Advances in Healthcare Technology

Advances in Healthcare Technology

Philips Research

VOLUME 6

Editor-in-Chief Dr. Frank Toolenaar

Philips Research Laboratories, Eindhoven, The Netherlands

SCOPE TO THE ‘PHILIPS RESEARCH BOOK SERIES’

As one of the largest private sector research establishments in the world, Philips Research is shaping the future with technology inventions that meet peoples’ needs and desires in the digital age. While the ultimate user benefits of these inventions end up on the high-street shelves, the often pioneering scientific and technological basis usually remains less visible.

This ‘Philips Research Book Series’ has been set up as a way for Philips researchers to contribute to the scientific community by publishing their comprehensive results and theories in book form.

Dr. Rick Harwig

Advances in Healthcare Technology

Care

Edited by

Gerhard Spekowius

and

Thomas Wendler

Shaping the Future of Medical

Philips Research Europe, Aachen, Germany

Philips Research Europe, Hamburg, Germany

A C.I.P. Catalogue record for this book is available from the Library of Congress.

ISBN-10 1-4020-4383-X (HB) ISBN-13 978-1-4020-4383-3 (HB) ISBN-10 1-4020-4384-8 (e-book) ISBN-13 978-1-4020-4384-0 (e-book)

Published by Springer,

P.O. Box 17, 3300 AA Dordrecht, The Netherlands.

Printed on acid-free paper

All Rights Reserved

© 2006 Springer

No part of this work may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, microfilming,

recording or otherwise, without written permission from the Publisher, with the exception of any material supplied specifically for the purpose of

being entered and executed on a computer system, for exclusive use by the purchaser of the work.

Printed in the Netherlands.

www.springer.com

TABLE OF CONTENTS

v Chapter 1

Advances and Trends in Healthcare Technology... 1

Robert Gossink, Jacques Souquet Chapter 2 Diagnostic Imaging ... 15

Falko Busse Chapter 3 Reconstruction Technologies for Medical Imaging Systems ... 35

Roland Proksa Chapter 4 Detectors for X-ray Imaging and Computed Tomography ... 49

Michael Overdick Chapter 5 3D-Rotational X-ray Imaging ... 65

Volker Rasche, Michael Grass, Robert Manzke Chapter 6 Coronary Magnetic Resonance Angiography ... 81

Peter Bornert, Kay Nehrke, Dye Jensen Chapter 7 4-Dimensional Ultrasonic Imaging ... 99

Christopher S. Hall PART I: TRENDS IN HEALTHCARE PART II: DIAGNOSTIC IMAGING CONTRIBUTING AUTHORS... ix

PREFACE ... xix

ACKNOWLEDGEMENTS ... xxiii

ABBREVIATIONS... xxv

...

...

...

.

Table of Contents vi

Chapter 8

Clinical Hybrid Imaging: Image Co-registration and Hardware

Combination for PET/CT and SPECT/CT ... 117

Chapter 9

New Technology for Image-Guided Therapy ... 139 Jeffrey Yanof, Michael Kuhn

Chapter 10

Image-Guided Therapy (IGT): New CT and Hybrid Imaging

Technologies ... 147 Jeffrey Yanof, Christopher Bauer, Steffen Renisch,

Chapter 11

Developments in Cardiac Interventions ... 167 Jörn Borgert, Raoul Florent, Sascha Krueger,

Sherif Makram-Ebeid, Babak Movassaghi, Holges Timinger, Volker Rasche

Chapter 12

MRI -Guided Focused Ultrasound ... 183 Chrit T.W. Moonen, Charles Mougenot

Chapter 13

Advances in External Beam Radiation Therapy ... 201 Todd McNutt, Michael R. Kaus, Lothar Spies

Chapter 14

Molecular Imaging Guided Radiotherapy... 217 Kenneth A. Krohn, Lothar Spies

Chapter 15

Molecular Medicine ... 235 Hans Hofstraat

PART III: INTEGRATION OF DIAGNOSTIC IMAGING AND THERAPY

PART IV: MOLECULAR MEDICINE

Y. H misch, M. Egges, H. Hines, K. Fiedler, I. Carlsen

Jochen Kr cker, Jörg Sabczynski ä

ü

Table of Contents vii

Chapter 17

Biomarkers in Disease Diagnosis and Treatment... 269 Ralf Hoffmann

Chapter 18

Molecular Agents for Targeted Imaging and Therapy ... 287 Holger Grüll, Marc S. Robillard

