1. The SEE-GRID initiative is co-funded by the European Commission under the FP6 Research Infrastructures contract no. 002356 Belgrade Children’s University Hospital’s Infrastructure, HIS and Grid-Based 3D Visualization Zoran Jovanović, Branko Marović, Lovro Ilijašić, Jovana Vuleta, Mara Bukvić, University of Belgrade Belgrade University Computing Center - RCUB University of Belgrade www.rcub.bg.ac.yu

2. TNC 2005 Conference - Poznan, 6-9 June 20052 eHospitals and NRENs Requirements for high speed networking, large amounts of data, and computational power Terabytes of data Computationally intensive operations in segmentation and analysis of 3D datasets Telemedicine – remote access to patient data and videoconferencing as a core University hospitals are most advanced and are eligible to be connected to the NREN Dark fiber to the hospitals (65 buildings) NRENs are the necessary infrastructure for development of advanced eHealth solutions

3. TNC 2005 Conference - Poznan, 6-9 June 20053 Mainstream in developing HIS Implementing multi-tier technologies Web browser as the basic component at the workstation level Multimedia interface developed worldwide Low cost maintenance Easy sharing of data worldwide Security solutions for Web based systems can easily be extended to healthcare (example e-Banking)

4. TNC 2005 Conference - Poznan, 6-9 June 20054 Belgrade Children’s University Hospital Computer Network

5. TNC 2005 Conference - Poznan, 6-9 June 20055 Diagnostic Medical Equipment New angiography lab with DICOM servers

6. TNC 2005 Conference - Poznan, 6-9 June 20056 NREN of Serbia and Montenegro Kraljevo BEOGRAD Kragujevac NIŠNIŠ NOVI SAD Local ISP Telekom Srbija Podgorica Subotica Bor Leskovac Novi Pazar Šabac Sombor Užice Valjevo Čačak Kruševac Pančevo Zrenjanin Athens/GrNet SEEREN/GEANT Pirot Vranje Szeged/Hungarnet SEEREN/GEANT Nodes: National NOC Core Nodes Gbps nodes International: 1Gbps/91Mbps 34 Mbps Internal: 2*1 Gbps Ethernet 1 Gbps Ethernet 1 Gbps Eth/SDH 2 Mbps

7. TNC 2005 Conference - Poznan, 6-9 June 20057 The UChHIS The HIS is platform independent object oriented distributed software with multi-tiered architecture built on J2EE Technology The HIS has centralized storage and thin clients Role based Web access to electronic patient records (EPR) is enabled EPR has attaching mechanism for any type of files (including DICOM files) and HIS provides a mechanism for opening attachments Search engine supports queries which combine various search parameters

8. TNC 2005 Conference - Poznan, 6-9 June 20058 Scheduling system of UChHIS  The HIS has a sophisticated scheduling system accommodated to specific requirements of the hospital and clinic treatment  Automatic computer supported invocation of patients for all clinics and waiting rooms by using prerecorded voice records  Patients can interact with HIS using web in order to define preferable medical examination date and to be informed about scheduled examinations via email and/or mobile phone SMS messages

9. TNC 2005 Conference - Poznan, 6-9 June 20059 User interface for EPR

10. TNC 2005 Conference - Poznan, 6-9 June 200510 Presenting EPR data Mechanisms for viewing data stored within EPR: Files created by users are almost immediately opened and viewed or modified at client work station by the default program for that type of file Files generated by medical diagnostic devices (usually DICOM files) are on demand transferred to client work station and viewed by a DICOM viewer Objective: Complete interactive analysis of 3D datasets from medical imaging devices (CT, MR, PET, SPECT…) Provide generalized 3D tools for remote diagnosis, surgical planning, and therapy evaluation - Virtual distant examination based on 3D datasets

11. TNC 2005 Conference - Poznan, 6-9 June 200511 3D Incorporation in the HIS Our basic idea: Split the system into a client and server part Dedicate the server part to processing of volumetric data Processing of volumetric data Creating 3D meshes of isosurfaces Conversion into VRML models Produce a lightweight client for user interaction and 3D rendering Use open standards (Web, VRML, Java…) Create virtual tools for user interaction

