Robert M. Allman M.D. Katherine P.Andriole Ph.D. Don Baune Daniel Bednarek Ph.D. Geoffrey Bookman Kenneth Burgess Eugene Chien Allan G. Farman M.D. Rao P.Gullapalli, Ph.D. Geoffrey S. Hastings M.D. Cynthia E. Keen ElizabethA. Krupkinski Ph.D. Nicola Montanari M.D. Sunita Munjal Bruce Reiner M.D. Ronald Schilling Ph.D. Eliot Siegel M.D. Douglas M. Tucker Ph.D. Paul WeissM.D. Gary J. Whitman M.D. Bym Williamson M.D.

An acceptable mammography film digitizer must provide high-quality images at a level of diagnostic accuracy comparable to reading conventional film examinations. The purpose of this study was to determine if there are significant differences between the interpretations of conventional film-screen mammography examinations and soft copy readings of the images produced by a mammography film digitizer. Eight radiologists interpreted 120 mammography examinations, half as original films and the other half as digital images on a soft copy work station. No radiologist read the same examination twice. The interpretations were recorded in accordance with the Breast Imaging Reporting and Data System and included other variables such as perceived image quality and diagnostic difficulty and confidence. The results provide support for the hypothesis that there are no significant differences between the interpretations of conventional film-screen mammography examinations and soft copy examinations produced by a mammography film digitizer.

It was no surprise that the August publication of our article “Comparison of ‘B’ readers' interpretations of chest radiographs for asbestos-related changes” in this journal ( 1 Gitlin J.N. Cook L.L. Linton O.W. Garrett-Mayer E. Comparison of “B” readers' interpretations of chest radiographs for asbestos related changes. Acad Radiol. 2004; 11: 843-856 Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar ) stirred controversy and a backlash from some who have a vested interest in asbestos compensation litigation. The study described in our paper was a “real life” comparison of available chest-radiograph readings and not a random sample of a definable universe. We were careful to restrict any extrapolations from our data and to explain the methodology used in the study and its limits. We focused on the comparison between actual readings by plaintiffs' experts (initial readers) and our blinded expert panel of B readers (consultants).

This report on the first phase of an evaluation and demonstration project to provide high quality mammography services to women in remote and underserved areas appears at a time of considerable controversy regarding the efficacy of screening mammography. The objectives of the first phase were focused on the technical feasibility of utilizing digital mammography in a mobile setting, transmitting the images via satellite for immediate interpretation at centers of excellence, and providing the results to the patient before she left the examination site. The next phase, a field trial on a Native American reservation, will include baseline data and operational measures to address patient participation, compliance with follow-up recommendations, and the costs and benefits of the program,With the support of the Komen Foundation, the project team was able to complete the initial phase of the project to evaluate a new method of providing real-time, expert mammography interpretations to rural and underserved women. In this phase, the project team tested the feasibility of using a mobile breast care center, equipped with a digital mammography unit, and a satellite telecommunication link to medical centers for image interpretation on an electronic review workstation. The satisfactory completion of this first phase supports the recommendation that a field trial using the methods described in this report be conducted with a remote rural population to determine the clinical efficacy and economic viability of this concept in delivering breast cancer detection services. (C) 2003 Published by Elsevier Science B.V.

There are no significant differences between the interpretations of radiographic images resulting from digitizing films using a recently developed CCD unit and the readings of the original films as measured by accuracy, sensitivity, specificity and ROC analysis. Digital imaging is rapidly becoming the basis of radiology practice resulting in the gradual elimination of conventional film examinations. Related to this trend is the ability of radiologists to provide reliable interpretations of imaging examinations using film digitization and soft copy display. An acceptable system must provide high-quality digital images to achieve the levels of diagnostic accuracy that are comparable to the interpretation of film. This study is an effort to contribute to the acceptance of digital imaging by testing the hypothesis.- The authors selected 120 radiographic examinations from the departmental film files which included chest, abdominal, extremity and other common procedures. Half of the cases contained specified abnormalities and half did not have such findings. All of the examinations had a high degree of diagnostic difficulty. The films were digitized on the CCD equipment and each of the four board certified radiologists who participated in the study interpreted each of the 120 cases, half on original film and half in the digitized format on a high resolution workstation. No radiologist read the same examination more than once. Data collection included variables such as perceived image quality, diagnostic difficulty and interpretation confidence. Accuracy measures were calculated and an ROC analysis was performed. As of this date, the preliminary results indicate acceptance of the hypothesis that there is no significant difference between the accuracy of film readings and the interpretations of the digitized images on a soft copy display. Differences noted in perceived image quality among readers were also not significant. The final results, including an ROC analysis, will be available in March 2002 when a paper is submitted for publication in the Journal of Digital Imaging. During the transition from conventional film practice to digital radiology there is a need to convert previous films to a digital format for comparison with new digital examinations and to facilitate expert reading and consultation on film procedures performed at distant sites. Diagnostic quality and cost effectiveness are key factors in the acceptability of film digitizers to meet these requirements. The preliminary results of this study are encouraging in that another option may be available to radiologists and administrators responsible for choosing equipment for the changing pratice of medical imaging.

