The System Design Hardware and Software Development of Telemedicine for Thyroid Uptake in Rural Area

*)

Mike Susmikanti*), Suratman*) Nuclear Information Development Center National Nuclear Energy Agency

Email: mike@batan.go.id, suratman@batan.go.id

Abstract
Thyroid scrofula many met in rural public at certain area or cloistered area in Indonesia. The spreading of specialist medical doctor doesn't flatten, so that rural areas and outlying still lacking of specialist medical doctor. Exploiting of nuclear detector and hardware usage and also software from systems instruments nuclear has started done. For the agenda of increasing service and ability in nuclear medical science area, National Nuclear Energy Agency (BATAN) develops equipments that are economic enough to test catching thyroid gland so-called thyroid uptake. Inspection systems of long distance can be done for resident at certain areas taken heed there is mumps or thyroid symptom. The result of recording of the data is a graphic so that from medical doctor long distance can analyses the patient. The system put down in a certain location consisted of detector for inspection of patient thyroid connected at personal computer with certain card and monitor presenting graph condition of patient. The software for thyroid uptake, applied in programming language Borland C++. Using this mobile system the patient in a rural or remote area can be monitored. At location where specialist medical doctor stays, drawn up computer that is in circuit to internet communication network module and or network Global System Mobile (GSM) to phone cellular. This mobile system is on ongoing in a project.

Keywords: Communication Network, Telemedicine, Rural Area, Thyroid Uptake 1. Introduction Based on the policy of government in Indonesia, the writer proposes a mobile telemedicine system to detection the thyroid disease in rural area. Thyroid symptom many met in rural public at certain area or cloistered area in Indonesia. Comparison the many medical doctors with resident still be relative low. The application of nuclear radiation in research, therapy and diagnosis in medical area has started grows in Indonesia. Some equipments of simple nuclear medicine with single detector and double detector system have been made. Single detector is used for the thyroid uptake and the double detector is used for the renograf. The system put down in certain location consisted of detector for inspection of patient thyroid connected at personal computer with certain card and monitor presenting graph condition of patient. Recording of detection of disease thyroid is by means of the detector where patient before all has been inseminated by the Iodine (I131) matter. The result of recording of the data is a graphic in a certain time, so that from a long distance the medical doctor can analyses the patient. The software for the thyroid uptake in the systems to which there have now applies in Borland C++ bases on Windows. Using this mobile system the patient in a rural or remote area can be monitored. At location where specialist medical doctor stays, drawn up computer that is in circuit

to internet communication network module and or network Global System Mobile (GSM) to phone cellular. While at location estimated many residents having thyroid symptom is drawn up by communications module, module to convert from analogue data to digital (ADC) and module thyroid uptake. Signal thyroid uptake was analog signal then is distribute to module ADC to be turned into digital signal. This signal processed in communications module for transmission to communication network applies internet in the form of graph or network GSM through hand phone. This system is on ongoing project therefore improvements are still required to enhance the system performance. 2. Thyroid Uptake The thyroid is a gland in the neck that controls metabolism, a chemical process that regulates the rate at which the body functions. The thyroid scan and a radioactive iodine uptake test, also known as a thyroid uptake, are nuclear medicine examinations that help evaluate the structure and function of the thyroid. The thyroid scan is used to determine the size shape and positions of the thyroid gland. The thyroid uptake is performed to evaluate the function of the gland. For both tests, a small amount of a radioactive material called radiopharmaceutical or radiotracer (iodine or technetium) is injected into a vein or swallowed by mouth. This material eventually collects in the thyroid, where it gives off energy in the form of gamma rays. Working together, a probe, camera and computer detect these emissions; measure the amount of radiotracer absorbed in to the gland and produce a digitized image of the thyroid gland. In a thyroid uptake, the patient will be given radioactive iodine (I131) in a liquid or capsule form to swallow. The patient is then scheduled to have the thyroid uptake several hours (from six to 24 hours) later. When it is time for the procedure to be performed, the patient will sit in a chair while a probe is placed over the thyroid gland in the neck. This small probe is capable of detecting and measuring the gamma rays emitted from the radiotracer that has accumulated in the thyroid gland. This procedure lasts approximately 30 minutes. There are many diseases that result in a hyper functioning thyroid gland, some of which require more definitive treatment and others need only a conservative approach. Thyroid uptake and scan helps determine which patients will require more definitive therapeutic approach. Some thyroid nodules function whereas others do not. A functioning nodule is much less likely to be malignant compared to a nonfunctioning one. A thyroid scan can assess whether the nodule functions or not. In patients with an enlarged thyroid gland, thyroid uptake and scan can help determine the extent of the enlargement and whether the goiter extends outside of the neck into the chest. 3. Hardware and Software Thyroid Uptake The hardware of thyroid uptake consists of detector, personal computer, monitor and printer (figure 1). The detector used for inspection of patient thyroid. This is a unique detector system. One detector is put down front of gland. Output from detector yields curve from thyroid investigated.

