Tuesday
February 28, 2006

Information technology & electronic communications
in all aspects of the profession

Welcome to the AVINews Monthly. We'd love your feedback on our ongoing efforts to improve the newsletter and its format, so email us your comments: martinmkm@mminformatics.com

In This Issue:
Executive Board
President's Comments
PACS Systems

Book Review
In the News
Jobs
Membership Renewal Form

Executive Board

Your officers for 2005-2006 are:

President - Dr. Michael K. Martin
President-elect - Dr. Stanley Robertson
Secretary/Treasurer - Dr. Dennis Ballance
Past President - Dr. Stephen Pittenger

Feedback

Please let us know if you have any suggestions or comments about AVI.

President's Comments

The main article in this issue demonstrates just how relevant veterinary informatics has become to the practicing veterinarian. Picture Archiving Communication Systems (PACS) have gone from the realm of the teaching hospital and large referral practice to the point that they are--or could be--an important component of just about any clinical practice. As someone who has been out of clinical practice for many years now, I was amazed to learn that even my relatively small city has a mobile MRI facility available at a local emergency clinic on a regular basis. Advances like these and the kinds of tools that Dr. Malinowski describes in his article bring many of these powerful tools within the reach of many practices that haven't even thought about them.

The NEWS section has a link to the New York State Pandemic Influenza Plan including a chapter on informatics. While the list of informatics applications is impressive, I'm struck by a similarity to the Internet before widespread adoption of the World Wide Web. Back then the Internet was loaded with great resources, all of which stood alone with their own document formats, protocols, etc. The introduction of WWW standards brought these disparate resources together into a common, interoperable web. Similar standards-based integration of our clinical, laboratory, and emergency response systems could have a similar impact on emergency preparedness. The pieces of the informatics "web" are all there waiting to be integrated just as telnet, ftp, gopher, etc., were there for the WWW to pull together.

The JOBS section has two interesting items with a common thread. Is this a trend or is it coincidence? One is at Virginia-Tech and the other at the National Library of Medicine. Both list "good communication skills" high on their lists of qualifications. It looks like the days of the stereotypical "computer nerd" are numbered. But for those who can understand the complexities of informatics and communicate them clearly to others, the field is rapidly providing quality career options.

Dr. Michael K. Martin

PACS: Much More Than an Image Viewer

by Robert Malinowski, DVM, MA

A Picture Archiving Communication System (PACS) server is typically seen as nothing more than a digital version of a film storage room. Even though a massive number of images can be stored, organized and easily retrieved, the end result is usually the same: the veterinarian views and interprets an image. From this perspective, there’s nothing particularly amazing or revolutionary about PACS. Instead of a hard copy film and a light box, a computer monitor and a mouse are used. So, what’s so special about PACS?

The primary strength of PACS is its ability to communicate with other programs. Much like the Digital Imaging and Communications in Medicine (DICOM) standard simplifies how images from various modalities are sent to PACS, it also allows countless programs to process this data after it has been acquired. A PACS server can serve as a massive information warehouse, supplying data to a wide variety of other applications. Let’s explore a few ways in which this information can be useful for clinical applications, research and education.

Cases on CD
Studies can be recorded to CD and physically sent to referring veterinarians or colleagues at other locations. This is very useful when individuals are unable to access the PACS network directly (due to security restrictions) or for backup purposes. Most PACS servers even include a free viewer on the CD that will allow the user to open the studies without any additional software. Images can be exported as JPG files and included in reports, journal articles or lectures. Completely automated DICOM CD burning systems are also available. These robotic systems copy studies to disc and even print patient information directly on the CD.

Radiation Therapy Treatment Planning
Patient data (CT, MR, PET) can be sent to a specialized software program (such as Varian Eclipse) in order to more accurately devise a treatment protocol. A 3D patient model is built from the data and the clinician defines targets and critical structures. The computer simulates how the radiation will be delivered, including its distribution in three dimensions. The software, using the results of the simulation, directly controls the linear accelerator, which results in a much safer treatment protocol.

Orthopedic Planning Tools
PACS viewers typically including basic tools for manipulating images and making basic measurements such as distance, angle and area. However, orthopedic surgeons need something much more robust if their digital films are going to be useful for pre-operative planning. Several vendors (AGFA, eFilm) have Orthopedic Planning add-ons available for their systems. This software allows CAD models of the implants to be superimposed on digital films. Clinicians can select a template from a specific vendor and can even customize size and direction. The resulting surgical plan can be saved back to PACS, printed on a hard-copy film or exported as a JPG file.

