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Purpose: Incidents are recommended to be analyzed by root cause analysis (RCA). Our institution also conducts RCA for incidents and takes measures to prevent recurrence. The purpose of this study was to evaluate the effectiveness of countermeasures against the root causes analyzed by RCA in order to prevent recurrence of incidents., Methods: Since the treatment planning CT scanner was replaced, incidents of failure to zero adjustment the coordinates of the bed position occurred four times during a three-month period. The RCA was used to investigate the root causes of these incidents and to formulate measures to prevent recurrence. To evaluate the effectiveness of the recurrence prevention measures, we collected the number of recurrence of incidents during the first year after the effectiveness of the recurrence prevention measures, and used the chi-square test to determine the significant difference in the probability of an incident occurring at a significance level of 5% or less., Results: The measures to prevent the recurrence of incidents were to double-check that the coordinates of the bed position were adjusted to zero and to simulate operations based on a work flow that incorporated this double-check. During the first year period following the implementation of these recurrence prevention measures, the number of recurrence incidents was zero, and the probability of their occurrence decreased statistically significantly (p<0.05)., Conclusion: Thorough double-checks and work simulation based on the work flow are effective methods for preventing the recurrence of incidents.

Purpose: The nutrition support team at our hospital introduced a flowchart to ensure smooth initiation of early enteral nutrition after open heart surgery. We assessed the effectiveness and safety of early enteral nutrition using the flowchart., Methods: We examined 240 patients who had undergone cardiovascular surgery between November 2013 and September 2015. The patients were divided into 2 groups for comparison;the flowchart intervention group( n=120) and the non-intervention group( n=120)., Results: The postoperative enteral nutrition in the intervention and the non-intervention groups was begun at 28.3 (23.2~40.5) hours and 37.0 (26.7~44.9) hours (p=0.04), respectively. There was no difference in the length of intensive care unit stay or postoperative infection rate. However, the length of hospital stay was prolonged in the intervention group (11.0 days versus 9.0 days;p<0.01). The rate of gastrointestinal complication was also comparable( 28% versus 21%;p=0.23)., Conclusion: Our study suggests that early enteral nutrition may be safely promoted by introducing the flowchart in patients who have undergone open heart surgery. Further investigation is needed to clarify the effectiveness.

In the last five years, many hospitals in Japan have created three-dimensional (3D) images from computed tomography (CT) data from patients who have undergone liver resection to share the images of liver structures with the surgical team and analyze the liver volume based on portal perfusion. However, using the previous software packages, the 3D liver model was fixed and rigid. Therefore, we developed novel 3D simulation software, called Liversim, to visualize real-time malformations of the liver. There were no marked differences during the process of liver resection between Liversim and actual surgery. Virtual liver resection showing real-time malformations of the liver using Liversim is useful for the safe performance of liver resections.

Pulmonary segmentectomy-level variations in the three-dimensional (3D) architecture of the bronchi and pulmonary vessels are much wider than those at the lobectomy level. Presurgical simulation with sharing of necessary information is believed to reduce the surgical time and number of detachment procedures required. For such simulations, the author’s group developed homemade software that: 1) reconstructs the shapes of the bronchi, vessels, lung, and tumors as simplified 3D images such as sequentially connected cylinders with branches and membranes from digital-imaging data on a personal computer screen; 2) allows surgeons to input data on the initial and terminal points, diameters of cylinders, etc. continuously by moving computed tomography (CT) images up and down; and 3) permits these data to be read by modeler shareware on the Internet. Although conventional 3D images from CT data are reconstructed by a volume-rendering method, those of the software developed by the author’s group are made using a surface-rendering method. This article explains the present status of and future trends in the actual processes of simulated surgery including segmentectomy and navigation, applications of newly developed operative procedures, and results of data analysis of more than 500 cases.

DICOM2PHITS and PSFC4PHITS are user assistance programs for medical physics PHITS applications. DICOM2PHITS is a program to construct the voxel PHITS simulation geometry from patient CT DICOM image data by using a conversion table from CT number to material composition. PSFC4PHITS is a program to convert the IAEA phase-space file data to PHITS format to be used as a simulation source of PHITS. Both of the programs are useful for users who want to apply PHITS simulation to verification of the treatment planning of radiation therapy. We are now developing a program to convert dose distribution obtained by PHITS to DICOM RT-dose format. We also want to develop a program which is able to implement treatment information included in other DICOM files (RT-plan and RT-structure) as a future plan.

