EH 1_2016

Main Themes  Medical Imaging  Computed Maxillofacial Imaging  Image Processing and Visualization  PACS and IHE  Telemedicine and E-Health  Computer Aided Diagnosis  Computer Assisted Radiation Therapy  Image and Model Guided Therapy  Personalized Medicine  Surgical Navigation  Surgical Robotics and Instrumentation  Surgical Simulation and Education  Computer Assisted Orthopaedic and Spinal Surgery  Computer Assisted Head and Neck, and ENT Surgery  Image Guided Neurosurgery  Minimally Invasive Cardiovascular and Thoracoabdominal Surgery  Digital Operating Room June 21–25, 2016 Convention Center Heidelberg, Germany COMPUTER ASSISTED RADIOLOGY AND SURGERY CARS 2016 30th International Congress and Exhibition Honorary President Davide Caramella, MD (I) Congress Organizing Committee Christos Angelopoulos, DDS (USA) Stanley Baum, MD (USA) Elizabeth Beckmann, BSc (UK) Leonard Berliner, MD (USA) Ulrich Bick, MD (D) Davide Caramella, MD (I) Kevin Cleary, PhD (USA) Takeyoshi Dohi, PhD (J) Kunio Doi, PhD (USA) Volkmar Falk, MD (D) Allan G. Farman, PhD, DSc (USA) Hubertus Feussner, MD (D) Guy Frija, MD (F) Stephen Golding, FRCR, MD (UK) Olga Golubnitschaja, MD (D) Makoto Hashizume, MD, PhD, FACS (J) Yoshihiko Hayakawa, PhD (J) Javier Herrero Jover, MD, PhD (E) David Hilderbrand (USA) Kiyonari Inamura, PhD (J) Pierre Jannin, PhD (F) Leo Joskowicz, PhD (IL) Heinz U. Lemke, PhD (D) (Chair) Hans-Peter Meinzer, PhD (D) Hironobu Nakamura, MD, PhD (J) Nassir Navab, PhD (D) Emanuele Neri, MD (I) Terry M. Peters, PhD (CDN) Osman M. Ratib, MD, PhD (CH) Hans G. Ringertz, MD, PhD (S) Ramin Shahidi, PhD (USA) Hiroyuki Yoshida, PhD (USA) www.cars-int.org www.healthcare-in-europe.com 15 EH @ ECR New portal gives all medical caseworkers access to images and data ‘It is happening now!’ Report: John Brosky Two years ago European Hospital spoke with Hans Vandewyngaerde, President for Europe, the Middle East and Africa (EMEA) for Agfa HealthCare, about a sweeping vision the company called ‘Images without Boundaries’. The idea was to build a capability to share images from anywhere to anyone involved in a patient’s care. ‘Imaging without boundaries is a success story,’ Vandewyngaerde told us ahead of the 2014 European Congress for Radiology (ECR). ‘The boundaries are gone. Agfa has launched with its customers large- scale programmes that fundamen- tally transform how they exchange images. “The next step,’ he added, ‘is to integrate care. This is the logical step in the journey that has taken us from analogue to digital in radi- ology, then to sharing the digital images. Now there is a need to converge those images with relevant data that can really help advance a patient-cantered view of healthcare.’ without computer assistance.’ Algorithm development A massive amount of data is needed for the algorithm to learn good image features. Deep learning algo- rithms also must be tuned. ‘Imagine recreating the visual system from eye to brain with only very small building blocks. How are these con- nected to each other? How many lay- ers of abstraction do you need? You have to strike a balance between abstraction and differentiation. You don’t want to be too fine and only detect meaningless dots and lines and circles. You also don’t want to be too coarse and fail to distinguish e.g. between cancer types. Shaping future diagnoses Harz believes computer-prepared and computer-aided diagnoses are the future (but 5-10 years before market approval). Indeed, in some scenarios, man-made decisions might no longer be accepted. In a recent skin cancer study, computer software ‘outperformed even expe- rienced doctors by such a wide margin,’ he said, ‘I wouldn’t have to think twice about which diagnosis to trust ECR 2016 will see the introduction of the Agfa Healthcare Portal, a suite of capabilities that pulls data from any standards-based source, inte- grates it with imaging and makes it available to everyone involved in a patient’s care in every format, from desk-top to laptop to hand-held mobile device. EH: Have you found Holy Grail of Health Care? For 15 years people have said this is the future. Why should we believe it this time? Hans Vandewyngaerde: ‘Because we have done it! At ECR 2016 we’ll show very specific use in cases where we have done this in the USA. We are now installing the Health Care Portal in Europe and have specific cases to show. We have a platform technology that is ready to be used, is already being used and is unique. ‘Healthcare systems are increas- ingly ready. Countries are chang- ing their governance to support the integrated care ecosystem, there’s a movement to shift from volume-based reimbursement to outcome-based reimbursement, to adapt security, patient consent and authorisation. ‘This is not happening because payers want to enable our technolo- gy. It’s happening because there are