Karen Smith

Telemedicine and the Grid

It's the latest buzzword in our newspapers, on the radio and on television. We're told that it's set to revolutionize patient care but what exactly is 'e-Science' ?

'e-Science will change the dynamic of the way

science is undertaken.'*

Today much medicine and biology is highly collaborative and inter-disciplinary.

Science thinks BIG and it will get progressively bigger through

distributed global collaborations enabled by the Internet. If there

is one thing that typifies such collaborations it is requirement

of being able to access and visualize huge amounts of data and that

of course requires huge computing resources.

Thanks to the World Wide Web we can now sit at our laptops, press

a few keys and gain access to information on Web pages written in

html anywhere on the Internet. However, e-Science will require even

more powerful infrastructure, scientists will need to access information

stored in dedicated databases, remote facilities and computing resources

as well. Grid architecture may well be the enabler of this 'virtual

world' vision. In essence Grid is 'An infrastructure that enables

flexible, secure, coordinated resource sharing among dynamic collections

of individuals, institutions and resources.' **

Currently

the West Anglia Cancer Network (WACN) provides cancer services for

a core population of 1.6 million and has an extended catchment area

of 2-4 million.

The Cancer Centre for the network is based at Addenbrooke's Hospital

in collaboration with Papworth Hospital for patients with lung cancer.

Six more Cancer Units at Bedford, King's Lynn, Peterborough, Hinchingbrooke,

West Suffolk and Harlow Hospitals (together with the Cancer Centre

at Addenbrooke's) serve the remainder of the region.

Figure 1: The WACN catchment area (left)

Grid technology could dramatically improve delivery of patient

careIt is clearly desirable to provide care as near as possible

to the patient's home, just ask any cancer patient travelling the

long journey back home on the train after a chemotherapy session.

It is also desirable to maintain continuity of care. For example,

there is a clear benefit for patients who require treatment at the

Cancer Centre in Addenbrooke's (e.g. for radiotherapy) to have their

treatment planned by the same Consultant they have seen at their

nearest Cancer Unit. However, clinicians are currently travelling

large distances to provide remote clinical services. Grid technology

may be able to prevent the necessity for such travel and provide

access to appropriate clinical information and images across the

network thus dramatically improving the delivery of patient care.

So how does it work?

Figures 2, 3 & 4 : Communication

and archiving of radiological images to support multi-disciplinary

meetings for the review of cancer diagnoses and treatment, and real-time

delivery of microscope imagery.

The

'Telemedicine on the Grid' project (which is a joint project between

the Cambridge eScience Centre, The University of Cambridge Department

of Radiology and the West Anglia Cancer Network) aims to provide

a secure infrastructure for advanced collaborative environments,

using: multi-site video-conferencing, real-time delivery of microscope

imagery and communication and archiving of radiological images to

support multi-disciplinary meetings for the review of cancer diagnoses

and treatment. The project also hopes to demonstrate the feasibility

of remote access to computational medical simulations and the data-mining

of patient record databases for improved clinical decision making.

Figure

5 : A working multidisciplinary team meeting (left)

Lets focus on one area as an example; the NHS needs clinicians

to participate in multidisciplinary team meetings (MDTs) in order

to discuss the diagnosis and care plans of patients. Bringing together

the necessary expertise and data can involve long travel times and

is very wasteful of scarce consultant time. In partnership with

the West Anglia Cancer Network, Macmillan Cancer Relief and Siemens

Medical Systems, the Cambridge e-Science Centre is deploying integrated

voice, video and data system technology to support MDTs.

The aim is to provide an integrated package including voice, video

and data from body scanners and pathology samples. The system must

meet the needs of clinicians with a high quality data and video

conferencing environment, and be simple to use. It must also be

sufficiently general to be easily adapted to other medical image

data, and open to the inclusion of electronic patient records. No

mean feat!

Figure

6: People looking at the system at the official launch (right).

Improvements in West Anglia and potentially throughout the National

Health Service:

It is hoped that this project will demonstrate the capability of

Grid technology to improve the delivery of patient care in the West

Anglia region and so potentially throughout the National Health

Service.

About the Authors:

Dr. Andy Parker is a particle physicist, with research interests

in new physics beyond the standard model, and is the Director of

the Cambridge eScience Centre.

Dr. Karen Smith is a neuroanatomist, and the Business Development

Manager for Life Sciences at the University of Cambridge Corporate

Liaison Office (CLO).

The Project Team:

Dr Martin Graves (Dept. of Radiology), Dr Richard Ansorge (Cavendish

Laboratory), Kate Caldwell (CeSC) and Mark Hayes (CeSC).

Quotes:

* John Taylor, Director General of Research Councils Office

of Science and Technology (from the e-Science Core Programme)

** Ian Foster and Carl Kesselman, inventors of the Globus approach

to the Grid

- June 2004

About the Author

Dr Karen Smith is a neuroanatomist. She was the Business Director of the Cambridge Computational Biology Institute and is now the Director of Bioprocess Leadership, Biochemical Engineering, University College London.