Machine learning algorithms are to analyze any dataset to extract data-driven model, prediction rule, or decision rule from the dataset. Various machine learning algorithms are now used to develop high-performance medical image processing systems such as computer-aided detection (CADe) system which detects clinically significant objects from medical images and computer-aided diagnosis (CADx) system which quantifies malignancy of manually or automatically detected clinical objects. In this paper, we introduce some applications of machine learning algorithms to the development of medical image processing system.

The use of video calls for home care can reduce anxiety and offer patients peace of mind. The most suitable terminals at facilities to support home care have been iPad Air and iPhone with FaceTime software. However, usage has been limited to specific terminals. In order to eliminate the need for special terminals and software, we have developed a program that has been customized to meet the needs of facilities using Web Real Time Communication(WebRTC)in cooperation with the University of Aizu. With this software, video calls can accommodate the large number of home care patients.

The purpose of this study was to develop an optimizing program of scanning parameters for double inversion recovery (DIR) MRI. The optimization algorithm consists of the following steps: (1) obtaining the initial parameters (TR, TE, and T1 values of the two attenuated tissues); (2) iterative calculation for minimization of errors; and (3) determination of the optimized TI(1st) and TI(2nd). To evaluate the developed algorithm, we performed the phantom and simulation studies using the phantoms which were imitated T1 values of white and gray matters and cerebrospinal fluid. In addition, white matter attenuated inversion recovery (WAIR) and gray matter attenuated inversion recovery (GAIR) images were obtained by optimized scan parameters in one volunteer. The developed algorithm could calculate the optimized TI(1st) and TI(2nd) values at once. Results of summation of signal intensity (SI) of two attenuated tissues shows that the SI of the two tissues were well-attenuated using the theoretical values which were calculated using the developed algorithm. The correlation coefficient of the SI of the phantom of the gray matter between actual and simulation measurements was r=0.997. The SI obtained by actual measurements well correlated with the SI obtained by the simulation measurements. The WAIR and GAIR images in the volunteer were well enhanced gray or white matters. We thus conclude that it is possible to calculate the optimized parameters for the DIR-MRI using the developed algorithm.

The Diagnosis Procedure Combination (DPC) is a case-mix classification system that is linked with a lump-sum payment system for inpatient care reimbursement. The key objectives of introducing the DPC system are to implement an electronic claim system and to provide transparency of hospital performance. The DPC data include discharge abstract and administrative claims data. The unique advantage of the DPC data is the inclusion of detailed process data and several clinical data that can be applied to clinical studies. In this report, we explain the structure and contents of the DPC database, and discuss the applicability of the DPC data to clinical studies, comparing them with the US Nationwide Inpatient Sample database.

When the industrial firms develop the product, the research result from research institutions is used or to reflect the ideas from users on the developed product would be significant in order to improve the product. To state the software product which developed jointly as an example to describe the adopted development technique and its result, and to consider the modality of the industry solidarity seen from the company side and joint development. The software development methods have the merit and demerit and necessary to choose the optimal development technique by the system which develops. We have been jointly developed the dose distribution browsing software. As the software development method, we adopted the prototype model. In order to display the dose distribution information, it is necessary to load four objects which are CT-Image, Structure Set, RT-Plan, and RT-Dose, are displayed in a composite manner. The prototype model which is the development technique was adopted by this joint development was optimal especially to develop the dose distribution browsing software. In a prototype model, since the detail design was created based on the program source code after the program was finally completed, there was merit on the period shortening of document written and consist in design and implementation. This software eventually opened to the public as an open source. Based on this developed prototype software, the release version of the dose distribution browsing software was developed. Developing this type of novelty software, it normally takes two to three years, but since the joint development was adopted, it shortens the development period to one year. Shortening the development period was able to hold down to the minimum development cost for a company and thus, this will be reflected to the product price. The specialists make requests on the product from user's point of view are important, but increase in specialists as professionals for product development will increase the expectations to develop a product to meet the users demand.

