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Introduction
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1
Introduction
The human community is not a constant “arrangement” of living persons. In contrast, it can be considered a living system which is based not only upon man itself but on several influencing factors. These include the density of population,
the extent of technological development, the professional specialization within a
population, and the development of the general environment, such as the weather
or the oxygen and carbon dioxide concentrations in the air. There is no doubt
that the total human population has increased exponentially since the development of the technology to use extra-human and extra-mammalian energy for
specific human purposes such as food supply, housing, and transportation. The
so-called technical decades are characterized by at least two main features:
1. The access to and use of non-biological, i.e., physical and chemical energy
sources
2. Changes in the “real” environment, and a broad neglect of the virtual world.
Even at a time when some of the most difficult questions in the understanding
of the physical environment were being analyzed, knowledge of the basic laws
within the human virtual world was quite poor. Freudian theory was accepted
by the medical world after Einstein’s theory of relativity in the natural sciences!
This is not surprising as the only access to the virtual world is by communication. Communication, again, is based upon changes in a system, especially upon
movements. Thus, with increasing transportation of goods and human migration the need for more sophisticated and reliable communication increased. Unlike the arrangement of any living system which is clearly separated from its environment, communication usually occurs in an analogous manner. The natural
and basic communication system of man is audio, or speech, and hearing. The
second is visual. Speech is a time-dependent communication system, visual
information and can be time dependent (movements) or time independent
(images). The first and finally successful attempt to make acoustic information
independent of time was the creation of a script. The translation of audio into
visual information, or of a speech into a written document, was the first successful
technique to maintain acoustic information over a long period of time. This
procedure can be considered to be equivalent to digitalization of an analog source
of information. It is an elegant and asynchronous solution of acoustic information
storage. The data and speed of reading a document are completely independent
of the time needed for writing and the date it was written. The technical
development of analog storage of acoustic information such as tapes, disks, or
CDs has the advantage that the original “note,” “temperature” or “color” have been
2
Telepathology
preserved. It is still asynchronous. However, the speed of playing a tape or disk
has to be equal to that of recording.
Whereas man has a long experience of “storing” acoustic information, and
using it for further future purposes, the storage of visual information has been
more difficult. Although there are impressive examples of “stored” images reaching back several thousands of years, it is not clear whether these images represent a “figure” of the environment, or the “beliefs” and “thoughts” of ancient people
translated into certain visual impressions of their environment. In subsequent
cultural epochs the visual storage of important events of man was performed by
sculpture and painting. Interestingly, the artists tried to include certain “nonreal” components into their work in order to maintain or allow an insight into
their own or environmental feelings, i.e., “visual translated or virtual” world. The
development of photography and its technical perfection was the next important step to ensure that visual information could be kept for years. It permits a
“real” and “non-biased” storage of time-independent spatial arrangements in our
environment, adjusted to the way most of us “see our world.” At the same time it
was realized that storage and evaluation of visual information is one of the most
important and practicable medical techniques for detecting and classifying a disease, and for treating the patient. These sources not only include “real” images
such as those taken from a microscope or chest X-rays. All data obtained from
“measurements,” which might include blood serum levels, ECG curves, antibody
levels or lung function tests, are transformed into visual information, and not
into audio. The more technical methods of detecting or classifying a disease are
available the greater the visual information will become. An increase in
information increases the need for appropriate storage and retrieval; otherwise
it is inaccessible and useless. Storage and retrieval of information are the columns
of communication. Medical communication is more efficient and less biased when
visual information can be stored, retrieved, and transmitted. It is important to
recognize that several “levels” within these visual data exist in respect to the
disease and treatment of patients. These levels are not fixed, depend upon the
nature of the disease, and, in addition, are subject to the development of medical
progress. The existence of these "information levels” reflects the handling of data,
for example, in a relational data bank. These information levels need to be
connected, and procedures to import, handle and display the data have to be
developed. In other words, communication between visual information at
different priority levels causes the need for introduction of a “second order
communication,” which is comparable to the creation of “second order statistics.”
It is often appropriate to retranslate the “second order information” not directly
into the “real world”, i.e., to present the data obtained by application of certain
“display rules,” but to present data obtained from calculations of numerous “similar” cases, and to search for the most probable diagnostic and therapeutic solution. These calculations most frequently use multivariate discriminant analysis,
or neural network applications, and can be performed independently of the location of the patient or the date of data input. Thus, we enter the virtual world,
an environment which is only “real” in a set of visual discrete information blocks,
blocks that are used to store and handle real information according to various,
not precisely defined aims. In medicine, the first step is to ensure that all the
Introduction
3
available information on a patient is incorporated in a patient file which consists of personal data, symptoms, findings, images, treatment procedures, and
outcome. To collect this information is not easy and usually requires a distributed information network. These can be hospital based, the data obtained by a
house physician, and can be fed in physically in different forms, either by direct
access to the information system, or by a physically separated “electronic card "
which might be equivalent to the commercial credit card system. Although
suggestions abound as to how these systems could work, and what kind of effort
would be involved to run them, the details have yet to be worked out. In addition, the technical progress which affects these system to a high degree is extremely rapid. The power and capability of the modern computer has not yet
reached its peak, and the creation of modern image archive systems, including
high-resolution image acquisition systems, is still in its infancy. What are the most
important rules or constraints of modern communication in medicine? What are
the needs of the doctors, the administration, the diagnostic laboratories, or the
surgical theaters in respect to these changes? What are the most promising ways
to take advantage of these developments, and which seem to be less efficient?
These questions can only be accurately answered if a basic understanding of
information uptake, processing, and release is taken into account.
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