1. System Integration and Radiation Assessment of a Digital Catheterization Laboratory

The increasing burden of cardiovascular disease in the country has made it imperative that minimally invasive diagnostic procedures become affordable to the people. The conflict between acquisition of high-quality angiographic images and limiting x-ray exposure of patients and staff has always been difficult to resolve satisfactorily. Cardiac angiography, with its simultaneous requirements for high acquisition rates and the need to visualize very small objects, places some of the most severe demands on x-ray generating equipment and the associated radiation safety measures to be adopted. This project essentially involves the integration of various components of a digital catheterization laboratory like the x-ray generator, x-ray tube, image intensifier and digital monitoring system with software to ensure high quality 1K x 1K resolution images in the medical grade DICOM format. The performance in terms of acquisition of fluoroscopic and cine angiographic images for the optimal performance of the system integrated catheterization laboratory and the associated radiation parameters are assessed in comparison with an imported digital catheterization laboratory.

2. Digitization of X-rays to medical grade format

For decades now, unlike any major medical imaging methods such as ultrasound, computerized tomography (CT), Magnetic Resonance Imaging (MRI), nuclear medicine etc, all of which are digital, conventional x-ray imaging remains a largely analog technology. Making the transition from analog to digital could bring several advantages to x-ray imaging. These would include improvement in contrast and other aspects of image quality by means of image processing. The project deals in capturing X-ray images through a 5.1 Megapixel Nikon digital camera and developing application software to convert the acquired images to medical grade DICOM format. The application software facilitates in gray shade level adjustments of the image, bones, soft tissue and even metal and plastic parts such as artificial hipbones all from one single image and image processing features like measurements and zooming on regions of interest. The report also highlights on the latest trends involved in digitization of x-rays using CR (Computed Radiography) and DR (Digital Radiography) technology.

3. ECG Acquisition and GSM based transmission

Telemedicine is now producing a great impact in monitoring of patients located in remote non-clinical environments. A number of applications, ranging from data collection, to chronic patient surveillance, and even to the control of therapeutic procedures, are being implemented in many parts of the world. As part of this growing trend, the project involves the acquisition of an electrocardiogram (ECG) and transmission of the signal through a Global System for Mobile (GSM) Communication platform. The project involves the validation of the prototype system composed of a portable data acquisition module and transmitting the same as an acoustic signal. The signal will be received by a GSM preprocessing module in the expert center, which is connected to the computer through an RS-232 port. The software modules handle the communication protocols between data acquisition module and the computer. The project validates the acquired ECG signal from the prototype system with ECG acquired through conventional system and analyzes the reasons for discrepancies, if present. The purpose of the system is to enable the provision of extended monitoring for patients in remote locations, in ambulances while being transported to ensure timely treatment, thereby integrating advances in communication technology with medical technology.

4. Application of GIS in Healthcare

Geographers have had a long history of applying geographical and cartographical analysis techniques to health problems. Today, the field of medical geography can be divided into two main area (i) studies involving the issues of healthcare provision and (ii) studies that involve the analysis of the spatial distribution of disease. The project details the application of GIS in healthcare with reference to the above. In addition, site planning of healthcare facilities can be examined in the context of spatial modeling methodologies such as maximizing patient accessibility to the hospitals and minimizing accessibility costs, or reducing the uncertainty of patients travel behaviors. To tackle these various accessibility patterns, several location models and spatial analysis methods have been exploited in geography, operational research and other disciplines. As geographical information system (GIS) have been introduced to healthcare planning, the application scope of spatial modeling has also increased at various practical levels in healthcare services. Keeping in view the above, application software has also been developed which will facilitate in creating an epidemiological database of the healthcare facilities and prevalence of disease pattern across the state.

5. Application of ISDN Technology in Telemedicine

The project highlights the Integrated Services Digital Network (ISDN) mode of communication in the application of Telemedicine between two locations at 64 kbps and 128 kbps bandwidths. The project involved the configuration of Basic Rate Interface (BRI) port on a router for transmission of data, which involved both textual and images in medical formats at baud rates of 64 kbps and 128 kbps. The transmission time involved for the transfer of data was calculated and a comparison was made with the time taken for the transfer of the same data through a leased line link at the same baud rates.

6. ECG Acquisition through RS 232

This project involves the integration of an ECG machine to a computer through an RS-232 port and subsequent acquisition of data in the proprietary format, conversion and calculation of lead voltages from the acquired data and display of the electrocardiogram. The application software developed in visual basic enables continuous monitoring of the ECG and storing it in picture formats (.jpg) with adjustable compression quality values for subsequent viewing and printing on an ordinary A4 size paper.

7. Design criteria of Operation Theatre and Robotic Surgery

The physical design of a hospital is an essential component of a hospital’s infection control strategy to minimize the risk of infection transmission. Operation Theatre design considers the separation of dirty and clean areas, adequate ventilation, lighting and storage facilities and design of patient accommodation areas. The report stresses the need for effective ventilation and identification of potential infections and risks involved in the design of hospitals. The study also discusses the usage of Robots in surgery. This latest technological development has lead to faster, precise and more effective surgical operations. The report deals with the advantages and also the future of Robotic Surgery.

8. Digital Catheterization Laboratory

This report is a study on the functionality of the digital Catheterization laboratory (Cath lab) and the technical specifications of the machinery used in a Cath lab. The medical aspects dealt in the report include angiogram, angiography and prevention to radiation exposure. A comparison between Siemens Cath lab and System Integrated Cath lab both installed at CARE Hospital is also one aspect of the report. The advancements possible in the area of Cath lab in near future is explained.

