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Documentation in endoscopy.

The use of video monitoring and imaging techniques have enhanced endoscopic documentation. Conventional photographic techniques using 35-mm photography produce excellent quality images but are cumbersome for routine use. Electronic images can be recorded on videotape or printed, and they can be stored electronically on computer or disk.

Compact Disks↗

Replacement of cinefilm with a digital archive and review network.

The replacement of cinefilm with digital cardiac angiography has accelerated significantly in recent years with the development and widespread adoption of the DICOM standard for interchange of procedure image data. While the acceptance of the Compact Disk-Recordable (CD-R) media has provided the opportunity for numerous laboratories to eliminate cinefilm in all its functions, the task is more complex for larger catheterization laboratories which require the use of high speed networks and automated libraries. The Cardiac Laboratory at the Mayo Clinic has implemented the final stages of a large-scale network and archive which meets a large institution's demanding requirements for access, speed, and storage for high volumes of digital cardiac angiographic images. Initial experience with the system demonstrates that this approach will be a successful one for the elimination of cinefilm and the employment of digital imaging and networking technology. In addition, direct access to digital image records will also facilitate the integration of image data with other clinical information acquired and stored in a digital format.

Cardiac Catheterization↗

Effects of ionizing radiation and magnetic fields on digital data stored on floppy disks.

PURPOSE: To evaluate the effect of x rays and magnetic fields on high-density, 3.5-inch floppy disks. MATERIALS AND METHODS: A 1-Mbyte worksheet file was stored on 20 recently purchased high-density floppy disks. Five disks were stored as controls. Five other disks were then exposed to 70-kVp and 6-MV x rays with exposures of 100-1,000 R (0.026-0.26 C.kg-1). Ten other disks were exposed to magnetic fields with a maximum strength of 1,000 G. Magnetic fields around an airport metal detector and x-ray unit were measured. Another set of 10 disks was passed through the metal detector 50 times and through the x-ray unit 12 times. RESULTS: Ionizing radiation had no effect on the data stored on the disks. Magnetic fields with a maximum strength of 500 G had no effect, but field strengths of 1,000 G completely erased the data. Neither the airport metal detector nor the x-ray unit had any effect on the data. CONCLUSION: Airport metal detectors and x-ray scanners have no effect on digital data stored on floppy disks.

Compact Disks↗

Data storage for managing the health enterprise and achieving business continuity.

As organizations move away from a silo mentality to a vision of enterprise-level information, more healthcare IT departments are rejecting the idea of information storage as an isolated, system-by-system solution. IT executives want storage solutions that act as a strategic element of an IT infrastructure, centralizing storage management activities to effectively reduce operational overhead and costs. This article focuses on three areas of enterprise storage: tape, disk, and disaster avoidance.

Archives↗

Spinning-disk self-referencing interferometry of antigen-antibody recognition.

A gold ridge microstructure fabricated to a height of lambda/8 on a high-reflectivity substrate behaves as a wave-front-splitting self-referencing interferometer in phase quadrature when illuminated by a Gaussian laser beam and observed in the far field along the optic axis. When immuno-gammaglobulin (IgG) antibodies are selectively immobilized on the gold microstructure, they recognize and bind to a specific antigen, which shifts the relative optical phase of the interferometer and modifies the far-field diffracted intensity. We detect bound antigen interferometrically on spinning disks at a sampling rate of 100 kHz and verify the interferometric nature of the signal by using two quadratures of opposite sign to rule out effects of dynamic light scattering. Strong molecular recognition is demonstrated by the absence of binding to nontarget molecules but strong signal change in response to a specific antigen. This BioCD has the potential to be applied as a spinning-disk interferometric immunoassay and biosensor.

Animals↗

Assessment of commercial compression algorithms, of the lossy DCT and lossless types, applied to diagnostic digital image files.

