The evolution of filmless radiology teaching

Preserving the value of legacy film-based teaching files in pediatric radiology

Senior pediatric radiologists who have spent a major portion of their careers interpreting conventional film-screen radiographic studies have collected a wealth of hard-copy teaching material that is at risk of becoming obsolete. The teaching value and usefulness of analog film teaching files can be preserved using available hardware and standard software. The final product can be made available in a high-quality digital format to students, trainees and faculty without complicated search-and-retrieval methodology. This paper describes a relatively simple and low-cost procedure to preserve and use this source of wisdom and experience. It also emphasizes the role that such a resource can play as part of a comprehensive educational program.

Artificial intelligence for precision education in radiology

In the era of personalized medicine, the emphasis of health care is shifting from populations to individuals. Artificial intelligence (AI) is capable of learning without explicit instruction and has emerging applications in medicine, particularly radiology. Whereas much attention has focused on teaching radiology trainees about AI, here our goal is to instead focus on how AI might be developed to better teach radiology trainees. While the idea of using AI to improve education is not new, the application of AI to medical and radiological education remains very limited. Based on the current educational foundation, we highlight an AI-integrated framework to augment radiology education and provide use case examples informed by our own institution's practice. The coming age of "AI-augmented radiology" may enable not only "precision medicine" but also what we describe as "precision medical education," where instruction is tailored to individual trainees based on their learning styles and needs.

Radiology Teaching Files: an Assessment of Their Role and Desired Features Based on a National Survey

A radiology teaching file (TF) is a system containing a collection of cases with teaching value. Given the wide variety of TF solutions available, we conducted a national survey to better understand the need for TFs, TF features desired by users and their current implementation. A 28-question survey was created which explored TF implementation, utilization, and preferences among respondents. The survey was emailed to residents and faculty throughout the USA, with a request for program coordinators to forward the survey to their departments. The survey was completed by 396 respondents from 115 different institutions. These respondents included 60% residents, 21% attendings (non-program directors), 12% program directors, 5% fellows, and 1% medical students. TFs were assigned to one of three categories: personal TFs, shared in-house TFs, and public TFs. Seventy-six percent of respondents kept a personal TF using a variety of media, and 67% used a shared in-house TF. Of the public TFs used, the most popular were those requiring paid subscriptions. The features respondents valued most provided efficient querying of cases, simulated basic PACS functionality, enabled self-directed learning, and facilitated case submissions. There is a trend toward utilizing electronic media for TFs. The media utilized should be understood and reviewed to ensure PHI is properly secured. Contemporary users demand a high degree of functionality from TF solutions, and use both in-house and commercial products to meet their needs.

Self-subsidization of educational expenses by senior radiology residents

RATIONALE AND OBJECTIVES

The purpose of this study is to document the degree of self-subsidization of educational expenses by senior radiology residents.

MATERIALS AND METHODS

Questionnaires were distributed to all radiology residents (n = 176) attending the New Jersey Medical School board review course held twice in 2006. Respondents (n = 175) documented the number and source of financial support for review courses they had or would attend, including the AFIP course in radiologic pathology. They also listed the amount of additional financial allowances paid to them by their programs and cited the funding source for the radiology board examinations.

RESULTS

Average AFIP expenditure, including tuition, room, board, and travel, equaled 3,969 dollars +/- 45 dollars, of which 46% was paid by the residents themselves. The respondents attended, on average, two review courses costing 4,116 dollars +/- 149 dollars, bearing 77% of the costs. The average additional allowance paid to residents was 1,938 dollars +/- 156 dollars. Total board expenditures of 3,120 dollars, including fees and travel, were borne entirely by the residents. Total out-of-pocket expenses for these activities was 7,928 dollars +/- 165 dollars, which amounted to 16% of senior residents' average annual salary (49,746 dollars).