Chapter 19

Targeted Nanoparticles for Molecular Imaging and Therapy ... 305 Shelton D. Caruthers, Samuel A. Wickline, Gregory M. Lanza

Chapter 20

Molecular Imaging with Annexin A5 ... 323 Chris Reutelingsperger, Leonard Hofstra

Chapter 21

Proteomics for Diagnostic Applications ... 337 Gordon R. Whiteley

Chapter 22

Medical Information Technology... 349 Charles Lagor, William P. Lord, Nicolas W. Chbat,

J. David Schaffer, Thomas Wendler Chapter 23

Developments in Clinical Information Technology ... 367 Kees Smedema, Cor Loef, Bert Verdonck

Chapter 24

Computer Aided Detection and Quantification... 385 Rafael Wiemker, Patrik Rogalla, Dag Wormanns, Thomas Bülow, Roland Opfer, Ahmet Ekin, Thomas Blaffert, Ori Hay,

Ekta Dharaiya, Roel Truyen, Joost Peters, Eike Hein, Valentina Romano, Florian Beyer

Chapter 16

Molecular Imaging Systems... 247 Tobias Schaeffter

PART V: MEDICAL INFORMATICS

Table of Contents viii

Index Chapter 26

Bioinformatics... 421 J. David Schaffer, Nevenka Dimitrova, Michael Zhang

Chapter 27

Perspectives in Personal Healthcare... 439 Thomas Zaengel, Eric Thelen, Jeroen Thijs

Chapter 28

On-body Sensors for Personal Healthcare... 463 Olaf Such, Jens Muchlsteff, Robert Pinter, Xavier Aubert,

Thomas Falck, Martin Elixmann, Harald Reiter, Eric Cohen-Solal, Balasundar Raju, John Petruzzello, Andreas Bravers, Jeroen Thijs, Claudia Igney

Chapter 29

Automated External Defibrillators for Layperson Use ... 489 Chuck Little, Wendy B. Katzman

Chapter 30

Remote Patient Monitoring Solutions ... 505 David Simons, Tadashi Egami, Jeff Perry

Chapter 31

Diabetic Care... 517 Golo von Basum, Rufus, Driessen, Francisco Morales,

Begonya Otal, Kristiane Schmidt Chapter 25

Medical Decision Support Systems... 403 William P. Lord, Dale C. Wiggins

PART VI: PERSONAL HEALTHCARE

... 533

CONTRIBUTING AUTHORS

Xavier-Louis Aubert PhD

Senior Scientist, Medical Signal Processing, Philips Research Europe - Aachen, Germany

Golo von Basum PhD

Senior Scientist, Care and Health Applications, Philips Research Europe - Eindhoven, The Netherlands

Christopher Bauer

Mechanical Design Engineer, CT Clinical Science Department, Philips Medical Systems, Cleveland, OH, USA

Florian Beyer MD

Radiologist, Institute for Radiology, University Hospital, Münster, Germany

Thomas Blaffert PhD

Senior Scientist, Digital Imaging, Philips Research Europe - Hamburg, Germany

Peter Börnert PhD

Principal Scientist, Tomographic Imaging Systems, Philips Research Europe - Hamburg, Germany

Jörn Borgert PhD

Senior Scientist, Tomographic Imaging Systems, Philips Research Europe - Hamburg, Germany

Andreas Brauers PhD

Research Scientist, Medical Signal Processing, Philips Research Europe - Aachen, Germany

Thomas Bülow PhD

Research Scientist, Digital Imaging, Philips Research Europe - Hamburg, Germany

Falko Busse PhD

Vice President Philips Research, Director Medical Imaging Systems, Philips Research Europe - Hamburg, Germany

ix

Contributing Authors

Ingwer C. Carlsen PhD

Principal Scientist, Digital Imaging, Philips Research Europe - Hamburg, Germany

Shelton D. Caruthers PhD

Senior Clinical Scientist, Philips Medical Systems, and

Associate Director, Cardiovascular MR Laboratories, Washington University School of Medicine, St. Louis, MO, USA

