Project of the Month January 2003

Image and Data Management System for the Hospital of Aalborg: The Patient is on the Computer – in 3D

A digital image transfer project for the digital transfer of images in both 2D and 3D would not only be innovative to the way Danish hospital staff will receive image data in the future, – this project is also likely to save lives. And it will save precious time in a health service where time is money – lots of money.

Images – and other patient information – can be retrieved on a screen located with the doctors. Previously doctors needed to hold their conferences at the Department of Radiology.

Photos with the kind permission of Medical Insight.

By Naia Bang / Texthuset Aalborg
A patient is admitted to the trauma centre of the Aalborg Hospital South. He was involved in a severe road accident, and the doctors fear the presence of several internal injuries. A CT-scan detects a kidney injury – contrast fluid is escaping from it. The doctors can observe this immediately – in 3D on the radiologist's laptop screen, and they can proceed with treatment right away.
Had it been only af few months earlier, the medical team would have to leave the patient to enter the CT-scanner room for the time-consuming task of getting the scanner to produce a 3D reconstruction. Or the patient would have to go through an additional examination.

Saving precious time
- No doubt the project is saving a lot of precious time, explains Luuk van den Poll, technical project manager of the Image and Data Management for the Hospital of Aalborg.
The routine for many doctors and surgeons is to spend time walking down to the Department of Radiology – the X-ray Department - and collect the images required. This could be X-ray pictures or pictures from a CT scan. If they are available, that is. For if another doctor needed the pictures and removed them from the department, loads of time can be spent looking for the missing pictures.
Still worse is the case if the doctor is not located at the same hospital. The taxi drivers of Aalborg know the route between the South and North Hospitals well and truly from bringing those brown envelopes containing pictures acquired at the South Hospital to a doctor waiting anxiously at the North Hospital. This is very costly in terms of time and money.
Adding to this is the scenario of two busy surgeons operating the same patient. Pressed for time they may not be able to discuss the patient between them during the day – but both surgeons need to see the pictures from the CT scan of the patient prior to operating. One of the surgeons would be the first to reach the Department of Radiology. A CT scanning session may have produced as much as 300 pictures. He now selects the pictures he deems relevant - and removes them from the files. Later the second surgeon calls around to the Department of Radiology. And he selects a number of other pictures among the ones remaining. So once the operation begins, two surgeons are working with each their set of different pictures. And eventhough they will definitely have discussed this case by now, they are still not using identical pictures for the operation.

Easy to Use
It may resemble a piece of luxurious toy for doctors, nurses and surgeons to watch patient pictures in 2D as well as 3D. But as proved by the example of the patient from the road accident, this is highly useful. The pictures are able to show vascular structures in 3D. This makes it considerably easier to locate blood clots for example. You can view bones. And make simulated X-ray pictures on the basis of CT pictures. This saves the patient from going through yet another time-consuming acquisition of images.
- The project has enabled doctors, surgeons and nurses to retrieve all the patient information required from the one and same source. The procedure is quite simple: They swish their personal access card through a card reader, enter the patient's social security number – and next they can view any picture acquired of the patient, explains Luuk van den Poll, and he elaborates:
- EasyViz, as the system is called, is quite easy to use. And ease of use has exactly been a high priority subsidiary goal; for if a new surgeon for example were to spend several hours familiarizing himself with the system, it would never be put to use. They simply could not afford time for that. So we have focused our effort on bringing the user just ”one click away from the patient”.
Currently the Aalborg Hospital South has got seven stationary screens placed at strategic points in the intensive care unit, neurosurgical, X-ray and the Oncological Department within easy reach for staff – and with access to vital information stored in a centralized database. Further the programme has been installed on a few PCs of selected consultant doctors and surgeons.
- In daily routines hospital staff spends a lot of time on conferences: Every morning for example, a meeting is held at the Department of Radiology for a plenary discussion of miscelleanous pictorial material on the patients treated by the Department. Next the staff goes to the respective departments to confer the further treatment of the patients - based on the pictures viewed. By using EasyViz the conference could be held at the respective departments – the radiologist will go to the department instead of an entire staff going to his department - and should two doctors have a simultaneous need for a closer study of a given patient at a later time, they could just retrieve pictures on the nearest screen, explains Luuk van den Poll.

Henrik E. Gregersen, consultant doctor, with his tiny PDA, on which he can retrieve 3D patient images acquired in e.g. a CT-scanner (in the background).

A Catching Enthusiasm
Doctors on call in their homes can receive images on their PC and use them to quickly make the decisions required.
As the only person Henrik Echternach Gregersen, who is a consultant doctor has been testing a PDA, a tiny handheld screen used by an increasing number of people for an electronic calendar. Via a wireless internal network in the X-ray Department Henrik E. Gregersen is able to retrieve the same information on his PDA as that retrieved by his colleagues on stationary screens. And in a near future the entire hospital will be equipped with a wireless network.
- When this happens, we will have access to all patient information, no matter where we are. And this is the pioneering aspect of the project, explains Henrik E. Gregersen, admitting that several of his colleagues at the Department of Radiology were more than sceptical when he first presented the tiny PDA. But event hough the screen is not larger than a packet of cigarettes, the picture is fine and clear. And if the fundings required can be provided, he will probably not be the only radiologist carrying a PDA in his breast pocket.
- This is the most fun project I've ever been working on. Not that it wasn't a rough going when time-pressure and technology were clashing – but when you had been working on something for an entire week and presented it to colleagues at the hospital… and experienced their enthusiasm and eager: ”What will be next?” – it gave you a new shot of energy, explains Luuk van den Poll – while stating that the project had its strength in developing the EasyViz in such a close interaction with users.

Aalborg Shows the Way
The Image and Data Management project was made reality by the Aalborg Hospital South and Medical Insight in a close cooperation. Luuk van den Poll works as a project manager of Medical Insight, domiciled in Hedehusene, and Andy B. Dobbs who is in charge of the project is director of the same company.
- To a small enterprise like ours the IT Lighthouse of Denmark has been priceless. It is really difficult for minor, relatively unknown enterprises to get anywhere near a Danish hospital as a supplier or contractor – no matter how interesting your project may be. But the Hospital of Aalborg believed in this idea, and the visions and enthusiasm of consultant doctor Henrik E. Gregersen has been a great motive power in the project, states Luuk van den Poll:
- Under the DDN umbrella we managed to deliver a system, which is currently putting the Hospital of Aalborg on the global leading edge when it comes to electronic image and data management. This enables us to put a mark on the future development, too. And that really opens prospects!

Read more about the Image and Data Management project on www.thedigitalnorthdenmark.dk

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