The German teleradiology system MEDICUS: system description and experiences in a German field test.

MEDICUS is a teleradiology system which has been developed in a joint project of the German Cancer Research Center (Deutsches Krebsforschungszentrum) and the Transfer Center Medical Informatics (Steinbeis-Transferzentrum Medizinische Informatik) in Heidelberg, Germany. The system is designed to work on ISDN lines as well as in a local area network. Special attention has been given to the design of the user interface and data security, integrity, and authentication. The software is in use in 13 radiology departments in university clinics, small hospitals, private practices, and research institutes. More than 25 thousand images have been processed in 6 months. The system is in use in six different application scenarios. MEDICUS is running under the UNIX operating system. The connection of the modalities could in most cases not be realized with the DICOM protocol as older machines were not equipped with this standard protocol. Clinical experiences show that the MEDICUS system provides a very high degree of functionality. The system has an efficient and user friendly graphical user interface. The result of a comparison with other systems shows that MEDICUS is currently the best known teleradiology system. Cost reductions are already obvious, but additional research has to be performed in this field. An even more powerful commercial successor is currently under construction at the Steinbeis-Transferzentrum Medizinische Informatik in Heidelberg.

Experiences with the german teleradiology system MEDICUS.

This paper introduces the teleradiology system, MEDICUS, which has been developed at the Deutsches Krebsforschungszentrum (German Cancer Research Center) in Heidelberg, Germany. The system is designed to work on ISDN lines as well as in a local area network. The global software architecture is explained in the article. Special attention has been given to the design of the user interface and data security, integrity and authentication. The software has been evaluated in a German field test at 13 radiology departments in university clinics, small hospitals, private practices and research institutes. More than 30 thousand images have been transmitted using this system during a 9 month period. Realized application scenarios are: in-house communication, image and report delivery to referring hospitals, remote reporting, radiotherapy treatment planning and research cooperation. Experience has shown that the system is easy to use and saves time. It obviates the need for patient transport and reduces film costs. Experiences of individuals while using the system during the field test helped define the functionality of the second generation teleradiology system which is even more flexible and is also available as a commercial product.

ARTEMIS-2: an application development experiment with the HELIOS environment.

A medical application is a highly complex system that embraces many data types and a very large number of data processing functions and methods. The development of integrated software engineering environments has deeply changed the conception of applications and the profile of the application developers. In this paper, we address the problem of the development process of a specific multimedia application, called ARTEMIS, within the distributed HELIOS environment. The application is intended to manage information about hypertensive patients, in particular, retrieval and display of administrative, clinical and biological data and display and analysis of digital angiography images and medical reports. The objective is to show how the developer can use, customize and organize the services HELIOS provides. A particular focus is set on reuse strategies and integration during the development process. A scenario has been realized and illustrates the current state of the application. The discussion focuses on the advantages of such distributed environments in medical application development.

Documentation and information services in the HELIOS project.

In a modern software project large amounts of documentation is produced. All parts of the complex software system require extensive documentation--both for reference purposes and promotional reasons. However, there are some aspects that often are forgotten or badly implemented; (i) the availability of on-line documentation, (ii) integration of the different formats of documentation, and (iii) the world wide promotional aspect. To solve these problems, the Helios project has chosen to integrate its public documentation and software material into a hypertext system using the World Wide Web.

Usability and efficiency. The HELIOS approach to development of user interfaces.

This paper describes the user interface related services of the HELIOS project. The design and implementation of efficient user interfaces is a prerequisite for successful introduction of computer support in health care ward units. Design principles must be based on a basic understanding of cognitive aspects of human-computer interaction, as well as on detailed knowledge about the specific needs and requirements of the health care professionals. In the HELIOS project, a style guide for design of user interfaces has been developed. The style guide defines detailed design guide-lines together with a set of interface elements specified for the ward domain. Development tools for construction and implementation of user interfaces to ward applications have been developed and integrated into the HELIOS SEE. The tools are based on the TeleUSE product, which has been extended and adjusted to the HELIOS specifications. A set of new widgets, designed to implement health care interface elements, has been incorporated into the development tool.

Influence of formic acid on fungal flora of barley and on aflatoxin production in Aspergillus flavus link.

In recent years Aspergillus flavus and aflatoxin production have been noted on several occasions in grain preserved with formic acid. Samples of mouldy barley treated with formic acid and stored in an open bin were investigated for the presence of fungi. In the lower part of the bin there was a clear dominance of Fusarium sporotrichioides, and deoxynivalenol and neosolaniol were detected. A. flavus and A. fumigatus were also present. Paecilomyces variotii occurred, almost as a pure culture, in the upper part of the bin, but no patulin was found. Cultivation of four fungal isolates from these genera on laboratory substrates containing formic acid showed P. variotii to be the most tolerant to formic acid, withstanding 150 mM, but still without patulin production. F. sporotrichioides and A. fumigatus tolerated only 6 mM formic acid. The growth of A. flavus was reduced and atypical at 60 mM formic acid. Pretreatment of A. flavus spores with formic acid increased aflatoxin production about 800 times.

Occurrence of ochratoxin- and citrinin-producing fungi on developing Danish barley grain.

The distribution of Aspergillus and Penicillium spp. isolates that produce ochratoxin A (AO) and citrinin was studied on developing barley from diverse locations in Denmark during the 1977 crop year. From 33 test fields, 243 isolates of the two genera were obtained with significant numbers of isolates on the grain at the earliest sampling date (1-2 weeks postanthesis). No specific argronomic factor was linked to the distribution of Aspergillus and Penicillium spp. A taxonomic study of 108 representative isolates of the two genera showed that A. flavus, P. chrysogenum, and P. purpurrescens were the predominant species. An investigation of the toxin-production capability of the identified species showed that seven strains (6.5%) produced OA and a single isolate synthesized citrinin. P. purpurrescens was the dominant OA-producing species with four toxin-positive isolates.

Aflatoxin in a Swedish grain sample.

So far aflatoxin has not been detected in crops grown in Sweden but only in imported feedstuffs or in feed mixtures containing imported products. During the survey for other mycotoxins in Swedish crops a compound was detected in oats which, by further analysis, was identified as aflatoxin B1. Quantitative evaluation showed concentrations as high as 2.6 ppm. The fungal population in this highly contaminated sample consisted almost entirely of Aspergillus flavus.