SARANATHAN COLLEGE OF

ENGINEERING

DEPARTMENT OF COMPUTER SCIENCE AND BUSINESS

SYSTEMS

CBM356-MEDICAL INFORMATICS

PREPARED BY
S.SENTHIL ME.,(PhD).
 UNIT-2 COMPUTERS IN CLINICAL
LABORATORY AND MEDICAL
TOPICS TO BE COVERED: IMAGING
Automated clinical laboratories
Automated methods in hematology, cytology and histology
Intelligent Laboratory Information System
Computer assisted medical imaging
nuclear medicine
ultrasound imaging
computed X-ray tomography
Radiation therapy and planning
Nuclear Magnetic Resonance
Automated clinical laboratories

• It enhances the speed, accuracy, and efficiency of diagnostic testing.

1. Automation in Sample Handling

• Automated Sample Collection: collect samples, such as blood or

urine, reducing the potential for human error.

• Sample Transport Systems: Robots that move samples between

different testing stations within the laboratory.
Contd..
2. Automated Analytical Instruments

• High-throughput analyzers: blood chemistry analyzers, immunoassay

analyzers, and hematology analyzers.

• Automated Microbiology Systems: inoculation, incubation, and

reading of microbiology cultures.
Contd..
• 3. Laboratory Information Management Systems (LIMS)

• Data Management: sample tracking to result in reporting, ensuring all

information is accurately recorded & easily accessible.

• Integration: it integrates with other hospital systems (like HIS or EMR)

for data exchange, improving workflow.
Contd..

4. Automated Quality Control

• Automated Calibration: perform quality control checks at regular

intervals.

• Error Detection: detect and flag errors, reducing the need for manual
rechecks.
Contd.
5. Automated Result Interpretation

• Algorithm-Based Analysis: interpret test results, providing

preliminary analysis that can be reviewed by clinicians.

• Decision Support Systems: assist in diagnosing based on laboratory

results.
Contd..
5. Automated Reporting

• Electronic Reporting: Test results are sent to the physician’s EMR,

reducing the time between testing and diagnosis.

• Notification Systems: alerts are generated for critical values

Contd..
6. Future Trends

• AI and Machine Learning: enhance automated diagnostics, predict

patient outcomes,& improve laboratory workflows.

• Point-of-Care Testing (POCT): Expansion of automated devices for use

in near-patient testing, reducing central laboratory testing.
2. Automated Methods in Hematology
• Automated Hematology Analyzers

• Complete Blood Count (CBC): perform a CBC, including (RBC) counts,

(WBC) counts, hemoglobin concentration, hematocrit, platelet counts,
in a matter of minutes.

• Differential Count: perform a five-part differential count (neutrophils,

lymphocytes, monocytes, eosinophils, basophils) with high
precision.

• Reticulocyte Counting: count reticulocytes using flow cytometry,

providing valuable information on bone marrow function.
Contd..
• Flow Cytometry

• Cell Analysis: Analyze the physical and chemical characteristics of

cells

Ex: identification of abnormal populations in diseases like

leukemia.

• Immunophenotyping: diagnosing and classifying hematologic

malignancies by detecting specific cell surface markers.
Contd..
• Automated Coagulation Analyzers

• Clotting Tests: prothrombin time (PT) and activated partial

thromboplastin time (aPTT), for assessing blood coagulation and
managing anticoagulant therapy.-blood

• D-Dimer Testing: D-dimer tests to help diagnose thrombotic

conditions like deep vein thrombosis or pulmonary embolism.
Automated Methods in Cytology
• Liquid-Based Cytology (LBC)Sample Preparation: Automated LBC
process & prepare samples by creating a thin layer of cells on a slide,
which improves the clarity and diagnostic accuracy.

• Automated Screening: ThinPrep Imaging System can automatically

scan slides & identify areas of interest, reducing the manual
workload for cytotechnologists and pathologists.
Contd..
• Computer-Assisted Cytology Automated Image Analysis: to analyze
cellular patterns & features to detect abnormalities, such as in
cervical cancer screening.

• AI and Machine Learning: AI-powered tools can assist in screening to

recognize patterns associated with specific diseases, offering support
to human diagnosticians.
Automated Methods in Histology
• Automated Tissue Processing Tissue Processors: Fixing, dehydrating,
clearing, and embedding tissue samples in paraffin, which prepares
them for sectioning and staining.

• Microwave-Assisted Processing: Some advanced processors use

microwave technology to accelerate tissue processing, reducing
turnaround time.

