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Monteiro Cordeiro N, Facina G, Pinto Nazário AC, Monteiro Sanvido V, Araujo Neto JT, Rodrigues Dos Santos E, Domingues da Silva M, Elias S. Towards precision medicine in breast imaging: A novel open mammography database with tailor-made 3D image retrieval for AI and teaching. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 248:108117. [PMID: 38498955 DOI: 10.1016/j.cmpb.2024.108117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 02/29/2024] [Accepted: 03/02/2024] [Indexed: 03/20/2024]
Abstract
This project addresses the global challenge of breast cancer, particularly in low-resource settings, by creating a pioneering mammography database. Breast cancer, identified by the World Health Organization as a leading cause of cancer death among women, often faces diagnostic and treatment resource constraints in low- and middle-income countries. To enhance early diagnosis and address educational setbacks, the project focuses on leveraging artificial intelligence (AI) technologies through a comprehensive database. Developed in collaboration with Ambra Health, a cloud-based medical image management software, the database comprises 941 mammography images from 100 anonymized cases, with 62 % including 3D images. Accessible through http://mamografia.unifesp.br, the platform facilitates a simple registration process and an advanced search system based on 169 clinical and imaging variables. The website, customizable to the user's native language, ensures data security through an automatic anonymization system. By providing high-resolution, 3D digital images and supplementary clinical information, the platform aims to promote education and research in breast cancer diagnosis, representing a significant advancement in resource-constrained healthcare environments.
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Affiliation(s)
| | - Gil Facina
- Federal University of São Paulo, R. Marselhesa, 249 - Vila Mariana, São Paulo, SP 04020-060, Brazil
| | | | - Vanessa Monteiro Sanvido
- Federal University of São Paulo, R. Marselhesa, 249 - Vila Mariana, São Paulo, SP 04020-060, Brazil
| | | | | | | | - Simone Elias
- Federal University of São Paulo, R. Marselhesa, 249 - Vila Mariana, São Paulo, SP 04020-060, Brazil.
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Andriole KP. Picture archiving and communication systems: past, present, and future. J Med Imaging (Bellingham) 2023; 10:061405. [PMID: 38162316 PMCID: PMC10754358 DOI: 10.1117/1.jmi.10.6.061405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 12/15/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
Picture archiving and communication systems (PACS) that digitally acquire, archive, transmit, and display medical images ultimately enabled the transition from an analog film-based operation to a digital workflow revolutionizing radiology. This article briefly traces early generation systems to present-day PACS, noting challenges along with key technological advances and benefits. Thoughts for future PACS evolution are discussed including the promise of integration of artificial intelligence applications.
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Affiliation(s)
- Katherine P. Andriole
- Brigham and Women’s Hospital, Department of Radiology, Harvard Medical School, Boston, Massachusetts, United States
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Kawashima H, Ichikawa K, Kitao A, Matsubara T, Sugiura T, Kobayashi T, Kobayashi S. Radiation dose considerations in digital radiography with an anti-scatter grid: A study using adult and pediatric phantoms. J Appl Clin Med Phys 2023; 24:e14081. [PMID: 37491809 PMCID: PMC10476983 DOI: 10.1002/acm2.14081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 05/23/2023] [Accepted: 06/08/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND When using an anti-scatter grid, a decrease in receptor dose caused by its X-ray absorption seems to lead to the misperception that radiation dose needs to be increased even in digital radiography (DR). OBJECTIVE To demonstrate that there is no need to increase radiation dose in DR with a grid, based on a visual evaluation using an adult and a pediatric abdomen phantom (PAD and PPD , respectively). MATERIALS AND METHODS Phantom images with and without a grid were obtained with exposure parameters determined based on a preliminarily measured signal-to-noise ratio improvement factor (SIF), an index for potential dose reduction when using a grid. In visual evaluation, four radiologists compared phantom images with a grid applied at different dose reduction rates (0% [no reduction], 18%, 36%, and 59% for PAD and 0% and 11% for PPD ) against an image without a grid at the baseline dose (as the reference). They graded the overall image quality of the former relative to that of the latter (reference) on a 3-point scale (3 = better, 2 = almost equal, 1 = worse). RESULTS The mean scores for dose reduction rates of 0%, 18%, 36%, and 59% were 3.00, 3.00, 2.75, and 1.00, respectively, for PAD ; those for 0% and 11% were 2.13 and 1.63, respectively, for PPD . These results support the validity of our view that no dose increase is necessary when using an anti-scatter grid. Actually, there is even a potential for improvement in image quality with dose reduction rates of ≤36% for PAD . CONCLUSION It is worth reconsidering the necessity of increasing radiation dose in the DR imaging of the adult and pediatric abdomens with an anti-scatter grid.