Nicolas W. Chbat PhD

Senior Member of the Research Staff, Healthcare Systems and IT Department, Philips Research North America - Briarcliff Manor, NY, USA

Eric Cohen-Solal PhD

Senior Member Research Staff, Healthcare Systems and IT, Philips Research North America - Briarcliff Manor, NY, USA

Ekta Dharaiya

Staff Scientist, CT Clinical Science, Philips Medical Systems, Cleveland, OH, USA

Nevenka Dimitrova PhD

Research Fellow, Healthcare Systems and IT, Philips Research North America - Briarcliff Manor, NY, USA

Rufus Driessen

Principal Scientist, Care and Health Applications, Philips Research Europe - Eindhoven, The Netherlands

Tadashi Egami

Product Manager Motiva, New Ventures, Philips Medical Systems, Milpitas CA, USA

Matthias Egger PhD

Sales and Marketing Manager PET Europe, Philips Medical Systems, Gland, Switzerland

Ahmet Ekin PhD

Senior Scientist, Video Processing, Philips Research Europe - Eindhoven, The Netherlands

x

Contributing Authors

Martin Elixmann PhD

Department Head, Connectivity Systems, Philips Research Europe - Aachen, Germany

Thomas Falck

Senior Scientist, Connectivity Systems, Philips Research Europe - Aachen, Germany

Klaus Fiedler PhD

Senior Scientist, Molecular Imaging Systems, Philips Research Europe - Aachen, Germany

Raoul Florent

Principal Scientist, Philips Medical Systems Research, Paris, France

Robert G. Gossink PhD

formerly Managing Director Philips Research Germany and Program Manager Healthcare Systems, presently advisor to Philips Research, Philips Research Europe - Aachen, Germany

Michael Grass PhD

Senior Scientist, Tomographic Imaging Systems, Philips Research Europe - Hamburg, Germany

Holger Grüll PhD

York Hämisch PhD

Product Manager Pre-Clinical Imaging Systems, Molecular Imaging Division, Philips Medical Systems, Böblingen, Germany

Christopher S. Hall PhD

Principal Member Research Staff, Healthcare Systems and IT, Philips Research North America - Briarcliff Manor, NY, USA

Ori Hay

Staff Scientist, CT Clinical Applications, Philips Medical Systems, Haifa, Israel

Eike Hein MD

Radiologist, Institute for Radiology, Charité Hospital, Humboldt University, Berlin, Germany

xi

Senior Scientist, Biomolecular Engineering, Philips Research Europe -

Eindhoven, The Netherlands

Contributing Authors

Horace Hines PhD

Chief Technical Officer, Nuclear Medicine, Philips Medical Systems, Milpitas, CA, USA

Ralf Hoffmann PhD

Principal Scientist, Biomolecular Engineering, Philips Research Europe - Eindhoven, The Netherlands

Hans Hofstraat PhD

Vice President Philips Research, Director Molecular Medicine, Philips Research Europe - Eindhoven, The Netherlands

Leonard Hofstra MD PhD

Associate Professor of Cardiology, Department of Cardiology, Cardiovascular Research Institute Maastricht, University Maastricht, The Netherlands

Claudia Hannelore Igney PhD

Research Scientist, Medical Signal Processing, Philips Research Europe - Aachen, Germany

Dye Jensen PhD

Department Head, Tomographic Imaging Systems, Philips Research Europe - Hamburg, Germany

Wendy B. Katzman

Principal, Decision Point Consulting, Seattle, WA, USA

Michael R. Kaus PhD

Senior Scientist, Digital Imaging, Philips Research Europe - Hamburg, Germany

Kenneth A. Krohn PhD

Professor of Radiology and Radiation Oncology, Adjunct Professor of Chemistry, University of Washington, Seattle, WA, USA

Senior Member Research Staff, Clinical Sites Research, Philips Research North America - Briarcliff Manor, NY, USA

