Search results for: Medical Image Retrieval

Authors: H. Sagha, S. Kasaei, E. Enayati, M. Dehghani

Abstract:

Although Face detection is not a recent activity in the field of image processing, it is still an open area for research. The greatest step in this field is the work reported by Viola and its recent analogous is Huang et al. Both of them use similar features and also similar training process. The former is just for detecting upright faces, but the latter can detect multi-view faces in still grayscale images using new features called 'sparse feature'. Finding these features is very time consuming and inefficient by proposed methods. Here, we propose a new approach for finding sparse features using a genetic algorithm system. This method requires less computational cost and gets more effective features in learning process for face detection that causes more accuracy.

Keywords: Face Detection, Genetic Algorithms, Sparse Feature.

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Authors: Sang Hyun Kim

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In this paper, a fast motion compensation algorithm is proposed that improves coding efficiency for video sequences with brightness variations. We also propose a cross entropy measure between histograms of two frames to detect brightness variations. The framewise brightness variation parameters, a multiplier and an offset field for image intensity, are estimated and compensated. Simulation results show that the proposed method yields a higher peak signal to noise ratio (PSNR) compared with the conventional method, with a greatly reduced computational load, when the video scene contains illumination changes.

Keywords: Motion estimation, Fast motion compensation, Brightness variation compensation, Brightness change detection, Cross entropy.

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Authors: Nami Matsumoto

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This study explores the experiences of cross-linguistic medical encounters by patients, and their views of receiving language support therein, with a particular focus on Japanese-English cases. The aim of this study is to investigate the reason for the frequent use of a spouse as a communication mediator from a Japanese perspective, through a comparison with that of English speakers. This study conducts an empirical qualitative analysis of the accounts of informants. A total of 31 informants who have experienced Japanese-English cross-linguistic medical encounters were recruited in Australia and Japan for semi-structured in-depth interviews. A breakdown of informants is 15 English speakers and 16 Japanese speakers. In order to obtain a further insight into collected data, additional interviews were held with 4 Australian doctors who are familiar with using interpreters. This study was approved by the Australian National University Human Research Ethics Committee, and written consent to participate in this study was obtained from all participants. The interviews lasted up to over one hour. They were audio-recorded and subsequently transcribed by the author. Japanese transcriptions were translated into English by the author. An analysis of interview data found that patients value relationship in communication. Particularly, Japanese informants, who have an English-speaking spouse, value trust-based communication interventions by their spouse, regardless of the language proficiency of the spouse. In Australia, health care interpreters are required to abide by the national code of ethics for interpreters. The Code defines the role of an interpreter exclusively to be language rendition and enshrines the tenets of accuracy, confidentiality and professional role boundaries. However, the analysis found that an interpreter who strictly complies with the Code sometimes fails to render the real intentions of the patient and their doctor. Findings from the study suggest that an interpreter should not be detached from the context and should be more engaged in the needs of patients. Their needs are not always communicated by an interpreter when they simply follow a professional code of ethics. The concept of relationship-centred care should be incorporated in the professional practice of health care interpreters.

Keywords: Health care, Japanese-English medical encounters, language barriers, trust.

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Authors: M.A. Calin, S.V. Parasca, M.R. Calin, D. Savastru, D. Manea

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The goal of this paper is to examine the effects of laser radiation on the skin wound healing using infrared thermography as non-invasive method for the monitoring of the skin temperature changes during laser treatment. Thirty Wistar rats were used in this study. A skin lesion was performed at the leg on all rats. The animals were exposed to laser radiation (λ = 670 nm, P = 15 mW, DP = 16.31 mW/cm2) for 600 s. Thermal images of wound were acquired before and after laser irradiation. The results have demonstrated that the tissue temperature decreases from 35.5±0.50°C in the first treatment day to 31.3±0.42°C after the third treatment day. This value is close to the normal value of the skin temperature and indicates the end of the skin repair process. In conclusion, the improvements in the wound healing following exposure to laser radiation have been revealed by infrared thermography.

Keywords: skin, wound, laser, thermal image

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Authors: D.R Prince Williams

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The notion of S-fuzzy left h-ideals in a hemiring is introduced and it's basic properties are investigated.We also study the homomorphic image and preimage of S-fuzzy left h-ideal of hemirings.Using a collection of left h-ideals of a hemiring, S-fuzzy left h-ideal of hemirings are established.The notion of a finite-valued S-fuzzy left h-ideal is introduced,and its characterization is given.S-fuzzy relations on hemirings are discussed.The notion of direct product and S-product are introduced and some properties of the direct product and S-product of S-fuzzy left h-ideal of hemiring are also discussed.