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Affiliation(s)
- Hiroki Kawashima
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health SciencesKanazawa UniversityKanazawaJapan
| | - Katsuhiro Ichikawa
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health SciencesKanazawa UniversityKanazawaJapan
| | - Azusa Kitao
- Department of RadiologyKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Takashi Matsubara
- Department of RadiologyKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Takumi Sugiura
- Department of RadiologyKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Tomohiro Kobayashi
- Department of RadiologyKanazawa University Graduate School of Medical SciencesKanazawaJapan
| | - Satoshi Kobayashi
- Faculty of Health Sciences, Institute of Medical, Pharmaceutical and Health SciencesKanazawa UniversityKanazawaJapan
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Demaerschalk BM, Hollander JE, Krupinski E, Scott J, Albert D, Bobokalonova Z, Bolster M, Chan A, Christopherson L, Coffey JD, Edgman-Levitan S, Goldwater J, Hayden E, Peoples C, Rising KL, Schwamm LH. Quality Frameworks for Virtual Care: Expert Panel Recommendations. MAYO CLINIC PROCEEDINGS: INNOVATIONS, QUALITY & OUTCOMES 2022; 7:31-44. [PMID: 36619179 PMCID: PMC9811201 DOI: 10.1016/j.mayocpiqo.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Given the significant advance of virtual care in the past year and half, it seems timely to focus on quality frameworks and how they have evolved collaboratively across health care organizations. Massachusetts General Hospital's (MGH) Center for TeleHealth and Mass General Brigham's (MGB) Virtual Care Program are committed to hosting annual symposia on key topics related to virtual care. Subject matter experts across the country, health care organizations, and academic medical centers are invited to participate. The inaugural MGH/MGB Virtual Care Symposium, which focused on rethinking curriculum, competency, and culture in the virtual care era, was held on September 2, 2020. The second MGH/MGB Virtual Care Symposium was held on November 2, 2021, and focused on virtual care quality frameworks. Resultant topics were (1) guiding principles necessary for the future of virtual care measurement; (2) best practices deployed to measure quality of virtual care and how they compare and align with in-person frameworks; (3) evolution of quality frameworks over time; (4) how increased adoption of virtual care has impacted patient access and experience and how it has been measured; (5) the pitfalls and barriers which have been encountered by organizations in developing virtual care quality frameworks; and (6) examples of how quality frameworks have been applied in various use cases. Common elements of a quality framework for virtual care programs among symposium participants included improving the patient and provider experience, a focus on achieving health equity, monitoring success rates and uptime of the technical elements of virtual care, financial stewardship, and clinical outcomes. Virtual care represents an evolution in the access to care paradigm that helps keep health care aligned with other modern industries in digital technology and systems adoption. With advances in health care delivery models, it is vitally important that the quality measurement systems be adapted to include virtual care encounters. New methods may be necessary for asynchronous transactions, but synchronous virtual visits and consults can likely be accommodated in traditional quality frameworks with minimal adjustments. Ultimately, quality frameworks for health care will adapt to hybrid in-person and virtual care practices.
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Affiliation(s)
- Bart M. Demaerschalk
- Department of Neurology, Mayo Clinic College of Medicine and Science and Center for Digital Health, Mayo Clinic, Phoenix, AZ,Correspondence: Address to Bart M. Demaerschalk, MD, M.Sc., Mayo Clinic College of Medicine and Science and Center for Digital Health Mayo Clinic, Phoenix, 13400 East Shea Boulevard, Scottsdale, AZ 85259.
