Digital Teaching File Research Articles

Strategic Improvements for Gross Anatomy Web-Based Teaching

Current generations of graduate students have been immersed in technology from their early school years and have high expectations regarding digital resources. To better meet the expectations of Gross Anatomy students at our institution, electronic radiology teaching files for first-year coursework were organized into a web site. The web site was custom designed to provide material that directly correlated to the Gross Anatomy dissection and lectures. Quick links provided sets of images grouped by anatomic location. Additionally, Lab and Study Companions provided specific material for the students to review prior to and after lectures and gross dissections. Student opinions of this education resource were compared to student opinions of the prior year's digital teaching files. The new content was ranked as more user friendly (3.1 points versus 2.3 points) and more useful for learning anatomy (3.3 points versus 2.6 points). Many students reported that using the web portal was critical in helping them to better understand relationships of anatomical structures. These findings suggest that a well-organized web portal can provide a user-friendly, valuable educational resource for medical students who are studying Gross Anatomy.

Digital teaching files – a useful teaching tool for the modern radiologist

Radiologists have always collected copies of model examples and interesting cases encountered in daily practice to use for teaching purposes. A collection of teaching files is an important resource for medical education and the dissemination of knowledge in radiology. Furthermore, the presence of a radiological teaching file is also a requirement at several universities and tertiary institutions in South Africa and abroad, where radiology postgraduate training is conducted.
 
 The advent of digital radiology and the more widespread use of picture archiving and communication systems (PACS) have led to a unique opportunity to change the way that radiology teaching cases are collected, stored and managed. Traditional teaching file systems are rapidly becoming obsolete and incompatible with the digital environment of modern radiology departments.

Incorporation of a Formalized Emergency Radiology Curriculum to Facilitate Population of a MIRC-based Digital Teaching File

Teaching files are integral to radiological training. Digital Imaging and Communication in Medicine compatible digital radiological data and technological advances have made digital teaching files a desirable way to preserve and share representative and/or unusual cases for training purposes. The Medical Imaging Resource Community (MIRC) system developed by the Radiological Society of North America (RSNA) is a robust multi-platform digital teaching file implementation that is freely available. An emergency radiology training curriculum developed by the American Society of Emergency Radiology (ASER) was incorporated to determine if such an approach might facilitate the entry, maintenance, and cataloguing of interesting cases. The RSNA MIRC software was obtained from the main MIRC website and installed. A coding system was developed based on the outline form of the ASER curriculum. Weekly reports were generated tallying the number of cases in each category of the curriculum. Resident participation in the entry and maintenance of cases markedly increased after incorporation of the ASER curriculum. The coding schema facilitated progress assessment. Ultimately, 454 total cases were entered into the MIRC database, representing at least 42% of the subcategories within the ASER curriculum (161 out of 376). The incorporation of the ASER emergency radiology curriculum greatly facilitated the location, cataloguing, tracking, and maintenance of representative cases and served as an effective means by which to unify the efforts of the department to develop a comprehensive teaching resource within this subspecialty. This approach and format will be extended to other educational curricula in other radiological subspecialties.

TH‐D‐350‐06: A Web Based Physics Teaching File for Radiology Residents

Purpose: To describe a web‐based digital teaching file of imaging physics for Radiology residents. Method and Materials: The RSNA R&E Foundation supported the development of a web‐based physics teaching file for Radiology residents. This RSNA Physics Teaching File was completed at the end of 2007 and is freely available to any computer with internet access. Modalities that employ x‐rays in the image formation process are described, including radiography, mammography, fluoroscopy, angiography, and computed tomography. There are also sections on general characteristics of digital images and image processing, which has become ubiquitous in digital imaging. Results: The website is hosted at SUNY Upstate Medical University and may be viewed at http://www.upstate.edu/radiology/rsna. Each section contains digital images generated with appropriate phantoms on the various modalities, as well as a selection of clinical images. Illustrated are important technical issues related to image quality (i.e. contrast, resolution, and noise) and how these are affected by parameters associated with image acquisition. Effect of changing tube voltage, tube current, field of view, image matrix size, and scatter reduction techniques are illustrated. Special sections were included to explain dual‐energy imaging and other image processing techniques in radiography. Conclusion: The teaching file web site is a valuable resource for teaching the physics of x‐ray imaging to radiology residents.

Using Applet–Servlet Communication for Optimizing Window, Level and Crop for DICOM to JPEG Conversion

In the creation of interesting radiological cases in a digital teaching file, it is necessary to adjust the window and level settings of an image to effectively display the educational focus. The web-based applet described in this paper presents an effective solution for real-time window and level adjustments without leaving the picture archiving and communications system workstation. Optimized images are created, as user-defined parameters are passed between the applet and a servlet on the Health Insurance Portability and Accountability Act-compliant teaching file server.