The need for diagnostic image compression of the lossy or irreversible type has been declining due to the rapid increase in commercially available formatted hard disk capacity. It is estimated that the latter has increased about three orders of magnitude in the past 14 years while the size of diagnostic image files has, of course, remained constant. During the same period, despite claims for significantly improved performance by vendors, it seems that only small progress has been made in commercial lossless and lossy compression algorithms. There is still no consensus for lossy compression to a level acceptable for diagnosis. This is mostly considered to be around a ratio of 10:1. However, acceptable compression ratios depend heavily on the type of images processed and may be compared with the 3:1 ratio produced by lossless algorithms. This last value was shown to increase to more than 5.5:1 for gamma-camera images when corrected for the noise content of individual bit planes and for the display capabilities of computer monitors. Therefore, any possible benefits of lossy over lossless compression become questionable when the currently available hard disk capacity and network transmission speed are considered against the inevitable loss of information in the lossy type of compression.

Algorithms↗

Management of scrap computer recycling in Taiwan.

It is estimated that approximately 300,000 scrap personal computers are generated each year in Taiwan [S.-L. Chang, A Study on the Scrap Computer Treatment Cost, Environment Protection Administration of Taiwan, December 1998 (in Chinese)]. The disposal of such a huge number of scrap computers presents a difficult task for the island due to the scarcity of landfills and incineration facilities available locally. Also, the hazardous materials contained (i.e., phosphor coatings of cathode ray tubes (CRTs), batteries, polychlorinated biphenyl capacitors, mercury-containing parts, liquid crystal display, high-lead content CRT funnel glass, and plastic containing flame-retardant bromine, etc.) in the scrap computers may seriously pollute the environment if they are not properly disposed of. Therefore, the EPA of Taiwan declared scrap personal computers the producer's recycling responsibility as of July 1997. Under this decree, the manufacturers, importers and sellers of personal computers have to properly recover and recycle the scrapped computers which they originally sell. On June 1, 1998, a producer responsibility recycling program for scrap computers was officially implemented in Taiwan. Under this program, consumers can bring their unwanted personal computers to the designated collection points and receive reward money. Currently, only six computer items are mandated to be recycled in this recycling program. They are notebooks, monitors, hard disks, power supplies, printed circuit boards and main frame shells. This article outlines the current scrap computer recycling system in Taiwan.

Bromine↗

Visualization and quantitative analysis of talocrural joint kinematics.

The three dimensional (3D) in vivo kinematic behavior of the ankle joint was evaluated using spiral volumetric CT scanning of a normal adult foot. The CT data were reconstructed and interpolated to create an isotropic 3D data volume. These data were rendered, visualized, segmented into their bony elements, labeled, and exported to disk using Mayo Analyze software. The labeled 3D CT datasets were analyzed to determine relative orientation, translation, and rotation of the tibia-talus, tibia-calcaneus and calcaneus-talus. Using these results, the 3D motion characteristics during normal adult foot flexion/extension were described quantitatively.

Adult↗

Redundant array of independent disks: practical on-line archiving of nuclear medicine image data.

While various methods for long-term archiving of nuclear medicine image data exist, none support rapid on-line search and retrieval of information. We assembled a 90-Gbyte redundant array of independent disks (RAID) system using 10-, 9-Gbyte disk drives. The system was connected to a personal computer and software was used to partition the array into 4-Gbyte sections. All studies (50,000) acquired over a 7-year period were archived in the system. Based on patient name/number and study date, information could be located within 20 seconds and retrieved for display and analysis in less than 5 seconds. RAID offers a practical, redundant method for long-term archiving of nuclear medicine studies that supports rapid on-line retrieval.

CD-ROM↗

Personal computer-based small PACS for radiotherapy--analog image filing system for radiotherapy.

The purpose of this study is to evaluate the usefulness of a personal computer-based small PACS using analog video images. The analog video recorder, personal computer, and display monitor constitute our system. An analog video recorder is composed of a laser disk recorder for still images and a video cassette recorder for moving images. The acquired video images are managed by a personal computer and database software. The serial communication ports of the personal computer and a video recorder are connected with the reverse cable, and the video recorder is controlled by the personal computer using our program. This system enables filing of multi-modality images including moving images and is used for following up and treatment planning of the patients who received radiotherapy.

Aftercare↗

Analog signal acquisition from computer optical disk drives for quantitative chemical sensing.

