The networked multimedia textbook: distributing radiology multimedia information across the Internet

Joint Photographic Experts Group compression of intraoral radiographs for image transmission on the World Wide Web

OBJECTIVE

The purpose of this study was to evaluate the subjective quality of Joint Photographic Experts Group (JPEG) compressed images of intraoral radiographs with file sizes of 30 kilobytes or less, which can be transmitted quickly on the World Wide Web.

STUDY DESIGN

Conventional intraoral radiographs were digitized at sampling rates of 100, 200, 300, 400, and 600 dots per inch through use of a flatbed scanner and saved in JPEG format in 11 compression degrees. Fifty-five combinations of sampling rate and compression degree were evaluated by means of a visual analog scale. Sampling rate and compression degree combinations whose quality was inferior to that of an average image were excluded. The quality of the remaining combinations was subsequently evaluated through assessment of 8 anatomical features in each image.

RESULTS

Forty of the 55 combinations provided a file size less than 30 kilobytes. Thirty combinations obtained VAS scores of 0 or higher on the standardized VAS. As a result, 16 combinations of sampling and compression conditions were selected for the second part of the study. Only one combination of sampling rate and compression degree was found to provide sufficient image quality for all 8 anatomical features.

CONCLUSIONS

Under the file size limit of the study design, the full-sized compressed image of an intraoral radiograph did not always provide sufficient quality. This problem will be reduced by improvements in telecommunications infrastructure, which will permit faster transfer of files of larger size.

Online continuing dental education

BACKGROUND

An increasing number of continuing dental education, or CDE, courses are available on the Internet. The authors conducted this study to determine general characteristics of online CDE course offerings.

METHODS

The authors found online CDE courses through Internet search engines and dental indexes. They recorded each course's Web page address, title, topic, length, credit hours and cost. Then they classified course providers, categorized topics, compared course length with credit hours and calculated cost per credit hour.

RESULTS

The authors located 157 online CDE courses offered by 32 providers. The courses covered a wide range of topics, and most were five screens long or shorter. Credit hours per screen ranged from 0.05 to two, and cost per credit hour ranged from no charge to $25.

CONCLUSIONS

Online CDE courses are hard to locate, making this material accessible only to people who are well-versed in retrieving information on the Internet. The brevity of most courses may make them appropriate for incremental study at the dental practitioner's convenience. Guidelines to correlate credit hours with course length should be developed.

PRACTICE IMPLICATIONS

Online CDE courses may become an important tool to help practitioners keep current. Several issues, however, need to be addressed before online CDE can reach its full potential.

"Robo-Rad": an inexpensive user-friendly multimedia report system for radiology

BACKGROUND AND PURPOSE

The complex information obtained by CT, MR, and ultrasound examinations is often difficult to convey with a written report. Today's multimedia computer technology provides a medium within which the audio and the visual components of a radiologic consultation can be made available simultaneously, with the projected capability of remote access from any personal computer. A system was developed to run on low-end computer systems with image quality adequate for reporting purposes and prudent memory management (each report occupies < 4 MB). With this system-"Robo-Rad"-the image and radiologist are recorded simultaneously while he or she describes and points out (with a mouse) areas of interest. This dynamic report, along with patient data, can be retrieved and viewed by the consulting physician at his/her convenience using a low-end PC or Macintosh computer.

MATERIALS AND METHODS

To assess the clinical utility of Robo-Rad, survey responses were solicited from clinical physicians at the Penn State University Hospital (41.5% faculty/fellows, 31.7% residents, 11.8% medical students, 2% clinical nursing; n = 101) during a hands-on demonstration using studies of 35 consecutive inpatients whose CT scans had been dictated into the system.

RESULTS

In an average week, the surveyed professionals ordered 3.2 +/- 3.0 CT studies, reviewed 3.8 +/- 3.0 CTs, spent 1.5 +/- 2.0 hours locating Ct studies, and discussed 2.3 +/- 1.9 CT cases with a radiologist. The average time spent discussing a single CT case with a radiologist was reported as 9.4 +/- 5.9 minutes. On a five-point rating scale (1 = not at all to 5 = very much so), respondents indicated that the Robo-Rad report was helpful (4.3 +/- 0.7) and provided clinically important information that would be difficult to convey with current dictation systems (4.2 +/- 0.8). Desire to discuss the case with a radiologist in addition to viewing the Robo-Rad report scored 3.2 +/- 1.0. If such a system were readily available, 91.8% of the respondents indicated that they would use it in addition to the currently available written report and audio dictation system, and 96.6% would use it instead of the current system. Local area network and modems were the modalities of highest interest for remote access (69.3% and 44.6%, respectively).

