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Elizabeth Krupinski

Publications and source records attributed to Elizabeth Krupinski.

12 recordsLinked to original sources
PubMed2006

Research recommendations for the american telemedicine association.

The American Telemedicine Association (ATA) convened a panel of experts to generate a research agenda for the telemedicine community to further support and promote the long-term acceptance and use of telehealth. Three principles to guide research and four key areas within which research is greatly needed were identified. These four areas are technical, clinical, human factors and ergonomics, and economic analyses. It is the hope of the panel that the research recommendations put forth in this document will give investigators the inspiration, tools and goals to make this happen.

Health Planning Guidelines↗
PubMed2005

Evaluation of and compensation for spatial noise of LCDs in medical applications.

Recent developments in liquid crystal display (LCD) technology suggest that this technology will replace the cathode ray tube (CRT) as the most popular softcopy display technology in the medical arena. However, LCDs are far from ideal for medical imaging. One of the principal problems they possess is spatial noise contamination, which requires accurate characterization and appropriate compensation before LCD images can be effectively utilized for reliable diagnosis. This paper presents some work we have conducted recently on characterization of spatial noise of high resolution LCDs. The primary purpose of this work is to explore the properties of spatial noise and propose a method to reduce it. A high quality CCD camera was used for physical evaluation. Spatial noise properties were analyzed and estimated from the camera images via signal modeling and processing. A noise compensation algorithm based on error diffusion was developed to process images before they were displayed. Results shown in this paper suggest that LCD spatial noise can be effectively reduced via appropriate processing.

Algorithms↗
PubMed2005

MR angiographic evaluation of platinum coil packs at 1.5T and 3T: an in vitro assessment of artifact production: technical note.

Susceptibility artifact from platinum coil packs impairs the visibility of perianeurysmal soft tissues at conventional 3D time-of-flight MR angiography. These artifacts limit the evaluation for residual-recurrent aneurysm and parent vessel stenosis. Reducing the echo time can decrease the artifact and improve perianeurysmal visualization. The purpose of this study was to assess quantitatively the effect of decreasing the echo time on artifact production at different field strengths and coil pack densities.

Artifacts↗
PubMed2004

Traditional versus telenursing outpatient management of patients with cancer with new ostomies.

PURPOSE/OBJECTIVES: To measure the impact of telenursing on patients discharged with ostomies resulting from cancer treatment. DESIGN: Quasi-experimental design with surveys. SETTING: Large tertiary care center in the southwestern United States. SAMPLE: 28 patients with cancer in two groups: traditional home health and home health plus telenursing. METHODS: Recorded the number of home health and telenursing contacts, dates when ostomy self-care needs were met, supplies used, and distance traveled. Patients completed a satisfaction survey and Maklebusts Ostomy Adjustment Scale. MAIN RESEARCH VARIABLES: Type of care, costs, patient satisfaction, ostomy adjustment, and time to achieve ostomy self-care. FINDINGS: Telenursing patients indicated higher satisfaction. The home health group averaged one more home health visit per patient (telenursing mean= three visits). Overall costs for both types of visits were about equal. The home health group used an average of four more pouches per patient, with increased cost of 52 dollars per patient. Telenursing patients believed that nurses had increased understanding of their problems, and they were more comfortable with what nurses told them about ostomy. Telenursing participants believed that telenursing made care more accessible; they preferred telemedicine rather than waiting for face-to-face visits but still believed that face-to-face visits were best. CONCLUSIONS: Combining traditional home health and telenursing is feasible for supporting discharged patients with new ostomies and enhances traditional home health, resulting in increased satisfaction overall. IMPLICATIONS FOR NURSING: Oncology nurses should develop telenursing programs that include patient and family education regarding oncology issues.

Aged↗
PubMed2003

High-volume teleradiology service: focus on radiologist satisfaction.

In 1998 we surveyed our radiologists on teleradiology satisfaction. Results were generally positive. In 2002 we experienced a sevenfold case increase in teleradiology volume. The present study surveyed the radiologists again. The hypothesis was that, with increased case volume and radiologist experience with the system, ratings would increase. Image quality was excellent/good, although plain film and ultra sound (US) had more fair/poor ratings. Monitors, navigation, image processing, and Web-based reporting were rated as excellent/good. The voice-recognition system was rated poorly. Diagnostic confidence was about the same as for film. Exceptions were magnetic resonance imaging (MRI) US, and plain film. Up to 10% of cases are unreadable because of poor image quality, not enough images, or inadequate patient history. Overall, the radiologists are satisfied, although some improvements can be made.

Attitude of Health Personnel↗
PubMed2003

Using a human visual system model to optimize soft-copy mammography display: influence of display phosphor.

RATIONALE AND OBJECTIVES: The authors developed an efficient method for optimizing cathode ray tube performance for soft-copy digital mammography displays, based on correlation between the performance of human observers and the performance of a mathematical computer model of the human visual system. The authors measured radiologist performance on soft-copy display monitors with different phosphors and used these results to validate the human visual performance model. MATERIALS AND METHODS: Six radiologists viewed a series of 250 mammographic images with microcalcifications of different contrast levels. They viewed images on two soft-copy display monitors with phosphor luminescence-one with P45 and the other with P104. The same images were analyzed with the JNDmetrix Visual Discrimination Model, which is based on psychophysical just-noticeable difference measurement principles and on frequency-channel vision-modeling principles. Receiver operating characteristic curves were generated for the human and model observers' performances, and results were compared statistically. RESULTS: Both human and model performance (area under the receiver operating characteristic curve) was better overall with the P45 than with the P104 monitor, especially for microcalcifications in the midlevel contrast range. There was high correlation between the human and model observers. CONCLUSION: The results indicate that the type of phosphor in a display monitor can influence observer performance significantly and that a model based on characteristics of the human visual system can be used to predict human observer performance accurately.

