Radiology information systems with picture archiving and communication capabilities have together provided modern radiology practices with the unlimited data storage and sharing capabilities necessary to cope with the ever-increasing routine data-demands.  These systems offer patient-specific medical image management in a digitized format, according to the well-known standards elaborated in Digital Imaging and Communications in Medicine (DICOM) [1]. Digital image storage has potential to enable data access in a unified manner by departments even outside of the radiology department of a hospital provided server-side components and storage facilities are shared by all departments in the hospital.  At the viewer’s end, digital systems can further be optimized for access by viewer computer systems (i.e. client systems) according to custom requirements of each clinical department in terms of resolution of rendering and image-processing capabilities.

Image digitization has paved the way to effective structural visualization of diseased tissue or organs;  today imaging has begun to have implications that transcend merely diagnostic value and is entering the realm of surgical planning minimally- or non-invasive examination and treatment through the realistic depiction of three-dimensional ‘depths’ of medical imaging as it relates to specific anatomical shapes. Image post-processing capabilities embedded in digital image management systems today often amplify the value of visualization by facilitating extraction of two or three dimensional measurements which is useful for purposes of reporting, and may employ cutting-edge digital signal processing technologies that quantify (or semi-quantify) either static or time-series image datasets. This augments the end-user’s cognitive capabilities by serving as a physician’s second-reader to accurately diagnose disease or plan out surgical decisions. 

Quantification of images has in-turn led into the concept of computer aided diagnostics (CAD), wherein a physician receives a diagnosis or ‘result’ from a non-human entity.  CAD may be dubbed as ‘clinical intelligence’ to support daily radiology tasks and is often based on techniques employing machine-learning and data-based rule-learning technology which actually ‘arrive at’ a clinical decision rather than merely ‘guiding’ a physician towards one.  This concept itself germinated in the 1960s but today has matured into a major focus of biomedical and clinical research relating to imaging-based biomarker discovery. Developments in this field of CAD have been incorporated into the routine diagnostic radiology approach to the structural screening of breast cancer on mammograms, early detection of heart disease [3-5] and even estimation of rupture risk of vascular aneurysms, to name just a few applications being investigated in this mushrooming space. But wait… there’s more!  We can do even more with imaging today…

One of the research domains receiving the most attention from funding agencies including the National Institutes of Health in the recent past has been the enabling of existing capital equipment with capabilities of imaging neuronal, cardiovascular and cellular ‘function’ as an extension to the convention of visualizing the structure of tissue or an organ.  As opposed to structural imaging, functional imaging focuses on revealing physiological activities within a certain tissue or organ by employing medical image modalities that usually reflect a spatial distribution of injected tracers or probes within the body.  Functional imaging has probably seen some of its greatest application in cognitive neuroimaging i.e. understanding the link between neuronal activity and functional imaging signals.  A few functional imaging modalities which have made an impact in this space, to name a few, include positron emission tomography (PET), infrared imaging, Electroencephalography (EEG), Magnetoencephalography (MEG), functional magnetic resonance imaging (fMRI) [2] to detect blood-oxygen-level-dependent contrast material as an indicator of brain neuronal activity, and diffusion weighted imaging conducted by the Human Connectome Project which aims to understand the details of neural connectivity and build for the first time an integrated roadmap of structural as well as functional neural connections within the brain [3]…


References:
[1] DICOM. http://medical.nema.org/Dicom/    
[2] Journal of Neuroscience Methods 74 (1997) 229–243. http://neurosci.info/courses/systems/FMRI/kim_fmri.pdf
[3] http://www.humanconnectomeproject.org/about/

Megatrends are defined as global, sustained and macroeconomic forces of development that impact business, economy, society, cultures and personal lives, thereby defining our future world and its increasing pace of change.  Three megatrends most relevant to medical imaging and radiology have been: a) Information Technology (IT) and Big Data; b) Demographic shifts defined by an ageing and growing population affecting healthcare expenditures; and c) Electronic, remote and mobile delivery of goods and services.

Our first megatrend is a global trend seen across all industries and one that has affected each of our personal lives over the last 5 years –the need to collect large amounts of data.  Be it photographs, documents, medical images or cloud services on our iPhones which justify never deleting another photograph to make space on our devices, the ‘big data’ megatrend has touched each of our lives.  IT and the effective use of the same is an important cornerstone of the megatrends observable in the healthcare space today. Efficient management of vast amounts of rapidly generated data as well as management of clinical workflows is largely dependent on the development, accessibility and scalability of IT infrastructures supporting the healthcare industry.

Our second megatrend relates to healthcare spending.  60% of a lifetime’s healthcare costs occur after the age of 65 years and by 2025 over 18% of the US population will be over 65 years old – an increase from 13% in 2010, amounting to an additional $4.5 trillion in healthcare spending!  With an increased number of people spending time and money in hospitals, there is also a simultaneous growth in the number of deaths owing to medical errors – a whopping ~100,000 per year.  Therefore, technologies for healthcare which present opportunities to save costs in terms of patient management while delivering optimal medical care with increased success rates and reduced rates of error are the ones which will define the healthcare delivery models of future.  Such technologies will cumulatively shape tomorrow’s cost of another year of healthy life…

The third megatrend of great relevance to healthcare is electronic delivery of goods and services in an era of rampant wireless device proliferation.  Remote monitoring of patients and disruptive non-invasive diagnostic technologies are now ubiquitous while digital workflows such as teleradiology and distributed care which reduce costs and improve home healthcare efficiency as they allowing caregivers to manage time and resources more effectively.  The ‘extended hospital’ today includes disruptive radiofrequency wireless-enabled technologies for remote diagnosis of cardiac health or injury and even telemonitoring technologies for monitoring patients over a wireless network, web video or the traditional telephones to reduce risk of death amongst critically ill or old patients while improving compliance in regard to medication regimens.

