Because of motion artifacts, spiral Computer Tomography (CT) is not presently a widely useful diagnostic tool in cardiac imaging. There are two time scales in CT data acquisition. The first is the time-scale of a single projection which is roughly a half millisecond. The second time-scale is that of a single rotation of the x-ray source which is about 400 ms. For diagnostic purposes, the fastest components of the heart cycle are on the order of 5 ms. Those of general interest are in the range of about 100 ms. Full-rotation CT acquisition is slower than required for freezing the cardiac motion of interest. This mismatch in speed causes motion artifacts in the reconstructed images. We focus our attention on accurately measuring lumen dimensions and on visualizing lesion architecture. This analysis requires local imaging; it does not require global motion compensation. The methods we use relate to one-dimensional motion tracking and motion compensation applied to the projection data. Dynamic programming is used for the tracking. Following the projection processing, the CT reconstruction algorithm then acts on the motion-corrected projection data to produce the reconstructed image. In addition to applying motion compensation to the projections, we also use region-of-interest (ROI) CT reconstruction algorithms in order to utilize the locally motion-corrected projection data without generating artifacts. Those artifacts come from missing projection data that should come from outside ROI. In our case the ROI is the cross-section of the vessel being imaged.
Rates of agreement for diagnosing ARVC/D using MRI are not known. 45 cardiac MRI cases were sent to 13 expert radiologists. Only 1 of 45 cases had complete agreement among readers. ARVC/D was more likely to be reported present if fat in the myocardium was reported, if the RV chamber size was enlarged, and if RV configuration was abnormal. A normal LV chamber size was more likely with a negative report and an enlarged LV chamber size was just as likely to be called positive as negative. The radiologists were more likely to correctly call a no ARVC/D case negative (71%) than positive, but they were below chance (47%) in calling an ARVC/D case positive. 13% of the cases were rated as having poor image quality, 42% fair, 38% good and 7% excellent. There was no relationship between image quality and percent readers agreeing on presence/absence of ARVC/D. Interreader variability for ARVC/D using MRI cardiac film images is quite high. Image quality does not seem to be a major contributing factor. Inclusion of MRI cine loop images of the heart, standardized protocol, and utilization of the most current MRI equipment may improve reader agreement as well as diagnostic accuracy.
KEYWORDS: Telemedicine, Asynchronous transfer mode, Video, Local area networks, Switches, Teleradiology, Networks, Network architectures, Radiology, Health sciences
In July 1996 the Arizona Telemedicine Program (ATP) was initiated by the state legislature in recognition of the needs of under-served populations in the state. Two important goals are: establish a statewide telemedicine network infrastructure; and use that infrastructure as a test bed to evaluate the effectiveness of state-of-the-art telemedicine services. These two goals exist in the context of an integrated, multidisciplinary telemedicine program. It is necessary to accommodate distinct levels of connectivity for sites depending on their association with the program and the corresponding level of services to be provided. For remote client sites requiring the highest level of service were selected the use of dedicated T1 circuits. At these sites the capabilities provided include: PC based store-and- forward services; point-to-point interactive real-time video interactions for clinical encounters; and multi-point interactive real-time video interactions for support groups and educational activities. For sites funded for lower levels of service we selected simple dial-up telephone based communications to support store-and-forward activities and inexpensive telephone based video conferencing equipment for administrative interactions. At the service sites distributed within the Arizona Health Sciences Center (AHSC) we selected standard LAN technology for store-and-forward applications and T1 based services for interactive video. To integrate these services we selected the Asynchronous Transfer Mode (ATM) protocol, integrated with the LAN environment within the AHSC. The integrated telemedicine network supports eight client sites and two service sites with T1-based ATM and four sites with dial-up lines. At the AHSC, ATM and LAN infrastructure is distributed to several clinical areas, allowing physicians to support telemedicine activities where they normally work. Between July 1997 and Jan 1999 over 2000 telemedicine sessions have been performed, nearly 50 percent of which are teleradiology consults. The use of T1-based ATM has facilitated the development of a wide-area infrastructure that has been easily integrated with LAN and dial-up technology to provide the foundation for diverse telemedicine services.
At the University of Arizona, software development for image viewing tasks use object-oriented techniques for scalability, portability, cost and the ability to adapt rapidly to changing technology. Object orientation facilitates object-based decomposition, rapid development, code reuse and portability. These techniques were used developing software for a diagnostic system for the Pulmonary Section of Toshiba General Hospital, Tokyo, Japan. Object-oriented analysis and design were based on the Grady Booch method. Implemented used visual C++. Software components are implemented as cooperating objects. The resulting Toshiba-Arizona Viewing Station (TAVS) software system was installed in Tokyo in July 1996 for clinical evaluation. The host system provides 1760 X 2140, grey scale resolution. HIS/RIS integration allows HIS/RIS workstations to control the TAVS. TAVS code has been demonstrated on systems ranging from 'palm-top' computers to high-performance desktop systems. TAVS software objects were then modified and a TAVS system was installed in the University Medical Center, Tucson, Arizona supporting diagnostic image viewing tasks in the Emergency Department. This approach has demonstrated support for rapid development and adaptability to diverse end-user requirements and produced software which can operate across platforms.
Automating image prefetching to meet reference requirements for primary reading an area having significant potential for improving the radiology service level and one to which attention has been long-due. IRES, a knowledge-based approach to image retrieval, has a natural appeal to radiologists over ad hoc rules of thumb because its embedded image retrieval knowledge is in concert with the image reference patterns and heuristics most of them use. This paper discusses the knowledge acquisition process and validation framework, presents some interesting validation results, and outlines future research directions.