Sascha Krüger PhD

Research Scientist, Tomographic Imaging Systems, Philips Research Europe - Hamburg, Germany

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Jochen Kr cker PhD ü

Contributing Authors

Michael Kuhn PhD

Vice President Technology Strategy, Philips Medical Systems, Hamburg, Germany

Charles Lagor MD PhD

Senior Member Research Staff, Healthcare Systems and IT, Philips Research North America - Briarcliff Manor, NY, USA

Gregory M. Lanza MD PhD

Associate Professor of Medicine and Bioengineering, Cardiovascular Division, Washington University Medical School, St. Louis, MO USA

Chuck Little

General Manager, Philips AED Business, Cardiac Solutions, Philips Medical

Cor Loef

Program Manager Interoperability, Business Group Healthcare IT, Philips Medical Systems, Best, The Netherlands

William P. Lord

Principal Member Research Staff, Healthcare Systems and IT, Philips Research North America - Briarcliff Manor, NY, USA

Todd R. McNutt PhD

Assistant Professor, Department of Radiation Oncology, Johns Hopkins School of Medicine, Baltimore, MD, USA

Sherif Makram-Ebeid PhD

Research Fellow, Philips Medical Systems Research, Paris, France

Robert Manzke PhD

Senior Member Research Staff, Clinical Sites Research, Philips Research North America - Briarcliff Manor, NY, USA

Chrit T.W. Moonen PhD

Research Director, Laboratory for Molecular and Functional Imaging, Centre Nationale de la Recherche Scientifique, University ‘Victor Segalen Bordeaux 2’, Bordeaux, France

Francisco Morales PhD

Department Head, Care and Health Applications, Philips Research Europe - Eindhoven, The Netherlands

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Systems, Seattle, WA, USA

Contributing Authors

Charles Mougenot

PhD student, Laboratory for Molecular and Functional Imaging, Centre

Nationale de la Recherche Scientifique, University ‘Victor Segalen Bordeaux 2’, Bordeaux, France

Babak Movassaghi PhD

Senior Member Research Staff, Clinical Sites Research, Philips Research North America - Briarcliff Manor, NY, USA

Jens Mühlsteff PhD

Research Scientist, Medical Signal Processing, Philips Research Europe - Aachen, Germany

Kay Nehrke PhD

Senior Scientist, Tomographic Imaging Systems, Philips Research Europe - Hamburg, Germany

Roland Opfer PhD

Research Scientist, Digital Imaging, Philips Research Europe - Hamburg, Germany

Begonya Otal

Research Scientist, Medical Signal Processing, Philips Research Europe - Aachen, Germany

Michael Overdick PhD

Department Head, X-ray Imaging Systems, Philips Research Europe - Aachen, Germany

Jeff Perry

Program Director Motiva, New Ventures, Philips Medical Systems, Milpitas, CA, USA

Joost Peters PhD

Staff Scientist, Advanced Development, Medical IT, Philips Medical Systems, Best, The Netherlands

John Petruzzello PhD

Senior Member Research Staff, Healthcare Systems and IT, Philips Research North America - Briarcliff Manor, USA

xiv

Contributing Authors

Robert Pinter PhD

Research Scientist, Medical Signal Processing, Philips Research Europe - Aachen, Germany

Roland Proksa

Research Fellow, Tomographic Imaging Systems, Philips Research Europe - Hamburg, Germany

Balasundar Raju PhD

Senior Member Research Staff, Healthcare Systems and IT, Philips Research North America - Briarcliff Manor, USA

Volker Rasche PhD

Professor of Cardiovascular Magnetic Resonance Imaging, University of Ulm, Ulm, Germany

Harald Reiter

Senior Scientist, Medical Signal Processing, Philips Research Europe - Aachen, Germany

Chris Reutelingsperger PhD

Associate Professor of Biochemistry, Department of Biochemistry, Cardiovascular Research Institute Maastricht, University Maastricht, The Netherlands

Steffen Renisch PhD

Senior Scientist, Digital Imaging, Philips Research Europe - Hamburg, Germany

Marc S. Robillard PhD

Senior Scientist, Molecular and Biomolecular Engineering, Philips Research Europe - Eindhoven, The Netherlands