The software for the thyroid uptake in the systems to which there have now applies in Turbo C++ or Borland C++ bases on Windows. Programming orients object has been applied in expansion of software for acquisition and equipment analysis of test thyroid uptake. Software to analyze thyroid uptake by using programming language Borland C++ bases on windows. The role of from software is for acquisition of data, presents curve, calculates parameters, save and prints end result. The concerned object is combination from data and procedure is the data manipulation. Object cans be in the form of window, knob or menu facilitating usage software. Application program works in operating system Windows is containing a number of functions books, what can be applied by every application. This function kept in related book dynamically (DLLS) what can be accessed by every program is being run. Windows also can implement a number of programs at a timely and ready for handling monitor types and printer differs in possibly attached at system. Programming orients object implemented at thyroid uptake to base on Windows will yield the application of rich of facility and capable of height.

Figure 1: System Hardware of Thyroid Uptake In the case of the thyroid, the uptake period extends to over few hours and may be even days. Uptake is done on a specific area of the body. Since the gamma scintillation camera gives a graphical (count) image of organs, it provides a very useful tool for the uptake. Hence, a simple manually operated counter/timer will serve the purpose. Collect counts for the standard I131 capsule or injection by setting the baseline and windows corresponding to its photo peak and fixing the capsule at 25 cm distance from detector as shown in figure 2.1 and figure 2.2. Keep a standard capsule of required activity (approximately 25 micro Curies) in the thyroid phantom. The phantom is kept at the same distance in the counting position (of 25 cm) as that of the patient. Collect counts ( X 1 ) for 2 minutes. Shield the phantom and take the background counts ( B1 ) for the same amount of time. Now the patient is administered the standard capsule of

known source strength and counting is done keeping the standard distance between the detector and the thyroid. If the counts for 2 minutes of the organ and the background (with the lead shield in front of thyroid) are X 2 and B2 respectively, the net thyroid counts of the organ whish represent the uptake is ( X 2 B2 ). Percentage uptake the radioactive material by the thyroid is given by the following relation: Percentage = Uptake
Net counts for specific time from the organ x 100 Net counts for the same time from the equivalent ad m istered in dose

( X 2 B2 ) x 100 ( X 1 B1 ) The flowchart for the thyroid uptake software consist of the processing data acquisition, curve appearance, keeps and thyroid data print are follow in figure 3. The main and sub menu of software thyroid uptake are given in figure 4. The sample medical record of patient is given in figure 5 and the sub menu of thyroid uptake graph is followed in figure 6.