We have developed and installed a Medical Image Access System in an intensive care unit. Images are acquired and transmitted automatically to this system, thus expanding on the previous results of Shile et. al. It is our goal to determine what effect regular, sustained availability of image data in the clinic has on the Intensive Care Unit and the Department of Radiology. Our system is installed and has been in regular use in the hospital since late August of 1993. Since the time of installation we have been collecting usage information from both the manual and automated systems. From this data we are performing the standard measures established by DeSimone et. al. Our initial results support the original findings that image availability in the clinic leads to earlier patient care decision based on the image data. However, our findings do not seem to indicate that there is a breakdown of communication between the clinician and the radiologist as a result of the use of the clinical display system. In addition to the established measure we are investigating other criteria to measure time saved by both the clinician and radiologist. The results are reported in this paper.
The acceptance of digital workstations as primary diagnostic devices for chest radiographs will be precluded if there is a reduction in the radiologist's accuracy of diagnosis compared to that
achieved with conventional screen-film images. Reduction in diagnostic efficacy is believed to be partially due to a reduction in contrast resolution on video monitors. We present the results of a pilot
study that tests the ability of the contrast-enhancement algorithm artifact-suppressed adaptive histogram equalization (ASAHE) to compensate for reduced contrast resolution. The ASAHE algorithm
is compared to a computed radiographic algorithm that previously delivered observer performance inferior to conventional screen-film images. The algorithms are compared on the basis of five readers interpreting an image set consisting of 45 dllnical cases, 23 of which
are confirmed as demonstrating pneumothoraces. Detection efficacy, measured by the area under a receiver operating characteristic (ROC) curve, is not significantly different for the two algorithms. The
average ROC curves for the algorithms have different shapes, suggesting that the ASAHE algorithm is affecting diagnostic performance in a way that is not well understood. The results of the pilot study indicate that a test with higher statistical power would need to be performed using this algorithm to form a final estimate of its usefulness.
In a radiological examination reading, radiologists usually compare a newly generated examination with previous examinations of the same patient. For this reason, the retrieval of old images is a critical design requirement of totally digital radiology using Picture Archiving and Communication Systems (PACS). To achieve the required performance in a PACS with a hierarchical and possibly distributed image archival system, pre-fetching of images from slower or remote storage devices to the local buffers of workstations is proposed. Image Retrieval Expert System (IRES) is a knowledge-based image retrieval system which will predict and then pre-fetch relevant old images. Previous work on IRES design focused on the knowledge acquisition phase and the development of an efficient modeling methodology and architecture. The goal of this paper is to evaluate the effectiveness of the current IRES design and to identify appropriate directions for exploring other design features and alternatives by means of a cognitive study and an associated survey study.
We present a solution method for adaptively smoothing magnetic resonance (MR) images while preserving discontinuities. We assume that the spatial behavior of MR data can be captured by a first order polynomial defined at every pixel. The formulation itself is similar to Leclerc's work on piecewise-smooth image segmentation, but we use the graduated non- convexity (GNC) algorithm as an optimizing tool for obtaining the solution. This requires initial values for polynomial coefficients of order greater than zed all three images displayed on laser-printed film. Two radiologists made subjective quality judgments of each film individually and then ranked the trio in terms of quality. The results indicated that the observers preferred ASAHE-processed low-resolution films to both high- and low-resolution unprocessed films.
KEYWORDS: Image processing, Diagnostics, Knowledge acquisition, Chest, Digital imaging, Data acquisition, Radiology, Acquisition tracking and pointing, Data modeling, Image retrieval
Many functional, technical, and perceptual considerations must be met before a workstation will be adequate for primary diagnosis. The focus of this paper is the functional aspect of the workstation. Specifically, we are concerned with determining how images and data must be presented to the radiologist, for the purpose of primary diagnosis, under the constraints imposed by the digital workstation. We have developed an interface that is being used to acquire detailed information about the current diagnostic process. The purpose of this interface is twofold. First, this interface enables us to monitor the image and information access patterns of the radiologists in the process of interpreting films. This information is used to automate the presentation of images and information to the radiologist in future cases. Second, this interface provides a continuously evolving tool to capture the physical attributes, or navigational cues, necessary for the radiologist to develop a mental model of the operation of the diagnostic workstation. This report describes the current operation and future goals of this interface.
This paper describes a new method to determine the lower limit of patient exposure: By
placing several imaging plates of a computed radiography system (CR) into the same cassette,
several images of the same patient can be obtained at different exposure levels (determined
by the x-ray transmission of the various imaging plates. Initial experiments indicate that
exposure reduction of between 50 and 75% might be acceptable. CR provides a powerful tool
to study the subject of exposure reduction.
Computed radiography uses a photostimulable phosphor coated imaging plate which is
exposed to x-rays and laser read to form an image. After laser reading, there is a
considerable amount of energy remaining on the imaging plate which is not used. This study
simulated a change in the laser readout process to utilize more of the energy on the image
plate, and potentially improve image quality without changing exposure factors. Images of a
contrast detail phantom were made before and after alteration of the readout process and
analyzed by both physical and psychophysical means. It was found that there is an increase
in the signal-to-noise ratio, when measured with an aperture of the size of a single pixel
(linear dimension about 0.15 mm). However there is no change in the signal-to-noise ratio,
when measured with apertures of the size of 0.75 mm (5 x 5 pixels) and 1.5 mm (10 x 10
pixels). This agrees with the results of the contrast detail study: after alteration, the
observers did not detect smaller objects than they had before the alteration. It appears the
imaging plate readout process is fairly optimized.
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