| | - Judd E. Hollander
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Elizabeth Krupinski
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta GA
| | | | - Daniel Albert
- Geisel School of Medicine and Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Marcy Bolster
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | - Albert Chan
- Department of Medicine, Division of Biomedical Informatics Research, Stanford University School of Medicine, Stanford, CA
| | - Laura Christopherson
- Mayo Clinic Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Jordan D. Coffey
- Mayo Clinic Center for Digital Health, Mayo Clinic College of Medicine and Science, Rochester, MN
| | - Susan Edgman-Levitan
- The John D. Stoekle Center for Primary Care Innovation, Massachusetts General Hospital, Boston, MA
| | | | - Emily Hayden
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
| | | | - Kristin L. Rising
- Jefferson Center for Connected Care, Thomas Jefferson University, Philadelphia, PA
| | - Lee H. Schwamm
- Harvard Medical School and Massachusetts General Hospital, Boston, MA
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Treviño M, Birdsong G, Carrigan A, Choyke P, Drew T, Eckstein M, Fernandez A, Gallas BD, Giger M, Hewitt SM, Horowitz TS, Jiang YV, Kudrick B, Martinez-Conde S, Mitroff S, Nebeling L, Saltz J, Samuelson F, Seltzer SE, Shabestari B, Shankar L, Siegel E, Tilkin M, Trueblood JS, Van Dyke AL, Venkatesan AM, Whitney D, Wolfe JM. Advancing Research on Medical Image Perception by Strengthening Multidisciplinary Collaboration. JNCI Cancer Spectr 2021; 6:6491257. [DOI: 10.1093/jncics/pkab099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 10/20/2021] [Accepted: 11/11/2021] [Indexed: 11/14/2022] Open
Abstract
Abstract
Medical image interpretation is central to detecting, diagnosing, and staging cancer and many other disorders. At a time when medical imaging is being transformed by digital technologies and artificial intelligence, understanding the basic perceptual and cognitive processes underlying medical image interpretation is vital for increasing diagnosticians’ accuracy and performance, improving patient outcomes, and reducing diagnostician burn-out. Medical image perception remains substantially understudied. In September of 2019, the National Cancer Institute convened a multidisciplinary panel of radiologists and pathologists together with researchers working in medical image perception and adjacent fields of cognition and perception for the “Cognition and Medical Image Perception Think Tank.” The Think Tank’s key objectives were: to identify critical unsolved problems related to visual perception in pathology and radiology from the perspective of diagnosticians; to discuss how these clinically relevant questions could be addressed through cognitive and perception research; to identify barriers and solutions for transdisciplinary collaborations; to define ways to elevate the profile of cognition and perception research within the medical image community; to determine the greatest needs to advance medical image perception; and to outline future goals and strategies to evaluate progress. The Think Tank emphasized diagnosticians’ perspectives as the crucial starting point for medical image perception research, with diagnosticians describing their interpretation process and identifying perceptual and cognitive problems that arise. This paper reports the deliberations of the Think Tank participants to address these objectives and highlight opportunities to expand research on medical image perception.
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Affiliation(s)
- Melissa Treviño
- National Cancer Institute, United States of America
- National Center for Complementary and Integrative Health, United States of America
| | - George Birdsong
- Emory University School of Medicine, United States of America
| | | | - Peter Choyke
- National Cancer Institute, United States of America
| | | | - Miguel Eckstein
- University of California, Santa Barbara, United States of America
| | - Anna Fernandez
- National Cancer Institute, United States of America
- Booz Allen Hamilton, United States of America
| | | | | | | | | | | | - Bonnie Kudrick
- Transportation Security Administration, United States of America
| | | | | | | | - Joseph Saltz
- Stony Brook University, United States of America
| | | | - Steven E Seltzer
- Brigham and Women’s Hospital, United States of America
- Harvard Medical School, United States of America
| | - Behrouz Shabestari
- National Institute of Biomedical Imaging and Bioengineering, United States of America
| | | | - Eliot Siegel
- University of Maryland School of Medicine, United States of America
| | - Mike Tilkin
- American College of Radiology, United States of America
| | | | | | | | - David Whitney
- University of California, Berkeley, United States of America
| | - Jeremy M Wolfe
- Brigham and Women’s Hospital, United States of America
- Harvard Medical School, United States of America
