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Patients usually get medical assistance in several clinics and hospitals during their lifetime, archiving vital information in a dispersed way. Clearly, a proper patient care should take into account that information in order to check for incompatibilities, avoid unnecessary exams, and get relevant clinical history. The Heart Institute (InCor) of São Paulo, Brazil, has been committed to the goal of integrating all exams and clinical information within the institution and other hospitals. Since InCor is one of the six institutes of the University of São Paulo Medical School and each institute has its own information system, exchanging information among the institutes is also a very important aspect that has been considered. In the last few years, a system for transmission, archiving, retrieval, processing, and visualization of medical images integrated with a hospital information system has been successfully created and constitutes the InCor's electronic patient record (EPR). This work describes the experience in the effort to develop a functional and comprehensive EPR, which includes laboratory exams, images (static, dynamic, and three dimensional), clinical reports, documents, and even real-time vital signals. A security policy based on a contextual role-based access control model was implemented to regulate user's access to EPR. Currently, more than 10 TB of digital imaging and communications in medicine (DICOM) images have been stored using the proposed architecture and the EPR stores daily more than 11 GB of integrated data. The proposed storage subsystem allows 6 months of visibility for rapid retrieval and more than two years for automatic retrieval using a jukebox. This paper addresses also a prototype for the integration of distributed and heterogeneous EPR.

The visualization of the left ventricle (LV) motion in gated single-photon-emission computerized tomography (SPECT) studies is complicated by the fact that 3-D density images cannot be directly presented using common display devices. A number of techniques, most of them concerned with visualization, have been developed to aid in the classification of the images. However, it has been shown that interpretation of LV images by strictly visual techniques is subject to errors and inconsistencies. For this reason, assistance in diagnosis can be improved only through the development of automatic or semiautomatic methods to analyze and to quantify LV parameters. We propose an automatic method to estimate the myocardial kinetic energy directly from gated SPECT sequences based on the optical flow method refined with a multiresolution technique. Specifically, the method quantifies the LV motion by a series of 3-D velocity vector fields computed for each voxel on the sequence of images. The 3-D velocity vector field obtained is used to estimate the kinetic energy, which may be an indication of the cardiac condition. The proposed procedure was applied to a group of volunteers and the cardiac condition of each subject studied by taking the relation between the maximum and minimum values of kinetic energy observed during the cardiac cycle.

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