Patrik Rogalla MD

Senior Radiologist, Institute for Radiology, Charité Hospital, Humboldt University, Berlin, Germany

Valentina Romano MD

Radiologist, Institute for Radiology, Charité Hospital, Humboldt University, Berlin, Germany

xv

Contributing Authors

Helen Routh PhD

Research Department Head, Healthcare Systems and IT, Philips Research North America - Briarcliff Manor, NY, USA

Jörg Sabczynski PhD

Senior Scientist, Digital Imaging Department, Philips Research Europe - Hamburg, Germany

J. David Schaffer PhD

Research Fellow, Healthcare Systems and IT, Philips Research North America - Briarcliff Manor, NY, USA

Tobias Schaeffter PhD

Principal Scientist, Tomographic Imaging Systems, Philips Research Europe - Hamburg, Germany

Kristiane Schmidt PhD

Senior Scientist, Care and Health Applications, Philips Research Europe - Eindhoven, The Netherlands

David P.L. Simons PhD

Senior Architect, Software Architectures, Philips Research Europe - Eindhoven, The Netherlands

Kees Smedema

Senior Director Business Development, Business Group Healthcare IT, Philips Medical Systems, Best, The Netherlands

Jacques Souquet PhD

President, SuperSonic Imagine, SA, Aix-en-Provence Cedex, France

Gerhard Spekowius PhD

Business Development Manager, Philips Research Europe - Aachen, Germany

Lothar Spies PhD

Department Head, Digital Imaging, Philips Research Europe - Hamburg, Germany

Olaf Such PhD

Senior Scientist, Medical Signal Processing, Philips Research Europe - Aachen, Germany

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Contributing Authors

Eric Thelen

Department Head, Medical Signal Processing, Philips Research Europe - Aachen, Germany

Jeroen A.J. Thijs

Research Scientist, Medical Signal Processing, Philips Research Europe - Aachen, Germany

Holger Timinger PhD

Research Scientist, Tomographic Imaging Systems, Philips Research Europe - Hamburg, Germany

Roel Truyen

Senior Scientist, Advanced Development, Medical IT, Philips Medical System, Best, The Netherlands

Bert Verdonck

Marketing Director Radiology IT, Business Group Healthcare IT, Philips Medical System, Best, The Netherlands

Thomas Wendler PhD

Research Fellow, Philips Research Europe - Hamburg, Germany

Gordon R. Whiteley PhD

Director, Clinical Proteomics Reference Lab, SAIC-Frederick, Inc., NCI Frederick, Gaithersburg, MD, USA

Samuel A. Wickline MD

Professor of Medicine, Biomedical Engineering, Physics, and Cellular Physiology, Washington University School of Medicine, St. Louis, MO, USA

Rafael Wiemker PhD

Senior Scientist, Digital Imaging, Philips Research Europe - Hamburg, Germany

Dale C. Wiggins

Senior Architect, Patient Monitoring, Philips Medical Systems, Andover, MA, USA

Dag Wormanns MD

Staff Radiologist, Department of Clinical Radiology, University Hospital, Münster, Germany

xvii

Contributing Authors

Jeffrey Yanof PhD

Senior Staff Scientist and Manager Image-Guided Therapy, Clinical Science Department, Philips Medical Systems, Cleveland, OH, USA

Thomas Zaengel PhD

Vice President Philips Research, Director Monitoring and Treatment, Philips Research Europe - Aachen, Germany

Professor, Computational Biology and Bioinformatics Lab, Cold Spring Harbour Laboratory, Cold Spring Harbour, NY, USA

xviii

Michael Q. Zhang PhD

PREFACE

Staying healthy and getting appropriate healthcare is certainly one of the most important issues in our society. In a continuous effort, huge investments are made to improve the value of the healthcare system. Among the many ways to optimize medical care, technology plays a predominant role. It not only helps to increase the quality, effectiveness and efficiency of health related procedures, it often stimulates and enables new ways to practise medicine. Apparently, the success of western medicine is to a large extent based on technology driven innovation. In the last century we have increasingly seen breakthrough improvements in medicine that were induced or supported by new technologies, and that were unthinkable without them, leading to better and often revolutionary new ways to detect or solve health problems. Advances in imaging technology, for instance, with the invention of computed tomography (CT) or magnetic resonance imaging (MRI) about thirty years ago, have certainly marked disruptive change for many procedures in diagnosis and therapy.

