The Biomedical Imaging and Visualization Project was previously known as the TELESYNERGY(R) Medical Consultation WorkStation (MCWS) Environment. The name change of the Project, and our section, appropriately reflects the fact that the scope of the project has gradually expanded over the years. Development of the MCWS was initially begun by CBEL in the mid 1990s, and it was first deployed in the Center for Information Technology (CIT) and NCI Radiation Oncology Branch (ROB) environments on the NIH campus in 1995 and 1997, respectively. The MCWS allows real-time multimedia conferencing between distributed sites, and the systems include high-resolution electronic view boxes for the display of CT, MRI or chest film images. Also included is a high-resolution video link for the presentation of a view of the consultant, the display of videotaped medical images or live presentations, or the display of histopathology images obtained from remote-controlled microscopes. The MCWS System originally utilized a high-speed fiber optic network when systems were contained within the NIH Campus. Currently, all communication between MCWS Sites occurs over ISDN Primary Rate Interface (PRI) Circuits. The National Cancer Institutes Radiation Oncology Sciences Program (ROSP) is: (1) participant in the NCI All Ireland Cancer Consortium (combining the cancer research capabilities of Bethesda, Belfast, and Dublin in a second five-year relationship aimed at an attack on cancer in Ireland);(2) supports the re-vitalization of the King Hussein Cancer Center (KHCC) in Amman Jordan, and (3) participates in a residency training program jointly with the Walter Reed Army Medical Center (WRAMC) and the National Naval Medical Center (NNMC), known as the NCI Capital Consortium. The TELESYNERGY(R) System quickly became a major IT component of these programs, through an NCI and CIT Collaboration. BIVS Staff have installed TELESYNERGY(R) Systems at Belfast City Hospital in Belfast, N.I., U.K., at St. Luke's Hospital, Trinity College Dublin Division of Radiation Therapy, Beaumont Hospital in Dublin, Cork University Hospital, University College Hospital Galway, all in the Republic of Ireland. In addition, a simplified and upgradeable TELESYNERGY(R)-Lite System was installed at the same time, within TCD, as a sample for duplication at five smaller cancer centers in the ROI by local staff. TELESYNERGY(R) Systems have also been installed at King Hussein Cancer Center (KHCC) in Amman, Jordan, in FY04, as part of an NCI-Jordan Cancer Consortium;at WRAMC, for use by the NCI Capital Consortium residents, in April of FY01 and an upgraded version was installed during the last quarter of FY04. In early FY08, at U.S. Army Telemedicine and Advanced Technology Research Center (TATRC) at Fort Detrick, MD, in order to allow TATRC Staff to connect with the WRAMC System and to evaluate the TELESYNERGY(R) Environment for possible use in a military application. Completed during FY07, was the task of converting the CIT-developed TELESYNERGY(R) Software from its original Sun/Solaris workstation environment to the PC/Linux workstation environment. Six of the existing TELESYNERGY(R) Systems utilize the new PC/Linux version of the software. The design, integration, and packaging was also completed for all hardware components of a portable, ruggedized version of the TELESYNERGY(R) environment, including a Very Small Aperture Terminal (VSAT) Satellite Antenna System. The BIVS-developed TELESYNERGY(R) Software Environments is no longer under development. Currently, ten full TELESYNERGY(R) Systems are operational worldwide, and are partially supported by CIT staff. During FY07, BIVS developed a small Telenephrology System on a mobile cart that provides Dr. Andrew Narva (NIDDK), the new Director of the National Kidney Disease Education Program, with the ability to conduct regularly scheduled clinics with his previous renal patients at the Zuni PHS Hospital in Zuni, AZ. In addition, BIVS implemented an EENT Imaging System on a mobile cart for Dr. Hirsh Komarow (NIAID), Staff Clinician in the Laboratory of Allergic Disease, for his use in the NIAID Pediatric Allergy Clinic. These systems continue to be supported by BIVS Staff. In FY09, efforts continued on the development of signal processing algorithms in support of our long-term MRI Diffusion Tensor Imaging (DTI) Research collaboration with Peter J. Basser, Ph.D., NIH Senior Investigator and Chief, Section on Tissue Biophysics and Biomimetics, NICHD, and members of his Section. These activities include the development and implementation of a new MR Pulse Sequence, which utilizes bipolar diffusion-encoding gradients for motion compensation. Future activities during FY10 will involve combining this technique with tractography methods. In addition, the development of an automated Organ and Lesion Volume Calculation Server continued, which was initiated during FY08 at the request of Ronald M. Summers, M.D., Ph.D., Chief, Image Processing Group, Department of Radiology and Imaging Sciences, CC. While the eventual goal is fully unattended calculation of designated organ and lesion volumes, our prototype is being developed as an operator-assisted system that will allow the calculation of gold standard volume values. During FY09, compatibility with the Digital Imaging and Communications in Medicine (DICOM) Standard, for electronic image exchange, was developed within the Organ and Lesion Volume Calculation Server. Testing and assurance of interoperability with the DICOM-Compliant Software Packages commonly used at NIH is the next step. In FY09 the development of a novel research-oriented Stereo Medical Image Display System continued with the procurement of all hardware components. This Stereo Medical Image Display System, which will be controlled by hand-motion via a haptics glove, is being developed to support brain imaging as the initial target application area. Powered by a high-performance workstation containing dual quad-core processors, with an integrated dual graphics processor engine, this system development platform will be controlled by a haptics glove with internal tactile feedback, and will have a speech recognition capability. The system will be developed in the JAVA Language, as an accessory component that will be compatible with the Medical Image Processing Analysis and Visualization (MIPAV) Application, which was designed by the Biomedical Imaging Research Services Section (BIRSS), DCB, CIT. During FY10, the implementation of a new MR Pulse Sequence, which utilizes bipolar diffusion-encoding gradients, combined with tractography methods, is expected to greatly improve image resolution. In addition, future development of the prototype Organ and Lesion Volume Calculation Server will include certification of DICOM Compliance and the development of a customized graphical user Interface. Also during FY10, application software will be developed, purchased, and/or borrowed to detect and interpret hand gestures within the 3D Medical Image Display System. Analysis of the intersecting trade-offs between make vs. buy;simple vs. complex gestures;and existing sign-language paradigms vs. newly-created hand gesture paradigms. In FY10, work is expected to start on the design and prototype development for a new class of Telecollaboration Platform, utilizing lessons learned from the TELESYNERGY(R) Project. BIVS will provide telecollaboration infrastructure in the about-to-begin Department of Defense-Bioinformatics Database Project (DoD-BDP) that will be supported by three DCB components. The DoD-BDP will be dedicated to the storage and retrieval of anonymized data specific to the Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD) patient population within the DoD and VA Health Systems.

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Narva, Andrew S; Romancito, Gayle; Faber, Thomas et al. (2017) Managing CKD by Telemedicine: The Zuni Telenephrology Clinic. Adv Chronic Kidney Dis 24:6-11