HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Goldberg, D. J. Articles by Parikh, T. Search for Related Content PubMed PubMed Citation Articles by Goldberg, D. J. Articles by Parikh, T. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?

Internet-Based Interactive Teaching File for Neuroradiology

¹ Laurie Imaging Center, 141 French St., New Brunswick, NJ 08901.
² Department of Radiology, UMDNJ, Robert Wood Johnson Medical School, P. O. Box 19, New Brunswick, NJ 08903-0019.

Received September 9, 1999; accepted after revision April 5, 2000.

 
Address correspondence to D. J. Goldberg.

Abstract

Top Abstract Introduction Materials and Methods Results and Discussion References

 
OBJECTIVE. Our goal was to implement an interactive neuroradiologic teaching file that can be accessed on the Internet and easily expanded to include radiologic, clinical, and pathologic correlation.

CONCLUSION. Our growing interactive neuroradiologic teaching file is available on the Internet. It provides an easily accessed database of interesting cases to aid in the study or analysis of difficult cases.

Introduction

Top Abstract Introduction Materials and Methods Results and Discussion References

 
The Internet has become a direct resource for gaining access to medical information and continues to grow at an astronomic rate. Over the past few years, there has been increasing interest in finding a way to use the Internet to provide radiologists with a database that can be constantly expanded and improved. Our goal was to implement an interactive neuroradiologic teaching file that can be accessed via the Internet. We found the Internet to be a valuable interface for posting a large database that houses a collection of teaching files; the database can be expanded to include radiologic, clinical, and pathologic correlation.

Materials and Methods

Top Abstract Introduction Materials and Methods Results and Discussion References

 
Much of our patient population was obtained from our outpatient referrals and inpatients at Robert Wood Johnson University Hospital and Saint Peter's Medical Center. All MR images were acquired using a Signa 1.5-T scanner (General Electric Medical Systems, Milwaukee, WI). Selected images from unusual or interesting MR studies were continually placed into a teaching file database. Approximately five to 10 images were chosen from each case. These images were then electronically transferred to a Macintosh Power PC 604e (Apple Computer, Cupertino, CA) using standard file transfer protocol software and customprogrammed software called SNAG.

At the time of the patient's study, the radiologists dictated which images to capture during the routine radiologic interpretation. At the end of the dictation, the key images were annotated, and a copy of the report was given to the technologist by the transcriptionist. The technologist transferred the selected images to the workstation. Using the image 1.61 software program (Research Services Branch, National Institutes of Health, Bethesda, MD), header information was omitted, ensuring patient confidentiality. The images were then configured to both a graphics interchange format (GIF) and a Joint Photographic Experts Group (JPEG) format. Minor modifications (i.e., changes in magnification, brightness, and gray scale) were made to the selected images by a radiology resident.

A separate teaching file database containing over 200 patient records was created using FileMaker Pro (Claris, Santa Clara, CA), a commercially available database program for Macintosh used to store records and distribute textual data [1]. Ten new interesting cases per month were added from our bimonthly neuroradiology conference. Information provided in the teaching file database included some or all of the following: chief complaint or presenting symptoms; pertinent radiographic findings; pathologic diagnosis, clinical diagnosis, or both; and a short description of the disease process. A short description and case discussion were attached to each teaching file case. This process allowed the relatively easy addition of new cases. Specifically, the pertinent clinical information and radiologic findings were discussed and recorded at the bimonthly neuroradiology conference for continuing medical education accreditation purposes. These data were entered into the teaching file database by the department secretary. Once a month, one of the authors reviewed the data to ensure accuracy before placing them on our server.

At this point, it was necessary to modify our server to allow Internet users to access our teaching file database. Tango (Pervasive Software, Austin, TX) for FileMaker Pro was used to provide this dynamic hypertext markup language (HTML) capability. Tango provides a simple way to create common gateway interface programs that query the database and return data to the Web server.

Last, a link between the selected teaching file data and the corresponding images was provided. The folders containing the images use a patient identification number. When the sort link is selected, Tango relays the message to the FileMaker Pro database. The results of the sort are then returned to Tango. Tango uses the returned patient identification numbers to create an HTML file with links to the folders containing the images. When the link is selected, an applescript is called that lists the contents of the folders.

Results and Discussion

Top Abstract Introduction Materials and Methods Results and Discussion References

 
Web Site
The user begins by accessing our home page at www.laurie.umdnj.edu (Fig. 1). Users are then instructed to choose an area of interest (e.g., teaching file). This action results in the display of the main Web page for the neuroradiologic teaching file database. At this point, the user can either sort by anatomic area, select a random search, or perform an advanced search. Currently, the cases cannot be accessed purely as unknowns; however, theoretically, this would not entail a great deal of work on our part.

View larger version (70K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1. —Screen capture shows portion of Laurie Imaging home page that has links to functions that can be used to navigate our server.

To describe how our database works, we will perform an advanced search for two keywords: brain and tumor. A data summary screen is displayed showing how many records matched the specified keywords (Fig. 2). The user is then instructed to find a case of interest and select either the GIF or JPEG link located in the column titled "Show images." This action results in the display of a series of selected images (Fig. 3). If interested, the user can choose the show information link at the top right of the screen. This action will result in the display of pertinent history, a brief description of the image, and pathologic diagnosis.