Finally, to conclude on these megatrends and their affect on the healthcare practice, it is important to note that although technology revolution defined by these megatrends is ubiquitous, change is SLOW. Development and deployment of advanced IT-enabled goods and services in healthcare hasn’t enabled the same levels of transformation that have occurred in other industries for a number of reasons, the most important being the fact that healthcare is a brutally regulated space which is monopolized by a few omnipresent heavy-weights with the capital to surmount these regulatory hurdles. However, despite these shortcomings of technology adoption in healthcare and the unfairness of the competitive landscape, ‘healthcare IT’ is an umbrella for a host of technologies which together constitute the forefront of an overwhelming confluence of interests from stakeholders that range from the lay patient to physicians and business leaders.  The digital, electronic and mobile technologies discussed in this post as well as several others breaking the threshold between academia and industry every day, will make a far-reaching financial impact that will disrupt the industry and drive real change in patient care, data management and healthcare-related business process workflows.

References:

* Images from http://suemontgomery.org/big-data-in-healthcare-collaboration-and-interoperability-are-essential-to-its-success/ , http://www.itpro.co.uk/strategy/20647/two-thirds-firms-will-invest-big-data-year-claims-gartner , http://blog.agfahealthcare.com/2013/06/11/the-icis-world-cloud/

   

Today I visited the Holocaust Museum, Yad Vashem, in Jerusalem, Israel. It was truly a frightening experience although the museum itself was a spectacular display of the carnage carried out by the Germans during Word War II (WWII). Revealing the truth about atrocities of WWII by sharing with us her grim experiences was Martha Weiss, holocaust death camp survivor, whom we were fortunate enough to meet as she reminisced the agony of what is meant to be a Holocaust Survivor...   Martha was identified as being a Jew by a traitor in Holland where she had been safe for some years under the protection of a guardian and sent off with her elder sister to the Auschwitz Concentration Camp at age 8. Her parents had sent her to Holland, away her home in the Czechoslovakia, in order for her to remain in hiding under a false 'Aryan' identity and therefore avoid being snagged by anti-Semitic (and as it turns out, highly 'sadistic') German captors - the Nazi SS Officers - carrying out the bidding of Adolf Hitler whom we all know for his falsely justified virulent hatred of the Jews. As per some historians (and evidence in the museum) this false 'justification' for hating the Jews seems to have originated from Darwin’s original ‘survival of the fittest’ theory which was contorted into an incorrect understanding by Hitler’s administration - whom incidentally regarded themselves as 'intellectuals' - that developed and implemented policies designed to protect the ‘superior race’ (i.e. themselves, or as they termed themselves, 'Aryans') and simultaneously preventing the ‘inferior races’ (psychopathically inferred by Hitler and company as being those of Jewish faith) from mixing with those adjudged superior, in order to avoid 'contamination' of the latter’s gene pool [1]. What was originally planned as a mass exodus of those of Jewish faith from Germany, except for 'Essential Jews' whom were given a badge and made to work to support the genocide of their brethren, turn culminated in the ‘final solution’ for the extermination of approximately six million Jews when neighboring countries (as well as ones not so near by) to Germany refused to become 'involved'.  In addition to the Jews, four million other people who belonged to what the German intelligentsia judged as ‘inferior races’ were also made to suffer, starve and then be murdered in cold blood. 

The brutal details of Martha's experiences are beyond the scope of this blog entry but several questions came to mind as I listened to her recounting the pathological and highly psychotic doings of the Nazi's in the pretext of 'Darwinism', and while I mental pieced together evidence presented along the museum's walls.  Is being an anti-Semite a 'feature' encoded in the so called 'Aryan' DNA..?  Is that why Hitler won his election to power with a landslide of 40% support from the German people..?  Is this the reason the SS Officers in the concentration camps had the same virulent fervor as their monstrous and conceited leader - based on a vague theory of 'Darwinism'..?  Is the anti-Semite pathology still latent in our DNA and is this why the world is still at war with the very victims of the holocaust ..?  As I understand from recent visitors to Poland including the holocaust survivors, this virulent hatred for Jews is still rampant in the local population as is evidenced by conniving jives that roll off the tongues of ordinary people such as the conductors of trains as they pass by locations where concentration camps once murdered millions ( ... details available upon request).  Could there be cure for this pathology in the interest of the human civilization being at peace with itself ..?

The Yad Vashem museum provides us a glimpse of the what Jewish life had been before the War and unveils a brave image of the miserable life of slaves which the 'entire world' willed upon the Jews between the world wars and of-course the holocaust.  Over 6 million were murdered but the museum has the goal of attributing a 'name' to every single victim of the holocaust whom were never given a righteous burial. Today they are at 4.2 million named victims and counting as historians continue to rummage through the remnants of the memoirs left behind by holocaust victims and their kin through whom they are survived today...

References:
[1] Darwinism and the Nazi Race Holocaust by Dr. Jerry Bergman on November 1, 1999.  


P.S - The following may be of interest:  http://www.yadvashem.org/yv/en/newsletters/pdf/giving_030-032.pdf