Picture Communication Research Articles

Frequency of tibial plateau fracture combined with dislocation and imaging features of medial or posteromedial fragments

Objective To evaluate the incidence and imaging features of tibial plateau fracture combined with dislocation. Methods A total of 298 patients with intact imaging data treated for tibial plateau fracture from December 2012 to June 2014 were analyzed retrospectively. Tilt angle of medial fragment fracture line, ratio of width of medial fragment to total plateau, surface area percentage, fragment height, and major displacement were measured on CT images using picture archiving and communication system (PACS). Results Eighteen patients (6.0%) had tibial plateau fractures combined with dislocation, with tilt angle of medial or posteromedial fragment fracture line of (62.1±14.1)°. Eleven patients (61%) had split of the medial tibial plateau with surface area percentage of (46.3±2.5)%, fragment height of (43.9±6.2)mm, and major displacement of (5.3±2.1)mm.Seven patients (39%) had posteromedial fragment fracture with surface area percentage of (25.1±5.7)%, fragment height of (40.0±10.1)mm, and major displacement of (4.8±6.45)mm. Conclusions Fracture line of fracture-dislocation tibial plateau fracture is much often through the eminence or located at the lateral eminence with large medial or posteromedial fragments. Surgical approaches and directions of nailing should be considered properly according to the morphological characteristics. Key words: Tibial fractures; Dislocations; Radiography

Simulation System for Radiology Education Integration of Physical and Virtual Realities: Overview and Software Considerations

Introduction: The aim of the proposed system is to give students a flexible, realistic, and interactive learning environment to study the physical limit of different postures and various imaging procedures. The suggested system will also familiarise the students with various imaging modalities, the anatomical structures that are observable under different X-ray tube settings and the quality of the resulting image. Current teaching practice for radiological sciences asks students to simulate the imaging procedure in role plays - consisting of one student as a patient and the other as the radiologist. Other ways include the use of a physical phantom consisting of bone and soft tissue equivalent material but in either way X-ray has to be used with all the requirements of such an examination room shielding, lead apron, and other radiation protection procedures. Proposed System: The proposed system has several physical components and virtual components. Students manipulate the mannequin into the model of the imaging modality and in a posture suitable for the purpose of the imaging study. The virtual components of our simulation system include a posture interface, a computational phantom generator, and a physics simulator. The synthetic image will be produced and conformed to the Digital Imaging and Communications in Medicine standard so that it can be stored, retrieved, and displayed in a standard picture archiving and communication system that hospitals use. Conclusion: The suggested system will familiarise the students and improve their competency level, not only for X-ray but various other imaging modalities, including the anatomical structures that are observable under different X-ray tube settings and the quality of the resulting image.

A comparative cost analysis of picture archiving and communications systems (PACS) versus conventional radiology in the private sector

Background: Radiology is rapidly advancing, with a global transition to digital imaging technology to improve productivity and enhance communication. The major challenge confronting radiology practices is to demonstrate cost savings and productivity gains when a picture archiving and communication system (PACS) is established.Aim: To undertake an incremental cost analysis of PACS compared with conventional radiology to determine productivity gains, if any, at two private hospitals in Durban.Method: An incremental cost analysis for chest radiographs, computed tomography and magnetic resonance imaging brain scans with and without contrast were performed. The overall incremental cost for PACS in comparison with a conventional radiology site was determined. The net present value was also determined to evaluate the capital budgeting requirements for both systems.Results: The incremental cost of both capital and the radiology information system for installing PACS shows an expected increase. The incremental PACS image cost shows a reduction.Conclusion: The study provides a benchmark for the cost incurred when implementing PACS. It also provides a decision framework for radiology departments that plan to introduce PACS and helps to determine the feasibility of its introduction.

SmartWADO: an Extensible WADO Middleware for Regional Medical Image Sharing.

Medical image sharing is an important problem in modern radiology, with wide applications in Internet and mobile devices. Some important features need to be added and optimized to medical image sharing. In this paper, we present an extensible Web Access to DICOM Persistent Objects (WADO) middleware based on image cache and real-time Web monitor technology for regional medical image sharing. We first develop the extension method of WADO standard and workflow of extended WADO service. Then, we design a medical image cache method to improve the performance of medical image on-demand transmission. Using the real-time monitor can discover the performance bottlenecks and optimized critical points. The experimental results show that the middleware effectively delivers medical images and reports to Web clients over the Internet, regardless of the platform used for access. It can be deployed in one hospital to provide WADO service to medical workers and also can be applied to regional picture archiving and communication systems (PACS) to transmit medical images and reports to Internet users in a way that is transparent to end-user applications.

