Mark S. Frank

Do picture archiving and communication systems improve Report turnaround times

Radiology departments are beginning to embrace new technologies to decrease operating budgets and improve services. One of these technologies is the picture archiving and communication system (PACS). PACS, through immediate availability of images to the radiologist, promises to decrease turnaround times of reports to the clinician. The purpose of this study was to determine if this technology actually decreases the time for referring clinicians to receive reports generated by the radiologist. The time to provide a preliminary report by a resident and time to finalize this report by a board-certified radiologist was retrospectively obtained for 6,022 abdominal and pelvic computed tomography (CT) scans over two 1-year periods from March 1, 1997 to March 1, 1998 and from March 1, 1998 to March 1, 1999. During the first year, interpretation was conducted using hard-copy film and during the second using PACS. In both 1-year periods, Med-Speak voice recognition software (IBM, White Plains, NY) was employed for dictation. The average time for a preliminary report for a abdominal and pelvic CT, dictated by a resident or fellow, to be available in alphanumeric form on the hospital information system using hard-copy film was 3.73 days. The installation of a PACS system decreased this turnaround time to 0.56 days, representing an 85.0% improvement. The time to availability of final reports, ie, signed by board-certified staff radiologists, was 5.49 days in the hard-copy interpretation subset and 5.97 days in the PACS subset. The addition of PACS into an academic gastrointestinal radiology division improves availability of alphanumeric preliminary reports of abdominal and pelvic CTs on the hospital information system (HIS), dictated by a resident or fellow, by 85.0%. There was no impact with a PACS on the time to final sign reports by a staff board certified radiologist as signing patterns remained relatively constant over the two interpretation formats.

Empowering radiologie education on the internet: A new virtual website technology for hosting interactive educational content on the world wide web

Objective: We describe a virtual web site hosting technology that enables educators in radiology to emblazon and make available for delivery on the world wide web their own interactive educational content, free from dependencies on in-house re-sources and policies.Materials/Methods: Ibis suite of technologies includes a graphically oriented software application, designed for the computer novice, to facilitate the input, storage, and management of domain expertise within a database system. The database stores this expertise as choreographed and interlinked multimedia entities including text, imagery, interactive questions, and audio. Case-based presentations or thematic lectures can be authored locally, previewed locally within a web browser, then uploaded at will as packaged knowledge objects to an educator’s (or department’s) personal web site housed within a virtual server architecture. This architecture can host an unlimited number of unique educational web sites for individuals or departments in need of such service. Each virtual site’s content is stored within that site’s protected back-end database connected to Internet Information Server (Microsoft Corp, Redmond WA) using a suite of Active Server Page (ASP) modules that incorporate Microsoft’s Active Data Objects (ADO) technology. Each person’s or department’s electronic teaching material appears as an independent web site with different levels of access—controlled by a username-password strategy—for teachers and students. There is essentially no static hypertext markup language (HTML). Rather, all pages displayed for a given site are rendered dynamically from case-based or thematic content that is fetched from that virtual site’s database. The dynamically rendered HTML is displayed within a web browser in a Socratic fashion that can assess the recipient’s current fund of knowledge while providing instantaneous user-specific feedback. Each site is emblazoned with the logo and identification of the participating institution. Individuals with teacher-level access can use a web browser to upload new content as well as manage content already stored on their virtual site. Each virtual site stores, collates, and scores participants’ responses to the interactive questions posed on line.Conclusion: This virtual web site strategy empowers the educator with an end-to-end solution for creating interactive educational content and hosting that content within theeducator’s personalized and protected educational site on the world wide web, thus providing a valuable outlet that can magnify the impact of his or her talents and contributions.

Beyond the electronic textbook model: Software techniques to make on-line educational content dynamic