An Integrated Approach to a Teaching File Linked to PACS

To meet the educational needs of a medical imaging department with a strong teaching commitment, a teaching file that uses digital data supplied by the institutional picture archiving and communications system (PACS) was required. This teaching file had to be easily used by the end users, have a simple submission process, be able to support multiple users, be searchable on all data fields, and implementing the teaching file must not incur any additional software or hardware costs. The teaching file developed to address this problem takes advantage of the database structure and capabilities of several components included in the commercial PACS installed at the hospital. MS Access is used to seamlessly integrate with the digital imaging and communication in medicine (DICOM) database of a normal work station that is part of the PACS. This integration allows relevant patient and study demographics to be copied from images of interest and then to be stored in a separate database as the back-end of the digital teaching file. When images for a particular teaching file case need to be reviewed, they are automatically retrieved and displayed from the main PACS database using an open application programming interface (API) connection defined on the PACS web server. Utilizing this open API connection means the teaching file contains only the relevant demographic information of each teaching file case; no image data is stored locally. The open API connection allows access to imaging data usually not encountered in a teaching file, allowing more comprehensive imaging case files to be developed by the radiologist. Other advantages of this teaching file design are that it does not duplicate image data, it is small allowing simple ongoing backup, and it can be opened with multiple users accessing the database without compromising data access or integrity.

Medical Imaging Resource Center (MIRC) for Veterinary Medicine: A Digital Image Teaching File

Veterinary radiology has a need for software to facilitate the creation of digital image teaching files. The Medical Imaging Resource Center (MIRC) is widely used in medicine to create teaching cases and store data from clinical trials. This open-source software was identified as a solution for use in veterinary medicine. The additional fields needed to adapt the system for veterinary use were identified as sex, species, and breed. Breed and species codes from the Matthew J. Ryan Veterinary Hospital of the University of Pennsylvania and from the Standard Nomenclature of Veterinary Diseases and Operations (SNVDO) were gathered and correlated. The sex fields added were male, male neutered, female, and female neutered. The breed and species codes were combined into a single term. These were coded in eXtensible Markup Language (XML) and added to the software's veterinary document template and search capabilities. MIRC was successfully adapted for use in creating digital teaching files for veterinary medicine.

Vendor-Neutral Case Input into a Server-based Digital Teaching File System

Although digital teaching files are important to radiology education, there are no current satisfactory solutions for export of Digital Imaging and Communications in Medicine (DICOM) images from picture archiving and communication systems (PACS) in desktop publishing format. A vendor-neutral digital teaching file, the Radiology Interesting Case Server (RadICS), offers an efficient tool for harvesting interesting cases from PACS without requiring modifications of the PACS configurations. Radiologists push imaging studies from PACS to RadICS via the standard DICOM Send process, and the RadICS server automatically converts the DICOM images into the Joint Photographic Experts Group format, a common desktop publishing format. They can then select key images and create an interesting case series at the PACS workstation. RadICS was tested successfully against multiple unmodified commercial PACS. Using RadICS, radiologists are able to harvest and author interesting cases at the point of clinical interpretation with minimal disruption in clinical work flow.

Digital Radiology Teaching & Education

There have been several significant advances in Digital Imaging over the past few decades which have radically altered Digital Radiology Teaching & Education. The creation and adoption of digital modalities allows for an easier integration of digital radiological material into modern teaching tools. The transition from the analog to the digital realm is more difficult for senior radiologists, with large stores of analog slides for their teaching material. There are four important steps in digital imaging for education: acquisition, storage, manipulation, and presentation. These steps mark the pathway of image data from a radiology modality into an educational product. The growing use of Picture Archival and Communication Systems (PACS) also contributes to the creation of digital imaging educational material. Although the last step, presentation, may seem to not be as important as the others, it should be an early project consideration, especially for larger database image repositories, such as digital teaching file systems.