3D Reconstruction
Studies with three-dimensional information (CT, MR) can be sent directly from PACS to a 3D visualization and analysis software package such as Voxar 3D. This powerful tool takes diagnostic imaging to the next level. CT data can be re-sliced on any plane. Virtual endoscopy lets the veterinarian travel through vessels and airways. Fractures and masses can be viewed in 3D. 3D add-ons are also available for desktop workstations such as eFilm. This technology is rapidly advancing and will soon be affordable for every practitioner.

Biomedical Simulations
The processing power of computers has been increasing with each generation. It is now possible to perform complex simulations entirely within a virtual environment. Three-dimensional models of the airway and bones can be reconstructed from CT data stored on PACS. These models are then loaded into simulation software such as Fluent (for airflow) or MSC Patran (for FEA / materials simulation). This is an excellent way to evaluate air distribution and assess implant strength. This union of Medicine and Engineering will revolutionize veterinary research if it is fully embraced.

Advanced Image Analysis
In this last section, I’d like to briefly mention an amazing program I’ve been using for the last few years called Analyze from Mayo Clinic. A brief listing of its features (by no means all-inclusive) includes 3D reconstruction, virtual endoscopy and surface rendering. I have literally lost track of the number of projects in which it has been involved. Most recently, I’ve used it to calculate bone mineral density and fat volume from CT data. It is very useful for creating CAD models for finite element analysis (FEA). With too many features to list, I highly recommend visiting http://analyzedirect.com/ to learn more.

My intention of this brief article was to introduce the veterinary community to the variety of applications that can utilize data stored on PACS. Far beyond mere images, the data that your clinic or university is storing has enormous untapped potential that will change the way you view diagnostic imaging.

Book Review

Measuring America; How an Untamed Wilderness Shaped the United States and Fulfilled the Promise of Democracy

Author: Andro Linklater
Resource type: Book
Number of pages: 288
Publisher: Walker & Company
Year published: 2002
ISBN: 0802713963
Price as of February 2006 (Amazon): $26.00 List, $7.99 Amazon's Bargain Table

No, the editor of the AVI Newsletter has not gone out of his mind recommending a book about 18th and 19th century history. (He may be out of his mind, but not about this.) This book provides a clear and detailed, yet very readable, account of the process by which surveying methods and measures were standardized in the early history of the United States. It shows how this standardization became an essential element in the western expansion of the United States and of the growth of such American institutions as private property ownership and the design of American cities. These stories alone would be enough to make the book a good read. But the book mixes in a thorough and insightful look at the factors that favored, inhibited, or outright blocked the development and adoption of effective standards. The lessons we can learn from our forefathers Washington, Jefferson and the rest are much more profound than the school-boy "I can never tell a lie." These leaders faced many of the same political and economic barriers to progress that we see today; yet they made slow but steady and essential progress in shaping what became the country we know today. And they did so by promoting standards for the new nation.

In the News

Pandemic Influenza Plan Informatics

New York State's pandemic influenza plan and related information is available from the New York Department of Health website. The plan includes an entire chapter (chapter 13) on Public Health Preparedness Informatics. While the plan addresses the use of standards such as HL7, SNOMED and LOINC in their laboratory reporting system, they also note that they still support a "flattened" format for labs that "cannot yet support the standards." Each of the informatics tools described is a significant accomplishment in its own right. The list gives one a sense of the scope of information processing and sharing that will be needed in an event on the scale of an influenza pandemic.

http://www.health.state.ny.us/diseases/communicable/influenza/pandemic/

E-Mail With Clients?

E-mail communication with clients is a contentious issue for both veterinarians and physicians. Issues of efficiency and effectiveness compete with concerns about confidentiality and loss of intangibles such as tone of voice. The February 15 issue of JAVMA included a news item on e-mail featuring AVI's own Steve Pittenger.

http://www.avma.org/onlnews/javma/feb06/060215e.asp

Jobs and Training

Veterinary Medical Terminology Position

The Veterinary Medical Informatics Lab at Virginia-Maryland Regional College of Veterinary Medicine (VMRCVM) has an immediate opening for a veterinarian interested in participating in the development of terminology resources for veterinary medical information systems. The position requires attention to detail and the ability to understand and research the exact meaning of medical terms. Excellent verbal and written communication skills are a must. Minimal computer skills required. This position is ideal for veterinarians with disabilities or those looking for a non-clinical position with a flexible schedule. Salary commensurate with experience. Search for posting #060178 at http://jobs.vt.edu. AA/EEOE

Researcher; Controlled Biomedical Vocabularies in Clinical Medicine

The NLM UMLS team is planning to recruit a researcher to work with real-life implementors of controlled biomedical vocabularies in clinical medicine. Some examples of questions we are trying to answer arise in:

• Distribution and use of appropriate standard vocabularies

• Choosing/creating controlled vocabulary to serve local needs

• Maintaining and updating vocabulary

• Deployment and clinical use of of vocabularies

• Obstacles/issues in using and reusing captured clinical data

• Data quality assurance methods.

