Development of the TELESYNERGY(R) 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 films. The TELESYNERGY(R) System quickly became a major IT component of several national and international National Cancer Institute (NCI) programs, through NCI/CIT collaborations. A portable, ruggedized version of the TELESYNERGY(R) environment was also developed, which includes a Very Small Aperture Terminal (VSAT) Satellite Antenna System. Currently, six full TELESYNERGY(R) Systems are operational worldwide, and are partially supported by CIT staff. During FY12, BIVS continued to support the small Telenephrology System that provides Dr. Andrew Narva, Director, National Kidney Disease Education Program, NIDDK, with the ability to conduct regularly scheduled clinics with his previous renal patients at the Zuni PHS Hospital in Zuni, AZ. In FY12, 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. Activities continued on development of techniques for reduction of motion artifacts in MRI studies. Efforts included the further development and evaluation of a controllable MRI phantom that can exhibit a range of complex motions to test the susceptibility of MRI sequences to motion artifacts. Evaluation of the efficacy of correction strategies to mitigate these motion artifacts also was extended during FY2012. During FY12, development was completed on the implementation of an automated Organ and Lesion Volume Calculation System, which was initiated at the request of Ronald M. Summers, M.D., Ph.D., Chief, Image Processing Group, Department of Radiology and Imaging Sciences, CC. Minor programming activity still continues related to the improvement of the client/server environment implemented within this project, to improve overall system efficiency. 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. In FY12, development continued on a novel research-oriented Stereo Medical Image Display System, which is being developed in the JAVA Language, and will be compatible with the Medical Image Processing Analysis and Visualization (MIPAV) Application designed by the Biomedical Imaging Research Services Section (BIRSS), DCB, CIT. This Stereo Medical Image Display System, which is to be controlled by hand-motion, is being developed to support brain imaging as the initial target application area. Powered by a high-performance workstation containing dual quad-core processors and an integrated dual graphics processing system, this development platform will be controlled by a 3D position-sensing haptics glove with internal tactile feedback, and will have a speech recognition capability. The implementation of software stereo image generation was demonstrated, utilizing a group of algorithms developed at Johns Hopkins University, which are organized as plug-ins to the MIPAV image processing environment. Computational latency, during stereo brain image generation, will be greatly improved during FY 2013 by the incorporation of a newly acquired high-speed graphics-rendering engine that will be added to the system. 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 December 2010, BIVS demonstrated the beta 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 is able to grant secure, authenticated access to outside consultants through the NIH Federated Login Service. During FY2012 integration was completed for a 12 Terabyte Disc Array, and for the Galaxy Web-based Platform that was developed by Penn State University and supports data-intensive biomedical research. These two new components allow the UDP Portal to easily incorporate genomic data into the patient case presentation. During FY 2012, BIVS continued with a collaborative project with Dr. Henry Masur, Chief, Critical Care Medicine Department (CCMD), CC, and Naomi OGrady, Staff Clinician, CCMD, CC, aimed at the development of novel methods for the graphical presentation of the status of patients within a critical care environment. The prototype system, departs from the electronic spreadsheet display format that is the goal standard for patient status display in the modern critical care unit, and is being implemented on the iPad platform to capitalize upon multi-touch display technology and swipe screen control capability. Software development began this year. Design of the required Data Gateway was also initiated, in order to allow patient data from the Clinical Centers Electronic Medical Record (EMR) System to eventually be channeled to the iPad, via the buildings wireless network, in an encrypted format that utilizes two-factor authentication during login.

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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