Keywords: hemiring, left h-ideal, anti fuzzy h-ideal, S-fuzzy left hideal, t-conorm , homomorphism.

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Authors: Kosmas Dimitropoulos, Athanasios Manitsaris, Ioannis Mavridis

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The paper presents an investigation into the role of virtual reality and web technologies in the field of distance education. Within this frame, special emphasis is given on the building of web-based virtual learning environments so as to successfully fulfill their educational objectives. In particular, basic pedagogical methods are studied, focusing mainly on the efficient preparation, approach and presentation of learning content, and specific designing rules are presented considering the hypermedia, virtual and educational nature of this kind of applications. The paper also aims to highlight the educational benefits arising from the use of virtual reality technology in medicine and study the emerging area of web-based medical simulations. Finally, an innovative virtual reality environment for distance education in medicine is demonstrated. The proposed environment reproduces conditions of the real learning process and enhances learning through a real-time interactive simulator.

Keywords: Distance education, medicine, virtual reality, web.

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Authors: Rasmus Engholm, Eva B. Vedel Jensen, Henrik Karstoft

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In this paper we present a noise reduction filter for video processing. It is based on the recently proposed two dimensional steering kernel, extended to three dimensions and further augmented to suit the spatial-temporal domain of video processing. Two alternative filters are proposed - the time symmetric kernel and the time asymmetric kernel. The first reduces the noise on single sequences, but to handle the problems at scene shift the asymmetric kernel is introduced. The performance of both are tested on simulated data and on a real video sequence together with the existing steering kernel. The proposed kernels improves the Rooted Mean Squared Error (RMSE) compared to the original steering kernel method on video material.

Keywords: Adaptive image filtering, noise reduction, kernel methods, video processing.

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Authors: Firas Gerges, Frank Y. Shih

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Malignant Melanoma, known simply as Melanoma, is a type of skin cancer that appears as a mole on the skin. It is critical to detect this cancer at an early stage because it can spread across the body and may lead to the patient death. When detected early, Melanoma is curable. In this paper we propose a deep learning model (Convolutional Neural Networks) in order to automatically classify skin lesion images as Malignant or Benign. Images underwent certain pre-processing steps to diminish the effect of the normal skin region on the model. The result of the proposed model showed a significant improvement over previous work, achieving an accuracy of 97%.

Keywords: Deep learning, skin cancer, image processing, melanoma.

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Authors: Youssef Khmou, Said Safi, Miloud Frikel

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This paper treats different aspects of entropy measure in classical information theory and statistical quantum mechanics, it presents the possibility of extending the definition of Von Neumann entropy to image and array processing. In the first part, we generalize the quantum entropy using singular values of arbitrary rectangular matrices to measure the randomness and the quality of denoising operation, this new definition of entropy can be implemented to compare the performance analysis of filtering methods. In the second part, we apply the concept of pure state in quantum formalism to generalize the maximum entropy method for narrowband and farfield source localization problem. Several computer simulation results are illustrated to demonstrate the effectiveness of the proposed techniques.

Keywords: Von Neumann entropy, Filtering, array, DoA, Maximum Entropy Method.

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Authors: Aarati Susan Mathew, Radhika Narendra Patel, Jiji Mathew

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A retrospective study conducted at Christian Medical College (CMC) Teaching Hospital, Vellore, India on 14th August 2014 to assess the accuracy of clinically estimated foetal weight upon labour admission. Estimating foetal weight is a crucial factor in assessing maternal and foetal complications during and after labour. Medical notes of ninety-eight postnatal women who fulfilled the inclusion criteria were studied to evaluate the correlation between their recorded Estimated Foetal Weight (EFW) on admission and actual birth weight (ABW) of the newborn after delivery. Data concerning maternal and foetal demographics was also noted. Accuracy was determined by absolute percentage error and proportion of estimates within 10% of ABW. Actual birth weights ranged from 950-4080g. A strong positive correlation between EFW and ABW (r=0.904) was noted. Term deliveries (≥40 weeks) in the normal weight range (2500-4000g) had a 59.5% estimation accuracy (n=74) compared to pre-term (<40 weeks) with an estimation accuracy of 0% (n=2). Out of the term deliveries, macrosomic babies (>4000g) were underestimated by 25% (n=3) and low birthweight (LBW) babies were overestimated by 12.7% (n=9). Registrars who estimated foetal weight were accurate in babies within normal weight ranges. However, there needs to be an improvement in predicting weight of macrosomic and LBW foetuses. We have suggested the use of an amended version of the Johnson’s formula for the Indian population for improvement and a need to re-audit once implemented.

