Electronic teaching files: seven-year experience using a commercial picture archiving and communication system.
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With the advent of electronic imaging and the internet, the ability to create, search, access, and archive digital imaging teaching files has dramatically improved. Despite the fact that a picture archival and communication system (PACS) has the potential to greatly simplify the creation of, archival, and access to a department or multifacility teaching file, this potential has not yet been satisfactorily realized in our own and most other PACS installations. Several limitations of the teaching file tools within our PACS have become apparent over time. These have, at our facility, resulted in a substantially reduced role of the teaching file tools for conferences, daily teaching, and research purposes. With the PACS at our institution, academic folders can only be created by the systems engineer, which often serves as an impediment to the teaching process. Once these folders are created, multiple steps are required to identify the appropriate folders, and subsequently save images. Difficulties exist for those attempting to search for the teaching file images. Without pre-existing knowledge of the folder name and contents, it is difficult to query the system for specific images. This is due to the fact that there is currently no fully satisfactory mechanism for categorizing, indexing, and searching cases using the PACS. There is currently no easy mechanism to save teaching, research, or clinical files onto a CD or other removable media or to automatically strip demographic or other patient information from the images. PACS vendors should provide much more sophisticated tools to create and annotate teaching file images in an easy to use but standard format (possibly Radiological Society of North America's Medical Image Resource Center [MIRC] format) that could be exchanged with other sites and other vendors' PAC systems. The privilege to create teaching or conference files should be given to the individual radiologists, technologists, and other users, and an audit should be kept of who has created these files, as well as keep track of who has accessed the files. Vendors should maintain a local PACS library of image quality phantoms, normal variants, and interesting cases and should have the capability of accessing central image repositories such as the RSNA's MIRC images. Commercial PAC systems should utilize a standard lexicon to facilitate the creation and categorization of images, as well as to facilitate sharing of images and related text with other sites. This should be combined with a very easy to use mechanism to write images and related text when appropriate onto removable media (while maintaining a high level of security and confidentiality) to make it easier to share images for teaching, research, or clinical purposes. (+info)
A Java viewer to publish Digital Imaging and Communications in Medicine (DICOM) radiologic images on the World Wide Web.
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The world wide web is an exciting service that allows one to publish electronic documents made of text and images on the internet. Client software called a web browser can access these documents, and display and print them. The most popular browsers are currently Microsoft Internet Explorer (Microsoft, Redmond, WA) and Netscape Communicator (Netscape Communications, Mountain View, CA). These browsers can display text in hypertext markup language (HTML) format and images in Joint Photographic Expert Group (JPEG) and Graphic Interchange Format (GIF). Currently, neither browser can display radiologic images in native Digital Imaging and Communications in Medicine (DICOM) format. With the aim to publish radiologic images on the internet, we wrote a dedicated Java applet. Our software can display radiologic and histologic images in DICOM, JPEG, and GIF formats, and provides a a number of functions like windowing and magnification lens. The applet is compatible with some web browsers, even the older versions. The software is free and available from the author. (+info)
The evolution of filmless radiology teaching.
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PURPOSE: The transition from hard-copy film to the picture archiving and communication systems (PACS) arena is often a long and difficult path, but the complete transformation to the digital environment does not end with the successful clinical practice utilizing PACS. The next hurdle for academic institutions is similar changes in the teaching field. The loss of hardcopy films can greatly hinder the radiology teaching file and teaching conference experiences. The next step in our growth is the conversion to digital teaching files and conferences. The original work 10 years ago with utilizing computers linked with laser disks and magneto-optical media, have now evolved into complex networks with expanding and relatively cheap storage media, such as CD-ROM and easily to navigate graphic-user interfaces such as hypertext markup language (HTML) and extensible markup language (XML), for use with multimedia teaching tools. CONCLUSIONS: The transition into the digital arena for radiology education and interdepartmental conferences can be accomplished through several different paths. These include direct transfer of images into a presentation program, as well as exportation of images into suitable image file formats for later use. There is also the ability to expand the PACS network to include conference rooms. Similar training and teaching can allow radiologists to transition into the digital environment for future digital teaching file creation as well as correlative radiology interdepartmental conferences. (+info)
Calibration of medium-resolution monochrome cathode ray tube displays for the purpose of board examinations.