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Singh T, Muscroft N, Collier N, England A. A comparison of effective dose and risk for different collimation options used in AP shoulder radiography. Radiography (Lond) 2021; 28:394-399. [PMID: 34887196 DOI: 10.1016/j.radi.2021.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/01/2021] [Accepted: 11/19/2021] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Radiography forms the cornerstone of the evaluation of shoulder disorders. While the benefits of radiography exceed the risks, there continues to be a compelling case for reduction of radiation exposure from diagnostic radiography. The aim of this project was to evaluate the radiation dose and risk for a variety of collimation settings used during anteroposterior (AP) shoulder radiography. METHODS This was a phantom based study where an ATOM adult dosimetry phantom was loaded with 272 thermoluminescent dosimeters (TLDs). Following loading, the phantom was setup for an AP shoulder X-ray projection with standard 25 × 30 cm rectangular collimation. The phantom was exposed three times and then the TLDs were removed and read. The experiment was repeated using a diamond shaped collimation and rectangular collimation with a minimum field of view to portray only relevant anatomy. Using the TLD dose measurements the effective doses and radiation risks were determined and compared. RESULTS As expected, organs neighbouring the shoulder experienced the highest absorbed doses (greater than 0.01 mGy); these organs included breast, lung and thyroid gland. The effective doses for standard rectangular, small rectangular and diamond collimation were 0.011, 0.008 and 0.016 mSv, respectively. When compared to standard collimation, a small field of view reduced effective dose by 27.3% and when moving to a diamond shape there was a 45.5% increase. The differences are likely driven by differences in the coverage of the radiosensitive lung and breast tissue. CONCLUSION By utilising a variety of different collimation settings, effective dose can be reduced. Reducing the radiation dose is both financially beneficial and results in a lower stochastic risk for patients. Image quality must also be considered when choosing different collimation settings. It stands to reason that by reducing the field size, dose will be reduced, and our study has served to quantify the effects in a practical situation. IMPLICATIONS FOR PRACTICE The utilisation of smaller/tight collimation is recommended as it offers the lowest dose when compared with other types of collimations. Although well-known this study serves to remind practitioners of the practical importance of collimation and is associated effect on effective dose and risk.
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Affiliation(s)
- T Singh
- School of Allied Health Professions, Keele University, Keele, Staffordshire, UK
| | - N Muscroft
- Warrington & Halton Teaching Hospitals NHS Trust, Warrington, UK
| | - N Collier
- Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - A England
- School of Allied Health Professions, Keele University, Keele, Staffordshire, UK; Discipline of Medical Imaging, School of Medicine, University College Cork, Ireland.
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Guðjónsdóttir J, Paalsson KE, Sveinsdóttir GP. Are the target exposure index and deviation index used efficiently? Radiography (Lond) 2021; 27:903-907. [PMID: 33707050 DOI: 10.1016/j.radi.2021.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 02/19/2021] [Accepted: 02/21/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Exposure index (EI) is important to evaluate correct exposure in radiography and thus important for image quality. The purpose of this study was to evaluate whether the target exposure index (EIT) and deviation index (DI) were used efficiently. METHODS Radiography departments in Iceland, using <10 years old equipment, were invited to participate. For each x-ray unit, admin users were asked about the use of EIT and data was gathered on EIT for five body parts (BP); lumbar spine, chest, hip, knee and hand. For each of the five BP, 100 examinations from the past year were selected randomly (or all, if < 100). The EI from one predefined view was recorded and the corresponding DI calculated. RESULTS A total of ten x-ray units, from four manufacturers and located at eight departments, were included in the study. The departments involved are comprised of a university hospital, smaller hospitals, and miscellaneous private departments. Two departments (25%) had not set EIT, five (62.5%) used default values and only one had revised EIT values. In four departments (50%) radiographers favored "acceptable EI range" over DI. The mean EI was significantly different (p < 0.05) from the EIT in the majority of the five BP, in four out of the six departments that had defined EIT. In total 30% of images from all departments combined had DI outside the range of -3.0 < DI < +3.0. The standard deviation of DI was from 1.4 to 2.7. CONCLUSION The study shows that the EIT and DI are not used efficiently, regardless of equipment vendor or department characteristics. IMPLICATIONS FOR PRACTICE Current recommendations on targeting the mean DI of 0 need to be reinforced. Theoretical knowledge and training need to be improved.
