A Dependable Massive Storage Service for Medical Imaging.

We present the construction of Babel, a distributed storage system that meets stringent requirements on dependability, availability, and scalability. Together with Babel, we developed an application that uses our system to store medical images. Accordingly, we show the feasibility of our proposal to provide an alternative solution for massive scientific storage and describe the software architecture style that manages the DICOM images life cycle, utilizing Babel like a virtual local storage component for a picture archiving and communication system (PACS-Babel Interface). Furthermore, we describe the communication interface in the Unified Modeling Language (UML) and show how it can be extended to manage the hard work associated with data migration processes on PACS in case of updates or disaster recovery.

Business Model for the Security of a Large-Scale PACS, Compliance with ISO/27002:2013 Standard.

Data security is a critical issue in an organization; a proper information security management (ISM) is an ongoing process that seeks to build and maintain programs, policies, and controls for protecting information. A hospital is one of the most complex organizations, where patient information has not only legal and economic implications but, more importantly, an impact on the patient's health. Imaging studies include medical images, patient identification data, and proprietary information of the study; these data are contained in the storage device of a PACS. This system must preserve the confidentiality, integrity, and availability of patient information. There are techniques such as firewalls, encryption, and data encapsulation that contribute to the protection of information. In addition, the Digital Imaging and Communications in Medicine (DICOM) standard and the requirements of the Health Insurance Portability and Accountability Act (HIPAA) regulations are also used to protect the patient clinical data. However, these techniques are not systematically applied to the picture and archiving and communication system (PACS) in most cases and are not sufficient to ensure the integrity of the images and associated data during transmission. The ISO/IEC 27001:2013 standard has been developed to improve the ISM. Currently, health institutions lack effective ISM processes that enable reliable interorganizational activities. In this paper, we present a business model that accomplishes the controls of ISO/IEC 27002:2013 standard and criteria of security and privacy from DICOM and HIPAA to improve the ISM of a large-scale PACS. The methodology associated with the model can monitor the flow of data in a PACS, facilitating the detection of unauthorized access to images and other abnormal activities.

[Technological advances in neurorehabilitation]. / Avances tecnológicos en neurorrehabilitación.

Neurological rehabilitation arose as formal method in the 60's, for the therapeutic treatment of patients with stroke or spinal cord injury, which develop severe sequelae that affect their motor and sensory abilities. Although the Central Nervous System has plasticity mechanisms for spontaneous recovery, a high percentage of patients should receive specialized therapies to regain motor function, such as Constraint Induced Movement Therapy or Upright physical Therapy. The neurorehabilitation has undergone drastic changes over the last two decades due to the incorporation of computer and robotic electronic devices, designed to produce positive changes in cortical excitability of the cerebral hemisphere damaged and so to improve neuroplasticity. Among equipment, we can mention those for electrotherapy devices, apparatus for transcranial magnetic stimulation, the robotic lower limb orthoses, robot for upper limb training, systems for functional electrical stimulation, neuroprosthesis and brain computer interfaces. These devices have caused controversy because of its application and benefits reported in the literature. The aim of Neurorehabilitation technologies is to take advantage of the functional neuromuscular structures preserved, and they compensate or re-learn the functions that previously made the damaged areas. The purpose of this article is to mention some clinical applications and benefits that these technologies offer to patients with neuronal injury.

System to measure the range of motion of the joints of the human hand .

