COMPUTING IN MEDICINE STRATHCLYDE BIOENGINEERING SEMINARS COMPUTING IN MEDICINE Proceedings 0/ a seminar on computing applied to medicine, held at the University 0/ Strathclyde, Glasgow, in August 1981 Edited by J. P. PAUL, M. M. JORDAN, M. W. FERGUSON-PELL and B. J. ANDREWS Editorial Associates E. M. SMITH and M. K. McColl Bioengineering Unit Wolfson Centre University of Strathclyde M © Bioengineering Unit, University of Strathclyde 1982 Softcover reprint ofthe hardcover 1st edition 1982978-0-333-31886-7 All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without permission First published 1981 by Scientijic and Medical Division THE MACMILLAN PRESS London and Basingstoke Companies and representatives throughout the world Typeset in Great Britain by RDL., 26 Mulgrave Road, Sutton, Surrey Printed by Unwin Brothers Limited, The Gresham Press, Old Woking, Surrey ISBN 978-1-349-06079-5 ISBN 978-1-349-06077-1 (eBook) DOI 10.1007/978-1-349-06077-1 PREFACE The fourth in the series of Strathclyde Bioengineering Seminars was held in August 1981 and considered the wide and highly topical subject of computing applied to medicine. Seminars in the present series were preceded by two broad-spectrum symposia held in 1964 and 1972. The series has covered the areas of Tissue Viability and its Clinical Applications, Extracorporeal Blood Treatment Systems, and Rehabilitation of the Disabled. These seminars were published by the Macmillan Press under the titles of Bedsore Biomechanics (July 1976), Artificial Organs (July 1977) and Disability (December 1979). The present volume and the associated seminar mark a rnilestone both for the series and for bioengineering. Professor R. M. Kenedi, who initiated the series, organised the meetings and edited their proceedings, retired from the University of Strathclyde in 1980 and took up the post of Associate Director (Engineering) in Hong Kong Polytechnic. Prior to his departure from Glasgow, Professor Kenedi initiated the preparation for this meeting and it was with great pleasure that we were able to welcome him back to introduce the Adam Thomson Lecture given by Mr Jack Perkins, and to participate in the seminar and its functions. Dr Monica M. Jordan, one of the editors of this volume, was a member of the Bioengineering Unit until February 1980, when she took UD a post in the National Institute of Medical Research, Mill Hili, London. She has been involved at a high level in the planning and organisation of this meeting, both before and after her translation. The present seminar, the fourth in the series, was held in August 1981 and related to research and development in applications of computers and micropro cessors in the field of medical practice. Special sessions included signal and image analysis, medical statistics, teaching, and modelling ofphysiological systems. It was attended by 190 registrants from the United Kingdom, Australia, Canada, Denmark, Eire, the Faroe Islands, France, Hong Kong, India, Israel, ItalY' Japan, Mexico, Netherlands, Norway, Portugal, Turkey, USA and West Germany. The details for the sections are given in the contents list and the companies and organisations participating in the scientific and industrial exhibition are identified on page viü. The organisers wish to express their particular appreciation for the support of the industrial exhlbitors in being present to show their equip ment and in contributing to the fmances of the occasion. Being aware of the financial difficulties facing young people starting in their careers who wished to attend seminars ofthis type, fmancial support for the registration of six relevant persons was provided by Messrs Ferranti, Hewlett Packard and IBM, and the organisers of the seminar extend to these companies v vi PREFACE the thanks of the individuals supported. In the fmancial crises facing universities at this time, it