The ISIS Center grew out of the Division of Imaging Physics, Department of Radiology in 1987 by Seong K. Mun, Ph.D. to highlight the strategic direction of the laboratory and it’s core competence. Our first major project focused on the development and implementation of a Digital Imaging Network (DIN) and Picture Archiving and Communications Systems (PACS) for the Department of Defense (DoD). The University of Washington, George Washington University, the FDA and MITRE Corporation were our research partners on the DIN/PACS program. Philips Medical Systems and AT&T Medical Systems provided prototype PACS equipment for the clinical evaluation and research activities. Our core research team consisted of Steve Horii, M.D., Betty Levine, M.S., Shih-Chung Benedict Lo, Ph.D. and Mary Lou Ingeholm, M.S., an AT&T engineer at that time.
An essential element of our DIN/PACS work included the testing of various types of digital imaging devices in our laboratory and at Georgetown University Medical Center. Matthew Freedman, M.D. worked in partnership with Fuji Medical Systems, Konica Medical Systems, 3M Medical Systems and Agfa Medical Systems in the area of imaging research using digital mammography and computed radiography. His work has had a major impact on the use of these technologies internationally. Dr. Freedman’s research has been aimed at mathematically guided optimization of image processing of digital radiography of the chest, the skeletal system and the breast. Starting in the mid 90s, Dr. Freedman developed new imaging programs in partnership with the Lombardi Cancer Center with the primary focus on breast and lung cancer.
Shih-Chung Benedict Lo, Ph.D. initiated medical image compression research in 1987 and continues to develop techniques tailored for this area. The full-frame cosine transform technique is specifically designed for projection X-ray images while the integer wavelet technique, concurrently developed with other investigators, can be used for CT and MRI. We also developed a unified framework that integrates all predictive transform and decomposition methods including wavelet and sub-band transforms. A bit-plane splitting technique has been developed to control for the error in sharp edge regions.
Dr. Lo expanded his research in the area of computer-aided detection and diagnosis system in partnership with Matthew Freedman. By 1998 this work, in collaboration with work at the University of Michigan, University of Iowa and Brooke Army Medical Center had advanced to a point where we could use this type of system to evaluate breast cancer. Today, the computer aided detection and diagnosis system has become a major research effort with remarkable results.
In 1994 the ISIS Center began work on a major telemedicine program, funded by the DoD, called the Akamai Project. During this project, the Center became a primary R&D team in support of Medical Diagnostic Imaging Support (MDIS) acquisition activities by working with the Medical Advance Technology Management Office (MATMO) of the US Army Medical Research and Material Command. We also worked closely with many of the major military medical centers including Madigan Army Medical Center, Tripler Army Medical Center, Walter Reed Army Medical Center, and Eisenhower Army Medical Center. In 1996 as US peace keeping troops were sent to Bosnia, the ISIS Center was requested by the DoD to develop and deploy a global teleradiology network to support US field hospitals in Herzegovina. The Deployable Radiology (DEPRAD) system was installed at the Combat Support Hospital in Hungary, the Mobile Army Surgical Hospital in Bosnia and at Landshuhl Regional Medical Center in Germany. Satellite, microwave and high-speed landlines were used for communication between the three sites and computed radiography and dry film printing replaced film developing. During the two years that the ISIS Center managed the DEPRAD Network, more than 20,000 digital diagnostic exams (computed radiography, CT and ultrasound) were acquired, transferred, reviewed and archived using this system. Betty Levine, M.S. and Kevin Cleary, Ph.D. of the ISIS Center led this deployment in partnership with Fred Goeringer, Robert deTreville and Thomas Semarge of the US Army Medical Research and Material Command.
The ISIS team led by Dukwoo Ro, Ph.D. installed telemedicine capability based on ViewSend Technology, manufactured by KLT Corporation, in the clinics of the US Embassies in Uganda, Tanzania, Haiti and Santo Domingo as a part of Project Path Finder for the Department of State. We have also been responsible for integrating a deployable telemedicine system to aid with humanitarian assistance in Cambodia and to aid victims of the US Embassy bombing in Kenya. We have also experimented with video telemedicine applications for illnesses including kidney stone disease management support for Martinsburg City Hospital in West Virginia, Urgent Care Support in Arlington, Va., Virginia and Surgical Spine Follow-up network with the Columbia Presbyterian Hospital in New York City. The telemedicine program with NASA ACTS Satellite included medical education program with Columbia, telemedicine experiment with Russia and a joint imaging and treatment planning research project with the University of Hawaii and Ohio State University.