Digitales Lehrarchiv

Film-based teaching files require a substantial investment in human, logistic, and financial resources. The combination of computer and network technology facilitates the workflow integration of distributing radiologic teaching cases within an institution (intranet) or via the World Wide Web (Internet). A digital teaching file (DTF) should include the following basic functions: image import from different sources and of different formats, editing of imported images, uniform case classification, quality control (peer review), a controlled access of different user groups (in-house and external), and an efficient retrieval strategy. The portable network graphics image format (PNG) is especially suitable for DTFs because of several features: pixel support, 2D-interlacing, gamma correction, and lossless compression. The American College of Radiology (ACR) "Index for Radiological Diagnoses" is hierarchically organized and thus an ideal classification system for a DTF. Computer-based training (CBT) in radiology is described in numerous publications, from supplementing traditional learning methods to certified education via the Internet. Attractiveness of a CBT application can be increased by integration of graphical and interactive elements but makes workflow integration of daily case input more difficult. Our DTF was built with established Internet instruments and integrated into a heterogeneous PACS/RIS environment. It facilitates a quick transfer (DICOM_Send) of selected images at the time of interpretation to the DTF and access to the DTF application at any time anywhere within the university hospital intranet employing a standard web browser. A DTF is a small but important building block in an institutional strategy of knowledge management.

Improving patient care: the use of a digital teaching file to enhance clinicians' access to the intellectual capital of interdepartmental conferences.

We describe a simple method for creating teaching cases from clinical data, radiologic images, surgical images, and images from pathologic slides that are presented at tumor board conferences. The resulting interdisciplinary case files are of educational value both during and after conference presentations and can be used by clinicians to gather appropriate historical, laboratory, imaging, surgical, and pathologic data on their patients. This system improves the efficiency and accuracy in gathering patient histories when care is transferred among clinics, the emergency department, and wards.

A simple method of capturing PACS and other radiographic images for digital teaching files or other image repositories.

We sought to develop an easy-to-use method of capturing and storing radiographic images. The method that we developed can capture any digital image-including an image from a picture archiving and communication system (PACS)-using widely available, inexpensive software. Our method is easy to learn, simple to use, and inexpensive to implement. It is adaptable in a wide range of networking environments and can capture and store images rapidly for a variety of uses. It can be used without interfering with clinical workflow at the PACS workstation.

Relative Value of Analog and Digital Teaching Files

Rationale and Objectives This study was performed to determine if it is financially reasonable for radiology residency programs that create and maintain their own teaching files to switch from analog teaching files (ATFs) to digital teaching files (DTFs). Materials and Methods Radiology residency program directors were surveyed electronically about the monetary value and importance of conventional ATFs and DTFs. The costs for maintaining each type of file were calculated at the authors' institution. Results Surveys were sent to the program directors of all 197 accredited radiology residencies. Responses were received from 48 (24%). DTFs were scored as more important than ATFs, but the difference was not significant ( P = .22). DTFs were rated as less complete ( P = .01) but more current ( P ⪡ .001) than ATFs. DTFs included the American College of Radiology Learning File (85%), in-house productions (77%), and other commercially available products (63%). Thirty percent of respondents had a DTF integrated into a picture archiving and communication system, and 28% reported having a technician dedicated to the teaching file. Program directors ascribed total median dollar values of $250 and $3,000 per year to their ATFs and DTFs, respectively. The annual costs at the authors' institution were much higher than these ascribed values: $44,720 ($91 per case) for maintaining a DTF produced in house and $24,601 ($50 per case) for maintaining an ATF, excluding physician time. Conclusion Program directors are more willing to pay for a DTF than an ATF. For both, the costs of maintenance are great and the relative monetary value is low.

The evolution of filmless radiology teaching

The transition from hard-copy film to the picture archiving and communication systems (PACS) arena is often a long and difficult path, but the complete transformation to the digital environment does not end with the successful clinical practice utilizing PACS. The next hurdle for academic institutions is similar changes in the teaching field. The loss of hardcopy films can greatly hinder the radiology teaching file and teaching conference experiences. The next step in our growth is the conversion to digital teaching files and conferences. The original work 10 years ago with utilizing computers linked with laser disks and magneto-optical media, have now evolved into complex networks with expanding and relatively cheap storage media, such as CD-ROM and easily to navigate graphic-user interfaces such as hypertext markup language (HTML) and extensible markup language (XML), for use with multimedia teaching tools. The transition into the digital arena for radiology education and interdepartmental conferences can be accomplished through several different paths. These include direct transfer of images into a presentation program, as well as exportation of images into suitable image file formats for later use. There is also the ability to expand the PACS network to include conference rooms. Similar training and teaching can allow radiologists to transition into the digital environment for future digital teaching file creation as well as correlative radiology interdepartmental conferences.

Integrating digital teaching-file systems with off-the-shelf presentation software to facilitate speaker-led conferences.

