Interventional telemedicine for noninvasive neuroradiosurgery: Remote-site high-performance computing, mathematical optimization, and virtual scenario simulation

Abstract

Interventional Telemedicine may have potential utility in providing connectivity and access to specialized high performance computing and advanced software resources in support of clinical procedures in the field of Minimally-Invasive Surgery and Stereotactic Linear Accelerator (LINAC) Radiosurgery. Such interventions may benefit from application of nonlinear quadratic inverse solution methods designed to provide the capability to reverse optimize a 'best case' treatment plan. The formidable decision-making challenges posed by increasingly complex optimized data and progressively versatile LINAC delivery systems require volume visualization of projected treatment data and imaging anatomy via photorealistic rendering and virtual scenario simulation techniques. Both these new directions are heavily dependent on access to specialized high performance computing platforms solely accessible via broad-bandwidth network connectivity. This pilot project presents resimulation of retrospective radiosurgical case data using inverse solution optimization models running on workstation clusters and then volume rendered and simulated on the Princeton Graphics Engine Supercomputer. Evidence for effective utilization of such optimization and virtual simulation methods running on remotely accessed, distant high performance computing resources is discussed in view of the potential for long-term clinical investigation and eventual development of Interventional Telemedicine as a clinically practical approach for providing support to remote or non-urban radiosurgery centers in the industrialized and developing world.

Low-bandwidth telemedicine for remote orthotic assessment

“…Telemedicine, the use of communication technologies to provide health care services and education over a distance, has been in existence since the late 1950s when microwave links were used for telepsychiatry consultations (Wittson et al, 1961). Since then many applications have been initiated in the fields of radiology (Reponen et al, 1995;von Hanwehr et al, 1995) dermatology (Perednia and Brown, 1995;Solomon et al, 1996), pathology (Ferrer-Roca et al, 1995;Kayser and Drlicek, 1992), neurology (Chaves-Carballo, 1992), and other specialties (Allen and Hayes, 1994;Hubble et al, 1993;Jerome, 1993;Rafuse, 1994;Lewis and Boyd Moir, 1995). In addition, some telemedicine initiatives have provided remote diagnosis and consultation tools for general health care (Carlson, 1994;Jennett et al, 1995;Perednia and Allen, 1995;Padeken er al., 1995;Sanders and Tedesco, 1993).…”

Telemedicine and neurosciences

“…This requires volume visualisation of projected treatment data and imaging anatomy via photorealistic rendering and virtual scenario simulation techniques -all manipulated remotely. 125 The author, with an interest in Linac based stereotactic radiosurgery, has used telemedicine to screen and evaluate 35 patients from Colombo (a telemedicine facility is available at the Apollo Hospital in Colombo) for radiosurgery and for stereotactic biopsy as these facilities are not available there. Plans are under way to make it possible for the experienced radiosurgical team in Chennai to plan and transmit the plan in real time to smaller less experienced radiosurgery centers that have the same equipment.…”

<title>Medical imaging</title>

“…The additional use of virtual reality lead to tele-surgery (and tele-medicine) 5 In tele-surgery the patient in the operating theatre is monitored by a stereoscopic camera. The additional use of virtual reality lead to tele-surgery (and tele-medicine) 5 In tele-surgery the patient in the operating theatre is monitored by a stereoscopic camera.…”