Presentation on theme: "Elizabeth A. Krupinski, PhD Arizona Telemedicine Program."— Presentation transcript:
Elizabeth A. Krupinski, PhD Arizona Telemedicine Program
Ovitt, et al. Intravenous angiography using digital video subtraction: x-ray imaging system. AJR 135(6):1141-4, An x-ray imaging system, using digital subtraction techniques, has been developed. The system requires: (1) high output generation equipment; (2) an image intensifier capable of receiving high output exposures, 1 mR (2.58 X 10(-7) C/kg) at the face of the intensifier, without loss of either contrast or resolution; (3) a precision digital video camera; (4) processing computer with sufficient storage capacity; and (5) digital image storage. With this system it is possible to visualize the major arteries after intravenous contrast injection.
Capp et al. The digital radiology department of the future. Rad Clin N Am 23(2):349-55, The boom in microelectronics, including cost-effectiveness, has now allowed us to consider the use of these objects to store digital images. There remains much research, development, And clinical evaluation to be done in receptor technology. Further improvements in image processing, optical laser disk storage, & optical transmission and further commercial Development of display technology must take place. All of These developments are occurring simultaneously. Within 5 to 10 years, radiology departments will most likely be totally electronic, probably cost-effective, and, it is hoped, more diagnostically accurate.
Oldest established TM application Well integrated in numerous settings Facilitated by co-evolution PACS Few to no reimbursement issues Only interventional radiology currently less amenable to teleradiology applications Little/no differences between teleradiology & on-site radiology
ACR-NEMA development DICOM Continual updates of DICOM Development of standards & practice guidelines that explicitly include teleradiology /tg18.htm /tg18.htm
Key is the human-computer interface Series of observer performance studies designed to optimize the digital reading room environment Performance metrics ◦ Diagnostic accuracy (ROC) ◦ Search efficiency (eye position) Human Visual System Modeling
Softcopy display parameters ◦ Luminance ◦ Calibration (tone scale) ◦ Type of phosphor ◦ CRT vs LCD ◦ MTF ◦ Viewing angle ◦ Number of displays ◦ Ambient lighting ◦ Compression ◦ Role of color P45P104
Spatial & contrast resolution limitations require radiologists to search images. The UVF is about 2.5 deg radius. Probability of target detection falls off as a function of target eccentricity from axis of gaze.
Total viewing time shorter Time to first hit shorter Total time on lesion shorter Fewer returns to lesion Total path length shorter Overall = more EFFICIENT
Hospital/MC Clinics Mobile van ◦ Mammo Dedicated ◦ PET clinic ◦ THH ◦ UASA Public Health Battlefield Hand-held
Medical Imaging Consultants -> ? ◦ Data acquisition & archiving RadWorks (GE) -> Siemens/Fuji ◦ Viewing station 35% of department’s reading volume 25% department’s income ◦ Reading only & reading + archiving ◦ $/case & $/set volume
68% sites using AHSC hub for TM services use TR service TR typically 1 st service requested ◦ 79% of sites with TR use only TR ◦ 21% started with TR & added services TR specialty with most volume
Time from mammography to consult with oncologist ~ 28 days ◦ Screening mammography ◦ Diagnostic mammography ◦ Biopsy ◦ Pathology processing & report ◦ Oncology consultation THIS IS TOO LONG!
Started in 2001 to rural sites 7/28 telerad sites send mammo Mostly use GE system Directly to TBC for reading Some archive some do not Contracts specify min TAT > 26,000 telemammography
Milestone Medical Systems RHS-1-30 Vacuum Histoprocessor Quick Processing
DMetrixTM -40 Slide Scanner System Telepathology
Telepathology report sent S&F to oncologist Oncologist connects RT videoconference to rural location Discuss pathology results If necessary discuss treatment options and plan of action
MI = prevention, detection, diagnosis, treatment & therapy Acquisition & display technology continually changes Clinician shortages are not easing Rapidly expanding types & number images ◦ Multi-modality & fusion complimentary information sources is becoming common ◦ Anatomy & function gross & molecular levels ◦ Merging specialties
(Quon et al. J Clin Oncol; 2005; 23: )
Clarke et al. Validation if Tumor Burden Measurements Using 3D Histopathology. In: Digital Mammography Springer-Verlag.
Image Display, Analysis & Processing are key links in the imaging chain Need to present data to the clinician in the most efficient & informative manner Taking into account perceptual & cognitive capabilities of human observer Ultimate goal = facilitate decision-making process & enhance patient care Related goal = improve workflow & the reading environment
Stereo vs Traditional - Az 0.85 to % increase TPs -105% increase calcs - 46% decrease FPs Getty et al. Stereoscopic Digital Mammography: Improved Accuracy of Lesion Detection in Breast Cancer Screening. In: Digital Mammography Springer-Verlag.
50 DR chest images (PA) : 1/2 solitary pulmonary nodule verified CT; 1/2 nodule free 6 radiologists (3 sr residents, 3 board- certified) 3MP Barco color medical-grade display (Barco Coronis MDCC-3120-DL) vs COTS color 2MP monitor (Dell 2405) Calibrated (DICOM GSDF ) to luminance corresponding to backlight aging 1-year time ◦ Max Barco 500 cd/m 2 min 0.77 cd/m 2 ◦ Max Dell COTS 342 cd/m 2 min cd/m 2
F = , p = Sensitivity = 0.91 vs 0.86 Specificity = 0.93 vs 0.92
F = 3.38, p = 0.067
No significant differences TN significantly different
VariableHow long correlationHow many correlation Blurred visionR = p = R = p = EyestrainR = p = R = p = Difficulty focusR = p = R = p = HeadacheR = p = R = p = Neck strainR = p = R = p < Shoulder strainR = p = R = p = Back strainR = p = R = p = General fatigueR = p = R = p <
TR has made a significant impact on patient care over the past 20 years Advances in technology will further change MI & interpretation of medical data by more clinicians Costs can increase & decrease Optimizing observer accuracy while maintaining efficiency & comfort are critical to continued success