Framework for Canadian telehealth guidelines: summary of the environmental scan.

A Canadian project (the National Initiative for Telehealth Guidelines) was established to develop telehealth guidelines that would be used by health professionals, by telehealth providers as benchmarks for standards of service and by accrediting agencies for accreditation criteria. An environmental scan was conducted, which focused on organizational, human resource, clinical and technological issues. A literature review, a stakeholder survey (245 mail-outs, 84 complete responses) and 48 key informant interviews were conducted.

Sustainability--the Holy Grail of telehealth?

The sustainability of a telehealth programme is one measure of its success. However, the term 'sustainable telehealth' has almost become an oxymoron. Many telehealth programmes are initiated in good faith and are based upon well founded principles.

Collaboration using Internet for the development of case-based teaching files: report of the Computer and Instrumentation Council Internet Focus Group.

Unlabelled: The Internet and particularly the World-Wide-Web is becoming a useful tool for the nuclear medicine community.

Methods: The Computer and Instrumentation Council of the Society of Nuclear Medicine convened an Internet Focus group to discuss collaboration using the Internet. The prototype application considered was development of case-based teaching files using the World-Wide-Web.

Automated alignment and sizing of myocardial stress and rest scans to three-dimensional normal templates using an image registration algorithm.

Unlabelled: To optimize the interpretation of myocardial SPECT, we developed an automated method for alignment, sizing and quantification of images using three-dimensional reference templates.

Methods: Stress and rest reference templates were built using a hybrid three-dimensional image registration scheme based on principal-axes and simplex-minimization techniques. Normal patient studies were correlated to a common orientation, position and size.

Protocols for selection of cardiac radionuclide studies for use as a data base of normal studies and typical patterns of diseases. COST B2 Working Group II, in association with relevant working/task groups of the European Association of Nuclear Medicine and the European Society of Cardiology.

A data base of clinical studies is required for quality assurance of software used for analysis of radionuclide cardiac imaging procedures. Studies used must be rigorously validated in terms of both the clinical condition of the patient undergoing the procedure and the imaging protocol used. Selection protocols for the creation of a software phantom data base of normal studies and three typical patterns of cardiac disease--recent transmural myocardial infarction, isolated myocardial ischaemia and dilated cardiomyopathy--have been developed by the Cardiac Working Group of the European COST B2 project in association with the Cardiac Task Group of the European Association of Nuclear Medicine and the Working Group on Nuclear Cardiology of the European Society of Cardiology.

A file format for the exchange of nuclear medicine image data: a specification of Interfile version 3.3.

Working Group 1 of the European project COST-B2 on quality assurance of nuclear medicine software has been concerned with the development of an appropriate mechanism for the transfer of nuclear medicine image data files between computer systems from different vendors. To this end a protocol based upon Report No. 10 of the American Association of Physicists in Medicine (AAPM) [1] was adopted.

Experience with gated cardiac software phantoms for quality control of applications programmes.

Ten gated cardiac software phantoms, representing normal and abnormal clinical conditions, were transferred to 9 different computer systems and tested with 11 cardiac programmes. Problems of inappropriate data format were encountered when analysing the phantoms on other systems. The global left ventricular ejection fraction (LVEF) values resulting from the different programmes were compared.

A standard protocol for the exchange of nuclear medicine image files.

In order to meet an increasing demand for a standard file format which would facilitate the exchange of image files from one computer to another, the protocol initiated by Report #10 of the American Association of Physicists in Medicine has been adopted. This protocol uses the concept of an ASCII file in which key-value pairs are used to describe the various parameters of the image file. Keys specific to nuclear medicine image files have been established and are published here.

In vivo red blood cell compatibility testing using indium-113m tropolone-labeled red blood cells.

In vivo radionuclide crossmatch is a method for identifying compatible blood for transfusion when allo- or autoantibodies preclude the use of conventional crossmatching techniques. A technique for labeling small volumes of donor red blood cells with [113mIn]tropolone is reported. The use of 113mIn minimizes the accumulation of background radioactivity and the radiation dose especially so when multiple crossmatches are performed.

Dependence of ejection fraction results on choice of algorithms for a cardiac phantom.

Ejection fraction results obtained from the Vanderbilt rotating cardiac phantom exhibit a strong dependence on the algorithms used to derive the time--activity curves and calculate the ejection fraction from those curves. This problem is caused because the background chamber is located behind the rotating attenuator which is used to produce the pseudo ejection fraction. As a result, the counts due to background in both the regions on the 'left ventricle' and the area assigned for background correction do not remain constant during the 'cardiac cycle'.

Effect of scintillation camera nonuniformity on ejection fraction measurements.

A rotating cardiac phantom with three possible ejection fraction (EF) values was used in conjunction with a scintillation camera employing energy correction and count skim arithmetic for uniformity correction. Studies were collected with and without any correction, with the energy window of the analyzer set properly, and with the camera properly tuned. The uniformity was then degraded in one experiment by off-setting the analyzer window both high and low with respect to the primary photopeak and in another experiment by de-tuning a selected photomultiplier tube.

An interface between several cameras and two computers, using differential analog transmission.

A system has been built to allow up to four scintillation cameras to be connected in parallel with two computers, yet provide for selection of individual pairs of camera/computer combinations with the exclusion of unwanted connections. Since the distances involved were relatively long, signal drivers were used to transmit the analog signals in a differential mode over multiple twin-paired lines rather than coaxial cable. By transmitting the signals differentially, any noise induced on the signal was subtracted at the receiver.

Left ventricular function during graded exercise in patients with coronary artery disease and in control subjects.

The left ventricular function of 30 patients with coronary artery disease and 11 control subjects was studied by electrocardiography gated cardiac blood pool scintigraphy as the participants lay on their backs and either rested or exercised on a cycle ergometer at graded levels on intensity. The control subject showed a progressive increase in ejection fraction from rest (51% +/- 7%) to intermediate (56% +/- 10%, P less than 0.05) and maximum levels of exercise (64% +/- 10%, P less than 0.