Distributing an electronic thoracic imaging teaching file using the Internet, Mosaic, and personal computers

Reinventing Radiology: Big Data and the Future of Medical Imaging

PURPOSE

Today, data surrounding most of our lives are collected and stored. Data scientists are beginning to explore applications that could harness this information and make sense of it.

MATERIALS AND METHODS

In this review, the topic of Big Data is explored, and applications in modern health care are considered.

RESULTS

Big Data is a concept that has evolved from the modern trend of "scientism." One of the primary goals of data scientists is to develop ways to discover new knowledge from the vast quantities of increasingly available information.

CONCLUSIONS

Current and future opportunities and challenges with respect to radiology are provided with emphasis on cardiothoracic imaging.

A Low Cost Method of Digitizing Radiographs Using a Photo Light Box

We evaluated a low cost device for digitizing X-ray films. It consisted of a locally-made wooden box and a readily-available digital camera. Two experienced paediatric radiologists interpreted the original X-ray films (the reference standard) and the corresponding images obtained in the photo light box. Ninety paediatric chest X-ray films were used (30 were normal chest radiographs, 30 showed pneumonic-consolidation and 30 had interstitial infiltrates). The presence or absence of the three signs most frequently found in acute respiratory pathologies were evaluated: normal pulmonary transparency, pneumonic consolidation and interstitial infiltration. There was very good agreement between the X-ray films and the digitized images, with kappa values from 0.86 to 0.98. There was good agreement between the two observers, with kappa values from 0.67 to 0.90. The low-cost photo light box represents an accessible and low-cost approach to transmitting X-ray images, allowing findings or a second opinion from a specialist radiologist to be obtained from a distance.

[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.

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.

Conversion of teaching file cases from film to digital format: a comparison between use of a diagnostic-quality digitizer and use of a flatbed scanner with transparency adapter

RATIONALE AND OBJECTIVES

The authors' institution had decided to convert its radiology teaching files from film to digital media. This study was performed to determine the simplest method for converting the analog film images to digital images without a subsequent loss in diagnostic accuracy.

MATERIALS AND METHODS

Twenty chest radiographs that demonstrated interstitial lung disease were randomly selected from the departmental teaching files and matched with 20 control radiographs from healthy adults. Analog film images were converted with both a diagnostic-quality film image digitizer (digitized) and a flatbed scanner equipped with a transparency adapter (scanned). Three radiology faculty members reviewed a mixed set of corresponding analog film, digitized, and scanned images. Reviewers judged whether each image depicted interstitial lung disease, indicated their level of confidence in the diagnosis, and rated each image for quality. Image quality was assessed by each reviewer subjectively at the time of viewing the individual image, without regard to other images. A one-way analysis of variance was performed to determine whether there was a statistically significant difference in diagnostic accuracy between the three image formats. Agreement in diagnosis between corresponding images in the three different formats was evaluated for each reviewer with the McNemar test.

RESULTS

There was no statistically significant difference in diagnostic accuracy between analog film and scanned images, but there was such a difference between these two groups and digitized images. Accuracy was 97% for analog film, 94% for scanned, and 89% for digitized images. Results of the McNemar test showed no statistically significant difference in agreement between the analog film images and the scanned images for any of the reviewers (P > .05).

CONCLUSION

A high-end flatbed scanner with transparency adapter provided accurate, simple, and inexpensive conversion of analog film teaching files to digital format, with no loss of the ability to detect or diagnose subtle abnormalities such as interstitial lung disease.

MyPACS.net: a Web-based teaching file authoring tool

OBJECTIVE

We sought to develop a Web service that would easily allow radiologists to create their own online teaching file cases from any Web browser.

CONCLUSION

We created MyPACS, a hosted teaching file authoring tool that allows easy uploading of images and descriptive information from any computer with Web access. Radiologists may designate their cases to be public or private (viewable only by the case author), and cases may be retrieved on searching for multiple parameters.

EMCyberSchool: an evaluation of computer-assisted instruction on the Internet

OBJECTIVES

To test the hypothesis that integration of the EMCyberSchool, a computer-assisted instruction (CAI) tool available on the Internet, into the curriculum of a senior medical student subinternship in emergency medicine (EM) would improve exam scores and course satisfaction.

METHODS

Students were prospectively randomized, by four-week blocks, into a CAI group and a no-CAI group. All students were surveyed on previous computer experience and their use and opinion of the EMCyberSchool.

RESULTS

Completed data were obtained from 100 of 120 students. Sixty-five percent of the students said they wanted CAI as an adjunct to their course curricula; only 28% actually used the educational tool. The students who used the site rated it useful (4.2/5), easy to use (4.4/5), and easy to access (4.1/5). Of the students who had access, and chose not to use the EMCyberSchool, 77.8% reported not having enough time as the reason for not using the site. The mean exam scores were 72.8% for the students in the CAI group and 68.2% for those in the no-CAI group (p = 0.058). In the CAI group, 77.5% (31/40) of the students rated the course as outstanding or excellent; compared with 66% (33/50) in the no-CAI group (p = 0.23).