12. TNC 2005 Conference - Poznan, 6-9 June 200512 Introduction: 3D Visualization Components

13. TNC 2005 Conference - Poznan, 6-9 June 200513 3D Visualization Components

14. TNC 2005 Conference - Poznan, 6-9 June 200514 3D datasets: require memory and computationally intensive processing 3D data from medical devices, PACS and HIS may require readers/converters to other formats Computational resources - Intensive computation is done by server part of the application and additionally - Web front end performs Grid job submission for the field server Managing storage - User initiated creation of replicas on the Grid with a storage management application and interfaces to data sources Communication bottleneck? – Yes between instances of server applications and data storage - Server can start with partially loaded segments of data Optimized traffic between the server and client How to provide 3D in a Web browser? VRML for 3D rendering, spatial interaction, and navigation Java for GUI and communication

15. TNC 2005 Conference - Poznan, 6-9 June 200515 Use of Grid

16. TNC 2005 Conference - Poznan, 6-9 June 200516 Field Engine Interpret data from HIS (Hospital Information System) PACS (Picture Archiving and Communication Systems) Numerical simulations (e.g. blood flow simulation) Provide vector or scalar value for arbitrary location within image volume V=F(x, y, z, t) Manage Caching Compute cross-section or volume textures for selected sub volumes Grid allows for distribution a large dataset over a number of nodes Only if and when it becomes necessary

17. TNC 2005 Conference - Poznan, 6-9 June 200517 Geometry Engine Creates and modifies geometry models Isosurface generation using Marching Cubes algorithm Compression through error-bound mesh simplification Two uses of isosurfaces – orientation in 3D and precise objects boundaries Meshes sent as VRML models Grid may be used to parallelize mesh generation and simplification

18. TNC 2005 Conference - Poznan, 6-9 June 200518 Web access through the RIS

19. TNC 2005 Conference - Poznan, 6-9 June 200519 Virtual Tools 3D remote manipulation tools designed to minimize the client load and bandwidth Cutting plane (oblique cross-sections)– Slicer (Sl) Distance and angles in 3D – Caliper (Cal) Annotations - points and objects of interest (A) Dicer - subvolume projection: averaging, maximum intensity projecting, and threshold (D) Geometry reconstructions – Surface (S) Cutting plane with vector field – Vector grid (VG) Viewpoint Virtual examination device

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26. TNC 2005 Conference - Poznan, 6-9 June 200526 Other Requirements Web front end At least one Web server running the front-end application May be at single location - UoB/RCUB Client PC with access to Internet Current software requirements Internet Explorer Cortona VRML client Microsoft Java VM

27. TNC 2005 Conference - Poznan, 6-9 June 200527 Benefits of Regional Usage of VIVE Improving of service provided by healthcare institutions in cases requiring advanced visualization of CT, MRI, and other modalities. Usage in Diagnosis Interventional planning Treatment validation Facilitates remote consultation and collaboration of medical specialists. Potential for building of fully collaborative 3D medical environments. Highly scalable distributed 3D visualization system which may provide a higher level of medical care with minimal additional investment. Promotion of Grids by providing a tool and resources needed in healthcare on everyday basis. Extension of Grid usage into domain of interactive visualization. Extensibility to other areas like Earth sciences (atmospheric science, geology, oceanography), aerodynamics, astrophysics, thermodynamics, and fluid dynamics.

28. TNC 2005 Conference - Poznan, 6-9 June 200528 What do we gain from the Grid Data transfer and replication Abstraction of data within patient electronic health record Replication of data at the locations close to computation elements On demand load of necessary parts of dataset - usage of spatially segmented formats Security Data encryption in transfer Stripping of data over several nodes Not necessary for the regular medical images Divide a single field over several WNs using a dispatcher and spatially segmented data format Functional distribution, thus allocating separate machines for texture and surface mesh creation Monitoring - Not crucial

29. TNC 2005 Conference - Poznan, 6-9 June 200529 Grid node of Belgrade University Computer Centre Running on SEE-GRID sites Using the application with your data/cases Promote - find a doctor! Get data from local devices Produce readers for local formats Arrange training for end-users Provide feedback Future Usage in non-medical domains Transparent distribution, replication, and long-term storage of 3D medical images over the Grid – integration with a electronic health record

30. TNC 2005 Conference - Poznan, 6-9 June 200530 Conclusion The NRENs and GRID are excellent testbeds for developing future eHealthcare appilications Experimental 3D remote medical imaging and manipulation system with a thin client works! GRID technology for storage and computation in SEE-GRID is used for eHealth applications Help in involving the end-users (medical community) is crucial! New visualization tool Remote 3D studies Telemedical cooperation – surgical planning The data sources in eHealth (CT, MRI, PET scanners) create large amounts of data that require computational clusters for segmentation and analysis.

31. TNC 2005 Conference - Poznan, 6-9 June 200531 Thank you for your attention!