Objective: We describe a working software technology that enables educators to incorporate their expertise and teaching style into highly interactive and Socratic educational material for distribution on the world wide web.Materials/Methods: A graphically oriented interactive authoring system was developed to enable the computer novice to create and store within a database his or her domain expertise in the form of electronic knowledge. The authoring system supports and facilitates the input and integration of several types of content, including free-form, stylized text, miniature and full-sized images, audio, and interactive questions with immediate feedback. The system enables the choreography and sequencing of these entities for display within a web page as well as the sequencing of entire web pages within a case-based or thematic presentation. Images or segments of text can be hyperlinked with point-and-click to other entities such as adjunctive web pages, audio, or other images, cases, or electronic chapters. Miniature (thumbnail) images are automatically linked to their full-sized counterparts. The authoring system contains a graphically oriented word processor, an image editor, and capabilities to automatically invoke and use external image-editing software such as Photoshop. The system works in both local area network (LAN) and internet-centric environments. An internal metalanguage (invisible to the author but stored with the content) was invented to represent the choreographic directives that specify the interactive delivery of the content on the world wide web. A database schema was developed to objectify and store both this electronic knowledge and its associated choreographic metalanguage. A database engine was combined with page-rendering algorithms in order to retrieve content from the database and deliver it on the web in a Socratic style, assess the recipient’s current fund of knowledge, and provide immediate feedback, thus stimulating in-person interaction with a human expert.Results: This technology enables the educator to choreograph a stylized, interactive delivery of his or her message using multimedia components assembled in virtually any order, spanning any number of thus exercise precise influence on specific learning objectives, embody his or her personal teaching style within the content, and ultimately enhance its educational impact.Conclusion: The described technology amplifies the efforts of the educator and provides a more dynamic and enriching learning environment for web-based education.

Integrating digital teaching-file systems with off-the-shelf presentation software to facilitate speaker-led conferences

Objective: Develop methods for automated transfer of images and associated text from a teaching-file repository into presentation material for speaker-led conferences.erials/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.

Hemidiaphragm paralysis: CT diagnosis.

We describe the use of computed tomography (CT) in diagnosing and documenting diaphragmatic paralysis in a patient with right lung cancer that invaded the mediastinum. The patient was unable to breath hold during CT scanning, and the images were degraded by motion artifact. Motion artifact, however, was noted only in the left lung. In patients with suspected phrenic nerve dysfunction who are having chest CT for any reason, we suggest obtaining several dynamic images at the lung bases during forced exhalation. The lack of motion artifact in the lung parenchyma may be useful for diagnosing phrenic nerve injury and hemidiaphragm paralysis.

Evaluation of a combined two- and three-dimensional compression method using human visual characteristics to yield high-quality 10:1 compression of cranial computed tomography scans.

RATIONALE AND OBJECTIVES.The compression of cranial computed tomography scans was improved by using independent intra- and interframe compression techniques. METHODS.For intraframe compression, an image was decomposed into four subimages, one subimagc was chosen as a reference subimage, and three of the subimages were predicted from the reference subimage. The prediction error was encoded with a classified vector quantizer (CVQ) based on human visual perception characteristics. Interframe redundancy is exploited by a displacement estimated interslice (DEI) algorithm that encodes the differences between reference subimages from adjacent slices. This combined DEI/CVQ method was subjectively evaluated by 13 radiologists under a blinded protocol, and was compared to the CVQ method alone, the DEI method alone, the original images, and to a standard intraframe discrete cosine transform (DCT) compression method. RESULTS.Only the combined DEI/CVQ method at 10:1 compression was not scored significantly different from the original images. At 15:1 compression, the DEI/CVQ method was scored significantly better than the 10:1 DCT and any other 15:1 compression methods. CONCLUSIONS.Compressed image quality is enhanced by exploiting inter- and intraframe redundancy, and by modelingsome characteristics of human visual perception. The DEI/CVQ method is well-suited for progressive transmission, and thus, holds potential in tcleradiology as well as picture archiving and communications systems.

Endobronchial Valves: Radiographic Appearance of a New Device for Lung Volume Reduction

WEB This is a Web exclusive article. ung volume reduction surgery (LVRS) has been shown to improve exercise capacity and to decrease symptoms in patients with severe emphysema. The procedure is associated with a decrease in mortality in a subgroup of patients with upper-lobe-predominant emphysema and poor exercise capacity [1] and has been approved for treatment of this group only. A substantial number of patients are not candidates for LVRS, in part because of the mortality, morbidity, and cost of the procedure. A search is underway for a less invasive and less expensive means of allowing patients with emphysema and comorbid conditions to benefit from lung volume reduction [2]. We discuss the radiologic findings and general use of endobronchial valves, an innovative nonsurgical approach to lung volume reduction in patients with emphysema.

Integrating digital educational content created and stored within disparate software environments: An extensible markup language (XML) solution in real-world use

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 of context as well as content, thus providing “presentationready” 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.