• Automated Microtomy Robotic Microtomes: cutting of tissue into

ultra-thin sections for mounting on slides, reducing human error.
Contd..
• Automated Staining H&E Staining: handle hematoxylin and eosin
(H&E) staining, for visualizing tissue structure.

• Immunohistochemistry (IHC) Staining: apply antibodies to tissue

sections to detect particular proteins, in diagnosing cancers and
other diseases.

• Special Stains: Automation can be applied to highlight specific tissue

components, such as connective tissue, microorganisms
Contd..

• Digital Pathology and Image Analysis Whole Slide Imaging (WSI):

Allows entire slides to be scanned and digitized, enabling pathologists
to view and analyze them on a computer screen.

• AI-Based Image Analysis: analyze histological images, quantifying

tissue features, & assisting in diagnosing conditions like cancer by
stained tissues.
Intelligent Laboratory Information System

1. AI in Laboratory Management
• How artificial intelligence is transforming the management of
laboratory workflows, data processing, and automation.
• Examples of AI applications, such as predictive analytics, anomaly
detection, and intelligent recommendations.1r
2. Automating Laboratory Data Handling with ILIS
• The role of automation in improving lab efficiency by reducing manual
data entry and processing errors.
• Case studies on laboratories that have successfully implemented ILIS
for automating sample management and data reporting.
Contd.
• 3. Regulatory Compliance and Data Integrity in ILIS
• How ILIS helps laboratories comply with regulatory standards like
FDA, GLP, and HIPAA.
• The importance of maintaining data integrity and traceability through
audit trails in lab information systems.
• 4. Integrating ILIS with Electronic Health Records (EHR)
• The advantages and challenges of integrating ILIS with EHR systems in
healthcare settings.
• Impact of integration on patient care, reducing delays in diagnosis and
treatment.
Contd..
• 5. Cloud-Based Laboratory Information Systems
• Benefits of moving laboratory data management to the cloud,
including scalability, security, and remote access.
• Comparing on-premises ILIS vs. cloud-based ILIS solutions.
• 6. The Role of Big Data and Analytics in ILIS
• How big data analytics within ILIS can help uncover trends, enhance
research outcomes, and improve decision-making.
• Advanced visualization tools and dashboards used in ILIS to present
lab data in meaningful ways.
Contd..
• 7. Improving Diagnostic Efficiency with ILIS
• Case studies of medical laboratories using ILIS to speed up diagnostic
testing and reporting processes.
• The impact of real-time data analysis on reducing lab turnaround
time.
• 8. Lab Workflow Optimization Using ILIS
• How ILIS can optimize lab workflows, reduce bottlenecks, and
improve resource allocation.
• Strategies for streamlining complex lab processes using intelligent
systems.
Contd..
• 9. Security Challenges in Laboratory Information Systems
• Data security concerns related to ILIS, including the risks of data breaches and
best practices for protecting sensitive laboratory information.
• The role of encryption, user authentication, and secure cloud storage in
safeguarding lab data.
• 10. The Future of ILIS: IoT and Blockchain Integration
• Emerging trends in ILIS, including the integration of the Internet of Things (IoT)
for real-time data collection from lab instruments.
• The use of blockchain technology to ensure data integrity and secure laboratory
audit trails.
• 11. Implementing Predictive Maintenance in Laboratories
• How predictive maintenance through ILIS can prevent equipment failures and
minimize downtime.
• Examples of machine learning algorithms used in laboratories to forecast
equipment performance and maintenance needs.
Contd..
• 12. Personalized Laboratory Management through AI
• The potential of personalized lab management systems that adapt to
the needs of individual researchers and lab staff.
• AI-driven personalization in laboratory processes, resource
management, and workflow optimization.
Computer-assisted medical imaging
• It combines advanced computing techniques with medical imaging.
MRI, CT scans, and X-rays.
Types of Medical Imaging:
Magnetic Resonance Imaging (MRI): Detailed images of organs &
tissues using magnetic fields.
Computed Tomography (CT): Uses X-rays to produce cross-sectional
images of the body.
Ultrasound: Uses sound waves to produce images of internal organs.
X-Ray: Commonly used for imaging bones and detecting fractures.
Positron Emission Tomography (PET): Images the metabolic processes
in the body.
Functions of Computer Assistance:

Image Enhancement:
Enhances the clarity & detail of medical images.
Easier for physicians to identify abnormalities.
3D Visualization:
Computers can process 2D images from MRI or CT scans
reconstruct them into 3D models
helping in surgical planning or in-depth diagnoses.
Automated Diagnosis:
To automatically identify cancer, fractures, or neurological
conditions by analyzing medical images.
Contd..
Image Segmentation:
To separating different structures (like tissues, bones, or
tumors) within an image to help healthcare professionals focus
on specific areas of interest.
• Augmented Reality (AR) & Virtual Reality (VR):
AR & VR combined with imaging, for doctors to examine patient
anatomy, plan surgeries.
• Telemedicine:
Allows radiologists to remotely review medical images and
provide expert consultations, increasing access to diagnostic
services.
Contd..
• Applications of Computer-Assisted Medical Imaging:

• Cancer Detection: AI tools used to identify tumors in mammograms,

MRIs, and CT scans at an early stage.

