SHORT OVERVIEW OF MEDICAL GRIDS G.Feofilov NGN-4 meeting, St.Petersburg 20.05.05

1. SHORT OVERVIEW OF MEDICAL GRIDSG.FeofilovNGN-4 meeting, St.Petersburg 20.05.05 CONTENTS Introduction PACS HEALTHGRID MAMMOGRID GPCALMA PLANS istc #2887? CONCLUSIONS

2. Motivation • WWW - was invented in 1992 at CERN • New generation of High Energy Physics experiments to be started in 2007 at CERN: AVALANCE OF DATA FROM LHC INSTALLATIONS • 10 mln Gbytes of data per year (20 mln DVDs/year ) • For example: ALICE is expecting about 1DVD/s amounts of data • One needs to increase the computer power existing at CERN by a factor of 1000 • WHAT TO DO? • New information and communications technology - GRID – it is the answer for 10000 physicists working in hundreds of institutes New opportunities for other researchers: see http://www.cern.ch/openlab • Our practical Experience: • SPbSU: in ALICE since 1992 • AliEn in SPbSU - since 2003. • AliEn –Succesful Data Challenge TESTS in September 2004(http://alien.cern.ch) • SPbSU joined also Nordic Grid Neighbourhood in 2004, http://www.nordugrid.org)

4. HEALTHGRID • “Grid-based E-health projects in the European Union” • See report by Tony Solomonides on behalf of • The HealthGrid Association • JINR(Dubna), June 2004, GRID Conference • References: • http://lyon2003.healthgrid.org/program.php • http://clermont2004.healthgrid.org/program.php • http://www.healthgrid.org/ nThe European HealthGrid Initiative

5. From report by Tony SolomonidesJINR(Dubna), June 2004, GRID Conference: • “What is a health grid? • combines Grid and e-Science ideas • oriented to biomedical advances • supports evidence-based practice” • “What projects • e-Science led to Grid projects • Grid projects included applications • e-Health applications took off”

6. Bio-numeric modelling Medical Expertise Legal Aspects Simulation &Imaging Grid Software Example 1Computational Grid • Secure & lawful Grid provision of medical services • Build 6 Grid-enabled medical prototype applications • Build suitable middleware on top of common standards • Install and evaluate a GEMSS test-bed • Anticipate privacy, security & other legal concerns Taken from Gerhard Engelbrecht

7. Example 2: MammoGRID • EU project to prototype a pan-European distributed databaseof mammographic images using Grid Technologies. • Aim: To provide a demonstrator for use in epidemiological studies, quality control and validation of computer aided detection algorithms

8. DIGITAL EPOCH in medicine IMR,CT,PET,FFDM… X-ray images: An impressive progress was made in last 3-4 years in large area X-ray Digital Detectors (due to a breakthrough in technologies for coordinate sensitive : amorphous-Se and amorphous-Si detectors) Example: FullFieldDigitalMammography, a-Se detector, 18cm*24cm, pixel dimension = 85 microns (!) Amount of diagnostic data per patient will certainly grow up from 20-40Mbyte/image to Gbytes? (for example for multislices CT) Transition: from FILM ---- to DIGITAL has started Benefits are almost obvious!

9. Benefits Benefits for the patient: lower dose (several times!), Immediate result! higher reliability of diagnosis! Benefits for the doctor: higher efficiency Plus new quality of everyday work! Possibility for Computer Aided Diagnostics (CAD)! Mass Screening Programs! Easy-to-use archive! Image sharing! Consultations, etc…

10. From letters@auntminnie.com Wed May 11 18:01:40 2005Date: Mon, 10 Jan 2005: • “FFDM Fulfills a Vision to Improve Clinical Effectiveness and Efficiency For Swedish Medical Center of Seattle, Washington,USA…”. • “The Selenia system allowed for single imaging, regardless of the breast size…” • “Digital System Has Dramatic Impact On Clinic's…” Digital imaging allows, in particular, NEW BENEFITS: • Full Field BreastTomosynthesis.Tomosynthesis is a 3-D method of imaging that can reduce or eliminate the tissue overlap effect.