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This report discusses calibration and set-up procedures for medium-resolution monochrome cathode ray tubes (CRTs) taken in preparation of the oral portion of the board examination of the American Board of Radiology (ABR). The board examinations took place in more than 100 rooms of a hotel. There was one display-station (a computer and the associated CRT display) in each of the hotel rooms used for the examinations. The examinations covered the radiologic specialties cardiopulmonary, musculoskeletal, gastrointestinal, vascular, pediatric, and genitourinary. The software used for set-up and calibration was the VeriLUM 4.0 package from Image Smiths in Germantown, MD. The set-up included setting minimum luminance and maximum luminance, as well as positioning of the CRT in each examination room with respect to reflections of roomlights. The calibration for the grey scale rendition was done meeting the Digital Imaging and communication in Medicine (DICOM) 14 Standard Display Function. We describe these procedures, and present the calibration data in. tables and graphs, listing initial values of minimum luminance, maximum luminance, and grey scale rendition (DICOM 14 standard display function). Changes of these parameters over the duration of the examination were observed and recorded on 11 monitors in a particular room. These changes strongly suggest that all calibrated CRTs be monitored over the duration of the examination. In addition, other CRT performance data affecting image quality such as spatial resolution should be included in set-up and image quality-control procedures. (+info)
The Radiological Society of North America's Medical Image Resource Center: an update.
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The Radiological Society of North America (RSNA) has initiated a long-term project called the Medical Image Resource Center (MIRC). The overall goal of the effort is to create an on-line library of medical images and related information and to maintain and index a number of other medical image resources. The rationale for the project, a summary of the overall requirements and objectives, and a finally a brief description of the future plans for MIRC are presented. (+info)
Integrating digital educational content created and stored within disparate software environments: an extensible markup language (XML) solution in real-world use.
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OBJECTIVE: To provide a standardized and scaleable mechanism for exchanging digital radiologic educational content between software systems that use disparate authoring, storage, and presentation technologies. MATERIALS/METHODS: Our institution uses two distinct software systems for creating educational content for radiology. Each system is used to create in-house educational content as well as commercial educational products. One system is an authoring and viewing application that facilitates the input and storage of hierarchical knowledge and associated imagery, and is capable of supporting a variety of entity relationships. This system is primarily used for the production and subsequent viewing of educational CD-ROMS. Another software system is primarily used for radiologic education on the world wide web. This system facilitates input and storage of interactive knowledge and associated imagery, delivering this content over the internet in a Socratic manner simulating in-person interaction with an expert. A subset of knowledge entities common to both systems was derived. An additional subset of knowledge entities that could be bidirectionally mapped via algorithmic transforms was also derived. An extensible markup language (XML) object model and associated lexicon were then created to represent these knowledge entities and their interactive behaviors. Forward-looking attention was exercised in the creation of the object model in order to facilitate straightforward future integration of other sources of educational content. XML generators and interpreters were written for both systems. RESULTS: Deriving the XML object model and lexicon was the most critical and time-consuming aspect of the project. The coding of the XML generators and interpreters required only a few hours for each environment. Subsequently, the transfer of hundreds of educational cases and thematic presentations between the systems can now be accomplished in a matter of minutes. The use of algorithmic transforms results in nearly 100% transfer of context as well as content, thus providing "presentation-ready" outcomes. CONCLUSION: The automation of knowledge exchange between dissimilar digital teaching environments magnifies the efforts of educators and enriches the learning experience for participants. XML is a powerful and useful mechanism for transfering educational content, as well as the context and interactive behaviors of such content, between disparate systems. (+info)
Integrating digital teaching-file systems with off-the-shelf presentation software to facilitate speaker-led conferences.
