DiagnosticoDiagnostico perinatalperinatal y y

TELEMEDICINATELEMEDICINA

Prof.Dr.O.Ferrer-RocaProf.Dr.O.Ferrer-Roca

UNESCO Chair UNESCO Chair TelemedicineTelemedicine

Congreso Nacional Congreso Nacional AEDPAEDP

6-7 Nov 20086-7 Nov 2008

Chair of Pathology

Transforming Healthcare through Technology

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Computer evolutionComputer evolution

Moore’s Law Moore’s Law Bell’s Corollary on Computer Class FormationBell’s Corollary on Computer Class FormationU

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Nanosensor sprays

El viaje fantastico

2004

Glucowatch

Foglet 5μ

CreationLevitationManipulationTeleportation

Hitachi 50μ RFIDTIN

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ters

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Bell´s law Bell´s law toto

CyberspacCyberspacee

New computer classesNew computer classes require new platforms, require new platforms, networks, and cyberization.networks, and cyberization.

New computer platformsNew computer platforms based on chip based on chip density evolution density evolution

New New apps and contentapps and content around each new around each new classclass

Each classEach class becomes a vertically becomes a vertically disintegrateddisintegrated industry based on industry based on hardware and hardware and software standards software standards ,, after it after it FLAILS FLAILS around 5-10 YEARSaround 5-10 YEARS

1999 20062000 veterinaria

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Imagen medicaImagen medica FonendoFonendo

Ultrasonografo portatil (con TM.)Ultrasonografo portatil (con TM.)

ZONARE Medical Systems- Z one ultra system

Siemens-Acuson P50

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Siemens-Acuson P10 Siemens-Acuson P10 20082008

HAND HELDHAND HELD

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Phot0Baby Phot0Baby Customizes Ultrasound VideosCustomizes Ultrasound Videos

Nursing Nursing management & management & something else…something else…

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Royal Philips ElectronicsRoyal Philips Electronics 4-D time-lapse ultrasound 4-D time-lapse ultrasound

imageimage time-lapsed imagestime-lapsed images space is intended to emulate that of a spa.space is intended to emulate that of a spa. view images of your baby on a bubble-like screenview images of your baby on a bubble-like screen

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VIRTUAL SONOGRAPHYVIRTUAL SONOGRAPHY20002000

Ultrasound in Obs & GynecologyUltrasound in Obs & Gynecology 2000 16:102,. Ferrer-Roca et al.16:102,. Ferrer-Roca et al.

Three dimensional ultrasound reconstruction Three dimensional ultrasound reconstruction and telemedicine. Image analysis.and telemedicine. Image analysis.

J Med Internet ResJ Med Internet Res 20012001, June 22; 3 (2): e21. , June 22; 3 (2): e21.

Ferrer-Roca et al.Ferrer-Roca et al.Virtual Sonography through the Internet: Virtual Sonography through the Internet:

Volume Compression IssueVolume Compression Issuehttp://http://www.pubmedcentral.nih.gov/articlerender.fcgi?artidwww.pubmedcentral.nih.gov/articlerender.fcgi?artid

=1761897=1761897

J Perinat MedJ Perinat Med ( (20062006) vol 34 :123-129 . ) vol 34 :123-129 . Ferrer-Roca et al. Ferrer-Roca et al.

Tele-Virtual Sonography. Tele-Virtual Sonography. www.atypon-link.com/WDG/doi/pdf/10.1515/JPM.2006.022

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Tele-Virtual Sonography

J Perinat MedJ Perinat Med 34 ( 34 (20062006) 123-129 . Ferrer-Roca et al. ) 123-129 . Ferrer-Roca et al.

