz und Telechirurgie

Summary. Interchange of information has become possible independent of the users place or time by modern telemedical services and opens up new dimensions for diagnostic and therapeutic procedures. For teleconferences and teleconsultations in surgery, the intraoperative high-quality transmission of live images is essential without disturbing the sterility and operation routine. The clinical specifications require special systems for broadband, stereoscopic online image transmission both intra- and inter-institutionally. Moreover, a telemedical concept integrates the communication equipment suitable for the different diagnostic and functional facilities of a clinic, a digital multimedia patient record and modules for cooperative working. These implementations are a prerequisite for extensive telesurgical interventions using navigational tools, guided instruments or autonomous roboter systems. The realization of such a comprehensive telesurgical concept (OP 2000) is presented.Zusammenfassung. Der standort- und zeitunabhängige Informationsaustausch, wie er durch moderne telemedizinische Dienste möglich wird, eröffnet auch der Chirurgie eine neue Dimension in Diagnostik und Therapie. Für Telekonferenzen und Telekonsile in operativen Fachgebieten ist besonders die qualitativ hochwertige intraoperative Übertragung von Live-Bewegtbildern erforderlich. Dabei dürfen die Anforderungen an die Sterilität und der Routineoperationsablauf nicht gestört werden. Die klinischen Rahmenbedingungen erfordern spezielle Systeme für eine breitbandige, stereoskopische Online-Bildübertragung sowohl hausintern als auch hausextern. Ergänzt werden müssen die Systeme durch eine adäquate Kommunikationsausrüstung der Diagnostik- und Funktionsräume einer Klinik sowie durch eine digitale, multimediale Patientenakte und durch Module, die ein kooperatives Arbeiten zulassen. Diese Implementierungen sind Voraussetzung für weitergehende telechirurgische Eingriffe unter Einbeziehung von Navigationshilfen, geführten Manipulatoren oder autonomen Robotersystemen. Die Realisierung eines solchen umfassenden telechirurgischen Konzepts (OP 2000) wird vorgestellt.

WinVicos - wavelet-based interactive video communication system for medical and non-medical applications

Using off-the-shelf hardware components and a specially developed high-end software communication system (WinVicos) various medical and non-medical applications like intraoperative teleconsultation and teleteaching have been enabled. WinVicos has been designed for the medical applications in different EU-projects, e.g. GALENOS - Generic Advanced Low-cost trans-European Network Over Satellite, Medaship - Medical Assistance for Ships, DELTASS - Disaster Emergency Logistic Telemedicine Advanced Satellites Systems, EMISPHER - Euro-Mediterranean Internet-Satellite Platform for Health, medical Education and Research, etc.

INTERACTIVE TELEMEDICAL APPLICATIONS IN OP 2000 VIA SATELLITE

Using off-the-shelf hardware components and a specially developed high-end software communication system (WinVicos) satellite networks for interactive telemedicine have been designed and developed. These networks allow for various telemedical applications, like teleteaching, telementoring, intraoperative teleconsultation, second opinioning, etc.. Based on the successful GALENOS network, several projects are currently being realized: MEDASHIP (Medical Assistance for Ships); DELTASS (Disaster Emergency Logistic Telemedicine Advanced Satellites Systems) and EMISPHER (Euro-Mediterranean Internet-Satellite Platform for Health, medical Education and Research).

Collaborative Work During Interventional Radiological Procedures Based on a Multicast Satellite-Terrestrial Network

Collaboration is a key requirement in several contemporary interventional radiology procedures (IRPs). This work proposes a multicast hybrid satellite system capable of supporting advanced IRP collaboration, and evaluates its feasibility and applicability. Following a detailed IRP requirements study, we have developed a system which supports IRP collaboration through the employment of a hybrid satellite-terrestrial network, a prototype multicast version of wavelet based interactive communication system (WinVicos) application, and a partition aggregation and conditional coding (PACC) wavelet codec. A semistructured questionnaire was also used to receive evaluative feedback from collaborating participants. The departments of interventional radiology of University Hospital of Patras, Greece and of Charite Hospital of Berlin, Germany have been connected on the system. Eight interventional radiologists and a vascular surgeon participated periodically in three satellite-terrestrial ldquofully collaborativerdquo IRPs (average time 90 min) of high complexity and in four terrestrial educational sessions with great success, evidenced by considerable improving the IRP outcomes (clinical and educational). In case of high complexity, where the simultaneous presence of remote interventional expert and/or surgeon is required, advanced collaboration among staff of geographically dispersed international centers is feasible via integration of existing networking and other technologies.

DELTASS - Disaster emergency logistic telemedicine advanced satellites system: Telemedical services for disaster emergencies

In the Disaster Emergency Logistic Telemedicine Advanced Satellites Systems (DELTASS) project, a disaster scenario was analysed and an appropriate telecommunication system for effective rescue measures for victims was set up. OP 2000 has designed various telemedical services for the support of the medical staff in a Mobile Field Hospital (MFH), which can be located in a disaster area by experts in a Reference Hospital (RH) located outside a disaster area. These services use a Workstation for Telemedical Applications via Satellite (WoTeSa) and Wavelet-based interactive Video Communication System (WinVicos) for the telemedical communication at the required quality, given the satellite bandwidth of 2 Mbit sec−1. Thus medical experts in the RH can support medical treatments in the MFH as well as a quick and reliable decision on to which hospital a victim/patient needs to be evacuated in order to get the best medical service (early triage).

Telepresence over satellite

Abstract The utilisation of distributed medical intelligence can contribute significantly to the continuous improvement of patient care and accelerates the qualification process of the medical staff. An efficient way of realization is the use of satellite networks for telemedical applications, as satellite communication has some distinct advantages over terrestrial communication channels: mesh topology networks, broad geographical coverage, multicast capabilities, etc. Using off-the-shelf hardware components and a specially designed communication software (WinVicos), various telemedical applications (teleconsultation, telementoring, teleteaching, etc.) have been realized.