CONCLUSIONS

Judging by these data, the Robo-Rad system would be of benefit to clinicians. It provides a user-friendly, low-cost multimedia radiology report utilizing readily available technology to improve radiologist-clinician communication.

A network-based training environment: a medical image processing paradigm

The capability of interactive multimedia and Internet technologies is investigated with respect to the implementation of a distance learning environment. The system is built according to a client-server architecture, based on the Internet infrastructure, composed of server nodes conceptually modelled as WWW sites. Sites are implemented by customization of available components. The environment integrates network-delivered interactive multimedia courses, network-based tutoring, SIG support, information databases of professional interest, as well as course and tutoring management. This capability has been demonstrated by means of an implemented system, validated with digital image processing content, specifically image enhancement. Image enhancement methods are theoretically described and applied to mammograms. Emphasis is given to the interactive presentation of the effects of algorithm parameters on images. The system end-user access depends on available bandwidth, so high-speed access can be achieved via LAN or local ISDN connections. Network based training offers new means of improved access and sharing of learning resources and expertise, as promising supplements in training.

Development of interactive patient-based multimedia computer programs in veterinary orthopedic radiology

Three computerized multimedia programs on large and small animal veterinary orthopedic radiology were developed and implemented for the radiology curriculum as an alternative to traditional film-based laboratory learning. Programs utilized "hot words" (colored text words that displayed an overlaid image label that highlighted lesions) and interactive quizzes which responded appropriately to selected answers. "Hot words" helped students develop confidence in accurate lesion detection and the interactive quizzes transformed learning from a passive to an active process. Multiple examples were provided for reinforcement and concepts were incorporated from other clinical disciplines for curriculum integration. Programs were written using a presentation software program, Toolbook for DOS based platform, and contained radiographic images made by laser-scanning digitization. Multiple students could simultaneously access the programs through a network server. These pilot programs were implemented successfully and computerized multimedia presentation proved to be well suited to teaching radiology. Development of the programs required attention to a number of hardware, software, time and cost factors.

Distance learning in mammographic digital image processing

The potential of interactive multimedia and Internet technologies is investigated with respect to the implementation of a distance learning system in medical imaging. The system is built according to a client-server architecture, based on the Internet infrastructure, composed of server nodes conceptually modelled as World Wide Web (WWW) sites. Sites are implemented by integration and customization of available components. The system evolves around network-delivered interactive multimedia courses and network-based tutoring, which constitute its main learning features. This potential has been demonstrated by means of an implemented system, validated with digital image processing content, specifically image enhancement. Image enhancement methods are theoretically described and applied on mammograms. Emphasis is given in the interactive presentation of the effects of algorithm parameters on images. The system end-user access depends on available bandwidth, so high speed access can be achieved via LAN or local ISDN connections.

Implementation of an electronic teaching file using web technology

The implementation of an electronic teaching file using web technology is discussed in this article. A web client server model is used for a standard web browser capable of displaying joint photographic Experts Group (JPEG) compression images. Like other web-based teaching files, this teaching file in a similar way uses a database containing information. This database section of the teaching file allows flexible database querying and viewing of pages generated by hypertext markup language (HTML). Because the browser client is so flexible, images types such as video and 3D representations with virtual reality markup language (VRML) can be displayed.

Applications of the World Wide Web to neurosurgical practice

OBJECTIVE

The objectives of the New York University (NYU) neurosurgery Web resource are the following: 1) to educate patients and families of patients who have neurosurgical problems, 2) to provide a forum for communication among neurosurgeons and other physicians, 3) to educate neurosurgeons, and 4) to provide neurosurgeons with resources for enhancing their practices.