Receiver Operating Characteristic (ROC) Plot

0.0 0.2 0.4 0.6 0.8 1.0False Alarm Rate

0.0

0.2

0.4

0.6

0.8

1.0

Hit

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Respuesta diagnostica con Ecografia local=66casos 12meses

Receiver Operating Characteristic (ROC) Plot

0.0 0.2 0.4 0.6 0.8 1.0False Alarm Rate

0.0

0.2

0.4

0.6

0.8

1.0

Hit

Rat

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Respuesta a distancia con TeleInvivo 66 casos-12meses

Diagnostic interobserver variability, local versus distant, was low since the kappa statistics is high (k=0.7);

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New image modalitiesNew image modalities

CT US MRI OCT CMicro Hybri

d

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3x

Image modalities-SSVS 2005

Areas identified by pathologist / technician

26Mb 16Mb

40x

250x

TEXCAN-II ® Ferrer-RocaSSVS 2005© Ferrer-Roca

Low power M

O 3x

SUPER-RESOLU

TION

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New ICT-tools New ICT-tools Health-GRID (2008)Health-GRID (2008)

GRID TECHNOLOGY IN TELEPATHOLOGY AND PERSONALIZED TREATMENTGRID TECHNOLOGY IN TELEPATHOLOGY AND PERSONALIZED TREATMENTFerrer-Roca OFerrer-Roca O. et al (2008). et al (2008)

In: Grid Technologies for eHealth: Applications for Telemedicine Services & Delivery

Editor: Dr. Ekaterina Kldiashvili. Georgian Telemedicine Union, Georgia

IGI Global Publ. Philadelphia. USA

Text Mining

Literature Based Discovery (LBD) technique that use annotations and data in existing biomedical sources to discover associations.

Image Mining

ISO 19115/19139 standard on image metadata ontologies,

MPEG-7 (MPEG Query Format-MPQF ISO/IEC 15938-12 ),

MPEG-21 or ISO 21000-14,

ISO 24800-3 for JPEG query search

ISO/IEC 15444-2 for JPX metadata set

DICOM (Q/R SCP query-retrieve service class )

KNOWLEDGE DISCOVERY

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TeleTele●●US US Solo Solo●●DPDP

WirelessWireless Hand-held portableHand-held portable Virtual sonography Virtual sonography Super-resolution imagesSuper-resolution images New image modalitiesNew image modalities Ultra-resolutionUltra-resolution Personalized medicinePersonalized medicine LBD-Image search LBD-Image search “solo- “solo-

perinatology”perinatology”

INNOVATIONS

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LUMA cervical imagingLUMA cervical imaging

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Image mergingImage merging

LOGIQ® E9 LOGIQ® E9

new image technology new image technology & real-time capability & real-time capability

to mergeto merge an ongoing an ongoing ultrasound exam with ultrasound exam with previously acquired previously acquired CT, MR or US images. CT, MR or US images.

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Siemens- ACUSON Siemens- ACUSON P10P10

Forthcomming Innov.ARFI (Acoustic Radiation Forced Impulse) imaging & new silicon US-technology

Precise semiconductor production that realizes isotropic 3D and 4D ultrasound imaging.

Dynamic TCE technology

Amnioscopic Rendering

Fetal Heart STIC (Spatio-Temporal Im

age Correlation)

RF images

HD (high density) transducer technology

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Photoacoustic Photoacoustic microscopy at super microscopy at super

depthsdepths3D tomographic photoacoustic microscopy (PAM) 3D tomographic photoacoustic microscopy (PAM)

• LightLight & & ultrasoundultrasound hybrid technology hybrid technology HIGH HIGH RESOLUTION IMAGING SUPER-DEPTH image. RESOLUTION IMAGING SUPER-DEPTH image.

•1. 1. Short-pulsed laserShort-pulsed laser light absorbed light absorbed causes an causes an increase in pressure via increase in pressure via thermoelastic expansionthermoelastic expansion. . •2. The increased pressure propagates through the tissue 2. The increased pressure propagates through the tissue as an ultrasonic wave, known as a as an ultrasonic wave, known as a photoacoustic wavephotoacoustic wave, , •3. The wave is detected by an 3. The wave is detected by an ultrasonic transducerultrasonic transducer that that produces electrical signals. produces electrical signals. •4. The signals are then 4. The signals are then amplified, digitizedamplified, digitized, and , and transferred to a computer, where an image is formed. transferred to a computer, where an image is formed.