• Cardiovascular Disease: Imaging technology helps detect blockages

in blood vessels or assess heart function.

• Neurology: diagnosing brain injuries, strokes, and degenerative

conditions such as Alzheimer's disease.

• Orthopedics: detect fractures, joint issues, and bone density

problems.
Contd..
• Future Trends:

• Deep Learning in Imaging:

Deep learning algorithms are being trained on massive datasets of medical
images to improve diagnosis accuracy further.

• Integration with Wearable Devices:

Wearables with imaging capabilities to provide real-time data & health
monitoring.

• Real-Time Imaging and Surgery:

Allow real-time analysis during surgeries, offering surgeons precise feedback and
minimizing risks.
Nuclear Medicine
• Nuclear Medicine is a branch of medical imaging

• NM uses radiopharmaceuticals to diagnose and treat various

diseases.

• provides unique insights into the function of organs and tissues,

making it different from other imaging methods like X-rays or MRI,
which show anatomy and structure.
Contd.
• Radiopharmaceuticals: compounds that are tagged with a small
amount of radioactive material. When introduced into the body, they
accumulate in specific organs or tissues.

• Common isotopes include Technetium-99m (bone scans.), Iodine-131

(used in thyroid scans), and Fluorine-18 (used in PET scans-brain
disorder).

• Imaging Modalities: (SPECT) Single-Photon Emission Computed

Tomography Produces 3D images by detecting gamma rays emitted
from radiopharmaceuticals in the body..
Contd.
• Positron Emission Tomography (PET): Uses positron-emitting
radiotracers to detect changes in metabolic processes, often used in
oncology, neurology, and cardiology.
• How Nuclear Medicine Works:
• A small amount of the radiopharmaceutical is administered, usually
via injection, inhalation, or ingestion.
• The substance travels to the target organ or tissue, emitting gamma
rays as it decays.
• A gamma camera or PET scanner detects these emissions and creates
detailed images of the inside of the body.
• The images highlight how organs and tissues function, which is
crucial for diagnosing diseases like cancer, heart disease, and
neurological disorders
Contd..
• Common Nuclear Medicine Procedures:
1.PET Scans (Positron Emission Tomography):
1. PET scans are widely used in oncology to detect cancer, monitor treatment
response, and detect metastasis.
2. Fluorodeoxyglucose (FDG) is a commonly used tracer in PET scans because it
highlights areas of high glucose metabolism, which is typical of cancer cells.
2.SPECT Scans (Single-Photon Emission Computed Tomography):
1. SPECT scans are used to assess blood flow to the heart, evaluate bone
disorders, and detect brain abnormalities like epilepsy and Alzheimer’s disease.
2. SPECT is often paired with CT scans to improve anatomical detail and diagnostic
accuracy.
3.Bone Scans:
1. A bone scan is used to detect abnormalities in the bones, such as fractures,
infections, or cancer that has spread to the bones (metastasis).
2. A radiotracer is injected into the bloodstream, and the scan can detect areas
of high bone activity, indicative of disease.
Contd..
• Thyroid Scans: Evaluate thyroid function and detect thyroid nodules
or cancer. The radiotracer, usually iodine-123 or iodine-131, is taken
up by thyroid tissue, and imaging can reveal overactive or
underactive regions.
• Cardiac Imaging: Nuclear stress tests use SPECT or PET to assess
blood flow to the heart muscle, both at rest and under stress,
helping diagnose coronary artery disease (CAD).
• It can detect areas of the heart that aren't receiving enough blood
flow (ischemia) and help plan treatment strategies like angioplasty or
bypass surgery.
• Brain Imaging: Nuclear medicine is used to diagnose neurological
conditions, including Alzheimer's disease, epilepsy, and Parkinson’s
disease. PET scans can measure glucose metabolism in the brain,
helping to detect regions of abnormal activity associated with these
conditions.
Therapeutic Applications:

Radioactive Iodine Therapy (I-131):