Develop methods for automated transfer of images and associated text from a teaching-file repository into presentation material for speaker-led conferences. Our institution uses a Microsoft Windows (Microsoft Corp, Redmond, WA) software application to maintain a digital teaching-file database that can store and retrieve content in a case-centric fashion. Virtually any number of images can be stored with any given case. Cases and their associated images can be retrieved via a module that supports searches by American College of Radiology (ACR) code and by free-text Boolean queries on the history, findings, diagnosis, and discussion components of a case. In addition to the software system serving directly as an interactive teaching tool, the digital teaching file itself serves as an image repository and resource for attending radiologists who create their own presentations and lectures. To better support this use, software modules were developed for interprocess communication and automated creation of Powerpoint slides. These modules are fully integrated with the teaching-file software application. A single image or a set of selected images can be automatically made into individual slides with two mouse clicks. Images are automatically centered and optimally sized. A slide title is automatically rendered from the user's preference of the case history or diagnosis (stored with the case), or via the entry of freeform text. We describe the programming techniques that are used, as well as how several features of the operating system and Powerpoint itself can be integrated with a customized software application to facilitate this objective. The creation of presentation-ready Powerpoint slides is fully automated from within our teaching-file application, and the time required to create a presentation compared to the conventional method of manually seeking and inserting files from within Powerpoint itself, on a per-slide basis, is drastically reduced. The benefits are magnified by having all imagery stored within an organized and searchable database system so that desired images can be easily located. A digital teaching-file system can serve as a useful image repository for purposes ancillary to direct computerized instruction. Software that supports these uses, such as the automated creation of presentation material for speaker-led conferences, facilitates the radiologist's role as an educator.

"WWW.MDTF.ORG": a World Wide Web forum for developing open-architecture, freely distributed, digital teaching file software by participant consensus.

To foster a community supported evaluation processes for open-source digital teaching file (DTF) development and maintenance. The mechanisms used to support this process will include standard web browsers, web servers, forum software, and custom additions to the forum software to potentially enable a mediated voting protocol. The web server will also serve as a focal point for beta and release software distribution, which is the desired end-goal of this process. We foresee that www.mdtf.org will provide for widespread distribution of open source DTF software that will include function and interface design decisions from community participation on the website forums.

A simple mechanism for sharing and transporting medical digital case information across disparate computer language and data storage environments.

It is challenging to remotely share generic medical case information without an agreed upon definition of a medical digital teaching file (DTF). By utilizing an application of the extensible markup language (XML) called web-distributed data exchange (WDDX) along with an agreed upon WDDX structure, it is technically easy to share or syndicate medical case DTFs across computing environments that use different information models and computer languages. Thus, this easily implemented technology offers us an immediately available means to share and increase the value of scientific knowledge.

Image file formats: past, present, and future.

Despite the rapid growth of the Internet for storage and display of World Wide Web-based teaching files, the available image file formats have remained relatively limited. The recently developed portable networks graphics (PNG) format is versatile and offers several advantages over the older Internet standard image file formats that make it an attractive option for digital teaching files. With the PNG format, it is possible to repeatedly open, edit, and save files with lossless compression along with gamma and chromicity correction. The two-dimensional interlacing capabilities of PNG allow an image to fill in from top to bottom and from right to left, making retrieval faster than with other formats. In addition, images can be viewed closer to the original settings, and metadata (ie, information about data) can be incorporated into files. The PNG format provides a network-friendly, patent-free, lossless compression scheme that is truly cross-platform and has many new features that are useful for multimedia and Web-based radiologic teaching. The widespread acceptance of PNG by the World Wide Web Consortium and by the most popular Web browsers and graphic manipulation software companies suggests an expanding role in the future of multimedia teaching file development.

Adobe acrobat: an alternative electronic teaching file construction methodology independent of HTML restrictions.

The goal of the project was to create a method by which an in-house digital teaching file could be constructed that was simple, inexpensive, independent of hypertext markup language (HTML) restrictions, and appears identical on multiple platforms. To accomplish this, Microsoft PowerPoint and Adobe Acrobat were used in succession to assemble digital teaching files in the Acrobat portable document file format. They were then verified to appear identically on computers running Windows, Macintosh Operating Systems (OS), and the Silicon Graphics Unix-based OS as either a free-standing file using Acrobat Reader software or from within a browser window using the Acrobat browser plug-in. This latter display method yields a file viewed through a browser window, yet remains independent of underlying HTML restrictions, which may confer an advantage over simple HTML teaching file construction. Thus, a hybrid of HTML-distributed Adobe Acrobat generated WWW documents may be a viable alternative for digital teaching file construction and distribution.

11-61 How to access and manipulate DICOM images in a digital teaching file

11-61 How to access and manipulate DICOM images in a digital teaching file