Sun K. Yoo

Instant wireless transmission of radiological images using a personal digital assistant phone for emergency teleconsultation

The instant transmission of radiological images may be important for making rapid clinical decisions about emergency patients. We have examined an instant image transfer system based on a personal digital assistant (PDA) phone with a built-in camera. Images displayed on a picture archiving and communication systems (PACS) monitor can be captured by the camera in the PDA phone directly. Images can then be transmitted from an emergency centre to a remote physician via a wireless high-bandwidth network (CDMA 1 × EVDO). We reviewed the radiological lesions in 10 normal and 10 abnormal cases produced by modalities such as computerized tomography (CT), magnetic resonance (MR) and digital angiography. The images were of 24–bit depth and 1144 × 880, 1120 × 840, 1024 × 768, 800 × 600, 640 × 480 and 320 × 240 pixels. Three neurosurgeons found that for satisfactory remote consultation a minimum size of 640 × 480 pixels was required for CT and MR images and 1024 × 768 pixels for angiography images. Although higher resolution produced higher clinical satisfaction, it also required more transmission time. At the limited bandwidth employed, higher resolutions could not be justified.

The effectiveness of cardiopulmonary resuscitation instruction: animation versus dispatcher through a cellular phone.

INTRODUCTION We developed a cardiopulmonary resuscitation (CPR) instruction programme using motion capture animation integrated into cellular phones. We compared the effectiveness of animation-assisted CPR instruction with dispatcher-assisted instruction in participants with no previous CPR training. METHODS This study was a single blind cluster randomized trial. Participants were allocated to either animation-assisted CPR (AA-CPR; 8 clusters, 44 participants) group or dispatcher-assisted CPR (DA-CPR; 8 clusters, 41 participants). The overall performance and time of each step of CPR cycle were recorded on a checklist by 3 assessors. The objective performances were evaluated using the Resusci Anne SkillReporter Manikin. Differences between the groups were compared using an independent t-test adjusted for the effect of clustering. RESULTS The AA-CPR group had a significantly better checklist score (p<0.001) and time to completion of 1 CPR cycle (p<0.001) than the DA-CPR group. In an objective assessment of psychomotor skill, the AA-CPR group demonstrated more accurate hand positioning (68.8+/-3.6%, p=0.033) and compression rate (72.4+/-3.7%, p=0.015) than DA-CPR group. However, the accuracy of compression depth (p=0.400), ventilation volume (p=0.977) and flow rate (p=0.627) were below 30% in both groups. CONCLUSION Audiovisual animated CPR instruction through a cellular phone resulted in better scores in checklist assessment and time interval compliance in participants without CPR skill compared to those who received CPR instructions from a dispatcher; however, the accuracy of important psychomotor skill measures was unsatisfactory in both groups.

Three-dimensional geometric modeling of the cochlea using helico-spiral approximation

In this paper, the three-dimensional geometry of the human cochlea is modeled by the helico-spiral seashell model. The 3-D helico-spiral model, the generalized representation of the Archimedian spiral model, provides a framework for measuring cochlear features based on consistent estimation of model parameters. Nonlinear least square minimization based algorithms are developed for the identification of rotation, center and intrinsic parameters of the helico-spiral representation. Two algorithms are designed for the rotation axis aligned to the modiolar axis: one is more susceptible in the presence of noise, while the other allows applicability to two-dimensional data sets. The estimated center and intrinsic parameters allow the calculation of length, height and angular positions needed for frequency mapping of multichannel cochlear implant electrodes. Model performance is evaluated with numerically synthesized curves with different levels of added random noise, histologic data and real human cochlear spiral computed tomography data.

A mobile telemedicine system for remote consultation in cases of acute stroke

A mobile telemedicine system, capable of transmitting video and audio simultaneously, was designed for consulting acute stroke patients remotely. It could use a wireless local area network (e.g. inside the hospital) or a mobile phone network (e.g. outside the hospital). When initiating a call, the sending unit chose a suitable encoding profile based on the measured data throughput, in order to allocate appropriate bit rates for video and audio transmission. The system was tested using a portable digital assistant (PDA) type phone and smart phone as receiving units. Video and audio recordings were made from five patients (two normal and three stroke patients) and then transmitted at different rates. Subjectively, both video and audio qualities improved as the data throughput increased. The physical findings, including facial droop, arm drift and abnormal speech, were observed remotely by four specialists according to the Cincinnati Pre-hospital Stroke Scale guideline. A comparison between the face-to-face method and the mobile telemedicine method showed that there were no discrepancies at bit rates of more than 400 kbit/s. We conclude that specialists could generally conduct remote consultations for stroke patients either using a public mobile network or a wireless LAN.