Structured reporting in radiology: an introduction

112 British Journal of Healthcare Management 2015 Vol 21 No 3 © 2 01 5 M A H ea lth ca re L td radiologist is unsure) • Provide advice on further appropriate investigations (radiological or non-radiological) • Provide advice on further management or referral to an appropriate speciality (advice should be appropriate for local practices) • Include degree of confidence in the diagnosis (e.g. consistent with, suspicious of, likely etc). An actionable radiology report is dependent on three key factors: • Access to clinical information: Instant access to a full imaging history on the picture archiving and communication system (PACS), ‘instant’ access to blood results, clinic letters, discharge summaries and endoscopy findings, is essential for accurate diagnosis by radiologists. The author’s hospital’s radiology information system (RIS) has ‘one-click’ URL links to patients’ blood results, and other electronic patient record information • Regular face-to-face dialogue with local clinical teams: Multidisciplinary team meatings (MDTMs) and face-to-face clinical consultation with clinical colleagues provide radiologists with the understanding of how patients are treated. This allow radiologists to give appropriate advice as part of our report • Special interest development: This development by radiologists through weekly dialogue through clinical meetings/MDTMs, is not confined to tertiary referral centres. Most modern radiologists work in clinical teams and develop special interests—for example, breast, musculoskeltal or chest radiology. The reporting platform (RIS-PACS software) required for radiologists to issue ‘actionable reports’ includes: • Full imaging history on the RIS, with details such as reports, further appointments and cancelled requests • One-click context link to patients’ blood results, histopathological reports, endoscopy reports and clinic attendance letter on the RIS • PACS with the full imaging history, and images for all exams done in the institution

Abstract T P28: Diagnostic Accuracy of Mobile Devices for Remote Acute Stroke Neuroimaging Interpretation

BACKGROUND: Advances in technology allow physicians’ access to radiological images remotely, virtually anytime, anywhere to streamline stroke management. OBJECTIVE: To compare the diagnostic accuracy of different mobile devices in interpretation of acute head CT for various ischemic stroke findings among various readers. METHODS: 20 selected acute stroke head CT were independently interpreted by 11 readers (7 Neurologists, 3 Neuroradiologists and 1 Radiologist) on 2 mobile devices, iPad® 2 (1024x768 pixels) and iPhone® 4 (960x640 pixels), and on the Picture Archiving and Communication System (PACS) workstation (1280x1024 pixels). Both mobile devices used a FDA-cleared ResolutionMD software (ResMD® Calgary Scientific, Calgary, Canada). Primary outcome measures included: any acute ischemic sign (AIS), any non acute ischemic sign (NAIS), and any hyperdense middle cerebral artery (HMCA) sign. For each outcome intra-rater inter-device accuracy, using a rater specific gold standard, were evaluated and estimated % Sensitivity (Sen) and % Specificity (Spe) with 95% Agrest-Coull Confidence Intervals (CIs) were reported from frequency tables. RESULTS: Across all 11 readers, for AIS: Sen = 76 (68, 82) and Spe = 75 (64, 83) on iPhone; Sen = 76 (69, 83), Spe = 71 (60, 80) on iPad. For for NAIS: Sen = 80 (72, 86) and Spe = 77 (67, 84) on iPhone and Sen = 75 (67, 82) and Spe = 80 (71, 87) on iPad. For HMCA Sen = 53 (39, 67) Spe = 97 (93, 99) on iPhone and Sen = 62 (48, 75) and Spe = 95 (91, 98) on iPad. CONCLUSIONS: This is the first study directly comparing the diagnostic accuracy of two different mobile devices for acute head CT ischemic stroke findings. Both iPhone and iPad have fair sensitivity for detection of AIS and NAIS, while poorer sensitivity for HMCA when read by readers from different specialties. Specificity was good to excellent for all 3 head CT ischemic stroke findings. iPhone and iPad have similarly good diagnostic accuracy for acute ischemic stroke head CT scan findings supporting their use for remote neuroimaging interpretation. Their validation in routine clinical practice needs to be confirmed in larger studies.

A comparison of two approaches for representing AAC vocabulary for young children

Purpose: Young children with complex communication needs often experience difficulty in using currently available graphic symbol systems as a method of augmentative and alternative communication (AAC). Information on young children's performance with graphic representations based on this population's conceptualizations of these vocabulary items may assist in the development of more effective AAC systems.Method: This study developed Developmentally Appropriate Symbols (DAS) for 10 early emerging vocabulary concepts using procedures designed to address both conceptual and appeal issues for graphic representations for young children. Using a post-test only, between-subjects comparison group design, 40 typically-developing 2.5–3.5-year-old children were randomly assigned to receive a brief training in either of two different types of graphic symbol sets: (a) DAS or (b) Picture Communication Symbols (PCS), a, commercially available graphic symbol system.Result: Results of a two sample independent t-test provide evidence that children in the DAS condition correctly identified more symbols than children trained with the PCS symbols. There was no evidence of a preference between the symbol sets.Conclusion: The results provide support for careful consideration of children's use and understanding of language in developing AAC systems for young children.

