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Beating the killers: the impact of computer imaging on health care: speakers' notes.



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NATIONAL SCIENCE BRIEFING

Beating the Killers -  

The impact of computer  

imaging on health care

12 March 1998

 

Speakers' notes

 

Dr Laurie Wilson, CSIRO Telecommunications and Industrial Physics

Medical Imaging began 103 years ago with this image of Mrs Roentgen's hand, complete with wedding ring. The computer has been in existence for about half of this time, and only in the last few years has the power of computers been sufficient to handle the huge amount of information contained in medical images.

To give an elementary example, the store all of the information in a simple X-ray such as a mammogram requires six times the computer memory required for the complete works of Shakespeare.

There are 3 ways in which computers may be used to enhance medical imaging:

  • Modern medical imaging departments are entirely digital, and all images are viewed on computer screens. Here is a view of the new Children's Hospital in Sydney, Australiaís first all-digital hospital.
  • Some of the technology being developed for virtual reality is being applied to give clinicians more realistic views of multi-dimensional images.
  • Finally, applying artificial intelligence to digital storage systems can provide a second pair of expert eyes for the clinicians.

I will first describe some of the more exciting developments in this field overall followed by a brief description of some of the work being done in CSIRO and related groups.

  • CSIRO 'Expert Assistants' for Medical Imaging
  • Aortic Aneurysm analysis system
  • Chest X-ray (with Prof Bruce Doust)
  • Mammography cancer detection (with Polartechnics)
  • Melanoma analysis system (with Polartechnics)

The ability to visualise large data sets is making possible tools for medical practitioners which may make cadavers (dead bodies) a thing of the past in medical schools. This is a visualisation of part of the 'Visible Human' data set, one of the most analysed sets of medical images in the world.

Multi-dimensional medical images can provide dramatic internal views of organs obtained non-invasively, such as dramatic 'fly-throughs' of a three-dimensional CT scan of the trachea and bronchi.

Surgeons have been particularly quick to take up the new technology, because of its ability to visualise what they will see on the operating table. We can turn the CT scans into plastic models which you can hold in your hand, and Australia produces some of the highest quality models in the world of this type. We have brought some samples along with us.

Computers can be given a sense of touch, using special mechanical devices. This can be used for realistic 'flight simulators' for surgeons. CSIRO is doing some innovative work in this area.

Finally, we can incorporate patient images in the surgeon's field of view to give him X-ray vision, to assist navigation during neurosurgery.

The 'knowledge' associated with medical imaging is knowledge of human anatomy, and CSIRO has developed some innovative applications which make use of computer representations of anatomical knowledge.

CSIRO is associated with 4 developments in this area:

  • Bruce Doust will describe the first application, an expert assistant for chest X-rays.
  • Polartechnics are developing a melanoma detecting device using image analysis techniques developed by CSIRO.
  • In another CSIRO-Polartechnics collaboration, we are developing a system for detecting breast cancers as a backup for radiologists. This system is being tested on images supplied by the New South Wales Breast Screening service and can detect over half the cancers that are regarded as very difficult even when viewed by two radiologists.
  • We are also developing a 3D application for vascular surgeons planning treatment of aortic aneurysms. This turns a 3D data set into a visualisable model, which will be invaluable to surgeons who can then plan minimally-invasive surgery to repair the potentially-fatal aneurysm without ever seeing the vessels with their own eyes.

Professor Bruce Doust, St Vincents Hospital, Sydney

Chest X-ray 'Expert Assistant' - A Radiologist's Viewpoint

In collaboration with CSIRO, we have developed an 'expert assistant' to assist clinicians in their assessment of chest X-rays. This system differs from those developed in other laboratories in that it is based on a computer representation of human anatomy. It identifies the major features of a chest X-ray, performs a number of measurements, detects a range of abnormalities and produces a 'report' couched in familiar radiological terminology.

Chest X-rays make up about 50% of all the examinations in most medical imaging departments. However, the chest X-ray is still acknowledged as a 'difficult' diagnosis.

Why is this technique likely to be useful?

  • Immediate response
  • Review
  • Level of skill increases with time
  • Available at all hours

Potential Roles for an 'expert assistant'

  • Remote communities (e.g. aborigines)
  • Battlefield
  • In foreign markets
  • Assisting junior doctors late at night
  • Improving diagnostic accuracy, especially screening

Conclusion

  • Unique new solution to a very old problem
  • Many medical and commercial benefits from further development

Victor Skladnev, Managing Director Polartechnics Ltd.

HEALTH CARE COSTS ARE RISING

Community screening programs can help.

WHY SCREENING PROGRAMS?

Facilitates detection at an earlier stage of diseases.

Generally early detection translates to simple and inexpensive treatment.

-- THIS IS ESPECIALLY TRUE OF CANCER

 

SCREENING LIMITATIONS

Large numbers of normals compared to abnormalities.  

Screening test accuracies are very sensitive to staff expertise and availability of specialised facilities.

 

Enhancing screening with EXPERT SYSTEMS

Relieve the task repetitiveness. 

Relieve the shortage of trained professionals. 

Cost-effective way to provide expert resources to all geographical areas. 

Standardise to a high level of accuracy around the country / world. 

Provide back-up in high-volume centres.

 

Are Expert Systems for screening PRACTICAL?

Many human diagnostic processes can now be reproduced.

 

COMPUTERS CAN NOW FULFIL THIS ROLE

Large memory capacity. 

Logical ability. 

Computer technology is improving at an exponential rate while costs are reducing. 

Hardware is now available to accurately measure many of the important disease discriminants.

 

Can Australia find a niche in this knowledge-based industry?

We have a substantial investment in the medical profession, highly trained excellent resources e.g. Sydney University / Sydney Melanoma Unit. 

Highly skilled engineers and scientists e.g. CSIRO / PLT. 

Relatively minimal disruption from legal and regulatory bodies. 

Able to access patients and develop datasets. 

Potentially a world leading capacity to develop the patient / symptom data set generally necessary for expert systems.

 

Are Expert System Screening Approaches commercially viable?

Cervical cancer screening:  

· billion / year market 

· massive export potential 

 

Melanoma detection

Australia has highest melanoma incidence rate. 

Rapidly expanding market

Breast cancer screening:  

Most common cancer in women, and third most common cancer worldwide. 

Huge market potential - dwarfs cervical cancer

There are opportunities for medical research in Australia - Polartechnics has done it

Polartechnics, an Australian R&D company, has generated $23 million of earnings from one marketing licence not including royalties and manufacturing profits. Selected by Johnson and Johnson for their technology, considered the most commercially viable and best technology. Focussed on providing the best skills - a synergy of medical, technical, research and commercial.

Possible and practical to use computers for medical technology. 

 

Copyright 1998, CSIRO Australia  

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