OFFICE MEMORANDUM © STANFORD UNIVERSITY ©@ OFFICE MEMORANDUM © STANFORD UNIVERSITY e@ OFFICE MEMORANDUM To From SuBJECT: MAY 1 9 1972 Date: May 9, 1972 Dr. Joshua Lederberg Executive Head, Department of Genetics Dr. Donald C. Harrison Cardiology Division / The proposal for a new research computer facility for Stanford University School of Medicine. Following the meeting which you called to discuss the characteristics of a research computer system for Stanford Uni- versity School of Medicine and your plans for submitting an application for such a facility to the Biotechnology Resources Branch of the NIH, I have discussed in some detail how the Cardiology Division could relate to your plans. In addition to discussing this with members of my staff, I have met with Dr. Elliott Levinthal and Mr. Ron Jamtgaard to discuss what kind of contribution we could make to the overall grant proposal and how it would fit into my own long-term plans for computer activities in Cardiology. Following all of these meetings I would like to express to you my wish to participate actively in this proposal. A number of members of my staff and our future plans for computer develop- ment in Cardiology can, I believe, make a major contribution to the overall program and I am certain that the program will be very useful to us. At my meeting with you on Wednesday I will outline in some detail the proposals which we would like to see incorporated into the final grant proposal. I have discussed these with your other staff members and will work with them to develop the necessary detail for a grant application, if you approve of our participation. Our Present Assets In the Cardiology Division we shall be adding a full-time faculty member in September to take over direction of all of our computer related activities. This is Dr. Robert Stenson who has been with us earlier and helped develop our cardiac catheterization system. He has a degree in electrical engineering and an extensive background in computer sciences. In addition, Mr. William Sanders, Director of our computer programming group, and two graduate students from the Engineering Department are presently actively working on computer applications in Cardiology. Dr. Edwin Alderman, Dr. Richard Popp, and I are also actively participating in the use of computers in Cardiology and for medical research. WNGNVYOWIW JD1dIO © ALISUZAINN GaOANVIS © WNONVYOWSW FD1ddO e@ ALISUTAINN GYOAINVLS © WNAONVYOWAW 3d1ddO e ALISUIAINN GYOINVIS © Dr. Joshua Lederberg -2- May 9, 1972 We have recently applied to the National Library of Medicine for a training program for medical doctors in computer sciences. This has been reviewed by the Study Section and has been recommended for funding beginning July 1, 1972. We must await approval of the Council for funding. However, fellows have been recruited for a computer training program in 1972-73. As part of this program we are cooperating with Dr. Edwin Parker of the Department of Communication and plan integrated teaching activities for our trainees and his trainees in hopes of getting individuals to work on medical data storage and retrieval systems. In addition, we are working with Dr. William Fairbank in the Department of Physics and Dr. James Meindl of the Integrated Circuits Laboratory in applying advanced technology in Cardiology. Both of these projects, which have been funded by NASA and the National Science Foundation, will require computer facilities at a later date. Our present computer assets include two dedicated Hewlett Packard systems with disc operating systems and the ability to collect and interpret data from the coronary care unit, from the cardiac catheterization laboratory, from an ultrasound laboratory, and from electrocardiograms. We are presently planning the addition of a third dedicated system in late 1972. Programs Which Would Relate to the Research Computer System 1. Interaction of Small Computer Systems At present our computer systems are used for real-time data analysis from the cardiac catheterization laboratory, from the cardiology intensive care unit, from the gamma camera located in the x-ray department, and from our ultrasonic laboratory. Much program development remains to be completed and small machine support from a larger system for our continuing development activities. could be useful. [In addition, data are being accumulated on individual patients who are studied in several of these units at different times. The data from each small dedicated computer system provides the basis for performing highly sophisticated calculations on the performance of the heart if the data from each com- puter system can be integrated and manipulated by a larger machine. This will require the interaction of each small system with a big computer system. Much research remains to be done in relationship to our dedicated computer systems in each of these areas, but tying the outputs from each system together into an integrated program would represent a major step forward for us and for our research efforts. Dr. Joshua Lederberg -3- May 9, 1972 Clearly, much