At the beginning of the new millennium, it is reasonable to expect that

90% of all researchers - since the beginnings of mankind - live today. The amount of research results that will directly or indirectly influence medicine may easily increase by an order of magnitude over the coming decades.

Medical technology innovation is a complex process, in which industry, academia, clinical institutions and regulatory bodies act closely together.

This book has been edited from the perspective of industrial research, and emphasizes the fact that R&D in industry is significantly contributing to many health related innovations and breakthroughs. The material presented here is published as part of a Philips Research book series. Philips, as one of the major players in the field, has a continuous, strong and

medical care. It is linked to many academic research activities, and to clinical research and validation performed at world-renowned hospital sites.

It is the general intention of this book to present a collection of innovative and valuable contributions to healthcare technology. The chapters were selected to cover different application areas ranging from hospital to home, and to create different views on how technology influences critical aspects of patient care. The aim was to gather a set of high quality

xix

the role of technology in the medical innovation process will increase potential impact of research to the medical field is illustrated by the fact that

is addressing very essential topics that will help shape the future of in proportion to the enormous amount of R&D efforts worldwide. The

successful healthcare and wellness oriented research program. This program

Preface contributions, each addressing different aspects of technology and application, resulting in a mix of state-of-the-art overviews, projections to the future, discussion of trends, and - as for most chapters - the presentation of research results for selected areas. Paradigm-changing developments expected for the coming decades are indicated.

In particular, the book is intended to give an overview of recent research results of the Philips healthcare and wellness research program, comple- mented by contributions from Philips Medical Systems, and chapters provided by distinguished clinical sites or universities. Improvement of medical care is shown as the result of collaboration between industry, academia and clinics. The content spans a combination of long-standing industrial research areas (such as imaging technology), new and rapidly evolving fields (like molecular medicine), important enabling technologies (like medical information technology) and innovations that open up novel ways to look at health care in a changing world (such as personal healthcare home care, and healthcare consumer oriented aspects). Overwiew chapters give general insight for the addressed research fields and also discuss trends that will influence and shape healthcare technology in the future.

How is the book organized? We have prepared the material along a number of specific healthcare related topics, reflected by the 6 independent parts of the book:

Diagnostic imaging is a long-standing and very successful area of innovation and certainly a mainstay for improving diagnosis and therapy, extending far into the future as more specific techniques such as molecular imaging evolve. The past decades have seen an unmatched progress in the optimization of imaging modalities towards better performance in speed and resolution, and for new applications, enabled by computing power, new imaging principles and agents. The attempt to complement anatomical with functional information has seen developments combining the strength of individual modalities. The imaging chapters in the second part give an overview of state-of-the-art and address recent achievements of imaging modalities. For CT, enabling technologies such as detectors and reconstruction techniques are discussed. For X-ray based volume techniques, xx

describing some drivers for recent and future changes in healthcare. These

The opening Healthcare trends part sets the stage for all the following,

cannot be understood without the socio-economic developments in society,

particularly the aging society and the related growth of chronic disease,

and the healthcare politics that these developments induce. For advances

in technology, some major trends are singled out, such as the impact of

Moore’s Law on medical imaging, the revolutionary changes anticipated

through molecular medicine, and expected new and growing sectors such

as e-health and personal healthcare.

Preface

principles and clinical applications of 3D-rotational X-ray imaging on conventional C-arm systems are presented. Representative for the many advances in MRI, recent problems and methodological solutions are described for coronary magnetic resonance angiography (CMRA). Improve- ments in ultrasound include four-dimensional ultrasound imaging, which impressively shows real-time rendering of moving anatomy with new applications in interventional cardiology and radiology. In the last 10 years, hybrid imaging systems such as PET/CT and SPECT/CT have become a rapid scientific and commercial success, as they meet strong clinical demands for matching anatomical and functional information. Continuous research is ongoing to improve and optimize the imaging methods as well as techniques for image fusion and co-registration.