is easy to forget that the Health Services also are under similar pressures, and the continuing support for the seminar programme by the Greater Glasgow Area Health Board is therefore particularly appreciated. Banking and travel facilities were provided by the Bank of Scotland and Mackays Travel Agency, to both ofwhom sincere thanks are due. Messrs John Dewar and Sons Umited, whisky Distillers, particularly favoured the occasion with a donation of their products for the benefit of participants at the conference banquet. A seminar cannot be held on the scale of the present one without adequate publicity and the organisers are indebted to the Biological Engineering Society and the Hospital Physicists' Association for undertaking circulation of informa tion and to the Biomedical Press UV and Taylor and Francis for publicity in their journals. The organisers acknowledge again their sense of indebtedness to the City of Glasgow Distriet Council for the warmth of the Civic Reception given by them to the seminar participants and guests. Professor Kenedi, introducing the Adam Thornson Lecture, recalled the contri bution to the growth of the Strathclyde Bioengineering Unit made by Emeritus Professor Adam Thornson. From his position as Head of Department of Mechanical Engineering at the Royal College of Science and Technology, which subsequently became the University of Strathclyde, he had been a wise counsellor and guide to many attending the seminar. His very considerable contribution to the University, and Bioengineering, has been gratefully acknowledged by the University's Court who established the Adam Thornson lectures in his honour. The attendance of Professor Thornson and Mrs Thornson was very much appreciated by all present. Mr Perkins, Professor Kenedi recalled, has been associated with medical com puting for rnany years and has long been an international leader in his field of study and research. His extensive participation and in particular his presentation of the Adam Thornson lecture contributed greatly to the potential for success of the seminar. The undersigned wishes to warmly support Professor Kenedi's sentiments and also extends his thanks to Professor Kenedi for introducing the Adam Thornson lecture and more widely for his unflagging support of the Strathclyde Bioengineering Unit, and in particular the seminar series. This is also the occasion to remember and thank all staff and students of the Bioengineering Unit for their help and forbearance. Similarly, thanks are due to the relevant administrative and supportive staff of the University for their support of the occasion. Glasgow, 1982 J.P.Paul SEMINAR ORGANISING COMMITTEE AND SECRETARIAT John P. Paul Monica M. Jordan } Coordinaton Martin W. Ferguson-Pell John D. S. Gaylor Brian J. Andrews Thelma M. Miller Gail Bailey Alexander C. Nicol Thomas R. M. Brown Clare Pinder Rita F. Cuthbert David A. Robb John H. Evans Alexis M. Ross Corla M. van Griethuysen David J. A. Srnith Loma B. Kerr Elizabeth M. Srnith UndaKneale AlexanderJ. Tullis Maria Lynch Rosemary Wilkinson Monica K. McColl Joan D. Wilson David J. MacDonald J ohn Maclean SESSION CHAIRMEN ASSOCIATES AND REPORTERS Brian J. Andrews Adrian Q. Beale Martin W. Ferguson-Pell Stanley A. Floyd John D. S. Gaylor Derek A. Hodson Monica M. Jordan Dennis F. Lovely James MacGregor Sarah K. Marlow Philip F. Millington Simon P. Marlow Sheila M. Nicol Philippa J. McLeod Graham Thynne vii EXHIBITORS Barr and Stroud Ud, Caxton Street, Glasgow, G13 1HZ, UK Cardio Kineties, 218 Regents Road, Salford, M2 3GS, UK Delft University of Teehnology, Department of Electrical Engineering, Mekelweg 4,2628 CD Delft, The Netherlands Digital Equipment Co Ltd, Digital House, 252-256 Kings Road, Reading, RG 1 4HS, UK Fenwiek Eleetronies, 301 Maxwell Road, Glasgow, G41 1T D, UK Kontron Medieal International, e/o Digital Eleetronies Ud, 