21. Use of DICOM as an Input for
Volume Rendering on Head-mounted
Display in Telemedicine
Jakub Kamiński, Msc, Jane Krzysztof, PhD,
Mateusz Kierepka, Msc
MedApp S.A.
Background: An advanced issue in head-mounted displays
for augmented reality (AR) applications in medical procedure
is the visualization of volumetric images, such as from CT or
MRI from DICOM files. Volume rendering is commonly used
for 3D images that contain rich information with opacity and
color throughout the volume that cannot be easily expressed
as surfaces such as polygonal meshes. The ability to change
lighting conditions and the transfer function on the-fly makes
it amongst the most flexible techniques. This in turn provides
opportunities for better embedding virtual objects in the real
world.
Methods: Current implementation is based on thin-client
solution for volume rendering that exploits a high-
performance laptop or standard desktop workstation as a
server (host application), allowing access to more system re-
sources. A lightweight software client running on a Microsoft
HoloLens device sends in a real-time input data stream to the
server using a standard Wi-Fi connection. Host application
performs a raycasting rendering with color transfer function
and advanced shading from a corresponding camera position
at the client’s requested resolution and streams content
frames back to device.
Results: The developed methodology allows for the use of
raw 3D or 4D data in DICOM files, in contrast to a common
approach with additional surface reconstruction to polygonal
models. Possible interactions include visualizing, slicing and
interacting with the holographic image by gestures and voice
commands.
Conclusions: The presented approach aims to achieve the
feasibility of using a Microsoft HoloLens to augment patient-
specific holographic images without preprocessing for pre-
operative diagnosis and during surgeries.
tablets) are beneficial in rapidly reducing symptoms, relieving
caregiver anxiety and providing psychological support in the
homebound patient. Live video communication can “see” the
patients in their environment, however, cameras are limited
to targeted views. A protocol will guide both targeted views
and an integrated rapid assessment. The Home Assessment
Protocol (HAP) was developed based upon an integrated ap-
proach from the Empowerment Framework. The HAP includes
observation in four categories: Patient Physical Characteris-
tics, Treatment Equipment Functioning, Environmental Quality
and Medications Available.
Methods: The HAP was evaluated by seven home hospice
nurse experts. The experts rated the importance of each item,
using a 5-point Likert scale (strongly agree to strongly disa-
gree). A content validity index required 5 of 7 experts to sig-
nificantly agree on item importance (p<0.05).
Results: Experts significantly agreed on all items in the cate-
gories of Patient Characteristics (SD<0.49), except skin
(SD=1.06) and Medications Available (SD<0.38). In the catego-
ry of Treatment Equipment Functioning and Environmental
Quality experts disagreed on item importance (SD≥0.88) ex-
cept for oxygenation (SD=0.76) and safety (SD=0). Expert im-
portance ratings ranked from greatest to least are: safety,
administration guide and nonverbal gestures, breathing, med-
ication dosage and medication administration, positioning,
oxygenation, urine collection bags, feeding, fans, skin, mas-
sage equipment, bedding. Additional comments advocate for
inclusion of fall prevention, oxygenation equipment and envi-
ronmental assessment.
Conclusions: The HAP provides a strategy to prioritize items
for viewing in critical moments. Expert home hospice nurses
strongly endorse the assessment of medication type, dosage
and administration; non-verbal gestures, breathing and safety
in remote home visits.
23. Health Plan Cost Impacts of a Health
System Virtual Visit Program
Tim Lovell, MBA 1,2 , Joe Dalto 1 , Cheryl Ledward 1 , William
Daines, MD 1 , Doug Elmer 2 , Michelle James 2
1
22. Evaluation of a Home Assessment
Protocol for using Mobile Technology for
Integrated Viewing
Melissa Koon, MSN, APRN, FNP-BC, NP-C and
Kimberly Shea, PhD, RN, CHPN
University of Arizona, College of Nursing
Background: The purpose of this project is to evaluate a pro-
tocol for technological assessment strategies that ensure the
use of an integrated visualization approach in remote home
visits. Remote visits using mobile technology (i.e. phones/
45 | Page
Intermountain Healthcare and 2 SelectHealth
Background: On Demand, Direct-To-Consumer telehealth
programs are appearing rapidly across the country, providing
quick and convenient access to patients for low acuity condi-
tions. But are these programs making an impact on the over-
all cost of care? This study evaluates health plan data for Utah
based SelectHealth using similar criteria as an Anthem study
published earlier this year. Based on index visits for various
health care venues, including urgent care, emergency care
and primary care, this study will compare the total cost of all
incurred care charges within 21 days following the index visit
and for each care venue.