Epidemiological characteristics of Barton's fracture

Objective To investigate the epidemiological features and variation trends of Barton's fracture. Methods Fracture patients treated between January 2003 and December 2012 at our hospital were identified through the picture archiving and communication system (PACS) and case reports checking system. This retrospective study included Barton's fracture. Data between 2003 and 2007 were classified as Group A, while data between 2008 and 2012 as Group B. Gender and age distribution were recorded and compared between the two groups. Results A total of 160 Barton's fractures were selected with 76 males (47.5%) and 84 females (52.5%), accounting for 1.392% (160/11, 496) of the distal ulna and radius fracture and 0.127% (160/126, 479) of human fractures. Age distribution showed the peak range of Barton's fracture was 51-60 years old (21.9%, 35/160). Proportion of palmar and dorsal types of Barton's fracture was 58.8% (94/160) and 41.2% (66/160) respectively. There were 67 cases and 93 cases in Groups A and B, accounting for 1.13% (67/5, 905) and 1.66% (93/5, 591) of the distal ulna and radius fracture and 0.103% (67/65, 267) and 0.152%(93/61, 212) of the human fracture over the same period (P 0.05). Cases of palmar and dorsal Barton's fracture in group A was 37 and 30, similar with 57 and 36 in Group B (P>0.05). Conclusions Barton's fracture is more prevalent in females than in males. Palmar type of Barton's fracture outnumbers dorsal type. There are no significant differences in gender and fracture type distribution between the two periods of 2003-2007 and 2008-2012. Key words: Radius fractures; Wrist injuries; Epidemiology

Identifying, locating, and sequencing picture communication symbols: Contributions from developmental visuospatial and temporal memory

This study investigated visuospatial and temporal working memory through assessment of feature binding abilities of typically developing first-, third-, and fifth-grade school-age children. One hundred and twelve children were asked to identify, locate, and sequence various numbers and arrays of picture communication symbols during a picture span assessment task. Feature binding was assessed through analysis of object recall, location recall, object–location recall, object–sequence recall, and location–sequence recall. Significant increases in picture span occurred with increasing grade level. Objects were highly salient with most children having recall greater than 90%. Most children had difficulty with recall of location, object sequence, and location sequence. A significant increase in location–sequence binding ability was noted as grade level increased from first to third grade. When visuospatial and temporal working memory capacity is exceeded, limitations in the ability to bind multiple features (object, location, and sequence) may reduce children’s abilities to successfully use visual graphic displays for communication.

Digital Imaging and Electronic Data Capture in Multi-Center Clinical Trials.

While medical image data is managed in picture archiving and communication systems (PACS) via the digital imaging and communications in medicine (DICOM) protocol, electronic data capture systems (EDCS) in clinical trials lack PACS interfacing. This complicates the trial workflow and increases errors, time, and costs. In this work, four system architectures of image integration for multi-center trials are analyzed with respect to data, function, visual, and context integration levels. We propose an open source-based architecture composed of OpenClinica, DCM4CHE, and Weasis for EDCS, PACS, and Viewer, respectively.

Simulation system for radiology education integration of physical and virtual realities: Overview and software considerations

Introduction: The aim of the proposed system is to give students a flexible, realistic, and interactive learning environment to study the physical limit of different postures and various imaging procedures. The suggested system will also familiarise the students with various imaging modalities, the anatomical structures that are observable under different X-ray tube settings and the quality of the resulting image. Current teaching practice for radiological sciences asks students to simulate the imaging procedure in role plays - consisting of one student as a patient and the other as the radiologist. Other ways include the use of a physical phantom consisting of bone and soft tissue equivalent material but in either way X-ray has to be used with all the requirements of such an examination room shielding, lead apron, and other radiation protection procedures. Proposed System: The proposed system has several physical components and virtual components. Students manipulate the mannequin into the model of the imaging modality and in a posture suitable for the purpose of the imaging study. The virtual components of our simulation system include a posture interface, a computational phantom generator, and a physics simulator. The synthetic image will be produced and conformed to the Digital Imaging and Communications in Medicine standard so that it can be stored, retrieved, and displayed in a standard picture archiving and communication system that hospitals use. Conclusion: The suggested system will familiarise the students and improve their competency level, not only for X-ray but various other imaging modalities, including the anatomical structures that are observable under different X-ray tube settings and the quality of the resulting image.