METHODS

The NYU neurosurgery Web resource resides on a Sun SparcStation 20, running Solaris 1.0 and National Center for Supercomputing Applications httpd 1.0. It is aimed at a broad audience that includes the general public as well as practicing neurosurgeons and other physicians. Accordingly, general information regarding a variety of neurosurgical problems is presented in easy-to-understand language. Material intended specifically for neurosurgeons, such as case discussions, is designed to stimulate discussion and encourage outside submissions. Interaction with the NYU faculty and residents may be accomplished by using electronic mail, file transfer protocol, and direct Web postings. Media in development include java applets and real-time video over the Internet. The uniform resource locator for the NYU neurosurgery Web site is "http:/(/)mcns10.med.nyu.edu/".

RESULTS

The Web site has averaged 1800 accesses per month, and 5 to 10 electronic mail messages are received daily. Several patients for whom our faculty have held consultations over the Web have undergone surgery at NYU. The most popular areas of the Web site are the spinal surgery section and the brain tumors section.

CONCLUSION

The ability to capitalize on the World Wide Web as a facile user is becoming an increasingly important skill for the modern neurosurgeon. In addition, Web sites published by neurosurgeons offer opportunities for communication and consultation that have previously been impossible.

Use of the Internet for educational applications in prosthodontics

Internet is the common term for the information superhighway. The Internet has become a major information resource for educational, governmental, and business institutions. This article reviews the current operation of the Internet as a background for discussing educational opportunities for instruction in prosthodontics. Electronic mail, news groups, file transfer protocol, Gopher, and network navigators are discussed. The use of the World Wide Web for educational purposes by The Ohio State University College of Dentistry Department of Restorative and Prosthetic Dentistry is described.

Neurosurgery and the Internet: a critical analysis and a review of available resources

Thanks to the development of computers and telecommunication, the concept of communication is undergoing radical changes. Scientific collaboration among medical professionals has evolved rapidly in the last few years toward the use of Internet, a new tool which will change the world of health. It is impossible to predict at present where this new type of scientific collaboration will lead us, but what is certain is that in the next decade, the so-called electronic communities will be created and will develop at an extraordinary rate. The increase in the capacity of image processing in computers and in the rate of transmission of data over the net will make possible applications such as the remote medical visit, video conferences, surgical simulation or even remote virtual surgery. However, while some medical professionals are dreaming of this type of electronic communication in the future, others are using it right now, taking advantage of all of its benefits. In fact, electronic communities are already a reality, being accessible today, and not a future goal. Being inside or outside these communities will make the difference between health professionals. It is well worth therefore being in contact with these new fields so as not to miss the boat of technological development. We present a comprehensive listing of neurosurgical resources available on the Internet, and some ideas on the present and future applications of the Internet in the world of Health Care.

A model for storage and retrieval of theoretical medical knowledge

A database model for structure and access of theoretical medical knowledge is presented. The basic principle is the organization of knowledge in three dimensions: Each topic--first dimension--is explained with media--second dimension--in different versions of varying details--third dimension--suitable for different users. Every topic is one database entry. Topics are interconnected with heading and sub-topics (tree structure) and to logically related topics (cross references). Access follows the 3D-concept with initial access by topic, by media, or user specific, and with intra-unit access to related topics, media, and user specific versions. The model is discussed and possible implementations are described.

Oral and maxillofacial radiology teaching file on the World Wide Web

An oral and maxillofacial radiology teaching file on the World Wide Web was created effective June 15, 1995. The file contains 106 cases (279 images) of 94 diseases in the oral and maxillofacial region.

A CD-ROM prototype of a multimedia-based interactive tool and guide, to perform quality control tests for the computed tomography scanners

Quality control tests for CT scanners are very important for correct machine performance, and for the radiation protection of patients and medical personnel. As proliferation of CT scanners continues, the need for distributable software tools to perform quality control tests becomes evident. A multimedia tool and guide will help medical physicists and technologists to perform these tests easily and correctly. The guide can be easily accessible in CD-ROM, or networked on the Internet. The user, medical physicist or technologist, can find in the present guide the pertinent theoretical information and the procedures necessary to perform the quality control tests, with the help of texts, CT images and photographs, narration and video. The results of the tests are automatically compared with machine specifications and acceptable values set by international bodies, and are stored in a table.