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Affiliation(s)
- J Guðjónsdóttir
- University of Iceland, Faculty of Medicine, Radiography, Stapa við Hringbraut 31, 101 Reykjavík, Iceland; Icelandic Radiation Safety Authority, Rauðarárstígur 10, 105 Reykjavík, Iceland.
| | - K E Paalsson
- Landspítali - the National University Hospital of Iceland, 101 Reykjavík, Iceland
| | - G P Sveinsdóttir
- University of Iceland, Faculty of Medicine, Radiography, Stapa við Hringbraut 31, 101 Reykjavík, Iceland.
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Kunitomo H, Ichikawa K. Signal-to-noise ratio improvements using anti-scatter grids with different object thicknesses and tube voltages. Phys Med 2020; 73:105-110. [DOI: 10.1016/j.ejmp.2020.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2019] [Revised: 02/29/2020] [Accepted: 04/15/2020] [Indexed: 10/24/2022] Open
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Durmaz FA, Brusan A, Ozturk C. Unified Open Hardware Platform for Digital X-Ray Devices; its Conceptual Model and First Implementation. IEEE JOURNAL OF TRANSLATIONAL ENGINEERING IN HEALTH AND MEDICINE 2020; 8:1800311. [PMID: 32617198 PMCID: PMC7326152 DOI: 10.1109/jtehm.2020.3000011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/05/2020] [Accepted: 05/06/2020] [Indexed: 11/27/2022]
Abstract
Background: Digital radiography devices are still the gold standard for diagnosis or therapy guidance in medicine. Despite the similarities between all direct digital x-ray systems, researchers and new companies face significant challenges during the development phase of innovative x-ray devices; each component is manufactured independently, guidance towards device integration from manufacturers is limited, global standards for device integration is lacking. Method: In scope of this study a plug-integrate-play (PIP) conceptual model for x-ray imaging system is introduced and implemented as an open hardware platform, SyncBox. The researchers are free to select each individual device component from different vendors based on their intended application and target performance are utilized in criteria. Result: As its first implementation, SyncBox and its platform a full body high resolution radiographic scanner that employs a novel TDI digital detector. Conclusion: We believe that SyncBox has a potential for introducing an open source hardware platform to x-ray equipment design.
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Affiliation(s)
- F Aytac Durmaz
- Institute of Biomedical Engineering, Boğaziçi University34684IstanbulTurkey
- Durmaz Technology AS34684IstanbulTurkey
- Pievision AS34684IstanbulTurkey
| | - Altay Brusan
- Institute of Biomedical Engineering, Boğaziçi University34684IstanbulTurkey
- Durmaz Technology AS34684IstanbulTurkey
| | - Cengizhan Ozturk
- Institute of Biomedical Engineering, Boğaziçi University34684IstanbulTurkey
- Center of Life Sciences and TechnologiesBoğaziçi University34684IstanbulTurkey
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Raveendran S, Thomas BP, Jayaseelan V. The Efficiency of WhatsApp in Teleconsultation of Finger Vascularity in Hand Surgery. J Hand Microsurg 2019; 12:163-167. [PMID: 33408441 DOI: 10.1055/s-0039-1683458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Background Teleconsultation over the smartphone is now widely used in modern medicine in the management of burns, flap cover, upper extremity trauma, and in the assessment of the feasibility of reimplantation in amputated fingers. The development of the WhatsApp application has enhanced the smartphone's efficiency remarkably to transmit images in clinical and academic settings with its failsafe and encrypted technology. In hand surgery, a teleconsultation technology must communicate details of finger vascularity effectively. However, there is a paucity of evidence on the functionality of these modern teleconsultation technologies in Hand Surgery. Here, the authors have estimated the efficiency of the WhatsApp teleconsultation in the assessment of finger vascularity. Materials and Methods In two phases, the authors transmitted clinical photographs of vascular and avascular fingers to experienced hand surgeons over the WhatsApp and asked them to assess the finger vascularity. The efficiency of the WhatsApp teleconsultation in assessing the details of finger vascularity was estimated from their responses. Results Despite 81.06% of the hand surgeons rating the vascular fingers on the transmitted photographs correctly, only 44.95% detected the avascular digits accurately; that is, 55.05% of the surgeons failed to diagnose the avascularity of fingers. This suggests serious implications in a clinical setting. The intra- and the inter-rater reliability values were 0.232 and 0.6086 (with 95% confidence interval), respectively, which indicated poor reliability of the WhatsApp teleconsultation regarding the assessment of finger vascularity. Conclusion The authors, therefore, conclude that WhatsApp is inadequate in teleconsultation given the value of vascularity details of the fingers in making a diagnosis in hand surgery.