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OBJECTIVE: Develop methods for automated transfer of images and associated text from a teaching-file repository into presentation material for speaker-led conferences. MATERIALS/METHODS: Our institution uses a Microsoft Windows (Microsoft Corp, Redmond, WA) software application to maintain a digital teaching-file database that can store and retrieve content in a case-centric fashion. Virtually any number of images can be stored with any given case. Cases and their associated images can be retrieved via a module that supports searches by American College of Radiology (ACR) code and by free-text Boolean queries on the history, findings, diagnosis, and discussion components of a case. In addition to the software system serving directly as an interactive teaching tool, the digital teaching file itself serves as an image repository and resource for attending radiologists who create their own presentations and lectures. To better support this use, software modules were developed for interprocess communication and automated creation of Powerpoint slides. These modules are fully integrated with the teaching-file software application. A single image or a set of selected images can be automatically made into individual slides with two mouse clicks. Images are automatically centered and optimally sized. A slide title is automatically rendered from the user's preference of the case history or diagnosis (stored with the case), or via the entry of freeform text. We describe the programming techniques that are used, as well as how several features of the operating system and Powerpoint itself can be integrated with a customized software application to facilitate this objective. RESULTS: The creation of presentation-ready Powerpoint slides is fully automated from within our teaching-file application, and the time required to create a presentation compared to the conventional method of manually seeking and inserting files from within Powerpoint itself, on a per-slide basis, is drastically reduced. The benefits are magnified by having all imagery stored within an organized and searchable database system so that desired images can be easily located. CONCLUSION: A digital teaching-file system can serve as a useful image repository for purposes ancillary to direct computerized instruction. Software that supports these uses, such as the automated creation of presentation material for speaker-led conferences, facilitates the radiologist's role as an educator. (+info)
Evaluation of the woman with postmenopausal bleeding: Society of Radiologists in Ultrasound-Sponsored Consensus Conference statement.
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OBJECTIVES: A panel of 14 physicians practicing medicine in the United States with expertise in radiology, obstetrics and gynecology, gynecologic oncology, hysteroscopy, epidemiology, and pathology was convened by the Society of Radiologists in Ultrasound to discuss the role of sonography in women with postmenopausal bleeding. Broad objectives of this conference were (1) to advance understanding of the utility of different diagnostic techniques for evaluating the endometrium in women with postmenopausal bleeding; (2) to formulate useful and practical guidelines for evaluation of women with postmenopausal bleeding, specifically as it relates to the use of sonography; and (3) to offer suggestions for future research projects. SETTING: October 24 and 25, 2000, Washington, DC, preceding the annual Society of Radiologists in Ultrasound Advances in Sonography conference. PROCEDURE: Specific questions to the panel included the following: (1) What are the relative effectiveness and cost-effectiveness of using transvaginal sonography versus office (nondirected) endometrial biopsy as the initial examination for a woman with postmenopausal bleeding? (2) What are the sonographic standards for evaluating a woman with postmenopausal bleeding? (3) What are the abnormal sonographic findings in a woman with postmenopausal bleeding? (4) When should saline infusion sonohysterography or hysteroscopy be used in the evaluation of postmenopausal bleeding? (5) Should the diagnostic approach be modified for patients taking hormone replacement medications, tamoxifen, or other selective estrogen receptor modulators? CONCLUSIONS: Consensus recommendations were used to create an algorithm for evaluating women with postmenopausal bleeding. All panelists agreed that because postmenopausal bleeding is the most common presenting symptom of endometrial cancer, when postmenopausal bleeding occurs, clinical evaluation is indicated. The panelists also agreed that either transvaginal sonography or endometrial biopsy could be used safely and effectively as the first diagnostic step. Whether sonography or endometrial biopsy is used initially depends on the physician's assessment of patient risk, the nature of the physician's practice, the availability of high-quality sonography, and patient preference. Similar sensitivities for detecting endometrial carcinoma are reported for transvaginal sonography when an endometrial thickness of greater than 5 mm is considered abnormal and for endometrial biopsy when "sufficient" tissue is obtained. Currently, with respect to mortality, morbidity, and quality-of-life end points, there are insufficient data to comment as to which approach is more effective. The conference concluded by identifying several important unanswered questions and suggestions that could be addressed by future research projects. (+info)