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D Piraino

Publications and source records attributed to D Piraino.

12 recordsLinked to original sources
PubMed2001

Tools to manage the enterprise-wide picture archiving and communications system environment.

The presentation will focus on the implementation and utilization of a central picture archiving and communications system (PACS) network-monitoring tool that allows for enterprise-wide operations management and support of the image distribution network. The MagicWatch (Siemens, Iselin, NJ) PACS/radiology information system (RIS) monitoring station from Siemens has allowed our organization to create a service support structure that has given us proactive control of our environment and has allowed us to meet the service level performance expectations of the users. The Radiology Help Desk has used the MagicWatch PACS monitoring station as an applications support tool that has allowed the group to monitor network activity and individual systems performance at each node. Fast and timely recognition of the effects of single events within the PACS/RIS environment has allowed the group to proactively recognize possible performance issues and resolve problems. The PACS/operations group performs network management control, image storage management, and software distribution management from a single, central point in the enterprise. The MagicWatch station allows for the complete automation of software distribution, installation, and configuration process across all the nodes in the system. The tool has allowed for the standardization of the workstations and provides a central configuration control for the establishment and maintenance of the system standards. This report will describe the PACS management and operation prior to the implementation of the MagicWatch PACS monitoring station and will highlight the operational benefits of a centralized network and system-monitoring tool.

Humans↗
PubMed2001

A web implementation: the good and the not-so-good.

E-commerce, e-mail, e-greeting, e-this, and e-that everywhere you turn there is a new "e" word for an internet or Web application. We, at the Cleveland Clinic Foundation, have been "e-nlightened" and will discuss in this report the implementation of a web-based radiology information system (RIS) in our radiology division or "e-radiology" division. The application, IDXRad Version 10.0 from IDX Corp, Burlington, VT, is in use at the Cleveland Clinic Foundation and has both intranet (for use in Radiology) and internet (referring physician viewing) modules. We will concentrate on the features of using a web browser for the application's front-end, including easy prototyping for screen review, easier mock-ups of demonstrations by vendors and developers, and easier training as more people become web-addicted. Project communication can be facilitated with an internal project web page, and use of the web browser can accommodate quicker turnaround of software upgrades as the software code is centrally located. Compared with other technologies, including client/server, there is a smaller roll out cost when using a standard web browser. However, the new technology requires a change and changes are never implemented without challenges. A seasoned technologist using a legacy system can enter data quicker using function keys than using a graphical user interface and pointing and clicking through a series of pop-up windows. Also, effective use of a web browser depends on intuitive design for it to be easily implemented and accepted by the user. Some software packages will not work on both of the popular web browsers and then are tailored to specific release levels. As computer-based patient records become a standard, patient confidentiality must be enforced. The technical design and application security features that support the web-based software package will be discussed. Also web technologies have their own implementation issues.

Computer Communication Networks↗
PubMed2001

Image distribution in a multi-facility radiology practice.

The Cleveland Clinic Health System is a multifacility practice that distributes images electronically. Issues specific to the internal department at the main campus must be addressed with regard to the overall commitment to the healthcare system. Training for new and old employees on diagnostic and transcription equipment is a key issue. Interfacing different systems or different configurations of a system, either hospital or radiology information systems, is many times difficult and sometimes insurmountable. Issues of confidentiality have been addressed. In light of the impending new regulations from the Health Insurance Portability and Accountability Act, are the current system security practices enough?

Humans↗
PubMed2000

Impact of digital radiography on clinical workflow and patient satisfaction.

Compared to traditional film radiography, digital radiography is believed to improve workflow and patient throughput. Digital radiography permits the technologist to immediately view the quality of the film directly at the modality. Additional workflow improvements, therefore, should be achieved with the integration of the radiology information system (RIS). To learn more about this proposed efficacy, a study was performed at The Cleveland Clinic Foundation (Cleveland, OH) comparing timings in three groups: traditional film radiography; digital radiography; and digital radiography with RIS integration. Our data validated a timesaving of digital radiography over traditional or standard films and an even greater timesaving in a digital radiography/RIS environment.

Efficiency↗
PubMed1997

Implementation of an electronic teaching file using web technology.

The implementation of an electronic teaching file using web technology is discussed in this article. A web client server model is used for a standard web browser capable of displaying joint photographic Experts Group (JPEG) compression images. Like other web-based teaching files, this teaching file in a similar way uses a database containing information. This database section of the teaching file allows flexible database querying and viewing of pages generated by hypertext markup language (HTML). Because the browser client is so flexible, images types such as video and 3D representations with virtual reality markup language (VRML) can be displayed.