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Affiliation(s)
- Sreekanth Raveendran
- Dr. Paul Brand Centre for Hand Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Binu Prathap Thomas
- Dr. Paul Brand Centre for Hand Surgery, Christian Medical College Vellore, Vellore, Tamil Nadu, India
| | - Visalakshi Jayaseelan
- Department of Biostatistics, Christian Medical College Vellore, Vellore, Tamil Nadu, India
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Tsalafoutas IA. Electronic collimation of radiographic images: does it comprise an overexposure risk? Br J Radiol 2018; 91:20170958. [PMID: 29544343 PMCID: PMC6223295 DOI: 10.1259/bjr.20170958] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 02/21/2018] [Accepted: 03/13/2018] [Indexed: 01/05/2023] Open
Abstract
OBJECTIVE To investigate whether electronic collimation software, which is available in all digital X-ray systems, may comprise an overexposure risk. METHODS In the context of surveys on Diagnostic Reference Levels carried out in two radiographic facilities, along with data on exposure factors, the radiographic field sizes were also recorded. In one facility (Unit A), a wireless flat panel detector is used with a conventional X-ray unit, while in the other, a fully digital system is installed (Unit B). The electronically collimated image sizes were compared with the original radiation field sizes. The differences between these two systems concerning the field sizes and the mode of electronic collimation utilization were investigated. RESULTS In Unit A, manual electronic collimation was extensively used and cases where the radiation field size was up to three times larger than that electronically collimated, were identified. On the contrary, in Unit B radiation fields were smaller and electronic collimation was automatic. CONCLUSION When electronic collimation is used in manual mode instead of proper pre-exposure collimation, then it does comprise an overexposure risk. The risk is larger in radiographic units where the field size is not automatically selected according to the examination protocol and no interlocks against oversized collimation settings exist. Advances in knowledge: When radiologists review masked images to make the diagnosis, possible suboptimal X-ray field collimation practices may go unnoticed for long. Therefore, radiologists and medical physicists should periodically survey the original images to determine the actual radiation field sizes used for each radiographic examination type.
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Affiliation(s)
- Ioannis A Tsalafoutas
- Medical Physics Department, General Anticancer Oncology Hospital of Athens ‘Agios Savvas’, Athens, Greece
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Zheng X. PATIENT SIZE BASED GUIDING EQUATIONS FOR AUTOMATIC mAs AND kVp SELECTIONS IN GENERAL MEDICAL X-RAY PROJECTION RADIOGRAPHY. RADIATION PROTECTION DOSIMETRY 2017; 174:545-550. [PMID: 27574322 DOI: 10.1093/rpd/ncw246] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 07/27/2016] [Indexed: 06/06/2023]
Abstract
A patient size based guiding equation for the automatic selections of mAs and peak voltage kVp in general medical X-ray projection radiography was derived from the first principles of dose and image quality optimization. Under various specific conditions of constant patient size d, kVp or mAs, this equation leads to various longstanding 'rules of thumbs' currently being employed in clinical practice. For automatic mAs control, this work suggests that the current level of dose to patient in X-ray radiography should be halved without compromise image quality. Further studies on the dependence of the absorbed dose on the patient's thickness are required in general X-ray projection radiography.