One of the most common therapeutic uses of nuclear medicine, radioactive
iodine is used to treat hyperthyroidism and thyroid cancer. It works by
selectively destroying overactive thyroid tissue or cancer cells.
1.Lutetium-177 Therapy:
Used in treating neuroendocrine tumors and prostate cancer, this therapy uses
Lutetium-177, a radioactive isotope that delivers radiation directly to tumor
cells, minimizing damage to surrounding healthy tissues.
2.Brachytherapy:
In this procedure, radioactive sources are placed inside or near a tumor to
deliver a high radiation dose directly to the cancerous tissue. It’s often used in
the treatment of prostate, cervical, and breast cancers.
Future Trends in Nuclear Medicine:

1. Theranostics:
This is a growing field that combines diagnostic imaging and targeted therapy. A
radiotracer identifies the location of a disease (diagnosis), and a therapeutic
isotope is delivered to the same location for treatment (therapy).
2.Advanced Radiopharmaceuticals:
Researchers are developing new radiopharmaceuticals that can target more
specific types of cells, such as cancer cells or plaques in Alzheimer's disease,
improving both diagnostic accuracy and treatment efficacy.
3.Artificial Intelligence and Machine Learning:
AI and machine learning are being integrated into nuclear medicine imaging to
enhance image quality, reduce noise, and help interpret complex data sets,
potentially leading to faster and more accurate diagnoses.
4.Hybrid Imaging Systems:
The use of hybrid imaging systems that combine PET with MRI or CT is on the rise,
providing more detailed and comprehensive diagnostic information by fusing
anatomical and functional images.
Ultrasound imaging
• ultrasound (also called sonography or ultrasonography)
is a noninvasive imaging test.
• An ultrasound picture is called a sonogram.
• Ultrasound uses high-frequency sound waves to create
real-time pictures or video of internal organs or other
soft tissues, such as blood vessels.
• Ultrasound imaging is to“see” details of soft tissues
inside your body without making any incisions (cuts).
• ultrasound doesn’t use radiation.
Are ultrasounds safe?

• Yes, research to date has largely shown ultrasound

technology to be safe with no harmful side effects.

• Ultrasounds that are performed externally (over your

skin) are generally not painful.
How does it work
• a healthcare provider passes a device called a transducer over an
area of your body or inside a body opening. The provider applies a
thin layer of gel to your skin so that the ultrasound waves are
transmitted from the transducer through the gel and into your body.

• The test converts electrical current into high-frequency sound

waves and sends the waves into your body’s tissue. You can’t hear
the sound waves.

• Sound waves bounce off structures inside your body, which

converts the waves into electrical signals. A computer then converts
the pattern of electrical signals into real-time images or
videos, which are displayed on a computer screen nearby.
Types of ultrasound
• Pregnancy ultrasound (prenatal ultrasound).
Healthcare providers often use ultrasound to
monitor you and the fetus during pregnancy.
• Confirm that you’re pregnant.
• Check to see if you’re pregnant with more than one
fetus.
• Estimate how long you’ve been pregnant and the
gestational age of the fetus.
• Check the fetal growth and position.
• See the fetal movement and heart rate.
• Check for congenital conditions (birth defects) in the
fetal brain, spinal cord, heart or other parts of its body.
• Check the amount of amniotic fluid.
Diagnostic ultrasound
• Providers use diagnostic ultrasounds to view internal parts of your
body to see if something is wrong or not working properly.
• Abdominal ultrasound:-can diagnose many causes of abdominal
pain.
• Kidney (renal) ultrasound:-assess the size, location and shape
of your kidneys
• Breast ultrasound:-identify breast lumps and cysts.
• Doppler ultrasound:-assesses the movement of materials
• Pelvic ultrasound:- looks at the organs in your pelvic area
between your lower abdomen (belly) and legs.
• Transvaginal ultrasound:-evaluates structures inside your pelvis
• Thyroid ultrasound:-use ultrasound to assess your thyroid, a
butterfly-shaped endocrine gland in your neck
• Transrectal ultrasound:-evaluates your rectum or other nearby
tissues
What is the difference between a 3D
ultrasound and a 4D ultrasound?

• 2D ultrasound produces outlines and flat-looking

images, which allows your healthcare provider to see
the fetus's internal organs and structures.
• Three-dimensional (3D) ultrasound allows the
visualization of some facial features of the fetus
and possibly other body parts such as fingers and
toes.
• Four-dimensional (4D) ultrasound is 3D ultrasound in
motion.
What conditions can be detected by
ultrasound?
• Abnormal growths, such as tumors or cancer.

• Blood clots.

• Enlarged spleen.

• Ectopic pregnancy (when a fertilized egg implants outside of your

uterus).

• Gallstones.

• Aortic aneurysm.