Keywords: Clinical palpation, estimated foetal weight, pregnancy, India, Johnson’s formula.

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Authors: Lin Cheng, Zijiang Yang

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Program synthesis is the task to automatically generate programs based on user specification. In this paper, we present a framework that synthesizes programs from flow charts that serve as accurate and intuitive specification. In order doing so, we propose a deep neural network called GRCNN that recognizes graph structure from its image. GRCNN is trained end-to-end, which can predict edge and node information of the flow chart simultaneously. Experiments show that the accuracy rate to synthesize a program is 66.4%, and the accuracy rates to recognize edge and node are 94.1% and 67.9%, respectively. On average, it takes about 60 milliseconds to synthesize a program.

Keywords: program synthesis, flow chart, specification, graph recognition, CNN.

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Authors: Mahamed G.H. Omran, Andries P Engelbrecht, Ayed Salman

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An end-member selection method for spectral unmixing that is based on Particle Swarm Optimization (PSO) is developed in this paper. The algorithm uses the K-means clustering algorithm and a method of dynamic selection of end-members subsets to find the appropriate set of end-members for a given set of multispectral images. The proposed algorithm has been successfully applied to test image sets from various platforms such as LANDSAT 5 MSS and NOAA's AVHRR. The experimental results of the proposed algorithm are encouraging. The influence of different values of the algorithm control parameters on performance is studied. Furthermore, the performance of different versions of PSO is also investigated.

Keywords: End-members selection, multispectral satellite imagery, particle swarm optimization, spectral unmixing.

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Authors: Sanghoon Park, Ki-Jin Kim, Kwang-Ho Ahn, Hyeon-Woo Lee

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It is very effective way to utilize a very wide tunable filter in co-existing multi-standards wireless communications environment. Especially, as the long term evolution (LTE) communication era has come, the multi-band coverage is one of the important features required for the RF components. In this paper, we present the frequency conversion technique, and so generate two types of RF filters which are specially designed for the superb tunable ability to support multiple wireless communication standards. With the help of a complex mixing structure, the inherent image signal is suppressed. The RF band-pass filter (BPF) and notch filter achieve 1.8dB and 1.6dB insertion losses and 18 dB and 17 dB attenuations, respectively. The quality factor show greater than 30.

Keywords: RF filters, interference, wideband, tunable, channel selection, complex mixing, balanced mixer.

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Authors: Hezlina Mohd Hashim, Abdul Mutalib Embong, Zullina H. Shaari

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This study analyses the perceptions of secondary school students about the accounting profession in Malaysia. Fifty five form three and form four students who are taking accounting/commerce subjects were met. Individual-s perception data were collected through questionnaires. The results at the secondary school level suggest that the stereotypical negative image of the accountant ends, with students expressing the positive view of the work of an accountant. There were also gender differences in perceiving the accounting profession. Overall, the results of the study suggest that we are now in line in projecting positive and accurate perceptions of the accounting profession to secondary school students.

Keywords: Perceptions, secondary school students, accounting profession, Malaysia.

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Authors: Masrour Dowlatabadi, Jalil Shirazi

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In this paper, an improved edge detection algorithm based on fuzzy combination of mathematical morphology and wavelet transform is proposed. The combined method is proposed to overcome the limitation of wavelet based edge detection and mathematical morphology based edge detection in noisy images. Experimental results show superiority of the proposed method, as compared to the traditional Prewitt, wavelet based and morphology based edge detection methods. The proposed method is an effective edge detection method for noisy image and keeps clear and continuous edges.

Keywords: Edge detection, Wavelet transform, Mathematical morphology, Fuzzy logic.

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Authors: S. Nagheli, N. Samani, D. A. Barry

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In this paper, the velocity potential and stream function of capture zone for a well field in an aquifer bounded by two parallel streams with or without a uniform regional flow of any directions are presented. The well field includes any number of extraction or injection wells or a combination of both types with any pumping rates. To delineate the capture envelope, the potential and streamlines equations are derived by conformal mapping method. This method can help us to release constrains of other methods. The equations can be applied as useful tools to design in-situ groundwater remediation systems, to evaluate the surface–subsurface water interaction and to manage the water resources.