Answers will help to guide and focus future UMLS changes or additions, to better serve real world users' needs.

Suggested qualifications include:

• In-depth knowledge of biomedical vocabularies

• Knowledge of alternative models and data schemas for representations of vocabularies

• Familiarity (preferably hands-on experience) with the design and implementation of clinical information systems

• Familiarity with the environment in which clinical information systems are deployed, including production uses, preferably from a clinical medical background

• Ability and proven record of doing independent research

• Good communication skills

The researcher could be funded as a postdoctoral fellow or under an intergovernmental personnel agreement (other arrangements might be possible), for a determined period of time (e.g. 2 years). Since the research will involve clinical information systems that are in actual use, it is expected that the researcher will need to work closely with institutions outside of NLM, which might require a substantial amount of traveling.

William T. Hole MD
NLM UMLS
Lister Hill Center, NLM
wth@nlm.nih.gov

About AVI

Joining the AVI
You may renew or apply for membership in the AVI by completing an application and paying the annual dues. An application is also included in each issue of the AVI Newsletter. Membership is for a full year, expiring July 31 each year. You may select from several membership categories, work groups, and newsletter formats as described in the application. All member categories share the privileges of the newsletter and the communication services of the society. Full and corporate members have voting privileges. If you share AVI's interests, please join us.

Mission
The AVI, formerly the American Veterinary Computer Society, was formed to expand the use of the computer as a tool in veterinary medicine. This includes serving as an educational resource, promoting the use of information technology and electronic communications, and developing and promoting standards in veterinary information management.

Benefits
Membership benefits include the monthly AVI newsletter, participation in work groups, the AVI-L listserv discussion list, and an annual membership directory.

Levels
Membership incorporates a range of levels to encourage participation from all segments of the profession, veterinarians and non-veterinarians, as well as its supporting organizations. This includes veterinary practitioners and their staff, faculty and staff of veterinary?colleges, diagnostic laboratories, medical records personnel, medical librarians, students, software and hardware developers, and corporations supplying veterinary products and services. Over one third of the members are individuals working in the field of clinical veterinary medicine, one third are in academia, and the remainder are in industry, government, and other veterinary medicine. Membership is international, including Australia, Brazil, Canada, Israel, South Korea, and Saudi Arabia, as well as the United States.

Meeting
The annual membership meeting is held in conjunction with the AVMA Annual Convention and includes the one-day Richard B. Talbot Symposium on Veterinary Informatics and two days of general information on computer usage. The members of the Association are encouraged to write articles and/or make presentations regarding their experiences, as these are valuable to establish veterinary informatics as a legitimate discipline and to encourage individuals in the veterinary community to become more involved in the information age.

Application
Membership Application (HTML)
Membership Application (RTF)

Date:  _________________

Association for Veterinary Informatics Application and Renewal Form

O  New      O  Renewal of AVI membership # ______
Please circle change in address or other information.

Membership Level

Newsletter format desired:  O  Hardcopy  O  Electronic (E-mail address required):_________________  O Both

Membership includes participation in one Work Group.  Please select one group from the list below.

Primary work or occupation:  (Please note new categories.)

Current interest or involvement in veterinary computing:

What topics would you like to see in the newsletter or at the AVMA meeting?  Other comments?

Dues are payable by August 1.  Membership is from August 1 to July 31the following year.  Dues must be received by September 1 of each year in order to be listed in the directory.

Make check payable to:   Association for Veterinary Informatics

Mail dues and form to:      
Dr. Dennis Ballance, Secretary/Treasurer, AVI                       
VMTH Computer Services
1 Shields Ave
Davis, CA 95616  
E-mail:  dwballance@ucdavis.edu

AVI Newsletter Archives
AVINews is an online resource to help AVI members keep informed of the latest and greatest in our profession.

To modify or cancel your subscription to this newsletter, please contact us. We welcome your comments, suggestions, and questions.

Copyright 2005, Association for Veterinary Informatics