Software Services Delivered from the Cloud

Picture Archiving and Communication Systems (PACS), alongside Radiological Information Systems (RIS) are nowadays widely disseminated, proven useful, hospital information systems components. The “Région Sans Film” (“Filmless Region”) program was launched in 2009 by the French ministry of health in order to help the generalization to all healthcare structures such as hospitals or general physician practices, of PACS, RIS, and archiving of medical images. It is done by means of a mutualized service platform whom building and running has been entrusted to an industrial consortium. This platform implements the latest technologies of medical image processing and of cloud computing. It is built in order to support service-oriented enterprise architecture composed of one main layer of software services. This natively scalable platform is innovative because it is the first one which contains all the materials for the implementation of all services in the cloud. The corresponding SLA are defined in order to be adaptable to the needs of further health structures which could later join the platform by participating in its mutualized purchasing. The goal is not only to share the costs but also to deliver new images sharing services. New business processes/services around sharing of images such as teleradiology or access to the images produced in hospitals to the general practitioners are defined towards the exercise of real filmless radiology.

ED-06 * BRAINSTEM GLIOMAS IN ADULTS: DO ADULT DIFFUSE INTRINSIC PONTINE GLIOMAS EXIST?

BACKGROUND: The majority of brainstem tumors in children are diffuse intrinsic pontine gliomas (DIPG), and are diagnosed in middle childhood. Recent data suggests DIPG is a disease of development. Relatively little information is available for adult brainstem gliomas (BSG). We reviewed clinical and radiographic information from adults with BSG referred to our institution. METHODS: Patients were enrolled on IRB-approved protocols. Clinical data was obtained from patient charts and electronic records. Radiographic data was reviewed on a Picture Archiving and Communications System (PACS) and assessed for primary tumor location, enhancement, intensity on T1, invasion of surrounding anatomical structures, and presence of CNS disease outside of the brainstem. RESULTS: 18 patients diagnosed with BSG were identified; diagnostic MRI was available for review on 15. M:F was 16:2; median age 29.5 (range 16-71) years at diagnosis. Presenting symptoms included long tract signs (61%), diplopia (50%), other visual changes (22%), imbalance (44%), headache (33%) and nausea/vomiting (33%). Primary tumor location varied: 27% were located in the pons only, 33% in pons with extension to medulla, 13% in pons with extension to midbrain, and 20% in pons with extension to midbrain and medulla. 80% showed contrast enhancement, with the majority (58%) of these enhanced diffusely. Other radiographic findings included encasement of the basilar artery (20%) and evidence of CNS disease outside of the brainstem (20%) at diagnosis (cerebellum and parietal lobe). The majority (88%) received radiation treatment; 56% received concurrent chemotherapy and 44% received adjuvant chemotherapy. Median time to first progression (defined radiographically and clinically) was 22 months (range 3-192 months). CONCLUSIONS: Although adults with brainstem tumors involving the pons have similar presentation as children with DIPG, imaging findings and clinical outcome differ significantly. Investigation into the biology of the adult lesions, including H3.3 mutations, may help define these as more distinct entities.

Imaging characteristics of basilar artery hypoplasia

To determine the imaging characteristics of basilar artery hypoplasia (BAH). From October 2009 to August 2013, 10 193 magnetic resonance angiogram (MRA) and 31 716 magnetic resonance imaging (MRI) consecutive cases were retrospectively retrieved from our institutional Picture Archiving and Communication System (PACS) database. BAH was defined as a continuous diameter reduction all over artery and a basilar artery diameter ≤ 2 mm. The same cut-off value was applied for vertebral artery hypoplasia (VAH). We measured the diameters of basilar and vertebral arteries with PACS in all patients according to source imaging and IMP construction of MRA. The carotid arterial computed tomography angiogram (CTA) profiles were reviewed in 50 patients. The fetal-type posterior circle of Willis (FTP) was assessed. The diagnosis of acute cerebral infarction was based on clinical symptoms, signs and a high signal on diffusion-weighted imaging (DWI). Acute cerebral infarction was divided into anterior circulation stroke (ACS) and posterior circulation stroke (PCS). A total of 210 BAH were identified among 10 193 consecutive patients. BAH was more common in females (56.7%) than males (43.3%) in the patient group. They had a fetal-type of posterior cerebral artery (FTP) (175 bilateral (83.3%), 35 unilateral (16.7%)). 99.5% patients had V4 VAH and 56.0% (28/50) V1-V3 VAH. Among 210 BAH, there are 74 patients (mean age 64 years, average 25-91 years, 44 males) with a diagnosis of acute cerebral infarction (ACI). The males were predominant in ACI (59.5% in males vs 40.5% in females, P = 0.021). The frequency of BAH was detected in 74 (2.2%) among 3 294 ACI patients. As a relatively rare vascular abnormality, BAH has always unilateral or bilateral FTP and V4 VAH.

