Marjorie Coristine

Goal Setting And User Testing To Ensure A PACS Interface Satisfactory To Radiologists

To be successful, a Picture Archiving Communication System (PACS) workstation must have a user interface which is easy for radiologists to use. This paper describes the iterative design methodology used in the Integrated Radiology Information System (IRIS) project to achieve an easy to use system. Iterative design involves the radiologists in the design effort throughout the project. Iterative user interface design requires a number of activities: goal setting, identification of important user interface issues, prototyping, structured user testing, evaluation of user-test results against the goals, and further prototyping if the goals are not met. These stages are described in detail with examples taken from the IRIS project.

Observational Assessment Of Field Trial Site For The Implementation Of A PACS Network

In building an integrated radiological information system (IRIS) and preparing for field trials at a large hospital, it was necessary to consider the working conventions and needs of radiologists and clinicians. It was also necessary to analyse the current practices involved in the requesting, reading, and reporting of x-rays. Because IRIS is designed to be a mechanism for effective consultations, an understanding of the conventions and nature of x-ray related consultations was also needed. In order to gain this understanding, two observational studies were conducted. The first addressed issues of x-ray related behavior in the emergency department, and the second assessed the task requirements of radiologists when reporting x-rays or consulting with other physicians about x-rays. These findings had major implications for the design of IRIS and for conducting the field trials.

Evaluation Of A Workstation By Clinicians

The Department of Electrical Engineering at the University of Ottawa has developed a multimedia medical communication facility. The purpose of this system is to facilitate communication among clinicians and radiologists. More timely information should be available to the clinician using this system, as well as providing a convenient consultation mechanism . The multimedia workstation must also be of sufficient quality that the radiologists report can be generated from the workstation without the actual x-ray films. From the physicians standpoint, the system must be easy to learn, easy to use, and have the appropriate functionality to accomodate diagnosis and report generation. This paper discusses the results of an evaluation of the imaging facilities from this perspective.

Clinical Experience with a Multimedia Workstation at the Ottawa Civic Hospital, Canada

The design and implementation of a multimedia workstation capable of handling images, voice, graphics and other computer data for radiological applications is described. This workstation is part of a multimedia communications system that was implemented by a multi-disciplinary, multi-institutional team of researchers. The system was installed in a large teaching hospital affiliated with the University of Ottawa, Canada and underwent extensive clinical evaluations. In the paper we describe the design and evaluation process for the user interface to the workstation.

Analysis of discrepancies observed between digital and analog images during a clinical trial of IRIS

A clinical trial of an Integrated Radiological Information System (IRIS) was conducted at the Ottawa Civic Hospital with the Department of Emergency Medicine and the Department of Radiological Sciences between April 4, and May 12, 1989. During the trial, 319 active Emergency Department cases (905 films) were processed using IRIS. Radiologists examined the digital images on the image screen to formulate a diagnosis, then before dictating a report, they examined the analog films. In 30 cases there was a discrepancy between the information obtained while viewing the digital images on IRIS and the information obtained from the analog films. These anomalous cases were used in an independent study of the discrepancies. In the study, each case was reviewed in both digital and analog form by three physicians who provided a comparative rating of diagnostic quality. Any perceived differences between the digital and analog media were noted. Particular attention was paid to rating the relevance of the IRIS enhancement capabilities. Although ratings for digital images were high, the comparative ratings for the film are in general better. An analysis of the individual cases shows that: (i) most of the discrepancies probably resulted from physician inexperience in reading radiographs in digital form, (ii) the IRIS enhancement facilities significantly increase the ratings of satisfaction or perceived quality of digital images and (iii) an appropriate choice of enhancement may make visible the required diagnostic features for cases where some reviewers did not find the image/digital discrepant.

Comparative evaluation of reporting analog films versus digital image using IRIS

A controlled experiment which simulated the standard reporting practices used by radiologists was performed on IRIS to (1) assess the quality of reporting using digital images and (2) evaluate the use of enhancement tools. Reports generated by 5 experienced radiologists using IRIS were compared to reports generated by the same radiologists using analog films on the same emergency department cases at least seven months earlier. In 100 cases, nine findings were missed using IRIS and 14 new findings were identified using IRIS. To make diagnoses, enhancements which caused the image to be darker and increased contrast were most frequently used. There was no systematic relationship between the enhancement tools used and different types of cases.