The author as a medical physicist has supported multiple institutions where the advanced radiation therapies as well as the conventional radiation therapy have been performed. Since the advanced radiation treatment techniques have spread rapidly, the quality assurance (QA) has been more important and complex that results in the increase of QA items. In order to maintain the quality of radiation therapy as accurate as possible, the efficient and objective approach for performing QA should be important. Author has developed some QA software which has solved those approaches based on the experiment. In this paper the background in multiple institutions as a view point of radiation treatment situation is presented and what author contributes to those institutions by a medical physics support is shown, finally it is considered that how the developed software has spread in Japan and used for many institutions via venture business.

In this article, the authors propose an image registration program of portal images and digitally reconstructed radiography (DRR) images used as simulation images for external beam radiation therapy planning. First, the center of the radiation field in a portal image taken using a computed radiograhy cassette is matched to the center of the portal image. Then scale points projected on a DRR image and the portal image are deleted, and the portal image with the radiation field is extracted. Registration of the DRR and portal images is performed using mutual information as the registration criterion. It was found that the absolute displacement misregistrations in two directions (x, y) were 1.2 +/- 0.7mm and 0.5 +/- 0.3 mm, respectively, and rotation disagreement about the z axis 0.3 +/- 0.3 degrees. It was concluded the proposed method was applicable to image registration of portal and DRR images in radiation therapy.

We developed software for estimating exposure doses and radiation exposure regions in cardiac catheterization inspection. In the software, the back of a thoracic phantom were divided into a total of 21 square blocks with a width of 30 degrees. Furthermore, we developed a system with which reference air kerma is distributed to each of the above blocks in accordance with the distribution ratio calculated from the data obtained by the system, and the calculation results are displayed. Coronary angiography was performed using thoracic phantoms, and actual measurements were obtained using a fluoroglass dosimeter. The calculated results obtained using the software were compared to the measured results. An almost identical tendency was seen, and the radiation regions of the top three estimated exposure doses were successfully estimated. Radiation region estimation using this software is affected by exposure time as one of its properties. This software enables estimating radiation exposure regions and exposure doses.

The primary data obtained from real-time PCR is the fluorescence intensity. We developed new software, GiMlet, to analyze the fluorescence data more effectively. To examine factors affecting the variance of the Ct values calculated from the fluorescence data, we conducted measurements of the same test solutions containing defined numbers of copies of the targeted DNA sequence using three kinds of real-time PCR equipment, namely, ABI PRISM 7500, 7700 and 7900HT, under consistent conditions, and analyzed the obtained fluorescence data using GiMlet. We also introduced a new baseline correction algorithm in GiMlet and examined the effect of this correction on the measurement results. The results revealed that the variances of the measured values and the PCR efficiency differed among the three kinds of real-time PCR equipment used and also according to the well-position of the PCR plate. The fluorescence data could be analyzed more precisely using the new algorithm.

It has been noted that the downtime of medical informatics systems is often long. Many systems encounter downtimes of hours or even days, which can have a critical effect on daily operations. Such systems remain especially weak in the areas of database and medical imaging data. The scheme design shows the three-layer architecture of the system: application, database, and storage layers. The application layer uses the DICOM protocol (Digital Imaging and Communication in Medicine) and HTTP (Hyper Text Transport Protocol) with AJAX (Asynchronous JavaScript+XML). The database is designed to decentralize in parallel using cluster technology. Consequently, restoration of the database can be done not only with ease but also with improved retrieval speed. In the storage layer, a network RAID (Redundant Array of Independent Disks) system, it is possible to construct exabyte-scale parallel file systems that exploit storage spread. Development and evaluation of the test-bed has been successful in medical information data backup and recovery in a network environment. This paper presents a schematic design of the new medical informatics system that can be accommodated from a recovery and the dynamic Web application for medical imaging distribution using AJAX.