The purpose of the study was to determine if there were differences between the interpretations of radiographic images resulting from digitizing films using a recently developed CCD unit, and the readings of the original films. The general hypothesis to be tested was that there were no significant differences in the measures of accuracy, sensitivity, specificity and ROC analyses when the interpretations related to the two modes were compared. The authors selected 120 radiographic examinations for the study from departmental teaching files, which included chest, abdomen, extremity and other cases that were considered difficult to interpret. The authors also selected six specific abnormalities visualized on 60 of the cases as true positives to classify the reports. After anonymizing the patient identification, the films were digitized and independently interpreted by four board-certified radiologists. Each reader read all of the examinations, half on film alternators and the other half on a high-resolution soft-copy workstation. No reader interpreted the same examination more than once. As of this date, the preliminary results indicate that the hypothesis will be accepted, but more analyses of the data must be performed to confirm the early findings. The additional work will include complete verification of data entry and classification of interpretations, a detailed review of perceived image quality and completion of the ROC analysis by pairs of readers. If the results are confirmed, radiologists, other physicians and administrators will have another reliable option to conventional film practice through increased access to remote primary diagnosis and consultation using high-speed telecommunication media.

OBJECTIVE:We determined the relative value of teleradiology and radiology resident coverage of the emergency department by measuring and comparing the effects of physician specialty, training level, and image display method on accuracy of radiograph interpretation.MATERIALS AND METHODS:A sample of four faculty emergency medicine physicians, four emergency medicine residents, four faculty radiologists, and four radiology residents participated in our study. Each physician interpreted 120 radiographs, approximately half containing a clinically important index finding. Radiographs were interpreted using the original films and high-resolution digital monitors. Accuracy of radiograph interpretation was measured as the area under the physicians' receiver operating characteristic (ROC) curves.RESULTS:The area under the ROC curve was 0.15 (95% confidence interval [CI], 0.10-0.20) greater for radiologists than for emergency medicine physicians, 0.07 (95% CI, 0.02-0.12) greater for faculty than for residents, and 0.07 (95% CI, 0.02-0.12) greater for films than for video monitors. Using these results, we estimated that teleradiology coverage by faculty radiologists would add 0.09 (95% CI, 0.03-0.15) to the area under the ROC curve for radiograph interpretation by emergency medicine faculty alone, and radiology resident coverage would add 0.08 (95% CI, 0.02-0.14) to this area.CONCLUSION:We observed significant differences between the interpretation of radiographs on film and on digital monitors. However, we observed differences of equal or greater magnitude associated with the training level and physician specialty of each observer. In evaluating teleradiology services, observer characteristics must be considered in addition to the quality of image display.

Careful planning of the study and full support of the radiology staff are essential for collection of such data. It important to obtain pilot data to identify potential problems and adequately train personnel. Such pilot data should be compared with data collected automatically from the HIS, RIS, or PACS to establish the reliability of various data sources. When data was collected without using a study form compliance was low. It is important to automate the data collection as much as possible in order to keep the forms simple and as short as possible. This will increase substantially the consistency at which accurate data are captured.

The Symposium will be the llth Conference on Computer Applications in Radiology, a series of national meetings that began in 1964.It will also be the sixth Conference on Computer Assisted Radiology, a series of international meetings that began in 1985.The sponsoring organizations include the American College of Radiology, Computer Assisted Radiology, the Radiology Information System Consortium, and the Society for Computer Applications in Radiology.The Symposium's program represents the mutual interests of the several sponsoring organizations and the departments of radiology at the host institutions, which currently emphasize advances in computer technology that affect radiology information systems, image management applications, and communication networks.S/CAR '92 has been organized to provide a platform for a broad spectrum of health care professionals to present recent advances in and the benefits of using computer technology to improve the clinical practice of radiology and to manage health care resources more effectively.The impact of recent developments in digital imaging technology and related applications to information management systems and networks, concerns radiologists, other physicians, physicists, engineers, administrators, computer scientists and technologists.Attendance at S/CAR '92 is appropriate for all of the disciplines concerned with medical imaging.The Symposium will feature scientific papers,

A satellite image transmission system has been installed between an orthopedic clinic in suburban Philadelphia and the Hospital of the University of Pennsylvania in central Philadelphia. The two facilities are approximately 15 miles apart. Images at the clinic are acquired with a laser scanning film digitizer at a 200 micron resolution. The resulting data (1680x2048x12 bits) are compressed using a non-destructive algorithm and transmitted via a Ku-Band satellite link to the hospital. The effective transmission rate is approximately one Mbit/second. Upon receipt, the images are restored before being archived and displayed on the existing Medical Image Management System in the Radiology Department. This paper describes the flow of image data and presents an overview of the technical aspects of the satellite transmission system. System parameters are tabulated and enhancements are also discussed.

The impact of new technology on Radiology has been and continues to be dramatic. The use of computers is rapidly changing the way Radiology is practiced. To date, automation has been primarily limited to computerized tomography, nuclear medicine imaging, and automated management systems. The full range of functions now available in such management systems are described and the potential impact of teleradiology, automatic speech recognition, high-density disks, and digital radiography are discussed.