of our work in this area is in an early developmental stage. If after several years, we are suc- cessful in our efforts these sophisticated programs would be used on a day-to-day basis for patient care. For that purpose we would expect to transfer our work from the research computer system to the proposed medical school utility system which by that time should be operational. However, for the present time a research system would admirably meet our needs. Computerized Analysis of Heart Images The interpretation of changes in wall motion of various parts of the heart and changes in volume distribution within the heart is extremely important to cardiologists for assess- ing the heart function in health and in disease. Recently we have developed a light-pen-computer-video disc method which has received widespread attention. However, this method is limited because of the inability of our small computers to directly process the video images. With the availability of a larger computer system our plan would be to move to computerized videodensitometric methods similar to those under study at the Mayo Clinic for analyzing video images, and use techniques developed by NASA Ames Laboratory for making three dimensional reconstructions of the heart. While some work has been done in this area, clearly, a major research effort by a group such as ours is indicated. The use of computers to analyze images of the heart generated by ultrasonic echocardiography is a newer field of research which shows great promise. Presently, Dr. Richard Popp of our staff, Mr. Michael Hirsch from electrical engineering, Dr. James Meindl, and I are working on new techniques for computerized echocardio- graphic analysis. Mr. Sanders and Mr. Hirsch have succeeded in collecting echo signals in real-time. They are now attempting to implement a real-time analysis of these signals. As far as we know, we are the only indi- viduals who are attempting to do this at this point. Ultra-high speed A-D conversion, perhaps some input preprocessing, the availability of large file storage, and a fast computer with adequate core would make it possible for us to extend our work with image processing in this area. As a non-invasive method for evaluating cardiovascular function, echocardiography has a great deal of promise. Dr. Popp is one of the leading Dr. Joshua Lederberg -4- May 9, 1972 investigators in this area and has recently received a research career development award to continue his work. We hope to build an array of ultrasonic transducers which could be activated by the computer control and the complex return signal analyzed by computer technique. This would lead us to developing ultrasonic imaging as a substitute for radiographic procedures now performed on the heart. Clearly, much work in the Mars photo analysis program which you direct would be of immense help to us in our image pro- cessing. I have discussed this at some length with Dr. Levinthal and he has indicated that a collaborative venture with some of your group would be possible. In all of our uses involving patients, we have an adequate backup system. Since all of this is research application it will not require minute-to-minute or day-to-day computer use. We would, however, wish to schedule higher intensity use of the computer at various times. The details of this could be worked out easily among the various groups sharing the research computer facility. Needs of the Cardiology Division Our needs can be expressed as follows: a. We need a great deal of programming help at the central computer and would hope that our programmers could work closely with the staff of the larger computer facility. b. We have a need for large core and large disc files for much of our work. c. Support for interconnecting our small computer systems. We need compatibility with the Hewlett-Packard computer line and would require this for our interactive small systems to be attached to a larger computer. I believe it would be wise to have compatibility with more than the Digital Equipment line in any case. a. Ultra~high speed input for video and ultrasonic echo Signals, plus a sophisticated interaction CRT display, and graphic hard copy output devices would also be needed for image analysis research. Dr. Joshua Lederberg -5- May 9, 1972 Interaction terminals, preferably CRT-keyboard units, for program development and retrieval of information deposited by the interconnected small computers. We would like the help of the overall group in trying to influence the utility system which is developed at Stanford to be compatible with the work we are perform- ing on the larger research system. Other specific needs and our relations to the system could be worked out in detail with Ron Jamtgaard when he is putting together the final application. I hope that you will choose to have us join you in this grant application and I look forward to discussing it with you Wednesday afternoon. DCH: gar cc Dr. Dr. Dr. Mr. Dr. Dr. Mr. Richard Popp Edwin Alderman John Schroeder William Sanders Robert Stenson Elliott Levinthal Ron Jamtgaard