Computer 'life-saver'

BHP Review, April 1978

BHP computers may be helping research to save lives. The computer interpreting valuable data is one of two of its kind in Victoria, and the only one with the Techtronic digitizer vital to the research programme.

Since May 1977, Dr Joss Xipell, Director Anatomical Pathology, Austin Hospital, and Dr Doug Brown, Sessional Renal Physician, Austin Hospital and Research Fellow University of Melbourne have been using computers to research into bone disease in kidney patients.

Dr Joss Xipell and Dr Doug Brown (right) discus computer printout.

Artificial kidney treatment and kidney transplants allow patients with kidney failure a chance to lead a more normal life.

Most patients have dialysis while awaiting a suitable transplant, but some require life long dialysis.

Bone disease is common in kidney failure due to the lack of active Vitamin D formed in normal kidneys from the natural vitamin. Activated Vitamin D is responsible for the absorption of calcium from the intestine and plays an important part in bone calcification.

Research in the Austin Hospital Renal Unit and Pathology Department is being conducted to assess the rate of development of bone disease in the 75 patients on artificial kidney treatment.

In a normal healthy person, the sun reacts on the skin, is absorbed by the liver, and then processed by the kidney for its final activation into Vitamin D.

Throughout our lives, new bone is regenerated to replace bone damaged by normal wear and tear.

Without active Vitamin D, there is not enough calcium to strengthen this newly formed bone leaving it soft and structurally weak. This often causes pain and sometimes, bone breakage.

To establish normal bone values in Australians and to compare this with bone from patients with renal failure, accurate measurements were made of the bone area and the degree of  in bone calcification in people who had died suddenly as a result of trauma or heart attacks.

Dr Joss Xipell, Dr Doug Brown and Lloyd Borrett check the computed diagram of the original bone slide.

However, this study has been hampered by a lack of appropriate techniques for the microscopic examination of bone.

Older techniques for measuring the degree of bone calcification including impressions on a slide in a conventional microscope, and measuring and counting bone interceps under a microscope, are tedious, time consuming and sometimes inaccurate.

Both Doug and Joss wanted to establish a more rapid and precise computerised electronic technique similar to one Joss saw in America, while on an overseas trip to investigate alternatives to the microscope method.

The cost of buying the Techtronic digitizer was out of the question because of insufficient research funds, and BHP was the only company with the crucial pieces of equipment and the digitizing tablet. This equipment is used in bone study work in specialised laboratories overseas. Dr Joss Xipell approached Dr Brian Garner of the BHP Corporate Data Processing (CDP) department and BHP agreed to help the Austin Hospital research department in its important and worthwhile work.

Initially, Dr Richard Hume of CDP wrote a computer programme for the doctors which was supervised by fellow CDP worker, Lloyd Borrett.

This programme, amended many times during the research, was devised to measure the total amount of unmineralised bone and the degree of bone reabsorption.

Dr Doug Brown works the 'Techtronic' digitizer.

It compares these factors in normal people and in patients with kidney disease using a projection microscope and mirror to magnify and project the bone images onto the Techtronic digitizer.

The Techtronic digitizer comprises an "electronic" pen which is used to trace the bone outline, and a computer display unit, similar to a television screen, which shows the outline of the particle of bone being examined.

It accurately measures the proportion of bone and osteoid (unmineralised bone) present in the microscope field. The total area of the field and the area of fibrous tissue replacing bone are digitized separately.

These results, combined with other data obtained by conventional microscopic methods at the Austin Hospital, and with radiological and biochemical results, present a comprehensive picture of the calcium and bone status of each patient.

Comparisons of results over the past three years, including the Techtronic digitizer findings, are used to assess the rate of progression of bone disease.

The relative importance of the lack of calcification and of reabsorption can be determined in patients with kidney disease and in those receiving artificial kidney treatment.

Using this information it is hoped to design more effective treatment systems to ensure healing of bone disease and also to prevent its development in new patients in the future.