Modelling heating of liver tumours with heterogeneous magnetic microsphere deposition.

Ferromagnetic embolization hyperthermia (FEH) is a novel treatment for liver cancer. Magnetic microspheres are injected into the hepatic artery and cluster in the periphery of tumours and are heated with externally applied magnetic fields. In order to more accurately simulate FEH, we modelled a three-dimensional heterogeneous distribution of heat sources. We constructed a fractal model of the vasculature in the periphery of a tumour. We used this model to compute the spatial distribution of the microspheres that lodge in capillaries. We used the distribution model as input to a finite-element heat transfer model of the FEH treatment. The overall appearance of the vascular tree is subjectively similar to that of the disorganized vascular network which encapsulates tumours. The microspheres are distributed in the tumour periphery in similar patterns to experimental observations. We expect the vasculature and microsphere deposition models to also be of interest to researchers of any targeted cancer therapies such as localized intra-arterial chemotherapy and selective internal radiotherapy. Our results show that heterogeneous microsphere distributions give significantly different results to those for a homogeneous model and thus are preferable when accurate results are required.

The changing nature of clinical decision support systems: a focus on consumers, genomics, public health and decision safety.

OBJECTIVES: To review the recent research literature in clinical decision support systems (CDSS). METHODS: A review of recent literature was undertaken, focussing on CDSS evaluation, consumers and public health, the impact of translational bioinformatics on CDSS design, and CDSS safety. RESULTS: In recent years, researchers have concentrated much less on the development of decision technologies, and have focussed more on the impact of CDSS in the clinical world. Recent work highlights that traditional process measures of CDSS effectiveness, such as document relevance are poor proxy measures for decision outcomes. Measuring the dynamics of decision making, for example via decision velocity, may produce a more accurate picture of effectiveness. Another trend is the broadening of user base for CDSS beyond front line clinicians. Consumers are now a major focus for biomedical informatics, as are public health officials, tasked with detecting and managing disease outbreaks at a health system, rather than individual patient level. Bioinformatics is also changing the nature of CDSS. Apart from personalisation of therapy recommendations, translational bioinformatics is creating new challenges in the interpretation of the meaning of genetic data. Finally, there is much recent interest in the safety and effectiveness of computerised physician order entry (CPOE) systems, given that prescribing and administration errors are a significant cause of morbidity and mortality. Of note, there is still much controversy surrounding the contention that poorly designed, implemented or used CDSS may actually lead to harm. CONCLUSIONS: CDSS research remains an active and evolving area of research, as CDSS penetrate more widely beyond their traditional domain into consumer decision support, and as decisions become more complex, for example by involving sequence level genetic data.

The Centre for Health Informatics at the University of New South Wales--a clinical informatics research centre.

OBJECTIVES: Building a sustainable health system in the 21st Century will require the reinvention of much of the present day system, and the intelligent use of information and communication technologies (ICT) to deliver high quality, safe, efficient and affordable health care. The Centre for Health Informatics (CHI) is Australia's largest academic research group in this emerging discipline. METHODS: Our research is underpinned by a planning process, based on different future scenarios for the health system, which helps us identify longer-term problems needing a sustained research effort. A research competency matrix is used to ensure that the Centre has the requisite core capabilities in the research methods and tools needed to pursue our research program. RESULTS: The Centre's work is internationally recognized for its contributions in the development of intelligent search systems to support evidence-based healthcare, developing evaluation methodologies for ICT, and in understanding how communication shapes the safety and quality of health care delivery. Centre researchers also are working on safety models and standards for ICT in healthcare, mining complex gene micro array, medical literature and medical record data, building health system simulation methods to model the impact of health policy changes, and developing novel computational methods to automate the diagnosis of 3-D medical images. CONCLUSIONS: Any individual research group like CHI must necessarily focus on a few areas to allow it to develop sufficient research capacity to make novel and internationally significant contributions. As CHI approaches the end of its first decade, it is becoming clear that developing capacity becomes increasingly challenging as the research territory changes under our feet, and that the Centre will continue to evolve and shift its focus in the years to come.