June 28, 2002

Linux hits hospitals in new X-ray tool

-By Dan Berkes -
A new tool that allows X-ray technicians to automatically record radiation levels is now on the market, and it's powered by Linux. BMS Austria's EasyDose device is no anomaly, it's just the tip of the Open Source iceberg and if it's successful, then Linux could eventually make a trip to the doctor's office extremely efficient.
On June 12, Bayer Medical Solutions Austria (BMS Austria) released its EasyDose X-ray dosimeter hardware product. Designed to capture and inspect radiation released during an X-ray procedure, EasyDose is part of the first wave of Linux-based medical products to arrive in hospitals and doctor's offices around the world.

At the heart of EasyDose is Transmeta's Midori Linux, a distribution of the Open Source operating system created specifically to power small or portable computing devices. Such gadgets initially included MP3 players, Web appliances, and home DSL routers. Measuring radiation levels in a hospital setting is probably one of the more unique uses for the Midori embedded distribution.

Filling a niche
"There is a specific niche for Linux in the hospital environment," says Norbert Bayer, founder and CEO of BMS Austria, "it's a lot more practical to use an Open Source operating system.

"We started EasyDose about two years ago and we had a very long testing period," says Bayer. "The device was tested in three Austrian hospitals for more than a year, to ensure that Linux was suitable and stable enough for the task."

EasyDose is the first product from the Vienna-based company to use Linux. Primarily a Microsoft shop since its founding in 1994, the company discovered that it was nearly impossible to handle support issues related to Microsoft products without making significant investments in a support infrastructure, Bayer says.

"We still think that Microsoft has some benefits; however, if you're designing a standard solution, a black box appliance like EasyDose, then it's a lot easier to design that type of system with Linux. You can place the whole system into a 4MB media with a graphical user interface," Bayer says.

Anatomy of a dosimeter
Roughly the size of a small hardcover book, the outer surface of the EasyDose device is bare save for a few small connecting ports and a 6.5-inch TFT touch screen that X-ray technicians use to enter patient data. Underneath the screen is a Cyrix GXM 233 MHz processor and a 6GB hard drive, used to store medical information in its SQL-powered database. Every time an X-ray is taken, two ionization chambers on the device record the amount of radiation that floods the room.

Even the user interface is Open Source. EasyDose uses ParaGUI, a cross-platform high-level application framework and graphical user interface library. Through this interface, or an optional Web interface that can be accessed from a traditional desktop computer, X-ray technicians can monitor the amount of radiation a patient is exposed to each time an X-ray is taken. Because EasyDose can be integrated into an existing hospital or lab computer network, that information can be easily merged into existing patient records.

The product comes just in time to meet the demand created by new European Union standards for healthcare providers. One of those New EU regulations mandates that X-ray procedures must be monitored.

The slow revolution
Ignacio Valdes believes envisions a bright future for Open Source medical technology, where hundreds of billions of dollars in cost savings could be realized with the use of open standards, like Linux. Since March 2000, Valdes has chronicled the ongoing ascent of Linux and Open Source technology in medicine through his Web site, LinuxMedNews.

"Medicine has a very low rate of computerization, with many places continuing to do things in an astoundingly inefficient way," Valdes says. "Records-keeping software has remained larger under-utilized because there is no standard front-, middle-, or back-end clinical computing software. There are hundreds of incompatible medical software vendors and no incentive to inter-operate because it locks in the customer with prohibitively high startup costs and even higher costs to switch vendors.

"Even worse is that most practitioners don't know the problem can be solved without spending big money. The saving grace of all this is that most clinical computing software works badly and isn't used much. Every auto parts store I've ever been to is vastly more efficient and computerized than any clinical venue."

Valdes also warns that the Open Source revolution will be a slow one: "Medicine being what it is, one can expect a 10-year delay before [Open Source software] becomes widespread."

Recalling a presentation he gave about 10 years ago on "this thing called the Internet," Valdes says that managers back then just didn't quite understand the technology or its applications.

"This is where most people in medicine are with regard to Free and Open Source software. Most are trying to get any software to work, much less Free and Open Source. They don't realize that many of the problems they're having are because the closed model hasn't worked very well in medicine."

Waiting in the wings
There are dozens of Open Source software products being developed by community members, including Debian-Med. Announced in January by Andreas Tille, the project is an enhancement of Debian designed to meet the requirements of hospitals and medical research facilities.

Much of the product was adapted from Debian Junior, the project with the goal of creating a Linux distribution easy enough for small children to use. Instead of small children, however, Tille wants to make Debian-Med easy enough so that even users with minimal technical skills can use the operating system and its included tools.

Tille says the project is still in the starting phase. "I'm currently busy developing some kind of infrastructure for a menu system to enhance [Debian-Med's] usability."

One of the main goals of Debian-Med is to support all fields of healthcare with an interest in Free and Open Source software. If there's a package that supports a particular need of the medical industry, Tille wants to ensure it's bundled on Debian-Med for easy access.

Tille says some of the requests surprised him: "I never imagined that there would be an interest from people in pharmacies or physiotherapy when I started the project, but people asked for it specifically."

Tille says Debian-Med probably won't plan a separate release from the official Debian distribution. He expects the first usable version of the project to be available with the upcoming Debian 3.0/Woody releases.

Learning to play together
BMS Austria's Bayer said his company is developing a number of Open Source-based medical products that can integrate with other hospital systems as well as each other. BMS Austria will focus on radiology hardware to automate many of the manual tasks that consume an X-ray technician's day.

Debian-Med's Tille says his goal is to bring authors of Free and Open Source medical software together. "We really do not compete with any software project -- the aim is integration."

If integration can be achieved and some significant hurdles -- not the least of which is increasing medical practitioner's technical knowledge -- then there are huge benefits to patients and caregivers alike.

"For the first time, medical schools will be able to train their students on medical software because this software will be standard and readily available," says LinuxMedNews' Valdes. "The same software interface you see in school would be the one you'd work on as a resident, then as a private practitioner. The software can be studied and modified to make it ever more suited for use over the years.

"There is practically no chance this will happen if closed software is used in medicine."

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