View larger version (89K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2. —Screen capture shows data summary screen that appears after specified search. Screen shows response for keywords "brain" and "tumor." Note links to display images (graphics interchange format and Joint Photographic Experts Group) from specific case.

View larger version (87K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3. —Screen capture shows individual images from selected case.

Transmission Speed
Transmission speed is always a popular question and a major concern when dealing with the Internet. Two components related to speed are important in the delivery of data over the Internet. The first is the speed of the server's central processing unit. Our system is a Macintosh Power PC 604e running at 212 MHz, which we found more than adequate for running the server. The second component related to speed and delivery is an optimized server database. To optimize the response time of our server to search requests, we used a separate database for the teaching file data. Our existing complete database has over 10,000 patient records. By limiting the size of the teaching file database and using a fast PC, search times are reduced to seconds. The average response time to receive and display a sample search by both cable modem and telephone connection was approximately 10 sec.

The speed at which a user can display images in a timely fashion is also important. Image transfer was dependent on the type of Internet connection the user was using. Typical transmission speeds for telephone modems range from 28.8 to 56 Kb/sec. Cable modems or T1 lines are much faster and capable of speeds up to 1.5 Mb/sec. High-quality GIF images were displayed in less than 10 sec over T1 or cable lines. JPEG images were transmitted in approximately 22 sec over conventional telephone lines. GIF images took much longer to display (65 sec) using conventional telephone lines. Therefore, we provided the user with both types of images; they could chose either format depending on their type of connection to the Internet.

Security
Security and patient confidentiality are a big concern. Any radiologist with Internet access can access and use our site. No authorization is required. As stated earlier, when the images are modified using the National Institutes of Health image program, the header and all identifying information are omitted, leaving no way for the user to identify the patient. Another security issue is access to our local network. Users are given general Internet access to the server. There is a firewall between the server and the remainder of our local network; this prevents unauthorized access.

Conclusion
The Internet has grown exponentially in recent years and has become an important tool for communication. There is no single comprehensive source that can supply more information than the Internet, and interest in the Internet has never been greater. Much of this interest is probably increased by the availability of information in such an easy forum. Another reason for increased interest and use is because of improvements in speed and response time. For these reasons, the Internet has become extremely popular for learning and accessing information in the field of medicine.

Recently, radiologists have been interested in providing teaching tools on the Internet. With the establishment of radiologic teaching file databases, we believe the Internet can be used by radiologists and residents who are studying for oral board examinations and by others for general interest or review purposes. Therefore, we developed a neuroradiologic teaching file database. The database was designed to be easily expanded with input from our radiologists. Our results show that this method of providing educational information on the Internet can be accomplished.

Acknowledgments
 
We thank Reuben Mezrich for his contribution in setting up our server.

References

Top Abstract Introduction Materials and Methods Results and Discussion References

 

1. Mezrich R, DeMarco J, Negin S, et al. Radiology on the information superhighway. Radiology 1995;195:73 -81[Abstract/Free Full Text]

CiteULike

Complore

Connotea

Del.icio.us

Digg

Reddit

Technorati

This article has been cited by other articles:

				A. W. C. Kamauu, S. L. DuVall, R. J. Robison, A. P. Liimatta, R. H. Wiggins III, and D. E. Avrin Informatics in Radiology (infoRAD): Vendor-Neutral Case Input into a Server-based Digital Teaching File System RadioGraphics, November 1, 2006; 26(6): 1877 - 1885. [Abstract] [Full Text] [PDF]

				G. L. Yang, A. Aziz, B. Narayanaswami, A. Anand, C. C. T. Lim, and W. L. Nowinski Informatics in Radiology (infoRAD): Multimedia Extension of Medical Imaging Resource Center Teaching Files RadioGraphics, November 1, 2005; 25(6): 1699 - 1708. [Abstract] [Full Text] [PDF]

				A. G. Ryan, L. J. Louis, and W. C. Yee Informatics in Radiology (infoRAD): HTML and Web Site Design for the Radiologist: A Primer RadioGraphics, July 1, 2005; 25(4): 1101 - 1118. [Abstract] [Full Text] [PDF]

				C.-S. Yam, D. Levine, M. Nishino, A. Sitek, and M. Larson A Simple Method for Displaying Cine Images on Web-Based Teaching Files Am. J. Roentgenol., February 1, 2005; 184(2): 691 - 694. [Abstract] [Full Text] [PDF]

				N. Nakata, S. Kandatsu, N. Suzuki, and K. Fukuda Informatics in Radiology (infoRAD): Mobile Wireless DICOM Server System and PDA with High-Resolution Display: Feasibility of Group Work for Radiologists RadioGraphics, January 1, 2005; 25(1): 273 - 283. [Abstract] [Full Text] [PDF]

				A. Rosset, O. Ratib, A. Geissbuhler, and J.-P. Vallee Integration of a Multimedia Teaching and Reference Database in a PACS Environment RadioGraphics, November 1, 2002; 22(6): 1567 - 1577. [Abstract] [Full Text] [PDF]

				E. Weinberger, R. Jakobovits, and M. Halsted MyPACS.net: A Web-Based Teaching File Authoring Tool Am. J. Roentgenol., September 1, 2002; 179(3): 579 - 582. [Abstract] [Full Text] [PDF]

This Article Abstract Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Goldberg, D. J. Articles by Parikh, T. Search for Related Content PubMed PubMed Citation Articles by Goldberg, D. J. Articles by Parikh, T. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?