CONCLUSION

The desire by both programs and trainees for success on the radiology board examination has stimulated the growth of review courses. The enduring popularity of the AFIP course has made this activity an essential rotation for most radiology residency programs. Each of these off-site opportunities incurs significant financial obligations to residents, and when added to the cost of the board exams, equals 16% of their average annual salary. Thus radiology residents are subsidizing their education to a considerable degree relative to their salaries. This study reveals that senior radiology residents significantly subsidize their education and bear the burden of hidden costs associated with their training.

Multimodal visualization interface for data management, self-learning and data presentation

A multimodal visualization software, called the Data Manager (DM), has been developed to increase interdisciplinary communication around the topic of visualization and modeling of various aspects of the human anatomy. Numerous tools used in Radiology are integrated in the interface that runs on standard personal computers. The available tools, combined to hierarchical data management and custom layouts, allow analyzing of medical imaging data using advanced features outside radiological premises (for example, for patient review, conference presentation or tutorial preparation). The system is free, and based on an open-source software development architecture, and therefore updates of the system for custom applications are possible.

Building an anonymized catalogued radiology museum in PACS: a feasibility study

The aim of this study was to test the feasibility of a software application that would allow the anonymization and cataloguing of whole DICOM datasets in order to build searchable radiology museums within PACS. The application was developed on a dedicated networked PC, using C# and HL7 coding. Whole DICOM datasets were pushed from PACS to a networked PC on which the application, Museum Builder, was developed. Museum Builder works by replacing the patient specific data (the forename, surname and hospital number) within each header of each DICOM file with terms from anatomical and surgical sieve menus. The date of birth is anonymized to 1 January of the same year. Whole DICOM datasets comprising hundreds of images can be anonymized and catalogued in a single episode. Museum Builder primes PACS with an HL7 script to receive a "new" patient. DICOM datasets are then pushed back to PACS where they are added to the database as "new" cases. The museum cases can then be searched for, on PACS, by any combination of terms that correspond to appropriate anatomical units, surgical sieve headings or radiological specialty. New radiology reports containing clinical histories, radiological descriptions, differential diagnoses and discussion can be added through the report window. Our institution has developed and used this tool to generate a PACS based radiology museum containing not only full DICOM datasets, but also relevant histological and clinical photographs. In conclusion, this technique offers a mechanism for generating anonymized catalogued radiology museums in PACS. Museum Builder represents a working prototype that demonstrates some of the archiving functions that are expected by teaching institutions from PACS.

Medical Imaging Resource Center (MIRC) for veterinary medicine: a digital image teaching file

RATIONALE FOR THE STUDY

Veterinary radiology has a need for software to facilitate the creation of digital image teaching files. The Medical Imaging Resource Center (MIRC) is widely used in medicine to create teaching cases and store data from clinical trials. This open-source software was identified as a solution for use in veterinary medicine.

METHODOLOGY

The additional fields needed to adapt the system for veterinary use were identified as sex, species, and breed. Breed and species codes from the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania and from the Standard Nomenclature of Veterinary Diseases and Operations (SNVDO) were gathered and correlated.

RESULTS

The sex fields added were male, male neutered, female, and female neutered. The breed and species codes were combined into a single term. These were coded in eXtensible Markup Language (XML) and added to the software's veterinary document template and search capabilities.

CONCLUSIONS

MIRC was successfully adapted for use in creating digital teaching files for veterinary medicine.

[Digital teaching archive. Concept, implementation, and experiences in a university setting]

Film-based teaching files require a substantial investment in human, logistic, and financial resources. The combination of computer and network technology facilitates the workflow integration of distributing radiologic teaching cases within an institution (intranet) or via the World Wide Web (Internet). A digital teaching file (DTF) should include the following basic functions: image import from different sources and of different formats, editing of imported images, uniform case classification, quality control (peer review), a controlled access of different user groups (in-house and external), and an efficient retrieval strategy. The portable network graphics image format (PNG) is especially suitable for DTFs because of several features: pixel support, 2D-interlacing, gamma correction, and lossless compression. The American College of Radiology (ACR) "Index for Radiological Diagnoses" is hierarchically organized and thus an ideal classification system for a DTF. Computer-based training (CBT) in radiology is described in numerous publications, from supplementing traditional learning methods to certified education via the Internet. Attractiveness of a CBT application can be increased by integration of graphical and interactive elements but makes workflow integration of daily case input more difficult. Our DTF was built with established Internet instruments and integrated into a heterogeneous PACS/RIS environment. It facilitates a quick transfer (DICOM_Send) of selected images at the time of interpretation to the DTF and access to the DTF application at any time anywhere within the university hospital intranet employing a standard web browser. A DTF is a small but important building block in an institutional strategy of knowledge management.