A Web-based mobile asthma management system

Continuous recording of daily symptoms constitutes an effective means of managing asthma patients. Daily management reduces the costs associated with hospitalization and improves the quality of patient care. We have implemented a Web-based mobile asthma management system. We used a pocket PC, mobile phone and desktop computer. The recorded items and individualized prescriptions were structured using Extensible Markup Language (XML) DTD (Data Type Definition). The mobile Web form was automatically adjusted to fit the different display resolutions of the terminal devices. The system provided reliable exchange of all relevant information between a doctor and the asthma patient using wireless mobile transmission. Email and Short Messaging Service (SMS) were used to send messages to patients, for example in the case of an automatically determined patient alert. Patients could obtain customized instructions according to their daily personal symptoms, peak expiratory flow (PEF), medications and activity restriction. The daily graph of PEF and the graphs of symptoms and medication were particularly useful for asthma patient control and self-awareness of the progress of the disease.

Web-based secure access from multiple patient repositories

BACKGROUND Internet-based health-record management requires not only the provision of strong data protection to prevent privacy intrusion and unauthorized access, but also the introduction of a common healthcare-record format to allow cooperation using heterogeneous repositories held at various hospitals. METHODS A secure multi-agent architecture is proposed for accessing healthcare information through the Internet from multiple heterogeneous repositories. The proposed system is organized into a four-tier architecture that consists of client applications, a central access-control system, local access-control systems, and hospital information systems. The eXtensible Markup Language (XML) and the role-based access-control (RBAC) system are combined for efficient repository management by providing methods for access-control, information exchange, user authentication, data integrity, and selective encryption. RESULT A multi-agent architecture using XML and RBAC can interconnect heterogeneous repositories with different formats and different hospital policies, and allow them to communicate securely. The authorized client, having confirmed access privileges, can retrieve the requested healthcare data in an XML-based common data format with embedded confidentiality. CONCLUSION The proposed method for Internet-based exchange of patient data is particularly useful for cooperative healthcare and the creation of lifetime healthcare records.

Three-dimensional modeling and visualization of the cochlea on the Internet

3D modeling and visualization of the cochlea using the World Wide Web (WWW) is an effective way of sharing anatomic information for cochlear implantation over the Internet, particularly for morphometry-based research and resident training in otolaryngology and neuroradiology. In this paper, 3D modeling, visualization and animation techniques are integrated in an interactive and platform-independent manner and implemented over the WWW. L.T. Cohen et al.s (1996) template shape with mean cross-sectional areas of the human cochlea is extended into a 3D geometrical model. Also, spiral computer tomography data of a patients cochlea is digitally segmented and geometrically represented. The cochlear electrode array is synthesized according to its specification. Then, cochlear implantation is animated with both idealized and real cochlear models. The insertion length, angular position and characteristic frequency of individual electrodes are estimated online during the virtual insertion. The optimization of the processing parameters is done to demonstrate the feasibility of this technology for clinical applications.

Design of RFID based the Patient Management and Tracking System in hospital

The patient location information in managing for patient workflow will be worked efficiently within the hospital. We designed the Patient Management and Tracking System (PMTS) based on RFID with RSSI(Received Signal Strength Indication) method. This system is able to track the movement of patient in hospital, and manage the waiting-list of patients at a medical office. Therefore, we are sure that the PMTS will be useful for decreasing a duty of medical staff and increase a convenience of patients.

A portable dental image viewer using a mobile network to provide a tele-dental service

We tested three imaging devices for suitability in emergency dental situations for telemedicine. The three devices were a special-purpose oral camera, a digital single lens reflex (DSLR) camera, and the built-in camera of a mobile phone. A total of 20 subjects volunteered to take part in the study. We simulated five different conditions which could affect the quality of the image and measured image transmission times across two widely available mobile networks (a CDMA-based 3G network and a Wireless Broadband Network, WiBRO). The DSLR produced the best quality images, although it was a relatively large device and not easy to use. The oral camera failed to give satisfactory images under certain conditions (i.e. without extra lighting, out of focus and head motion). In contrast, the mobile phone based camera was very easy to use and to handle, and it gave good information for initial diagnosis, even at high compression ratios. If the image acquisition conditions are carefully set up, this device might be the best for emergency dental trauma situations.

Implementation of a large-scale hospital information infrastructure for multi-unit health-care services:

Summary With the increase in demand for high quality medical services, the need for an innovative hospital information system has become essential. An improved system has been implemented in all hospital units of the Yonsei University Health System. Interoperability between multi-units required appropriate hardware infrastructure and software architecture. This large-scale hospital information system encompassed PACS (Picture Archiving and Communications Systems), EMR (Electronic Medical Records) and ERP (Enterprise Resource Planning). It involved two tertiary hospitals and 50 community hospitals. The monthly data production rate by the integrated hospital information system is about 1.8 TByte and the total quantity of data produced so far is about 60 TByte. Large scale information exchange and sharing will be particularly useful for telemedicine applications.