• Kidney or bladder stones.

• Cholecystitis (gallbladder inflammation).

• Varicocele (enlarged veins in the testicles).

Radiation therapy and planning

• Radiation therapy is a treatment used primarily in oncology (cancer

treatment),
• ionizing radiation is applied to kill or damage cancer cells.
• It works by damaging the DNA within the cells, making it impossible
for them to grow
• external beam radiation
Steps Involved in Radiation Therapy Planning
• Patient Immobilization and Positioning:
• To ensure precision during treatment, the patient is placed in a
reproducible position. Immobilization devices, such as molds or masks,
are often used to prevent any movement that could affect the accuracy of
radiation delivery.
• Accurate positioning is crucial because radiation needs to target the
tumor while avoiding healthy tissues.
• Imaging and Tumor Localization:
• CT (Computed Tomography), MRI (Magnetic Resonance Imaging), and
PET (Positron Emission Tomography) scans are used to capture detailed
images of the patient’s anatomy.
• These scans help in defining the tumor volume (target area) and its
location relative to surrounding tissues and organs (called organs at risk).
• Tumor contouring: Radiation oncologists outline the tumor and nearby
organs on these images to determine the exact area to be irradiated.
contd..
• Defining Target Volumes:

• Gross Tumor Volume (GTV): The visible or palpable tumor mass.

• Clinical Target Volume (CTV): Includes the GTV and any regions where microscopic
disease may exist.

• Planning Target Volume (PTV): The CTV with an added margin to account for
movement (e.g., breathing) or setup inaccuracies.

• Dose Prescription: The oncologist will decide the amount of radiation (measured in
Gray, Gy) to be delivered to the tumor. This dose is typically delivered in fractions
(smaller daily doses) over several weeks to reduce damage to healthy tissue. The
aim is to deliver a curative dose to the tumor while minimizing the dose to
surrounding healthy tissues to avoid unnecessary side effects.
Contd..
• Quality Assurance and Dose Calculation: Before delivering treatment, a
verification step is necessary. Radiation physicists use algorithms to calculate
the radiation dose, ensuring it aligns with the oncologist’s prescription.
• Phantom studies and mock treatments may be performed on devices that
simulate the patient’s body to ensure the radiation plan will work as expected.
• In vivo dosimetry may be used during treatment to monitor the actual dose
delivered in real-time.
• Delivery of Radiation: Treatment is delivered daily over the course of several
weeks. The patient is carefully positioned using markers or lasers to ensure
reproducibility each day.Treatment is painless and usually lasts just a few
minutes per session.
• Post-Treatment Follow-Up: Imaging studies are done post-treatment to assess
the tumor’s response to the radiation.Follow-up appointments are scheduled
to monitor for any side effects or recurrence of cancer.
contd..
• Advanced Techniques in Radiation Therapy
• IMRT (Intensity-Modulated Radiation Therapy): Delivers varying
intensities of radiation within each beam, allowing for more precise
dose distribution and sparing of healthy tissues.
• VMAT (Volumetric Modulated Arc Therapy): A form of IMRT that
delivers radiation in a continuous arc around the patient.
• Stereotactic Body Radiation Therapy (SBRT): Involves very high doses
of radiation delivered over fewer sessions, typically for small, well-
defined tumors.
• Proton Therapy: Uses protons instead of photons (X-rays). Protons
have a distinct advantage in sparing healthy tissue because they
deposit most of their energy directly at the tumor site.
Contd.
• Side Effects and Complications
• Acute side effects: These occur during or immediately after
treatment, including skin reactions, fatigue, and organ-specific
symptoms (e.g., cough for lung radiation).
• Late side effects: These may develop months or years after
treatment, potentially including fibrosis, secondary cancers, or
functional damage to organs.
Nuclear Magnetic Resonance (NMR)
• A procedure that uses radio waves, a powerful magnet,
and a computer to make a series of detailed pictures of
areas inside the body.
• A contrast agent, such as gadolinium, may be injected
into a vein to help the tissues and organs show up more
clearly in the picture.
• Nuclear magnetic resonance imaging may be used to
help diagnose disease, plan treatment, or find out how
well treatment is working.
• It is especially useful for imaging the brain and spinal
cord, the heart and blood vessels, the bones, joints, and
other soft tissues, the organs in the pelvis and
abdomen, and the breast.
Contd.
• Also called magnetic resonance imaging, MRI, and
NMRI.
• Magnetic resonance imaging (MRI) of the abdomen.
• The patient lies on a table that slides into the MRI
machine, which takes pictures of the inside of the body.
The pad on the patient’s abdomen helps make the
pictures clearer.