persistent, powerful drivers. There is a strong belief on the part of payers, especially governmental payers, that this is going to help reduce costs and improve patient treatment. Cost is a big pressure point and while countries are moving at different speeds, and with different blue- prints, it is something that’s really happening – already in England, France, and Belgium. ‘It’s very important to see how powerfully patients are becoming part of the process and a driver for this change. Today, it’s not very organised, varying greatly from dia- betic patients to wound care man- agement, or ophthalmology care. But clearly there is an expectation, it is going to grow stronger, and patients are already beginning to steer workflows according to what they expect.’ Let’s take a step back. What is integrated care? ‘Integrated Care is multi-agency, multi-disciplinary collaboration focused on meeting the medical, and also social needs of patients. It is highly patient-centric in a coordi- nated way. The vertical management of healthcare is now going trans- versal, across boundaries, across agencies, across disciplines. To do this you really need to look beyond the hospital, beyond acute care. Integrating care also mean involving social care data. ‘Patients need a portal where there is a lot more than images, to also view data such as a medical history, a history of medications or radiation dose. A patient can log in to view the results of the exam. Immediately the patient may want to share images with the physician, may wish to schedule follow up appointments. All of this should be possible and right away, which brings us to a very basic use case calling for a portal. Which is what we will show at ECR 2016. What did Agfa build with the Healthcare Portal suite? ‘The portal was introduced less than a year ago and it has advanced rapidly since then. It is built on an open architecture that is compatible with existing operating systems. It is browser based, cloud-ready, easy to install and seamlessly integrates with any data or image source be it PACS, EMR or EHR, and much more beyond this, including social services. ‘We recently announced Agfa has taken a significant stake in the com- pany My Personal Health Record Express. We are continually building cases of use with them, advanc- ing further every month in terms of viewing images, lab results, and clinical notes. There is secure mes- saging between a patient and a physician. The patient can upload images and documents. Physicians can have peer-to-peer communica- tion with other providers. There is a great focus on integrating into mobile devices with iOS and Android. ‘The Agfa Healthcare Portal goes beyond grabbing data and images by gives meaning to the data. This is very new and very unique. It is a very cool thing that distinguish- es our portal, an architecture that builds in a semantic layer so that data from different sources can talk to other data in different semantic formats, from Chinese to English. We have some highly innovative intellectual property built around this, so that we can input data and images from different sources, add a meaning to this data, and configure the display through the portal.’ What will all this mean for radi- ologists? ‘The radiology community has a cru- cial role to play because they have done this before and they know how to do it. They have worked through the digital transformation. They know what it takes to move from a departmental workflow to an integrated network. They are the best placed if they believe and accept that this is happening. ‘The radiology community, if they play it right, can become – and should become – a centre of com- petence on image management, which is a crucial component of the digital convergence that under- pins integrated care. The radiology community has the deepest and best experience with the manage- ment of images, to view or to share, with standardisation, archiving and, crucially, with the workflow around images. ‘Radiologists at ECR should come to the Agfa stand where we can show relevant cases of use on what has already happened and where we think integrated care is going to go.’ ECR 2016 AGFA is here. Hans Vandewyngaerde is President EMEA at Agfa HealthCare For computer scientist Markus Harz PhD six-months’ work in a USA breast care centre has added much to his seven years in project management and ten years in medical image analysis. He has also contributed to several international research projects, scientifically and through project management. His PhD proposed methods for computer assistance in complex image-based clinical tasks. Machine learning and computer vision are always important tools in his approach. Data from different sources can talk to other data in different semantic formats, from Chinese to English

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