Reinventing the apprenticeship: the hot seat in the digital era

RATIONALE AND OBJECTIVES

Describe new interactive digital teaching methods for medical student education in radiology and evaluate student responses.

MATERIALS AND METHODS

Third- and fourth-year medical students on radiology clerkship were taught using either film-based "hot seat" format, digital "hot seat," or didactic slide-based format. Digital hot seat included direct projection of full-resolution images and use of digital tablet for annotation. Students completed surveys commenting on each method.

RESULTS

Before 2003-2004, comments were available from general course surveys. Only positive responses were made regarding digital hot seat format. Dedicated surveys of teaching methods since July 2003 (23 students) showed 100% gave high ratings to digital hot seat methods (1 or 2 on a scale from 1 to 5), citing easier visibility of findings and ability to draw on images as positive features. Fifty-two percent rated film hot seat method <3, with limited visibility as the main complaint. Didactic slide teaching was rated <3 by 74%. Eighty-three percent chose digital hot seat as their favorite format overall.

CONCLUSIONS

Students overwhelmingly favor digital hot seat teaching over film-based or didactic slide presentations. Digital hot seat methods preserve the best features of case-based interactive teaching while improving visibility of findings.

Casimage project: a digital teaching files authoring environment

The goal of the Casimage project is to offer an authoring and editing environment integrated with the Picture Archiving and Communication Systems (PACS) for creating image-based electronic teaching files. This software is based on a client/server architecture allowing remote access of users to a central database. This authoring environment allows radiologists to create reference databases and collection of digital images for teaching and research directly from clinical cases being reviewed on PACS diagnostic workstations. The environment includes all tools to create teaching files, including textual description, annotations, and image manipulation. The software also allows users to generate stand-alone CD-ROMs and web-based teaching files to easily share their collections. The system includes a web server compatible with the Medical Imaging Resource Center standard (MIRC, http://mirc.rsna.org) to easily integrate collections in the RSNA web network dedicated to teaching files. This software could be installed on any PACS workstation to allow users to add new cases at any time and anywhere during clinical operations. Several images collections were created with this tool, including thoracic imaging that was subsequently made available on a CD-Rom and on our web site and through the MIRC network for public access.

A cost-effective web-based teaching file system

Teaching files are common in radiology. Although there is an increasing role of digital technology in radiology departments, today's teaching files have not yet seen the application of this new technology. This may have been due in part to poor or incomplete implementation in many commercial software packages. We have demonstrated that by utilizing free software from the Internet, a web-based teaching file system, which is easy to use, low cost, and secure, can be created.

Integration of a multimedia teaching and reference database in a PACS environment

In one radiology department, a computerized authoring and editing environment was developed and integrated with the picture archiving and communication systems (PACS) for creation of image-based electronic teaching files to replace a collection of printed film images. This multimedia database and authoring environment allows physicians to create reference databases for teaching and research directly from clinical cases being reviewed on PACS diagnostic workstations. The database engine allows users to generate stand-alone CD-ROMs (compact disks, read-only memory) and World Wide Web-based teaching files. The system is fully compliant with the Digital Imaging and Communications in Medicine (DICOM) standard and supports a large number of standard multimedia image file formats. The focus of the development was on convenience and ease of use of a generic system adaptable to all users. The software was integrated on the PACS workstations to allow users to add new cases to the database at any time and anywhere in the department. A pilot system was implemented in clinical operation, with a central server and several client units.