For hundreds of years, students and spectators could gather in operating theaters like the Ether Dome at Boston’s Massachusetts General Hospital to watch doctors perform surgery. Now IBM and researchers at another famous Boston hospital, Brigham and Women’s, have developed a tool that lets many physicians gather virutally to get a good look at a single patient. Called the Radiology Theatre, it’s a secure Web-based collaboration environment where teams of doctors in different locations can examine high-resolution CT scans, MRIs, and other test results and discuss the information over audio and video links.
“We are not all in the same location, and the information that’s needed to take care of patients does not all come from the same place,” says Francine Jacobson, a thoracic radiologist at Brigham and Women’s who is the lead investigator working with IBM’s software engineers. “Bringing together both the data and the radiologists in the same Web browser in a truly interactive manner, and avoiding a lot of the compatibility issues we’ve had in the past, is truly exciting.”
Officially unveiled today, the Radiology Theatre is essentially a mashup of free and open-source software components—such as the WebKit browser engine, the OpenAjax Hub, and the Oviyam medical image browser (developed in India)—that IBM has integrated using a proprietary Web application development platform called Blue Spruce. The system makes it easy to combine multiple types of Web resources and communications tools, such as maps, images, chat interfaces, whiteboards, and live webcam video, inside a single browser window. Over the last few months, IBM’s Emerging Internet Technology Group has been demonstrating several proof-of-concept projects built on Blue Spruce, including a news browser for financial analysts and a map-based collaboration platform for real estate investors.
The Radiology Theatre is the first telemedicine application for Blue Spruce. “The fundamental reason we did this was that everybody has been trying to replicate the power of face-to-face interactions, but they haven’t gotten there, because the images aren’t clear enough or the network isn’t fast enough or they could share certain kinds of data in a Web conference but they’d have to send other data by e-mail,” says David Boloker, the Brookline, MA-based chief technology officer for the Emerging Internet Technology Group. “We wanted to see how far we could extend the browser with high-definition video and audio and multi-user interactions, all on the same Web page.”
While TV doctors still gather in hushed radiology rooms to scrutinize film-based X-rays and CT scans on light boards, nearly all medical images are now captured digitally. In the Radiology Theatre, physicians logging in from different locations can call up these digital images from hospital databases, zoom in on specific sections of the images, use whiteboard tools to draw on the images, and consult in real time via webcam. Boloker says the initial idea for the system came from discussions with radiologists in Melbourne, Australia, who needed a better way to consult with physicians in rural clinics in Australia’s Northern Territory, thousands of miles away. But the same technologies that lets doctors communicate with other doctors could eventually be used to help far-away doctors communicate with patients, says Boloker. “You can do it all via the Web,” he says.
Jacobson has been using the Radiology Theatre to explore CT data and pulmonary function test results from patients involved in a long-term study of chronic obstructive pulmonary disease (COPD) funded by the Flight Attendant Medical Research Institute. She’s not making use of the system’s collaboration features, at the moment, but she says just being able to combine several types of data on the same screen is valuable. “When you’re looking for things that will lead to earlier identification of disease states, it’s important to learn what subtle things that we might consider normal that we should notice,” Jacobson says. With Radiology Theature, “We can look at the density of lung tissue in a particular area while at the same time looking at the pulmonary function test.”
Jacobson says she expects the Radiology Theatre to come in handy as she gets deeper into a multi-center study of the genetic epidemiology of COPD that involves researchers in Denver. But collaborators don’t have to be thousands of miles away: she says the Radiology Theatre might also help doctors at the Brigham intensive care unit who need to consult with experts across the street at the new Shapiro Cardiovascular Center. “I think as medicine has become more specialized, we are less co-located, and more based in the particular clinics where we work,” Jacobson says. “We’re all very busy, so getting together is not easy.”
IBM doesn’t have immediate plans to turn the Radiology Theatre into a commercial product, but it views the underlying Blue Spruce platform as part of its bid to influence the burgeoning market for cooperative, browser-based applications. And Boloker says he views the Radiology Theatre “as a platform that we could easily built a product on in the future.” While many of the individual components of the radiology environment are based on open-source software, and might therefore be easy for competitors to replicate, “the core platform—including audio and video and multi-user interaction—is all IBM technology,” Boloker says. “We’ve made it much easier to bring in widgets from here and there and make them all work together in a secure way.”