9. Design of Telemedicine Workstation

The main objective of Telemedicine is to provide the expertise available at tertiary centers to secondary care centers and in turn to the primary health care centers. The purpose of the system is to give health care providers at remote locations the ability to consult with specialists by integration of medical, communication and information technology enabling transmission of a combination of video, audio, and externally acquired images. The system can also be used for education purposes to support bi-directional video/audio communications for grand round lectures, classes, and case conferences. In order to maximize the utilization of the available transmission medium (ranging from land-based copper and fiber optic cable to satellite link) while providing the best possible video and audio quality, the compression performed by the system is adaptable to a wide variety of bandwidths.

10. Application of Leased Line Technology in Telemedicine

The project highlights one particular mode of communication (leased line) in the application of Telemedicine between two locations with varying bandwidth from 64 kbps to 256 kbps. The project dealt with transfer of data in the form of textual and image content between two locations using leased line routers modems and other necessary hardware. An understanding of bandwidth sharing between multiple locations running simultaneously was also implemented. An analysis to establish the transmission time required for transferring data at different baud rates from different locations (Mahaboobnagar, Agartala and Rajahamundry) was carried out.

11. Computerization of Records in Histopathology Lab

The project involved developing application software for the histopathological lab wherein a separate code is generated based on the International Classification of diseases (ICD) for various pathologoical diseases. The software package was developed in Microsoft Visual Basic as the front end and Microsoft Access as the back end.

12. Digitization of Fluoroscopic images to medical grade format

The project deals with converting images from the output console of image intensifier to one of the standard storage formats using a frame grabber card and capture software. These stacked images are then converted to DICOM (Digital Imaging and Communication in Medicine), a medical grade format by application software.

13. Transcranial Doppler Device: Validation and design aspects

The project involved the clinical validation of a Transcranial Doppler device (TCD) used as a non-invasive diagnostic tool. It involved the study of anatomy and flow patterns of normal cerebral circulation in the normal subjects using this device. The carotid flow velocities and other parameters obtained from this device are compared with a standard ultrasound Doppler device, thereby validating the new prototype mode TCD. Based on the results of the study, design constraints and scope for improvement of this TCD were suggested in order to make it a commercially viable and effective product.

14. Teleradiology: Acquisition and transmission of medical Images

Medical and communication advancements over the last decade have made it possible to enable transfer of clinical information and images from medical equipment (CT, MRI) in the medical grade digital format (DICOM) from remote centers to specialty centers for diagnosis. More commonly referred to as "'Tele-Radiology", this technology increases the reach of the physician who can utilize his skills to the maximum number of patients rather than being confined by geography. The project essentially involves the integration of the medical equipment (CT, MRI) by the development of application software facilitating seamless transmission between the imaging modality and computer. The application software enables creating the patient record along with the basic clinical information derived from the attributes of the image and further ensures the transmission of the patient record through leased line network for archival of the same in the server system for viewing by specialists in the hub centre for reporting the diagnosis. The software has been developed with Visual Basic 6.0 as the front end and Microsoft Access serving as the database.

15. Validation of X -Ray in Digital Format Acquired Through CCD Sensor

Digital radiography is a form of imaging where digital X-ray sensors are used instead of traditional photographic film. The practice of digital radiographic imaging is poised to undergo dramatic change in the very near future owing to a rapid proliferation of electronically readable x-ray detectors. Although self-scanning, direct-readout digital detectors have been in use since the introduction of the charged-coupled device (CCD) almost 30 years ago, recent advances in manufacturing technology have made possible a new generation of large-area, flat-panel detectors with integrated, thin-film transistor readout mechanisms. This project involves the use of a digital detector (NAOMI) containing 240 CCD sensors for the acquisition of the image. The acquired images will be in medical grade DICOM format. The application software enables in archiving the acquired DICOM images from the DR system and in comparing them with the scanned X-ray images of the respective patients obtained from conventional methods. The main advantages of DR include time efficiency, ability to digitally transfer and enhance images and regulate dose efficiency.

16. Multi-Parameter Data Acquisition of Blood Pressure, Temperature and Electrocardiogram

One of the most important issues that need to be addressed in the medical field is the delivery of quality healthcare. This project envisages the development of portable ruggedized, simple cost efficient multipurpose diagnostic tools, especially for primary diagnosis and one that can be used as a rural healthcare device. The multipurpose kit used in this project helps measure three parameters namely: ECG, Temperature and BP, the hardware of which is directly incorporated into the kit. The application software has been developed in VB.net as front end and Microsoft access as back end. The application software links with the kit through a Dynamic Linked Library (DLL) file which receives the commands to trigger the selected parameter and acquires the data collected from the kit. One end of the kit is connected to a computer system via the USB 2.0 port with a facility of connecting via RS232 also while the other end is connected to the respective sensors namely electrodes in case of ECG, Cuff for BP and thermistor for temperature. This measures the bio signals and converts them into digital signals and sends them back to the system for display. The flexibility of the Dotnet platform ensures that the data can be transferred to the server via internet / intranet thus enabling the complete patient information being stored at the server database. This multipurpose kit, which is “Telemedicine friendly” can find its best application in providing a mechanism for assimilating basic diagnostic health profile especially of the rural population.