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Affiliation(s)
- Xiaoming Zheng
- Medical Radiation Science, School of Dentistry and Health Sciences, Faculty of Science, Charles Sturt University, Wagga Wagga, New South Wales2678, Australia
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Scott AW, Zhou Y, Allahverdian J, Nute JL, Lee C. Evaluation of digital radiography practice using exposure index tracking. J Appl Clin Med Phys 2016; 17:343-355. [PMID: 27929507 PMCID: PMC5690495 DOI: 10.1120/jacmp.v17i6.6082] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 07/07/2016] [Accepted: 07/03/2016] [Indexed: 11/23/2022] Open
Abstract
Some digital radiography (DR) detectors and software allow for remote download of exam statistics, including image reject status, body part, projection, and exposure index (EI). The ability to have automated data collection from multiple DR units is conducive to a quality control (QC) program monitoring institutional radiographic exposures. We have implemented such a QC program with the goal to identify outliers in machine radiation output and opportunities for improvement in radiation dose levels. We studied the QC records of four digital detectors in greater detail on a monthly basis for one year. Although individual patient entrance skin exposure varied, the radiation dose levels to the detectors were made to be consistent via phototimer recalibration. The exposure data stored on each digital detector were periodically downloaded in a spreadsheet format for analysis. EI median and stan-dard deviation were calculated for each protocol (by body part) and EI histograms were created for torso protocols. When histograms of EI values for different units were compared, we observed differences up to 400 in average EI (representing 60% difference in radiation levels to the detector) between units nominally cali-brated to the same EI. We identified distinct components of the EI distributions, which in some cases, had mean EI values 300 apart. Peaks were observed at the current calibrated EI, a previously calibrated EI, and an EI representing computed radiography (CR) techniques. Our findings in this ongoing project have allowed us to make useful interventions, from emphasizing the use of phototimers instead of institutional memory of manual techniques to improvements in our phototimer calibration. We believe that this QC program can be implemented at other sites and can reveal problems with radiation levels in the aggregate that are difficult to identify on a case-by-case basis.
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Abstract
The interpretation of medical images across medical specialties is critical to patient care. As technology changes, so does health care, and clinicians today are increasingly viewing medical images in a variety of environments. Although access to such data is useful, even clinicians with expertise in image interpretation make errors. These errors may become more frequent as clinician workdays become longer and the number of images to be interpreted becomes larger. To prevent errors in medical image interpretation, we need to understand the underlying perceptual and cognitive mechanisms that guide image interpretation. We can then use what is learned to develop better training methods, automated image analysis, and processing tools. We can devise methods to reduce clinician fatigue and stress, and develop practice guidelines thereby improving patient care and outcomes.
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Quality-controlled dose reduction of full-leg radiography in patients with knee malalignment. Skeletal Radiol 2015; 44:423-9. [PMID: 25476156 DOI: 10.1007/s00256-014-2004-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 08/13/2014] [Accepted: 09/02/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Digital plain radiographs of the full leg are frequently performed examinations of children and young adults. Thus, the objective of this work was to reduce the radiation exposure dependent on specific indications, and to determine objective quality-control criteria to ensure accurate assessment. MATERIALS AND METHODS Institutional review board approval and informed consent of all participants were obtained. In this prospective, randomized controlled, blinded, two-armed single-center study, 288 evaluable patients underwent plain radiography of the full leg with standard and reduced doses. The evaluation of the plain radiographs was conducted using the following criteria: mechanical axis, leg length, and maturation of the epiphyseal plate. Two blinded radiologists evaluated these criteria using a score ranging from 1 (definitely assessable) to 4 (not assessable). If a single criterion had been evaluated with a score of 3 or more points or all criteria with 2 points, the radiograph was scored as "not assessable". The study was designed as a non-inferiority trial. RESULTS Eleven (3.8%) examined X-rays were scored as not assessable. The rate of non-assessable radiographs with 33% reduced dose was significantly not inferior to the rate of non-assessable radiographs with standard dose. The evaluation of the quality criteria was dose independent. CONCLUSIONS Full-leg plain radiography in patients with knee malalignment can be performed at 33% reduced dose without loss of relevant diagnostic information.
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Hirschorn DS, Krupinski EA, Flynn MJ. PACS Displays: How to Select the Right Display Technology. J Am Coll Radiol 2014; 11:1270-6. [DOI: 10.1016/j.jacr.2014.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
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Abstract
At the end of the millennium, cone-beam computed tomography (CBCT) heralded a new dental technology for the next century. Owing to the dramatic and positive impact of CBCT on implant dentistry and orthognathic/orthodontic patient care, additional applications for this technology soon evolved. New software programs were developed to improve the applicability of, and access to, CBCT for dental patients. Improved, rapid, and cost-effective computer technology, combined with the ability of software engineers to develop multiple dental imaging applications for CBCT with broad diagnostic capability, have played a large part in the rapid incorporation of CBCT technology into dentistry.