11. Picture Archiving and Communications Systems (PACS), Examples: • M.D. Anderson Cancer Center's (USA) physicians are viewing over 200,000 diagnostic-quality images per month (!)

12. OPTION - One can pay tons of money and buy everything: PACS: WHAT TO DO?

14. What to do? PACS:ANOTHER APPROACH: May 12 14:21:42 2005Date: Wed, 11 May 2005 13:36:30 -0700From: AuntMinnie <letters@auntminnie.com> • “When UDIAT Diagnostic Center outside of Barcelona needed a more reliablePACS system, it built its own -- one it has sold to imaging centers throughout Spain. • When it needed a state-of-the-art breast imaging capability, it went all-digital -- removing its existing analog systems during the transition.” • “Consistency has been the hallmark of UDIAT, allowing the facility to complete an estimated 27,000 screening mammograms, 8,000diagnostic mammograms, and 1,000 breast biopsies per year.”

15. Tele Medicine- example Regional Tele Medicine System. RTS 3.0 (Russia) , 2000-2003 • See (http://ww.ctmed.ru/products/rts3_0.html (in Russian). • automated OFF-LINE system that uses technology: “Clients +-Server + Web”. • Client part: is based on Microsoft Windows 95/98/NT/2000, • Server part of the system - RedHat Linux (6.1 and higher), Oracle data base, WWW module (web-server+consultant) • TCP/IP protocol, transportation of medical video images DICOM, (utrasonic,MRI,scanned Roentgen films, etc.), image local data storage and search, • and additional information on patient, teleconsultations • Image transformations: brightness/contrtast/color, zoom, simultaneous image viewing, • Data e-mail transfer, simultaneous work of doctor and consultant • Security:? – via Patient’s ID • IS IT GRID? Obviously - NO

16. http://ww.ctmed.ru/products/rts3_0.html

17. MEDICAL GRIDS

18. Intial e-Diamond plans • IBM has joined with Oxford University and the UK government to build a computing Small and Medium grid prototype to help enable early screening and Business Centre Software diagnosis of breast cancer. It's called the eDiamond Storage grid. It was planned thatSoftware IBM's DB2 and DiscoveryLink middleware will provide the advanced search and data mining capabilities, • IBM WebSphere will enable file serving. Server: IBM hardware powering the Grid will include IBM's eServer pSeries and xSeries servers, along with TotalStorage FAStT500 storage servers. • PCs: Users access the grid through Netvista desktop computers and IntelliStation workstations with T221 high-resolution flat screen monitors. :

19. Status of St.Petersburg mammal gland screening (data of 2002) • St.Petersburg’s decree (07.03.01) on “Special Oncology Program for St.Petersburg for 2001-2005” • St.Petersburg: the highest rate in Russia of oncology decease • Mammal gland cancer is No.1 since 1981 • 2163 new mammal cancer patients in 2002 (21,6% of all oncology cases) (see Tables below). • Mortality –about 9% of the all mortality is due to the oncology • 2003: 21861 women are registered total with a general diagnosis of mammal gland oncology • The population of women in St.Petersburg is 2544 thousand

20. MammoGRID, http://mammogrid.vitamib.com.).

21. Mammogrid technologies • Mammography CADe (CALMA) DICOM MF™ (Mirada) • Distributed computation AliEn GRID (CERN) (in future – gLite(CERN) ?)

22. Standard Mammogram Form(from report by T.Solomonides, JINR, June 2004)

23. AN EXCELLENT EXAMPLE: GPCALMA http://gpcalma.to.infn.it

25. The GPCALMA (Grid Platform for Computer Assisted Library for MAmmography) collaboration involves several departments of physics, INFN sections, and italian hospitals GPCALMA has built a large distributed database of digitised mammographic images (about 5500 images corresponding to 1650 patients) and developed a CAD (Computer Aided Detection) software which is integrated in a station that can also be used for acquire new images, as archive and to perform statistical analysis GPCALMA