Keywords: Complex potential, conformal mapping, groundwater remediation, image well theory, Laplace’s equation, superposition principle.

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Authors: Keiko Shimazu, Yasuhiro Maida, Tetsuya Sugata, Daisuke Tamakoshi, Kenji Makabe, Haruki Suzuki

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In this paper, we report how to acquire serious victims’ locations in the Acute Stage of Large-scale Disasters, in an Emergency Information Network System designed by us. The background of our concept is based on the Great East Japan Earthquake occurred on March 11^th, 2011. Through many experiences of national crises caused by earthquakes and tsunamis, we have established advanced communication systems and advanced disaster medical response systems. However, Japan was devastated by huge tsunamis swept a vast area of Tohoku causing a complete breakdown of all the infrastructures including telecommunications. Therefore, we noticed that we need interdisciplinary collaboration between science of disaster medicine, regional administrative sociology, satellite communication technology and systems engineering experts. Communication of emergency information was limited causing a serious delay in the initial rescue and medical operation. For the emergency rescue and medical operations, the most important thing is to identify the number of casualties, their locations and status and to dispatch doctors and rescue workers from multiple organizations. In the case of the Tohoku earthquake, the dispatching mechanism and/or decision support system did not exist to allocate the appropriate number of doctors and locate disaster victims. Even though the doctors and rescue workers from multiple government organizations have their own dedicated communication system, the systems are not interoperable.

Keywords: Crisis management, disaster mitigation, messing, MGRS, Satellite communication system.

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Authors: Yang-Keun Ahn, Min-Wook Kim, Young-Choong Park, Kwang-Soon Choi, Woo-Chool Park, Hae-Moon Seo, Kwang-Mo Jung

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Active research is underway on virtual touch screens that complement the physical limitations of conventional touch screens. This paper discusses a virtual touch screen that uses a multi-layer perceptron to recognize and control three-dimensional (3D) depth information from a time of flight (TOF) camera. This system extracts an object-s area from the image input and compares it with the trajectory of the object, which is learned in advance, to recognize gestures. The system enables the maneuvering of content in virtual space by utilizing human actions.

Keywords: Gesture Recognition, Depth Sensor, Virtual Touch Screen

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Authors: Ardhendu Behera, Denis Lalanne, Rolf Ingold

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This paper proposes a method, combining color and layout features, for identifying documents captured from low-resolution handheld devices. On one hand, the document image color density surface is estimated and represented with an equivalent ellipse and on the other hand, the document shallow layout structure is computed and hierarchically represented. Our identification method first uses the color information in the documents in order to focus the search space on documents having a similar color distribution, and finally selects the document having the most similar layout structure in the remaining of the search space.

Keywords: Document color modeling, document visualsignature, kernel density estimation, document identification.

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Authors: M. Bastanfard, B. Jalaeian, S. Jafari

Abstract:

Sonogram images of normal and lymphocyte thyroid tissues have considerable overlap which makes it difficult to interpret and distinguish. Classification from sonogram images of thyroid gland is tackled in semiautomatic way. While making manual diagnosis from images, some relevant information need not to be recognized by human visual system. Quantitative image analysis could be helpful to manual diagnostic process so far done by physician. Two classes are considered: normal tissue and chronic lymphocyte thyroid (Hashimoto's Thyroid). Data structure is analyzed using K-nearest-neighbors classification. This paper is mentioned that unlike the wavelet sub bands' energy, histograms and Haralick features are not appropriate to distinguish between normal tissue and Hashimoto's thyroid.

Keywords: Sonogram, thyroid, Haralick feature, wavelet.

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Authors: Y. Boutiche, N. Ramou, M. Ben Gharsallah

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This paper is devoted to present and discuss a model that allows a local segmentation by using statistical information of a given image. It is based on Chan-Vese model, curve evolution, partial differential equations and binary level sets method. The proposed model uses the piecewise constant approximation of Chan-Vese model to compute Signed Pressure Force (SPF) function, this one attracts the curve to the true object(s)-s boundaries. The implemented model is used to extract weld defects from weld radiographic images in the aim to calculate the perimeter and surfaces of those weld defects; encouraged resultants are obtained on synthetic and real radiographic images.

Keywords: Active contour, Chan-Vese Model, local segmentation, weld radiographic images.

