Development of the TELESYNERGY Medical Consultation WorkStation System (MCWS) was initiated 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 teleconferencing between distributed sites, and the systems include high-resolution electronic view boxes for the display of CT, MRI or chest film images. The TELESYNERGY(R) System quickly became a major IT component of several national and international National Cancer Institute (NCI) sponsored programs, through NCI/CIT collaborations. During FY10, BIVS has continued to support 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 FY10, 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 (STBB), NICHD, and members of his Section. Activity centered on testing the feasibility of the Compressed Sensing Algorithm to reduce number of radial views for Diffusion Tensor MR Imaging. Reduction of the acquisition time without significant drop of DTI data quality is extremely important in a clinical setting, especially in Traumatic Brain imaging. The Compressed Sensing Framework incorporates signal sensing and compression, which allows reconstructing original signal from a sparse set of data points. Radial fast spin-echo magnetic resonance data can be represented as a sparse matrix and reconstructed using wavelet functions. During FY2010, development continued on the implementation of an automated Organ and Lesion Volume Calculation Server, 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 FY10, software compatibility with the Digital Imaging and Communications in Medicine (DICOM) Standard, for electronic medical image exchange, was completed, along with assurance of interoperability with the DICOM-Compliant Software Packages commonly used at NIH. In FY10, the development of a novel research-oriented Stereo Medical Image Display System continued with a survey of available open source software that could support the selected 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 development platform will be controlled by a haptics glove with internal tactile feedback, and will have a speech recognition capability. The system is being developed in the JAVA Language, and will be compatible with the Medical Image Processing Analysis and Visualization (MIPAV) Application that was designed by the Biomedical Imaging Research Services Section (BIRSS), DCB, CIT. During FY10, BIVS was asked by Dr. William Gahl Chief of the NHGRI Undiagnosed Diseases Program (UDP), and dr. Murat Sincan, Research Fellow, NHGRI, to create a secure portal whereby the UDP could provide outside consultants remote secure login to NIH to help as outside experts in the diagnosis of undiagnosed diseases. Consultants are NIH staff members, from other Institutes, and also outside subject matter experts. In July 2010, BIVS demonstrated an alpha version of the UDP Portal website, which indicated how a sample case might appear to an internal NIH case manager or an outside reviewer, using sample de-identified patient data that was provided by NHGRI. Ultimately, this system will provide an on-line repository of de-identified case studies for UDPs patients. The UDP will be able to grant secure, authenticated access to outside consultants through the NIH Federated Login Service. In FY11, BIVS will continue to support the NIDDK Telenephrology Clinic on an as-needed basis. During normal system operation, the procedures are automated and BIVS involvement is required only for troubleshooting unexpected occurrences. During FY11, the implementation of new MR Pulse Sequences, which utilizes bipolar diffusion-encoding gradients, combined with tractography methods, will continue. During FY11, future development of the prototype Organ and Lesion Volume Calculation Server will center on the development of a customized Graphical User Interface to support this system. Also during FY11, the 3D Medical Image Display System will be assembled from the acquired components. 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, will allow the selection, acquisition, and integration of the final software components for the phase one prototype system. During FY11, the UDP Portal will enter the beta testing phase, with internal NIH staff members and selected outside collaborators exercising the Portal and providing valuable feedback to the system developers. In FY11, work is expected to start on the design and prototype development for a new class of Telecollaboration Platforms, utilizing lessons learned from the TELESYNERGY(R) Project. BIVS hope to provide a novel telecollaboration infrastructure in the proposed Department of Defense-Bioinformatics Database System (DoD-BDS) that will be supported by three DCB components. The DoD-BDS will be dedicated to the storage and retrieval of de-identified data specific to the Traumatic Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD) patient population within NIH, 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