The combination of diagnostic imaging with therapy is a significant trend and is paving the road to treatment centres of the future. In image- guided therapy (IGT), imaging is used to plan, implement and follow-up treatment, and to improve treatment accuracy through better planning and precise targeting. Recent trends and innovations in the field are reviewed in part 3. Multi-modality-guided percutaneous ablation based on CT data and a for catheter-based cardiac interventions that have recently been introduced into clinical practice. The field of high intensity focused ultrasound (HIFU) is presented, a technology to generate therapeutic local hyperthermia inside the body, using MRI guidance of the procedure to allow optimized in situ target definition and the identification of nearby tissue to be spared. Another application shown is image-guidance in adaptive radiation therapy through monitoring the course of treatment. Finally, an example for molecular imaging guided radiation therapy is presented in which the assessment of tumor markers is investigated with the perspective to optimize future radiation therapy.

Molecular medicine is expected to become the big game changer in medical care. Understanding disease phenomena on the molecular level and deriving according methods for diagnosis and therapy will truly be a paradigm shifting change in medicine. Application wise, it has the potential to take the step from a symptom-based diagnosis and treatment to a medicine of the future focussing on prediction, prevention, understanding of disease processes, highly individualized treatment and cure of diseases. Technology- wise, it is marking a shift from traditional research disciplines such as mechanics, electronics, and physics to molecular biology and genetics. The main technologies that enable the field are the in vivo identification of disease location through highly specific targeted agents (molecular imaging), and the in vitro detection of biomarkers (molecular diagnostics). In part 4, a comprehensive review of molecular imaging systems and their relevant

xxi

CT-integrated robot system are discussed. Successful techniques are described

Preface properties (e.g. their sensitivity) is presented, followed by various chapters on biomarkers and agents for diagnosis and therapy including their clinical applications

Medical information technology appears as an important factor for improving the quality and efficiency of patient care, for significantly reducing cost, and as enabler for new methods and applications. IT support has become essential for modern medicine. This part of the book starts with a global view on the IT research field, focussing on technology for physicians, patients and researchers. Challenges in the creation of electronic medical records (EMR), departmental IT systems, and workflow solutions are addressed. A growing field of medical IT research is its application in computer-aided detection (CAD) and computer-aided diagnosis (CADx), for which successful examples in lung nodule detection are presented. Another vital field is covered through research on medical decision support systems (DSS). Bioinformatics research shows that some areas in biology and medicine are strongly based on IT and generate excitement about new potential clinical applications such as clinical genotyping, early diagnosis, prognostic disease models, personalized medicine and wellness monitoring.

Last but not least, the field of personal healthcare indicates important changes in the healthcare system, induced by changes in the society such as the aging population, the pressure to rethink healthcare financing, and changing demands of health care consumers. New and rapidly emerging sectors of care move away from the traditional cycle of hospital-based diagnosis, therapy and follow-up: Self care, home care, remote monitoring devices and services hold promises to individualize care while reducing cost.

Wellness programs and prevention measures become increasingly attractive that support health and well being preceding the traditional hospital care, and call for novel devices and services. Technology wise, new sensors, easy to use devices for diagnosis, treatment and monitoring, electronics for home and ubiquitous use mark the way to the aspects of personal healthcare as presented in the final part of the book.

Gerhard Spekowius and Thomas Wendler, September 2005

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ACKNOWLEDGMENTS

As editors, we thank all authors for their excellent and exciting chapters.

Particularly, we appreciate the distinguished contributions provided by academic and clinical researchers. Furthermore, we acknowledge the valuable input of our Philips Medical Systems colleagues

The creation of this book was supported by an editorial board with key members of the Philips Research organization. We like to thank all board members for their assistance in setting up and improving the individual parts:

Helen Routh for the Medical Informatics part,

Falko Busse for the Diagnostic Imaging and Therapy part, Hans Hofstraat for the Molecular Medicine part, and Thomas Zaengel for the Personal Healthcare part.