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Authors: I. Oloyede

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The study investigates the accuracy and loss of deep learning algorithms with the set of coronavirus (COVID-19) images dataset by comparing Bayesian convolutional neural network and traditional convolutional neural network in low dimensional dataset. 50 sets of X-ray images out of which 25 were COVID-19 and the remaining 20 were normal, twenty images were set as training while five were set as validation that were used to ascertained the accuracy of the model. The study found out that Bayesian convolution neural network outperformed conventional neural network at low dimensional dataset that could have exhibited under fitting. The study therefore recommended Bayesian Convolutional neural network (BCNN) for android apps in computer vision for image detection.

Keywords: BCNN, CNN, Images, COVID-19, Deep Learning.

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Authors: J. I. Asnor, S. Rosnah, Z. W. H. Wan, H. A. B. Badrul

Abstract:

Pineapples can be classified using an index with seven levels of maturity based on the green and yellow color of the skin. As the pineapple ripens, the skin will change from pale green to a golden or yellowish color. The issues that occur in agriculture nowadays are to do with farmers being unable to distinguish between the indexes of pineapple maturity correctly and effectively. There are several reasons for why farmers cannot properly follow the guideline provide by Federal Agriculture Marketing Authority (FAMA) and one of reason is that due to manual inspection done by experts, there are no specific and universal guidelines to be adopted by farmers due to the different points of view of the experts when sorting the pineapples based on their knowledge and experience. Therefore, an automatic system will help farmers to identify pineapple maturity effectively and will become a universal indicator to farmers.

Keywords: Artificial Neural Network, Image Processing, Index of Maturity, Pineapple

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Authors: Sultan Noman Qasem

Abstract:

This paper presents an evolutionary algorithm for solving multi-objective optimization problems-based artificial neural network (ANN). The multi-objective evolutionary algorithm used in this study is genetic algorithm while ANN used is radial basis function network (RBFN). The proposed algorithm named memetic elitist Pareto non-dominated sorting genetic algorithm-based RBFN (MEPGAN). The proposed algorithm is implemented on medical diseases problems. The experimental results indicate that the proposed algorithm is viable, and provides an effective means to design multi-objective RBFNs with good generalization capability and compact network structure. This study shows that MEPGAN generates RBFNs coming with an appropriate balance between accuracy and simplicity, comparing to the other algorithms found in literature.

Keywords: Radial basis function network, Hybrid learning, Multi-objective optimization, Genetic algorithm.

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Authors: YasirSalih, AamirSaeed Malik, Wazirahbt.Md-Esa

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In the recent years, high dynamic range imaging has gain popularity with the advancement in digital photography. In this contribution we present a subjective evaluation of various tone production and tone mapping techniques by a number of participants. Firstly, standard HDR images were used and the participants were asked to rate them based on a given rating scheme. After that, the participant was asked to rate HDR image generated using linear and nonlinear combination approach of multiple exposure images. The experimental results showed that linearly generated HDR images have better visualization than the nonlinear combined ones. In addition, Reinhard et al. and the exponential tone mapping operators have shown better results compared to logarithmic and the Garrett et al. tone mapping operators.

Keywords: tone mapping, high dynamic range, low dynamic range, bits per pixel.

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Authors: John N. Ellinas

Abstract:

In this paper, a robust watermarking algorithm using the wavelet transform and edge detection is presented. The efficiency of an image watermarking technique depends on the preservation of visually significant information. This is attained by embedding the watermark transparently with the maximum possible strength. The watermark embedding process is carried over the subband coefficients that lie on edges, where distortions are less noticeable, with a subband level dependent strength. Also, the watermark is embedded to selected coefficients around edges, using a different scale factor for watermark strength, that are captured by a morphological dilation operation. The experimental evaluation of the proposed method shows very good results in terms of robustness and transparency to various attacks such as median filtering, Gaussian noise, JPEG compression and geometrical transformations.

Keywords: Watermarking, wavelet transform, edge detection.

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Authors: C. Hönnscheidt, R. Krull

Abstract:

Oxidative stress makes up common incidents in eukaryotic metabolism. The presence of diverse components disturbing the equilibrium during oxygen metabolism increases oxidative damage unspecifically in living cells. Body´s own ubiquinone (Q10) seems to be a promising drug in defending the heightened appearance of reactive oxygen species (ROS). Though, its lipophilic properties require a new strategy in drug formulation to overcome their low bioavailability. Consequently, the manufacture of heterogeneous nanodispersions is in focus for medical applications. The composition of conventional nanodispersions is made up of a drug-consisting core and a surfactive agent, also named as surfactant. Long-termed encapsulation of the surfactive components into tissues might be the consequence of the use during medical therapeutics. The potential of provoking side-effects is given by their nonbiodegradable properties. Further improvements during fabrication process use the incorporation of biodegradable components such as modified γ-polyglutamic acid which decreases the potential of prospective side-effects.