Breast Neoplasms↗
PubMed2002

Gadolinium-enhanced 3D MR angiography of renal artery stenosis: a pilot comparison of maximum intensity projection, multiplanar reformatting, and 3D volume-rendering postprocessing algorithms.

RATIONALE AND OBJECTIVES: The authors compared diagnostic accuracy of maximum intensity projection (MIP), multiplanar reformatting (MPR), and three-dimensional (3D) volume rendering (VR) in the evaluation of gadolinium-enhanced 3D magnetic resonance (MR) angiography of the renal arteries. They hypothesized that VR is as accurate as or more accurate than MIP and MPR at depicting renal artery stenosis. MATERIALS AND METHODS: The study group comprised 28 consecutive patients who underwent gadolinium-enhanced 3D MR angiography of the renal arteries. Studies were postprocessed to display images in MIP, MPR, and VR formats. Digital subtraction angiography (DSA), when performed (nine of 28 patients), was the standard for comparison. For each main renal artery, an estimate of percentage stenosis was made for any stenoses detected by three independent radiologists. For calculation of sensitivity, specificity, and accuracy, MR angiographic stenosis estimates were categorized as mild (0%-39%), moderate (40%-69%), or severe (> or = 70%). DSA stenosis estimates of 70% or greater were considered hemodynamically significant. RESULTS: Analysis of variance demonstrated MIP estimates of stenosis were statistically greater than VR estimates in two readers and greater than MPR estimates in all readers for all patients. MIP images also showed the largest mean difference from DSA stenosis estimates for all three readers. For both VR and MPR, mean differences between MR angiographic stenoses estimates and DSA estimates reached significance for only one reader, whereas, for MIP versus DSA, mean differences reached significance for all three readers. Although not statistically significant compared with DSA, accuracies of VR (87%) and MPR (89%) were greater than that of MIP (81%). CONCLUSION: In this pilot study, MIP was the least accurate of the three image display algorithms tested. VR and MPR yielded similar values for each method of comparison.

Adult↗
PubMed2002

Telemedicine versus in-person dermatology referrals: an analysis of case complexity.

The goal of this study was to determine whether teledermatology referrals differ significantly from in-person referrals with respect to case complexity and diagnosis of cases referred. Teledermatology cases were compared to in-person cases seen by the same university dermatologist who also reviews the teledermatology cases. These were also compared with in-person cases evaluated by a different dermatologist at local clinics using traditional referral patterns. Study parameters included Current Procedural Terminology (CPT) codes as a measure of case complexity, International Classification of Disease (ICD) codes as a measure of case types, and time from referral to actual consultation. The most common CPT codes used for teledermatology were 99241 and 99242 with no significant differences in the frequency of assigned CPT codes for teledermatology versus in-person consultation. An analysis of the diagnostic codes revealed no significant differences between the types of cases referred to telemedicine and those referred for in-person consultation. Time between referral and actual encounter with the dermatologist was significantly shorter via telemedicine than either local or university clinic in-person visits.

Chi-Square Distribution↗
PubMed2002

Radiology resident evaluation of head CT scan orders in the emergency department.

BACKGROUND AND PURPOSE: Prior studies have revealed little difference in residents' abilities to interpret cranial CT scans. The purpose of this study was to assess the performance of radiology residents at different levels of training in the interpretation of emergency head CT images. METHODS: Radiology residents prospectively interpreted 1324 consecutive head CT scans ordered in the emergency department at the University of Arizona Health Science Center. The residents completed a preliminary interpretation form that included their interpretation and confidence in that interpretation. One of five neuroradiologists with a Certificate of Added Qualification subsequently interpreted the images and classified their assessment of the residents' interpretations as follows: "agree," "disagree-insignificant," or "disagree-significant." The data were analyzed by using analysis-of-variance or chi-squared methods. RESULTS: Overall, the agreement rate was 91%; the insignificant disagreement rate, 7%; and the significant disagreement rate, 2%. The level of training had a significant (P =.032) effect on the rate of agreement; upper-level residents had higher rates of agreement than those of more junior residents. There were 62 false-negative findings. The most commonly missed findings were fractures (n = 18) and chronic ischemic foci (n = 12). The most common false-positive interpretations involved 10 suspected intracranial hemorrhages and suspected fractures. CONCLUSION: The level of resident training has a significant effect on the rate of disagreement between the preliminary interpretations of emergency cranial CT scans by residents and the final interpretations by neuroradiologists. Efforts to reduce residents' errors should focus on the identification of fractures and signs of chronic ischemic change.

Brain↗
PubMedDate not supplied

Increasing access to care via tele-health: the Arizona experience.

The Arizona Telemedicine Program (ATP) is a large, multidisciplinary, university-based program that provides telemedicine services, distance learning, informatics training, and telemedicine technology assessment capabilities to communities throughout Arizona. The types of teleconsultation services available include real-time and store-forward consultations, continuing medical education, and patient information sessions. Since the inception of the ATP, there have been 97,722 telemedicine events. The most frequently used telemedicine service is teleradiology, comprising 85,728 teleconsults. Next in frequency are teledermatology and telepsychiatry consultations. Results of patient satisfaction surveys indicate high levels of patient satisfaction with both real-time and store-forward consultations. Three studies of the efficacy of telemedicine services are discussed. One study of the efficacy and diagnostic accuracy of utilizing telecolposcopy, revealed a positive predictive value of the telecolposcopic impression of between 81% and 82%, while the positive predictive value of an in-person impression was 80%.

Arizona↗