Medical 3D Graphics With eXtensible 3D

Introduction

The 3D medical visualization field, both research and commercial, is heavily fragmented due to the lack of information sharing. As a result there is a tremendous amount of incompatibilities and duplicated efforts in fundamental methods like: volumetric rendering, registration and segmentation. The lack of cooperation capabilities also results in limited access to interpreted studies, due to multiple proprietary file formats, which restrict data sharing and collaboration. While the DICOM and HL7 ([Health Level 7], n.d.) standards are complex and capable for medical data interchange and structured reports, they do not represent the presentation state information required for interactive 3D graphics and haptic simulation. Further, proprietary file formats and software and hardware platforms are not easily accessible due to intellectual property, cost, and technical constraints.

The Blue Button Initiative ([Blue button Implementation Guide], n.d.) in the United States is a standard that facilitates patients’ electronic access to their medical information, wherever it may be stored. In Europe, the United Kingdom’s NHS Constitution also guarantees this right to patients. Additionally, as a multinational effort coordinated by EuroRec (European Institute for Health Records), by 2020 all European Union (EU) citizens should be able to access their online medical records anywhere in Europe. Accountable care organizations are appearing in increasing numbers, and require partnerships between healthcare organizations and providers; high levels of communication are necessary among these constituents to minimize waste, provide timely care, improve quality and reduce costs over the patient lifetime.

Enterprise scale’ systems are characterized by their high availability and speed. Maintenance is a key concern as in many ways these systems determine the inertia of an organization; thus premium is placed on both their durability and extensibility. ‘Web scale’ systems include these requirements, but in addition they must address the challenges of distributed information, heterogeneous users, and non-linear network behavior. As the Web becomes the primary and common interface for numerous information services, we must consider the requirements, emergent properties, and access patterns for health data from laboratory to clinic.

Historically, the medical communities’ IT systems have been insular, focused on providing information for their specific function, without concern for data integration or aggregation across the enterprise. Now the changes are fast as the medical enterprises realized that sharing of information within the organization significantly reduces costs and increases efficiency. Finally, in the shift of reimbursement of care from volume to value, medical enterprises are being compelled to share data among and between themselves. This has proven to be especially challenging as Electronic Health Record (EHR) systems, the main clinical data input mechanism for healthcare providers, have been slow to adopt interoperability to deliver integrated services to patients and caregivers, especially where the interoperability and security of the web and mobile devices are concerned.

Meanwhile, the web and entertainment industry has been adding more and more realism to their graphical models and rendering pipelines, including representations and computation for bones, skin and musculature, as well as physics and inverse kinematics, for their virtual characters. However, these representations are often proprietary or physiological simplifications. There are efforts underway to bring together the graphics and physiological models to deliver high-fidelity patient-specific, interactive 3D models to surgeons and trainees. In this paper we demonstrate several examples that are enabled by the interoperability of the Web3D/ISO/IEC Standard, Extensible 3D (X3D). We present the case that, given the requirements of electronic health records and care coordination, the two worlds of Web3D graphics and electronic health records are converging to live as interactive, graphical hypermedia documents in the World Wide Web architecture and ecosystem.

In the real case of long-term care and the knowledge enterprise, it is ’mission-critical’ that data becomes verifiable information and that views of this information are interoperable between systems and portable across platforms. We use the term ’enterprise’ broadly to describe any organization (research, clinical, industrial) where the access of diversified workers to data must be scalable and efficient (through ‘Enterprise’ systems); however, the results and interpretations of a patient’s pathology are only valid in so much as they are reproducible; that is, able to be independently read and evaluated by different parties and stakeholders across the ‘enterprise’.