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Computers in Radiology |
1
Department of Medical Education, Frankford Hospital Health System, 2412
Ashwood Ave., Philadelphia, PA 19154.
2
Department of Diagnostic Imaging, Temple University, Broad and Ontario Sts.,
Philadelphia, PA 19140.
3
Present address: Department of Radiology, Southampton Hospital, 240 Meeting
House Ln., Southampton, NY 11968.
Received August 16, 1999;
accepted after revision January 4, 2000.
Address correspondence to N. A. Roach.
Abstract
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CONCLUSION. We designed a database that could be saved in a standard format using readily available software. Users of our database can save images in a Joint Photographic Experts Group (JPEG) format, allowing their easy incorporation into other programs.
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We created a cost-effective database of radiographic teaching images using a PC. The database allows the incorporation of the actual images. Previous databases contained only relevant statistical information and referenced images that were not saved in the databases. Using available resources, our database allows the input of digital images and relevant information associated with the images (i.e., the patient's sex, age, history, and diagnosis). The complete database can be saved on a transportable, standard medium such as a Zip disk (Iomega, Roy, UT) or a CD-ROM [2]. Our images were saved in a standard Joint Photographic Experts Group (JPEG) format to allow their incorporation into other computer applications, such as presentation programs, word processing programs, or Web page design programs [3].
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On a PC, the images were converted to either a JPEG format or graphical interchange format (GIF) using Adobe Photoshop version 5.0 (Adobe, San Jose, CA). We generally preferred the JPEG images over the GIF images because the JPEG images were subjectively of the same quality as the GIF images but used approximately 10% less memory. Although, in theory, JPEG is a lossy compression system, it did not detract from visible image quality (in fact, the American College of Radiology learning file CDs use the JPEG format). Additionally, our database allows images to be saved as TIFFs if necessary.
We adjusted the gray-scale values of our images with Adobe Photoshop software. It is possible to re-adjust the gray-scale values while viewing the images in photograph-editing software. Images embedded in the database can be copied from the database by extracting them or using the copy-paste feature; these tasks do not degrade the images.
Our database was designed on a PC equipped with the following software: Windows NT Workstation version 4.0 (Microsoft, Redmond, WA), Microsoft Office 97 (Microsoft), and Adobe Photoshop. The PC had a Pentium (Intel, Santa Clara, CA) 166-MHz microprocessor, 64 MB of random access memory, a 4-MB video card, a 9-GB hard drive, a 100-MB internal Zip drive (Iomega), and an internal CD-ROM Writer 7200 Series (Hewlett-Packard, Loveland, CO).
Our database was created using Microsoft Access 97 (Microsoft) with the following fields: patient's last name, patient's first name, date of birth, date of study, sex, age on date of study, history, diagnosis, other diagnoses, referring physician, location of study (e.g., hospital, outpatient clinic), image package, order of images in series, medical record number, modality of study, American College of Radiology code, and anatomic region. The database was intentionally designed with many fields so that users could enter large amounts of information and have greater flexibility when submitting queries. Examples of how the database works in practice are shown in Figures 1 and 2. Figure 3 shows a radiographic image from the database. Figure 4 shows the database design view of table 1 from Figure 1. The data type for all fields was text except for the age, date, and image fields. The data type for the age field was a number; the data type for the date fields was date/time; and the data type for the image field was object linking and embedding object (required format).
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To view images in a database created with Microsoft Access, the graphic filters for Microsoft Access should be installed during the initial installation of Microsoft Office [4]. If in doubt as to whether this was done, simply reinstall Microsoft Office and choose all the features of the "Custom" installation (instead of the "Typical" installation).
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An alternative method of organizing data is to place items in a directory hierarchy. However, this type of system tends to become unwieldy as the number of images increases. In a large image collection, the user may have to browse through many layers to find the image needed. Additionally, one can get lost in the many sublayers of a hierarchy.
The decision to use JPEG images, despite their lossy format, was a practical one. TIFF, GIF, or bitmap files are larger and use more memory. Nevertheless, our database can accommodate multiple image types; therefore, if an abnormality can be seen only on a TIFF image, we can leave it in TIFF format.
JPEG images have the additional advantage of being transportable to other desktop computer applications. Word processing programs could incorporate the images in a written document such as a radiology report. The images could also be inserted in a presentation program for a slide show. Furthermore, JPEG is one of two standard formats used for images appearing on the Internet (GIF being the other). Having the images in JPEG format allows easy incorporation into a Web page. Web programs that allow easy conversion of existing databases to server side format are also available (Cold Fusion; Allaire, Cambridge, MA).
We stored 50 JPEG radiographic images of 10 patients with relevant information in our database. This database used 14 MB of storage space and was backed up on a Zip disk. Therefore, with a 640-MB CD-ROM, approximately 2000 images could be stored.
Using a CD as a storage medium has obvious advantages. First, a CD is portable. A 1-oz CD containing 2000 images is easier to transport and store than 2000 images printed on film. Additionally, locating images is easier on CD than in a file cabinet. A CD can be used in almost every PC, even a laptop. Finally, the cost of collecting teaching images on a CD is only a fraction of that of maintaining the same images on film. For example, most of the expense of storing digital images on a CD is the initial cost of computer hardware and software: users of our database would need to purchase a PC ($600), monitor ($200), CD-Writer ($200), Zip drive ($100), Microsoft Windows NT ($300), Microsoft Office ($500), Adobe Photoshop ($550), and one CD ($2), for a total of $2452 [5]. The cost of printing 2000 images on film would total $3420 (2000 x $1.71 per film [price of one AGFA 14 x 17 inch film purchased in bulk from a local vendor]). Therefore, in the long run, the overall cost of printing 2000 radiographic images and storing them far exceeds that of storing 2000 images on one CD.
We succeeded in creating an inexpensive electronic database of digital radiographic teaching images using commercially available software. We also showed the cost-effectiveness of storing a collection of radiographic images on a CD-ROM using a commercially available system that allows access on most PCs. Additionally, because the images are stored in a conventional JPEG format, they can be easily incorporated into other computer applications for word processing, presentations, and Web page design.
Acknowledgments
We thank Nancy Washburne for her assistance in the preparation of this
article.
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