Purpose: In this study, we created a whole body fusion image of PET and MRI using automated software for fusion imaging, and assessed the accuracy of the software., Materials and Methods: Twenty patients with abnormal FDG-PET findings underwent whole body MRI. Images from both modalities were automatically fused in two ways using software (Fusion Viewer, Nihon Medi-Physics Co., Ltd., Nishinomiya, Japan) with a registration algorithm based on maximum mutual information. One was to create a whole body fusion image at once, named whole body fusion (WBF). The other was to create fusion images of the head and body separately, named partial body fusion (PBF). Two radiologists measured the misregistration between PET and MRI in the fusion images at nine landmarks (brain, cervical spine, chest, heart, liver, right kidney, left kidney, vertebra, base of bladder)., Results: When fusion images were created using WBF at once, misregistration was observed in the head and neck area in approximately half of the cases, whereas almost no misregistration was observed in the body. When fusion images were created using PBF, the misregistration in the head and neck areas was significantly smaller than in those using WBF, and misregistration in the body was very small., Conclusion: The PBF technique that creates highly accurate whole body PET/MRI fusion images is easy to use and may provide clinically useful information.

We developed a new software named TEICTDM based on the Bayesian estimation utilized in the therapeutic drug monitoring (TDM) of teicoplanin, a glycopeptide antibiotic, for the estimation of individual pharmacokinetic parameters. Therefore, it is necessary to input more than one plasma concentration(s) determined in individual patient. Individual pharmacokinetic parameters were calculated by a least squares methods, MULTI2 (BAYES). Two-compartment model was applied to determine individual pharmacokinetic parameters in male healthy volunteers in Japan, and the relationship between clearance of teicoplanin and creatinine clearance in adult patients with various degrees of renal impairment in Europe was used. A series of work from data input to graph drawing or printing of results could efficiently carried out with the best of use of this software, suggesting that this software is now available in clinical practice.

In the clinical setting, the functions required for electronic medical records for chemotherapy are proposed from a system developed for individuals. The directivity of a future electronic medical record system is considered in the present condition of an electronic medical record system and a medical system expansionist policy from the history of medical information from Japan.

We developed a flowchart for the treatment of cancer-related hypercalcemia based on the review of previous reports. The treatment protocols were standardized in each group of four different ranges of serum calcium concentration (< 12, 12-14, 14-16, < 16 mg/dl). In each Ca range, specific treatment was adjusted according to the clinical evaluation of symptoms and progression of illness of the patients.

We developed a quantification analysis software program for measuring regional cerebral blood flow (rCBF) at rest and under acetazolamide (ACZ) stress by the modified split-dose (MSD) method with iodine-123 N-isopropyl-p-iodoamphetamine (IMP) and compared the rCBF values measured by the MSD method and by the split dose (123)I-IMP SPECT (SD) method requiring one continuous withdrawal of arterial blood. Since the MSD method allows the input of two arterial blood sampling parameter values, the background subtraction procedure for obtaining ACZ-induced images in the MSD method is not identical to the procedure in the SD method. With our software program for rCBF quantification, the resting rCBF values determined by the MSD method were closely correlated with the values measured by the SD method (r=0.94), and there was also a good correlation between the ACZ-induced rCBF values obtained by the MSD method and by the SD method (r=0.81). The increase in rCBF under ACZ stress was estimated to be approximately 26% by the SD method and 38% by the MSD method, suggesting that the MSD method tends to overestimate the increase in rCBF under ACZ stress in comparison with the SD method, but the variability of the rCBF values at rest and during ACZ stress analyzed by the MSD method was smaller than the variability with the SD method. Further clinical studies are required to validate our rCBF quantification analysis program for the MSD method.

The monitor chamber of a radiotherapy system needs to be calibrated once a week. Because the calibration procedure requires a large variety of complicated calculations, we have developed software that facilitates calculation and enables comparison and storage of data. According to the standard measurement of absorbed dose, we used Visual Basic 6.0 (Microsoft Corp.) to establish the calibration method. This new technique has simplified the conventional intricate calculation required for calibration of the monitor chamber and enabled automatic processing of calculated results. We have confirmed the usefulness of this software in calibrating the monitor chamber. In the routine inspection, we can compare the current data with former results. Because of this advantage, it is possible to eliminate serious accidents such as overdosing and underdosing.