Keywords: Biopolymers, γ-Polyglutamic acid, Oxidative stress, Ubiquinone.

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Authors: S. O. Adeosun, O. I. Sekunowo, O. P. Gbenebor, W. A. Ayoola, A. O. Odunade, T. A. Idowu

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Sand cast samples of the as-received 66/34Mg-Al alloy were first homogenized at 4900C and then divided into three groups on which annealing, normalising and artificial ageing were respectively carried out. Thermal ageing of the samples involved treatment at 5000C, soaked for 4 hours and quenched in water at ambient temperature followed by tempering at 2000C for 2 hours. Test specimens were subjected to microstructure and mechanical analyses and the results compared. Precipitation of significant volume of stable Mg17Al12 crystals in the aged specimen’s matrix conferred superior mechanical characteristics compared with the annealed, normalized and as-cast specimens. The ultimate tensile strength was 93.4MPa with micro-hardness of 64.9HRC and impact energy (toughness) of 4.05J. In particular, its Young modulus was 10.4GPa which compared well with that of cortical (trabecule) bone’s modulus that varies from 12-17GPa.

Keywords: Mg-Al alloy, artificial ageing, medical implant, cortical bone, mechanical properties.

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Authors: Walter Hussak, Heiko Schröder

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Star graphs are Cayley graphs of symmetric groups of permutations, with transpositions as the generating sets. A star graph is a preferred interconnection network topology to a hypercube for its ability to connect a greater number of nodes with lower degree. However, an attractive property of the hypercube is that it has a Hamiltonian decomposition, i.e. its edges can be partitioned into disjoint Hamiltonian cycles, and therefore a simple routing can be found in the case of an edge failure. The existence of Hamiltonian cycles in Cayley graphs has been known for some time. So far, there are no published results on the much stronger condition of the existence of Hamiltonian decompositions. In this paper, we give a construction of a Hamiltonian decomposition of the star graph 5-star of degree 4, by defining an automorphism for 5-star and a Hamiltonian cycle which is edge-disjoint with its image under the automorphism.

Keywords: interconnection networks, paths and cycles, graphs andgroups.

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Authors: D. Tedesco, G. Feletti, P. Trucco

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The present study aims to develop a Decision Support System (DSS) to support operational decisions in Emergency Medical Service (EMS) systems regarding the assignment of medical emergency requests to Emergency Departments (ED). This problem is called “hospital selection” and concerns the definition of policies for the selection of the ED to which patients who require further treatment are transported by ambulance. The employed research methodology consists of a first phase of review of the technical-scientific literature concerning DSSs to support the EMS management and, in particular, the hospital selection decision. From the literature analysis, it emerged that current studies mainly focused on the EMS phases related to the ambulance service and consider a process that ends when the ambulance is available after completing a mission. Therefore, all the ED-related issues are excluded and considered as part of a separate process. Indeed, the most studied hospital selection policy turned out to be proximity, thus allowing to minimize the travelling time and to free-up the ambulance in the shortest possible time. The purpose of the present study consists in developing an optimization model for assigning medical emergency requests to the EDs also considering the expected time performance in the subsequent phases of the process, such as the case mix, the expected service throughput times, and the operational capacity of different EDs in hospitals. To this end, a Discrete Event Simulation (DES) model was created to compare different hospital selection policies. The model was implemented with the AnyLogic software and finally validated on a realistic case. The hospital selection policy that returned the best results was the minimization of the Time To Provider (TTP), considered as the time from the beginning of the ambulance journey to the ED at the beginning of the clinical evaluation by the doctor. Finally, two approaches were further compared: a static approach, based on a retrospective estimation of the TTP, and a dynamic approach, focused on a predictive estimation of the TTP which is determined with a constantly updated Winters forecasting model. Findings reveal that considering the minimization of TTP is the best hospital selection policy. It allows to significantly reducing service throughput times in the ED with a negligible increase in travel time. Furthermore, an immediate view of the saturation state of the ED is produced and the case mix present in the ED structures (i.e., the different triage codes) is considered, as different severity codes correspond to different service throughput times. Besides, the use of a predictive approach is certainly more reliable in terms on TTP estimation, than a retrospective approach. These considerations can support decision-makers in introducing different hospital selection policies to enhance EMSs performance.

Keywords: Emergency medical services, hospital selection, discrete event simulation, forecast model.

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