Figure 2.1: Standard thyroid set-up

Figure 2.2: Controlled positioning of collimator in front of thyroid

Start

Register Class For Main Windows

Makes Main Window & presents it to Monitor

Process: Acquisition, Curve appearance, processing, Keeps data

Takes Messages From queue

No Exit Yes Finish

Translates & sends message To sub Windows

Figure 3: Flowchart for the thyroid uptake

Figure 4: Patient Record

Figure 5: Main Menu Thyroid Uptake Software

Figure 6: Sub menu Thyroid Uptake Graph 4. Communication Hardware Using this mobile system the patient in a rural or remote area can be monitored. At location where specialist medical doctor stays such as hospital in city, drawn up computer that is in circuit to Internet communication network module and or network GSM to phone cellular. System proposed early is a monitoring systems thyroid uptake, which very possibly can overcome problem lacking of medical doctor in rural by using Internet communication network and network GSM. This system addressed for hospital serving health service for a few countryside with public health center which spread over around it with radius some kilometers and condition of infrastructure which minim, as seen at figure 7.

Public Health Center

Public Health Center

Hospital

Public Health Center

Public Health Center

Figure 7: Hospital serves some countryside If one of countryside is required by analysis thyroid to a patient, while traveled distance enough far with condition of heavy road street for towards to a medical doctor in hospital, hence every countryside which have public health center can be done retrieval of signal thyroid uptake and sent through internet network and GSM to hospital reference. After signal thyroid uptake is received in personal computer (PC) hence analyzable the signal by medical doctor in hospital. As for module developed that is in located hospital is prepared computer that is to communications module such as internet and cellular phone call. While in every countryside which have public health center is prepared communications module, analogue to digital converter (ADC) and module thyroid uptake as following in figure 8.

Mobile Terminal

Internet

Global IP Server

Mobile Terminal

BTS Mobile phone

Uptake Thyroid Modul

Detector

Patient

Information

Media

Source

Figure 8: Hardware modules in public health center and hospital 5. Analysis

Signal thyroid uptake is analog signal obtained through detector put down on course and certain distance with position of thyroid patient, then is distribute to module ADC to be turned into digital signal. This signal processed in communications module for transmission to internet network or network GSM through hand phone. Real crux of signal thyroid uptake is result of graph from patient. In signal hospital result of thyroid uptake is received through internet or hand phone which then is sent to communications module to be processed and sent to PC to be presented in monitor as seen in figure 9.

Figure 9: The output of Thyroid Uptake Graph 6. Summary The result of visible attempt of signal thyroid uptake obtained from patient body. This signal can be recorded through personal computer during connection between two communications from public health center in rural area and hospital in city. This codified signal can be presented at other of time if medical doctor indium hospital will analyze it returns. The information about the analysis of type thyroid especially relating to appearance indium graph bound doesnt yet complete. According to the writer, the analysis of symptom thyroid between thyroid uptake and thyroid scan cannot be separated. Project of mobile thyroid uptake system is being developed indium rural needed policy and support from related local government and institution. Required also understanding of public and usage of thyroid uptake indium countryside. Repair from system hardware and software to increase perform from this system still is done.

7. Reference [1] Bairi, B.R.; Singh Balvinder; Rathod, N.C.; Narurkar, P.V.; Handbook of Nuclear Medical Instruments, Tata McGraw-Hill Publishing Company limited, New Delhi,1994 [2] http://www.saskatoonhealtregion.ca/Thyroid/Test&Procedures-Nuclear Medicine-I131.htm, 7/9/2007 [3] http://www.saskatoonhealtregion.ca/Thyroid/Test&Procedures-Nuclear MedicineThyroid Uptake and Scan I-131.htm, 7/9/2007 [4] http://www.radiologyinfo.org/Thyroid Scan and Uptake.htm, August 18, 2006 [5] http://www.radiologyinfo.org/Thyroid Scan and Uptake.htm, 7/9/2007 [6] Pambudi, Iwan Tutuka; Febriyanto, Rony; Prihanto Harry; Hardware and Software development of Mobile Eletrocardiogram (ECG) System, The proceeding of National Applied Information Technology, Yogyakarta, June 16, 2007