In addition, we like to thank Rob Gossink for the initial ideas to create the book, and for taking the responsibility for the Trends in Healthcare part.

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ABBREVIATIONS

3D Three-dimensional

4D Four-dimensional

AD Alzheimer’s disease ADC Analog-to-digital converter ADT Admission discharge and transfer AED Automated external defibrillator AES Advanced event surveillance AF Atrial fibrillation

AFA Atrial fibrillation ablation

ART Algebraic reconstruction technique ART Adaptive radiation therapy

BP Blood pressure

BTV Biological target volume CA Contrast agent

CAD Computer aided detection CADx Computer aided diagnosis CDSS Clinical decision support systems CHF Congestive heart failure

CMRA Coronary magnetic resonance angiography CNR Contrast to noise ratio

CPOE Computerized physician order entry CRP Cardiopulmonary resucitation CRT Cardiac resynchronization therapy CSA Charge sensitive amplifier

CT Computed tomography

CTA Computed tomography angiography

CTF CT fluoroscopy

CVD Cardiovascular diseases CZT Cadmium zinc telluride

DICOM Standard for digital imaging and communications in medicine

DM Disease management

DSP Digital signal processor

DWI Diffusion-weighted MR imaging EHR Electronic health record

ELISA Enzyme linked immunosorbent assay EMR Electronic medical record

EMT Electromagnetic tracking EP Electrophysiology

xxv

xxv Abbreviations EPR Electronic patient record

FDA Food and Drug Administration

FDG Fluor-deoxyglykose (

F-fluoro-2-deoxy-D-glucose) FLT Fluorothymidine (

F-fluoro-3’deoxy-3’-L-fluorothymidine) FMISO

F-Fluoromisonidazole

GPS Global positioning system HIFU High intensity focused ultrasound HIM Health information management HIS Hospital information systems HIT Healthcare IT

HR Heart rate

HU Hounsfield unit

ICD Implantable cardioverter defibrillator IGRT Image-guided radiation therapy IGT Image-guided therapy

IGT Impaired glucose tolerance II-TV Image intensifier television system IMRT Intensity modulated radiation therapy

IR Infrared

IT Information technology IVUS Intra-vascular ultrasound KDD Knowledge discovery from data LAN Local area network

LED Light emitting diode LOR Line of response MAG Motion adapted gating

MALDI Matrix enhanced surface desorption ionization MCI Mild cognitive impairment

MDx Molecular diagnostics

MI Molecular imaging

MIP Maximum intensity projection

ML Maximum likelihood

MLC Multi-leave collimator MPI Magnetic particle imaging MPR Multi-planar reconstruction MR Magnetic resonance

MRI Magnetic resonance imaging MRS Magnetic resonance spectroscopy MRT Magnetic resonance tomography MTF Modulation transfer function

i

Abbreviations

NCE New chemical entities

NCHS National Center for Health Statistics NCI National Cancer Institute

Noise equivalent count rate NIH National Institute of Health NIR Near infrared

NLOS Non-line of sight

NLP Natural language processing NM Nuclear medicine

OPMS Optical position measurement system PACS Picture archiving and communication systems PCD Programmed cell death

PET Positron emission tomography PFC Perfluorocarbon

PHC Personal healthcare PHR Personal health record PMS Philips Medical Systems PMT Photo multiplier tube PSA Prostate specific antigen

PTCA Percutaneous transluminal coronary angiography PTV Planned target volume

RA Rotational angiography

RF Radio frequency

RFA Radio frequency ablation RIS Radiology information systems RSNA Radiological Society of North America RT Radiation therapy

RTP Radiation therapy treatment planning SCA Sudden cardiac arrest

SELDI Surface enhanced laser desorption ionization SENSE Sensitivity encoding

SMASH Simultaneous acquisition of spatial harmonics SNP

SNR Signal to noise ratio

SPECT Single photon emission computed tomography TEE Trans-esophageal echocardiography

TFT Thin film transistor TOF Time of flight

US Ultrasound

XDS Cross enterprise document sharing

xxvii

Single nucleotide polymorphism

NEC