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Affiliation(s)
- Kenneth Abramovitch
- Loma Linda University School of Dentistry, 11092 Anderson Street, Loma Linda, CA 92354, USA.
| | - Dwight D Rice
- Loma Linda University School of Dentistry, 11092 Anderson Street, Loma Linda, CA 92354, USA
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Mothiram U, Brennan PC, Lewis SJ, Moran B, Robinson J. Digital radiography exposure indices: A review. J Med Radiat Sci 2014; 61:112-8. [PMID: 26229645 PMCID: PMC4175837 DOI: 10.1002/jmrs.49] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Revised: 02/13/2014] [Accepted: 03/04/2014] [Indexed: 01/13/2023] Open
Abstract
Digital radiography (DR) technologies have the advantage of a wide dynamic range compared to their film-screen predecessors, however, this poses a potential for increased patient exposure if left unchecked. Manufacturers have developed the exposure index (EI) to counter this, which provides radiographers with feedback on the exposure reaching the detector. As these EIs were manufacturer-specific, a wide variety of EIs existed. To offset this, the international standardised EI has been developed by the International Electrotechnical Commission (IEC) and the American Association of Physicists in Medicine (AAPM). The purpose of this article is to explore the current literature relating to EIs, beginning with the historical development of the EI, the development of the standardised EI and an exploration of common themes and studies as evidenced in the research literature. It is anticipated that this review will provide radiographers with a useful guide to understanding EIs, their application in clinical practice, limitations and suggestions for further research.
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Affiliation(s)
- Ursula Mothiram
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Science, University of SydneySydney, New South Wales, Australia
| | - Patrick C Brennan
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Science, University of SydneySydney, New South Wales, Australia
| | - Sarah J Lewis
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Science, University of SydneySydney, New South Wales, Australia
| | | | - John Robinson
- Medical Imaging Optimisation and Perception Group (MIOPeG), Discipline of Medical Radiation Sciences, Faculty of Health Science, University of SydneySydney, New South Wales, Australia
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Standards and Guidelines in Telemedicine and Telehealth. Healthcare (Basel) 2014; 2:74-93. [PMID: 27429261 PMCID: PMC4934495 DOI: 10.3390/healthcare2010074] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 01/14/2014] [Accepted: 02/07/2014] [Indexed: 02/08/2023] Open
Abstract
The development of guidelines and standards for telemedicine is an important and valuable process to help insure effective and safe delivery of quality healthcare. Some organizations, such as the American Telemedicine Association (ATA), have made the development of standards and guidelines a priority. The practice guidelines developed so far have been well received by the telemedicine community and are being adopted in numerous practices, as well as being used in research to support the practice and growth of telemedicine. Studies that utilize published guidelines not only help bring them into greater public awareness, but they also provide evidence needed to validate existing guidelines and guide the revision of future versions. Telemedicine will continue to grow and be adopted by more healthcare practitioners and patients in a wide variety of forms not just in the traditional clinical environments, and practice guidelines will be a key factor in fostering this growth. Creation of guidelines is important to payers and regulators as well as increasingly they are adopting and integrating them into regulations and policies. This paper will review some of the recent ATA efforts in developing telemedicine practice guidelines, review the role of research in guidelines development, review data regarding their use, and discuss some of areas where guidelines are still needed.
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Hunter TB, Krupinski EA, Weinstein RS. Factors in the selection of a teleradiology provider in the United States. J Telemed Telecare 2013; 19:354-9. [PMID: 24163300 DOI: 10.1177/1357633x13503428] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Commercial teleradiology is well established in the US. There are many factors to consider when engaging a teleradiology provider. One of the basic questions is what do you expect to gain from it? Do you want a final reading from an attending radiologist (known as a consultant radiologist in many countries) or would you be satisfied with a preliminary reading from a teleradiology provider and a final reading from your own in-house radiologist the following day? Do you simply require after-hours coverage or do you need to supplement the coverage provided by your own internal radiologists during normal working hours? Teleradiology is not without its drawbacks. It can add additional costs, particularly for after-hours coverage. Teleradiology rarely provides in-house coverage for procedures, and the interpreting radiologist may sometimes be difficult to contact for consultation. Choosing a teleradiology vendor requires due diligence. When the contracting entity defines its expectations well and chooses its teleradiology vendor with care, the end result will be satisfactory for all concerned, including the patients.
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Affiliation(s)
- Tim B Hunter
- Department of Medical Imaging, University of Arizona, Tucson, Arizona, USA
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