Computer Communication Networks↗
PubMed1991

Radiology image interpretation system: modified observer performance study of an image interpretation expert system.

Application of computer-based expert systems to diagnostic medical problems has been described in many areas including clinical diagnosis and radiology. Expert systems are computer programs that contain encoded expert knowledge to provide expert advice. A modified observer-performance study was done comparing the efficacy of the Radiology Image Interpretation System (RIIS), an expert system that diagnoses focal bone abnormalities, and radiology residents on a known set of 44 abnormal and 10 normal cases. Modified receiver operating characteristic curves for four inexperienced residents, five experienced residents, and RIIS were generated using the set of known radiographs. The true-positive rates of RIIS and the residents at false-positive rates of 0.05, 0.15, and 0.20 were estimated using the modified receiver operating characteristics curve and were compared using a paired t test. On the average, the RIIS system was less accurate when compared with experienced and inexperienced residents but the difference was only significant for experienced residents at a false-positive rate of 0.05. RIIS performed better than inexperienced residents when RIIS was used by experienced residents but this difference was not significant.

Bone Diseases↗
PubMed1990

Total knee replacement: radiologic findings in failure of porous-coated metal-backed patellar component.

One technique for replacing the articular surface of the patella in total knee replacement is the use of a cementless porous-coated metal-backed polyethylene component. Anteroposterior, lateral, and Merchant or skyline radiographs in 10 cases of porous-coated metal-backed components that failed were evaluated for component alignment, component displacement, radiolucencies, loose beads, and integrity of the patellar component. Component failure was documented by surgery in all 10 cases. Seven cases of failure involved the patellar pegs or junction of the pegs with the metal backing and three cases involved the polyethylene portion. In the seven cases of peg-metal backing failure, three cases showed loose beads before failure and seven cases showed displacement of the metal backing at time of failure. All three cases of polyethylene failure showed narrowing or displacement of the polyethylene portion. Our experience shows that displacement of the metal backing, displacement of the polyethylene, and disruption of patellar pegs are seen in failed porous-coated metal-backed patellar components. Loose beads may be seen before peg-metal backing failure.

Humans↗
PubMedDate not supplied

Optimization of a dual echo in the steady state (DESS) free-precession sequence for imaging cartilage.

Three-dimensional (3D) MR imaging of the knee is useful to detect cartilage abnormalities, although the tissue contrast in 3D gradient-recalled echo (GRE) sequences such as gradient-recalled acquisition in the steady state (GRASS) or fast low-angle shot (FLASH) is poor. T2 contrast can be added to a GRASS sequence by combining the signals from the first and second gradient echoes, which form immediately after and immediately before each radio frequency (RF) pulse in a 3D GRE sequence. We have optimized a 3D dual echo in the steady state (DESS) sequence, which produces one averaged image from the two echoes, for use in the detection of articular cartilage abnormalities. In the optimization process, we examined the imaging parameters of flip angle (alpha), repetition time (TR), echo time (TE), and bandwidth to maximize the contrast between cartilage and joint fluid. A theoretical simulation of the sequence was confirmed with experiments conducted on phantoms with known T1 and T2. On the basis of theoretical predictions and experiments using healthy volunteers, we determined that an optimized sequence with a bandwidth of 98 Hz per pixel, TR of 30 msec, a TE of 7.1 msec, and an alpha of 60 degrees produced the highest contrast between cartilage and fluid within a defined acquisition time of 6 minutes. Additional contrast was obtained by filtering the second-echo image to eliminate noise before adding it to the first-echo image.

Cartilage, Articular↗
PubMedDate not supplied

Transient osteoporosis of the hip: clinical and imaging features.

Transient osteoporosis of the hip is a form of reflex sympathetic dystrophy characterized by pain, limping, limitation of hip joint motion, and delayed radiographic patchy osteoporosis of the proximal femur. Spontaneous resolution is usually paralleled by radiographic recovery, usually within a few months. We present clinical and imaging features in seven cases of unilateral transient osteoporosis of the hip. In the appropriate clinical setting, conventional radiography will support the diagnosis. The role of more sensitive imaging techniques such as bone scintigraphy and magnetic resonance imaging in the early diagnosis of this disease has yet to be defined.

Adult↗