Today, the manual goniometer is a common tool used in clinical practice to measure the range of motion (ROM) of joints in the hand. This device is not only tedious and highly timeconsuming to use, but its accuracy mainly depends on the experience of the examiner. The majority of electronic goniometers currently available on the market exhibit these same limitations. This document presents the physical design and attributes of a system known as the MULTIELGON, which can be used automatically to obtain multiple measurements of the angles of the hand's small finger joints simultaneously using a novel angle-to-voltage transducer. The reproducibility and repeatability of the transducer were evaluated; low dispersion and high homogeneity were demonstrated. Correlation and Bland-Altman analyses were used to compare the accuracy of the novel transducer (A) and traditional manual goniometer (B); the correlation coefficient was 0.9995. The Bland-Altman analysis determined the limits of agreement (1.4° to 1.7°) with a 95% confidence interval for any variation between the instruments (A and B), which gave readings differing by less than 3.1°. Differences were sufficiently small to propose that the manual goniometer can be replaced by the transducer; moreover A is best to evaluate the hand's small finger joints than B. The system is comprised of the device, the interface and the MULTIELGON GUI. The device consists of 14 angle-to-voltage transducers that can be attached to joints in the hand using a PVC clamp and an elastic glove. The MULTIELGON can be utilized to evaluate patients, as well as record and manage ROM data for surgical and rehabilitation decisions.

A software and hardware architecture for a high-availability PACS.

Increasing radiology studies has led to the emergence of new requirements for management medical information, mainly affecting the storage of digital images. Today, it is a necessary interaction between workflow management and legal rules that govern it, to allow an efficient control of medical technology and associated costs. Another important topic that is growing in importance within the healthcare sector is compliance, which includes the retention of studies, information security, and patient privacy. Previously, we conducted a series of extensive analysis and measurements of pre-existing operating conditions. These studies and projects have been described in other papers. The first phase: hardware and software installation and initial tests were completed in March 2006. The storage phase was built step by step until the PACS-INR was totally completed. Two important aspects were considered in the integration of components: (1) the reliability and performance of the system to transfer and display DICOM images, and (2) the availability of data backups for disaster recovery and downtime scenarios. This paper describes the high-availability model for a large-scale PACS to support the storage and retrieve of data using CAS and DAS technologies to provide an open storage platform. This solution offers a simple framework that integrates and automates the information at low cost and minimum risk. Likewise, the model allows an optimized use of the information infrastructure in the clinical environment. The tests of the model include massive data migration, openness, scalability, and standard compatibility to avoid locking data into a proprietary technology.

Communication interface and graphic module for audiometry equipment.

The National Rehabilitation Institute (INR) in Mexico City purchased 12 Madsen Orbiter 922 audiometers in 2006. While this audiometer is excellent for diagnosing the degree and type of hearing loss, it has presented problems in transfering, saving and printing the results of special tests and logoaudiometry from audiometer to workstation with the NOAH-3 system. The data are lost when the audiometer is turned off or a new patient is captured. There is no database storing and, shortly after the results have been printed on the thermal paper, the audiograms are erased. This problem was addressed by designing and implementing the InterAudio (AAMS) communication and graphical interface. The limitations and scope of the Automatic Audiometric Measurement System were analyzed, then a search of technical information was performed that included the resources for designing, developing and implementing the transfer interface, the user's graphical module requirements, and the tools for printing and saving the study.

Proposal and Evaluation of a Telerehabilitation Platform Designed for Patients With Partial Rotator Cuff Tears: A Preliminary Study.

OBJECTIVE: To propose and evaluate the effectiveness of a telerehabilitation platform designed for patients with rotator cuff (RC) tears. METHODS: During the first study phase, a virtual service platform that included information on RC tear pathology, joint care, and a series of instructions regarding therapeutic exercise was designed and created. Subsequently, in the clinical phase, a quasi-experimental study was performed. The platform was tested on patients and evaluated at baseline and at 1, 2, 3, and 6 months with respect to their pain levels and functionality on the Constant-Murley (CM) scale. RESULTS: Eleven patients were included, 5 women and 6 men, with a median age of 55 years (range, 42-68 years). Pain diminished from a baseline value of 64 mm (range, 40-80 mm) to 16 mm (range, 0-30 mm) at 6 months (p<0.001). Points on the CM scale rose from a baseline value of 54 points (range, 51-66 points) to 85 points (range, 70-100 points) at 6 months (p=0.001). Functionality in daily living and work activities, movement, and strength exhibited significant changes at 6 months (p<0.05). CONCLUSION: Significant changes were observed in pain and functionality in this group of participants who used a telerehabilitation platform. To the best of our knowledge, this is the first study that included a specific program for RC tears.