Simulation and visualization research had a modest beginning with an attempt to develop a breast cancer palpation project in 1995. With funding from the Whitaker Foundation, Jianchao Zeng, Ph.D. has expanded the simulation research by developing a prostate needle biopsy simulation system in collaboration with Armed Forces Institute of Pathology (AFIP) and Water Reed Army Medical Center (WRAMC). A spine biopsy simulation program in partnership with Korean Advanced Institute of Science and Technology further enriched our surgical simulation research.
Kevin Cleary, PhD, launched a strategic program of Computer-Assisted Intervention and Robotics Research by organizing the Spine Surgery Workshop in 1999 that produced a report on “Technical Requirements for Spine Surgery”. This program pioneered the use of a mobile CT scanner in the operating room for spine tumor resections. The ISIS Center began collaborating with Johns Hopkins to apply their precision "needle driver" robot for spinal nerve and facet blocks.
In 1996, Matthew Freedman began a research program to search for new imaging methods that would decrease the number of breast biopsies that resulted in benign findings. This earlier work was followed in 1997 with a study that looked at the application of imaging studies on the prevention of breast cancer. One study evaluated changes in mammographic breast density in women randomized to receive placebo, estrogen or Raloxifene. In an ensuing study, short-term changes in breast density in women receiving either Tamoxifen or no medication were evaluated using mammograms or breast MRI. These same patients had breast biopsies for the purpose of measuring biomarker correlation. Comparisons were made between the response and non-response to Tamoxifen groups.
The ISIS Center launched a major technology assessment project, Project Phoenix, under the sponsorship of National Library of Medicine of the NIH. Project Phoenix studied the impact of real-time telemedicine on the outcome of patient undergoing renal dialysis at two sites in the Washington D.C. area. Project Phoenix also studied data security and patient confidentiality issues inherent to an electronic environment. An Internet-based monitoring of home dialysis patients was also developed as an outgrowth of this data. Walid Tome, Ph.D., Betty Levine, M.S., James Winchester, M.D. and Jeff Collmann, Ph.D were instrumental in the successful execution of Project Phoenix. Experience from Project Phoenix laid the foundation for our current activities in e-health research especially the development of MyCareTeam, an Internet-based diabetes management system.
The ISIS Center was seen as a place to recruit subject matter experts and seasoned research managers. A growing number of ISIS staff members are providing research and program management support at the US Army Medical Research and Material Command and the Office of Health Affairs of the DoD under the interagency personnel agreement (IPA) program.
The ISIS Center has organized conferences, workshops and special training programs including the following:
International Conference in Image Management and Communication System:
IMAC 89, Washington, D.C., June 1989
IMAC 91, Kyoto, Japan, April 1991
IMAC 93, Berlin, Germany, June 1993
IMAC 95, Hawaii, August 1995
IMAC 97, Seoul, Korea 1997
Computed Radiography Training School (1994-1996), Washington, D.C.
PACS-RIS School:
The First School, May 1990, Washington, D.C.
The Second School, March 1992, Winston-Salem, NC
The Third School, April 1993, Washington, D.C.
The Fourth School, 1994, Washington, DC
The Fifth School, 1995, Washington, DC
The Sixth School, July 1996, Washington, DC
National Forum Conference: (For Department of Defense)
Forum I, Telemedicine On-Line Today, McLean, VA, 1995
Forum II, Global Telemedicine, Tysons Corner, VA, 1996
Pacific Medical Technology (PACMEDTek) Symposium
Honolulu, Hawaii, August 1998
Symposium: Medical Imaging
IEEE-EMBS Annual Meeting, Seattle, WA, 1994
Spine Workshop
April 1999, Ellicott City, Maryland