CONCLUSIONS

Although desired, it remains unclear whether CAI on the Internet is a useful adjunct for teaching EM to medical students.

Consulting with radiologists outside the hospital by using Java

A Java-based teleradiology system that makes use of the Internet has been developed. Using this system, an on-call, off-duty radiologist can make diagnoses and perform consultations easily by reviewing the transferred images at home. The image accessibility of the system allows a hospital with such a system to assist an affiliated rural hospital without a full-time radiologist. The system consists of three components: the image server subsystem, the database server subsystem, and the client subsystem. All client subsystems of the system are designed to be symmetric. Users may retrieve images, manipulate them, and perform remote consultations. In addition, a user may add annotations to an image area of interest. Screen synchronization is achieved by means of the command-passing technique and local command execution to reduce the network bandwidth and transmission demands; user interaction is achieved by means of a synchronized indicator for pointing out areas of interest and dialog windows for conversation. Because Java programs can run on heterogeneous platforms, the need for system maintenance and user training is minimized. Although the drawback of Internet bandwidth still exists, the system enables platform-independent teleradiology via the Internet and allows easy and cost-effective remote consultation.

Digital photography of digital imaging and communications in medicine-3 images from computers in the radiologist's office

To fully take advantage of the widespread use of digital imaging systems and to update and eliminate redundant steps involved in medical radiographic publication, we present our experience of processing Digital Imaging and Communications in Medicine (DICOM)-3 digital images from the point of acquisition to the point of publisher-ready radiographic images without intervening hardcopies.

The Internet as a resource for palliative care and hospice: a review and proposals

The last 3 years have witnessed an enormous growth and utilization of the Internet and its graphical subdivision, the World Wide Web (WWW). Its medical applications offer numerous advantages and strengths, including ease of publication and access to large volumes of information. This paper explores the potential applications of the Internet and the WWW for palliative care and hospice. It will describe the reasons for the immense interest in this medium and discuss the various strengths and weakness of the Internet and the World Wide Web as a Palliative Care resource. Foremost among these weaknesses is the lack of editorial control and the peer review process, allowing anecdotal and unbalanced information to be published. To provide the growing number of health-care professionals and patients who utilize this medium with balanced, evidence-based information, publishing by various palliative care and hospice organizations needs to be encouraged and palliative care electronic journal publishing needs to be accelerated.

Use of the Internet for teaching in nuclear medicine

The Internet provides several new capabilities for education in nuclear medicine, including learning at a distance, facilitation of collaboration, increased availability of training resources, and ability to develop interactive teaching materials. Dedicated case-authoring software aided development of digital teaching files at the Mallinckrodt Institute of Radiology and the Joint Program in Nuclear Medicine. Accesses to these two teaching files from sites around the world have grown rapidly. Improvements in the speed of the Internet will allow inclusion of more images at higher resolution and more extensive use of cine. Development of server-based software will allow simulation of the actual image-reading environment. A better understanding of how to use this new media will spur continued expansion in use of the Internet for nuclear medical education.

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.

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.

Trauma on the Internet: early experience with a World Wide Web server dedicated to trauma and critical care

The Internet is the newest and one of the most powerful communications media today. This study evaluates the utility of dissemination of educational information and exchange of ideas related to trauma at a single site on the Internet. A World Wide Web server on a desktop computer provided a library of downloadable medical software, trauma prevention information, and patient case studies.

RESULTS

Most server accesses came from connections at other educational institutions (29.6%). Connections by foreign clients accounted for 17.9% of use. Over a 6-month period, the usage increased from an average of 80 files transmitted per day to 600 per day (750% increase).

CONCLUSIONS

A trauma and surgical critical care related data server has shown a progressive increase in use in its initial period. Further development by other trauma care providers will be of value in educating the health care community and lay public.

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.

Introducing the Internet

The benefits to medical practitioners of using the Internet are growing rapidly as the Internet becomes easier to use and ever more biomedical resources become available on line. The Internet is the largest computer network in the world; it is also a virtual community, larger than many nation states, with its own rules of behaviour or "netiquette." There are several types of Internet connection and various ways of acquiring a connection. Once connected, you can obtain, free of charge, programs that allow easy use of the Internet's resources and help on how to use these resources; you can access many of these resources through the hypertext references in the on line version of this series (go to http:@www.bmj.com/bmj/ to reach the electronic version). You can then explore the various methods for accessing, manipulating, or disseminating data on the Internet, such as electronic mail, telnet, file transfer protocol, and the world wide web. Results from a search of the world wide web for information on the rare condition of Recklinghausen's neurofibromatosis illustrate the breadth of medical information available on the Internet.