PAM PAM optical irradiation, ultrasonic optical irradiation, ultrasonic detection, and image formation detection, and image formation

5MHz US & 804 nm light 3cm depth

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OPTICAL COHERENCE OPTICAL COHERENCE TOMOGRAPHYTOMOGRAPHY

LLimited to imaging 1 to 2 mm below the surface in biological tissueimited to imaging 1 to 2 mm below the surface in biological tissue OCT OCT echo techniqueecho technique similar similar to UltraSound image

Depending on high-brightness and wide-spectrum light sources such as superluminescent diodes or ultrashort pulse lasers, OCT has achieved sub-micrometre resolution (with very wide-spectrum sources emitting over a ~100 nm wavelength range).

Resolution : EQUIVALENT TO LOW POWER MICROSCOPE.

OCT high resolution based on light

Optical Ultrasound: imaging reflections from tissue to provide cross-sectional images.

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OCT-ScannersOCT-Scanners

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OCT & MicroscopyOCT & Microscopy

Fiberoptic OCT systemFiberoptic OCT system OCT endoscopyOCT endoscopy

OCT

MO

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OCT-Optical biopsyOCT-Optical biopsy

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OCT-ColposcopeOCT-Colposcope

Resolucion transversa 20 micrasResolucion transversa 20 micras

Zeiss

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High Speed OCT High Speed OCT colposcopecolposcope

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Ultra-High resolution OCTUltra-High resolution OCT

CYTOLOGIST

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Ultra-High & spectroscopic Ultra-High & spectroscopic OCTOCT

1x3 micras1x3 micras100 micras

UH-resolution OCTSpectroscopic OCT- melanocytes Red

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OCT Microscope - OCT Microscope - EX1301 EX1301

Gloucestershire Royal Hospital and University College London Hospital (UCLH) are to trial Gloucestershire Royal Hospital and University College London Hospital (UCLH) are to trial MDL’s Optical Coherence Tomography (OCT) scanner for research into rapid in-vivo MDL’s Optical Coherence Tomography (OCT) scanner for research into rapid in-vivo identification of cancers affecting the cervix, oesophagus, skin, lung and other organs.identification of cancers affecting the cervix, oesophagus, skin, lung and other organs.

http://www.md-ltd.co.uk/

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OCT & Embrion OCT & Embrion developmentdevelopment

Animal development in vivoAnimal development in vivo

No hay razón, mas que los plazos éticos y de autorización para no hacerlo en humanos

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MEDICINE AT DISTANCEMEDICINE AT DISTANCE

Standardization Standardization & interoperability& interoperability Quality assurance Quality assurance Risk management & consumer/user confidenceRisk management & consumer/user confidence Plug & play Plug & play easy to use / easy to integrate easy to use / easy to integrate Portability & Mobility.Portability & Mobility.

TECHNICALTECHNICAL IMPLEMENTATIONIMPLEMENTATIONee--medicine,medicine, tt--medicine,medicine, pp--medicine.medicine.

LIC

ENC

ING

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AMI@medicine in AMI@medicine in NeonatologyNeonatology

Alimentación con el roce del tejido

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SUMMARYSUMMARY

La TM debe realizarse con criterio de calidad.La TM debe realizarse con criterio de calidad. La TM debe implantarse en PERINATOLOGIA.La TM debe implantarse en PERINATOLOGIA. La SONOGRAFIA VIRTUAL es de gran utilidad.La SONOGRAFIA VIRTUAL es de gran utilidad. Las NUEVAS MODALIDADES imagen la acercan Las NUEVAS MODALIDADES imagen la acercan

a la Anatomía Patológica.a la Anatomía Patológica.

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THANK YOU FOR YOUR THANK YOU FOR YOUR ATTENTIONATTENTION

Prof.Dr.O.Ferrer-RocaProf.Dr.O.Ferrer-RocaUNESCO Chair TelemedicineUNESCO Chair Telemedicine

““Who's who in the World”,Who's who in the World”, 1996- 1996-actact

““Who's who in Medicine and Healthcare”, 1999-act.Who's who in Medicine and Healthcare”, 1999-act. ““Who's who in Technology”, Who's who in Technology”, 1999-act. 1999-act. ““Who’s who of Professionals”, Who’s who of Professionals”, 2000-act. 2000-act. ““Who’s who in Science and Engineering”, 2001-act.Who’s who in Science and Engineering”, 2001-act.

catai@teide.netcatai@teide.nethtttp://www.teide.net/cataihtttp://www.teide.net/catai