Awards, Announcements, and News

Awards, Announcements, and News

Die fatalen Folgen der Implementierung einer HL7-ADT-Schnittstelle

The fatal consequences of implementing a HL7 ADT interface One of our sites implemented a HL7 ADT interface for demographic patient data between the hospital information system (HIS) and the radiology information system (RIS). In the RIS, they implemented a rule that merges patient records if these have an identical patient identification number (PID). They didn’t realise that the two systems had overlapping number ranges. As a result, they performed many merges on different patients. Following the RIS, the picture archiving and communication system (PACS) also merged the patient dossiers and changed the corresponding DICOM-header. When the mistake was discovered, we managed to separate the patients in the RIS but not in the PACS. This implicates some decisions and workarounds for the daily tasks of our radiologists and for the future migration to a new RIS/PACS.

Using Picture Communication to Assess Pain Location in Children

Using Picture Communication to Assess Pain Location in Children

Effects of animation on naming and identification across two graphic symbol sets representing verbs and prepositions.

The effects of animation on naming and identification of graphic symbols for verbs and prepositions were studied in 2 graphic symbol sets in preschoolers. Using a 2 × 2 × 2 × 3 completely randomized block design, preschoolers across three age groups were randomly assigned to combinations of symbol set (Autism Language Program [ALP] Animated Graphics or Picture Communication Symbols [PCS]), symbol format (animated or static), and word class (verbs or prepositions). Children were asked to name symbols and to identify a target symbol from an array given the spoken label. Animated symbols were more readily named than static symbols, although this was more pronounced for verbs than for prepositions. ALP symbols were named more accurately than PCS in particular with prepositions. Animation did not facilitate identification. ALP symbols for prepositions were identified better than PCS, but there was no difference for verbs. Finally, older children guessed and identified symbols more effectively than younger children. Animation improves the naming of graphic symbols for verbs. For prepositions, ALP symbols are named more accurately and are more readily identifiable than PCS. Naming and identifying symbols are learned skills that develop over time. Limitations and future research directions are discussed.

Shared Storybook Reading – An Authentic Context for Developing Literacy, Language, and Communication Skills

Shared storybook reading provides an authentic context for facilitating the literacy, language, and communication skills of children with complex communication needs who use augmentative and alternative communication (AAC). This paper discusses the research surrounding the effectiveness of shared storybook reading and provides suggestions on how to maximize the language and literacy outcomes for children who use AAC. The paper highlights how simple AAC technologies, aided language displays, and picture communication symbols can be used to support communication during shared storybook reading for beginning communicators. In addition, it outlines how systematic strategies can be implemented to extend the communication skills of children with access to comprehensive AAC systems. Finally, the paper discusses the need to select books for shared storybook reading that are appealing, engaging, and age-appropriate, and the importance of providing frequent opportunities for repeated readings.

Automatic lung segmentation for large-scale medical image management

Digital medical images assist specialists in improving their diagnostic efficiency and in treating diseases. For example, the chest Computed Tomography (CT) images help in diagnosing the lung disease. The chest CT scan generates multiple images of a patient's lung. The size of the medical imaging data has increased with the usage of medical images. In a picture archiving and communication system, large-scale medical images must be transmitted to specialists through either wired or wireless communications and retained in the archive. Hence, medical images have to be compressed, and there should be no damage to the Region of Interest (RoI) during compression. In order to protect the RoI, image segmentation is needed to detect RoI in medical images. Among the various image segmentation methods available, the method using Level-set is robust to irregular noises. However, the problems faced in using this method include manual input of the initial contour and slow performance speed. Inputting an initial contour to the Level-set that correctly fits the object's form helps in reducing the number of repetitions. This in turn helps in improving the segmentation performance speed. However, it is difficult for a user to input an appropriate initial contour. Therefore, this paper aims at providing a method to auto-configure the initial contour in the Level-set method. Multi-resolution analysis helps in reducing the pace of the auto-configuration process of the initial contour. In addition, the volume data of a CT image is used to prevent data loss that occurs during the MRA transformation process. Studies have confirmed that the proposed method facilitates drastic improve.