27. GPCALMA, Proceedings of the Seventh MexicanSymposium on MedicalPhysics 2003, Vol. 682/1, pp. 67-72, Mexico City, • The distributed database is realized throught the connection of all the hospitals and research centers in GRID tecnology. • In each hospital local patients digital images are stored in the local database. • Using GRID connection, GPCALMA will allow each node to work on distributed database data as well as local database data. • Using its database the GPCALMA tools perform several analysis. A texture analysis, i.e. an automated classification on adipose, dense or glandular texture, can be provided by the system. GPCALMA software also allows classification of pathological features, in particular massive lesions analysis and microcalcification clusters analysis

28. approach is being applied to a group of Hospitalswhich joined the GPCALMA project (Grid Platform for Computer Assisted Library for MAmmography), which will allowcommon screening programs for early diagnosis of breast and, in the future, lung cancer. HEP techniques come into play in writing the application code, which makes use of neural networks for the image analysis and proved to be useful in improving the radiologists' performances in the diagnosis gpcalma

29. gpcalma • A prototype of the system, based on AliEn GRID Services, is already available, with a central Server running common services and several clients connecting to it. • Mammograms can be acquired in any location; the related information required to select and access them at any time is stored in a common service called Data Catalogue, which can be queried by any client.

31. Future of GRID for medicine in Europe: additionally to HealthGRID and to MammoGRID: EUROPEAN HADRON THERAPY CENTERS advanced treatment planning model simulations data base

32. Hadron Therapy in Europe: • HICAT (Germany)-approved • EITOLE (France)-approved • CNAO (Italy)-approved • MEDAUSTRON (Austria) -approved • Sweden? • Baltic Light (Stockholm+St.Petersburg)? • St.Petersburg? (see ISTC Project#2887)

33. Stockholm St. Petersburg GSI MIT University Ohio State University Bratislava CERN Tsukuba PSI Laibach Loma Linda Hyogo Lyon Indiana State University Kashiwa MGH Boston Mailand Chiba Kapstadt International Cooperations in HADRON THERAPY(from report by E.Griesmayer, MedAustron) Heidelberg

34. EXAMPLES OF NEW APPLICATIONS IN HADRON THERAPY: • Advanced treatment planning for hadron therapy • Distributed data bases of various diagnostic images • Afvanced simulations etc.

35. IMRT (MedAaustron) Glandula Parotid Cancer • Пример: фотоны (2 поля и 5 полей) и протоны (3 поля) 2 fields photons 5 fields photons 3 fields protons Treatment plan for protons and X-rays by Universitätskliniken Wien & Innsbruck

36. Application example: Орган риска Optimization of treatment plan опухоль (conformal distr.)

37. Why collaborate, why ENLIGHT?(European Network for LIGht Ion Hadrong Therapy) • Establish a common European Platform:coherence, integration • 1st round of facilities: • R&D phase of Ion therapy with the aim to establish Ion therapy as viable, solution for a number of cancer cases • Work in European context to establish international standards of treatment; “interoperability” • Profit from respective experience in building, managing, operating • Reduce Duplication, Increase Quality, profit from best ideas, concepts • Collaborate with “technology” providers: GSI/Heidelberg, CERN, INFN, CEA. . • Promote medical data acquisition, handling, curation, validation, standardisation and exchange • Establish a common European Platform

38. С.ПЕТЕРБУРГ • Для реализации адронной терапии необходима разработка комплекса, обеспечивающего гарантию качества на всех этапах лучевого лечения. Выполнение данного требования подразумевает необходимость объединения в одном проекте: • Современного фундаментального опыта онкологии и радиотерапии • Современных технологий формирования и вывода пучков, • Физических современных методик диагностики, прецизионного планирования и контроля облучения • Новейших технологий обработки, хранения и передачи массивов данных современных диагностических систем.

39. ЗАКЛЮЧЕНИЕ • ЕВРОПА ДВИЖЕТСЯ К СОЗДАНИЮ СЕТИ ЦЕНТРОВ АДРОННОЙ ТЕРАПИИ С ПРОТОННЫМИ и 12C ПУЧКАМИ . • Новейшие информационные технологии, разработанные для физики сверхвысоких энегрий, являются в настоящее время неотъемлемой частью многих важнейших приложений, в том числе и в медицине 3) В С.Петербурге и в СПбГУ есть все условия для начала работ (кроме средств)