11 Greenhill Creseent, Holywell Industrial Estate, Watford, WDI 8XG, UK Strathand Ud, 44 St Andrews Square, Glasgow, GI 5PL, UK Strathelyde Regional Couneil, Publie Relations Department, India Street, Glasgow Tandy Corporation, Tameway Tower, Bridge Street, Walsall, West Midlands, WSl ILA,UK Universita Degli Studi Di Roma, Istituto Di Fisiologia Umana, Citta Universitaria, 00100 Roma, Italy University of Glasgow, Department of Anaesthesia, Phase I Glasgow Royal Infirmary, Glasgow, G4 OSF, UK University of Glasgow, Department of Eleetronies and Eleetrieal Engineering, Glasgow, G12 8QQ, UK University of Strathc1yde, Bioengineering Unit, Wolfson Centre, 106 Rottenrow, Glasgow, G4 ONW, UK University of Strathelyde, Department of Health Physies, J ohn Anderson Building 107 Rottenrow, Glasgow, G4 ONG, UK Versatee Eleetronies Ud, 27-35 London Road, Newbury, Berkshire, RG13 IJL, UK viii CONTENTS Preface v Seminar Organising Committee, Secretariat, Chairman Associates and Reporters vii Exhibitors vili THE 1981 ADAM THOMSON LECTURE: TRANSFORMING DATA AND IDEAS INTO INFORMATION W. J. Perkins, The National Institute for Medical Research, London 2 SECTION A APPUCATIONS OF MICROPROCESSORS AND MICROCOMPUTERS 13 Mini-and microcomputers in medical research 15 M. M.Jordan 2 FRED: A microprocessor-controlled colour television display system for rehabilitation of the handicapped 22 D. J. Dewhurst 3 Microcomputer assisted cardiovascular monitoring 27 G. N. C. Kenny and D. Campbell 4 MICKIE: Experiences of interviewing patients by micro 31 S. S. Somerville, J. S. Stewart and G. E. T. Raine 5 Interactive computing in the microbiology laboratory 37 F. Johnson, N. Pearson, T. McDonald and F. W. O'Grady 6 Data processing in pathology laboratories: why has it taken so long to come of age? 42 N. W. Carter 7 A laboratory microcomputing system for physiological signal and system analysis 46 S. R. Smith, L. Jankovic, T. Going and S. LaI 8 On-line analysis of respiratory waveform with a microcomputer 52 P. D. Davis, G. N. C. Kenny and D. Campbell 9 A portable microprocessor-based heart-rate meter 57 C. J. Watkins and J. R. Roberts 10 ECG data compression: some practical considerations 62 J. C. M. Peden 11 An analysis of heart-rate variability after myocardial infarction 68 S. R. W. Grainger, S. R. Rakowski and P. C. Carson ix x CONTENTS 12 Patient monitoring by computer-large or small? 76 J. S. S. Stewart Section A Discussion 85 SECTION B PANEL DISCUSSION 1 87 SECTION C PANEL DISCUSSION 2 93 SECTION D SIGNAL ANALYSIS 101 1 Patterns in signals 103 J. H. van Bemmel 2 Progress with CARE 111 P. W. MacFarlane, A. Irving, J. C. M. Peden, M. Podolski, D. Shoat, M. P. Watts and T. D. V. Lawrie 3 On-line information and data reduction in patient monitoring 117 J. A. BIom and J. E. W. Beneken 4 Modelling respiratory sinus arrhythrnia and its application to the study of neuropathy 126 R.1. Kitney 5 An automatie system for clinical gait analysis 135 A. Cappozzo, F. Di Giacinto, T.l.eo and V. Macellari 6 The StrathcIyde TV system for human motion analysis 142 B. J. Andrews, S. M. NicoI, G. Thynne and A. Q. Beale 7 A quantitative method for assessment of differentiation techniques used for Iocomotion analysis 146 B. J. Andrews, A. Cappozzo and F. Gazzani 8 A computer assisted quantitative description ofhuman muscle contraction tension-time relationship ISS K. Larsen, N. H. Secher and N. Rube 9 On-line analysis of motor unit action potentials and the interpretation of specific parameters 160 K. L. Boon and A. R. Th. Peismaeker 10 An averaging technique for a rowing exercise ECG test 167 J. A. van Alste and W. van Eck Section D Discussion 174 SECTION E SIGNAL AND IMAGE ANALYSIS 175 1 Digital image processing in medicine 177 R. S.l.edley, L. S. Rotolo and T. J. Golab 2 Interactive pattern recognition; desirability and characteristics of a system 187 E. S. Geisema