Optoelectronic consumer products that are widely employed in the office and home attract attention for optical sensor applications due to (1) their cost advantage over analytical instruments produced only in small quantities, (2) robustness in operation due to the detailed manufacturability improvements, and (3) ease of operation. We demonstrate here a new approach for quantitative chemical/biochemical sensing when analog signals are acquired from conventional optical disk drives, and these signals are used for quantitative detection of optical changes of sensor films deposited on conventional CD and DVD optical disks. Because we do not alter manufacturing process of optical disks, any disk can be employed for deposition and readout of sensor films. The optical disk drives also perform their original function of reading and writing digital content to optical media because no optical modifications are introduced to obtain the analog signal. Such a sensor platform is quite universal and can be applied for chemical and biological quantitative detection, as well as for monitoring of changes of physical properties of regions deposited onto a CD or DVD (e.g., during combinatorial screening of materials). As a model example, we demonstrate the concept using chemical detection of ionic species such as Ca2+ in liquids (e.g., blood, urine, or water). Colorimetric calcium-sensitive sensor films were deposited onto a DVD, exposed to water with different concentrations of Ca2+, and quantified in the optical disk drive. The developed lab-on-DVD system demonstrated a 5 ppm detection limit of Ca2+ determinations, similar or slightly better than that achieved using a conventional fiber-optic portable spectrometer. This detection limit corresponded to a 0.023 absorbance unit resolution, as determined by the measurement of the same colorimetric films with a portable spectrometer. Determinations of Ca2+ unknowns using the lab-on-DVD system demonstrated +/-5 ppm accuracy and 2-5% relative standard deviation precision in predicting 100 ppm Ca2+.

Biosensing Techniques↗

Integration, acceptance testing, and clinical operation of the Medical Information, Communication and Archive System, phase II.

The Medical Information, Communication and Archive System (MICAS) is a multivendor incremental approach to picture archiving and communications system (PACS). It is a multimodality integrated image management system that is seamlessly integrated with the radiology information system (RIS). Phase II enhancements of MICAS include a permanent archive, automated workflow, study caches, Microsoft (Redmond, WA) Windows NT diagnostic workstations with all components adhering to Digital Information Communications in Medicine (DICOM) standards. MICAS is designed as an enterprise-wide PACS to provide images and reports throughout the Strong Health healthcare network. Phase II includes the addition of a Cemax-Icon (Fremont, CA) archive, PACS broker (Mitra, Waterloo, Canada), an interface (IDX PACSlink, Burlington, VT) to the RIS (IDXrad) plus the conversion of the UNIX-based redundant array of inexpensive disks (RAID) 5 temporary archives in phase I to NT-based RAID 0 DICOM modality-specific study caches (ImageLabs, Bedford, MA). The phase I acquisition engines and workflow management software was uninstalled and the Cemax archive manager (AM) assumed these functions. The existing ImageLabs UNIX-based viewing software was enhanced and converted to an NT-based DICOM viewer. Installation of phase II hardware and software and integration with existing components began in July 1998. Phase II of MICAS demonstrates that a multivendor open-system incremental approach to PACS is feasible, cost-effective, and has significant advantages over a single-vendor implementation.

Compact Disks↗

Experience of Norwegian general dental practitioners with solid state and storage phosphor detectors.

OBJECTIVES: To evaluate the opinions of Norwegian dental practitioners regarding the use of solid state sensor and storage phosphor (SP) detectors for intra-oral radiography. METHODS: A questionnaire received from 2199 dentists 309 (219 male, 86 female, four unknown) confirmed the use of digital radiography in their practices. RESULTS: Sixty-one per cent of dentists used a SP and 35% a sensor system; four (1.3%) used both. Approximately 50% of dentists had experienced technical problems and 33% had needed repairs. Almost all dentists stored their images on the hard disk (>97%) and 81% made a daily back-up. More sensor than SP users found difficulty with the positioning holder. Two-thirds of dentists reported digital image quality was the same or better than film. More Digora (Soredex, Helsinki, Finland) users reported better image quality than Denoptix (Gendex, Milan, Italy) or Digident (Digident, Nesher, Israel) users. Mean reduction in exposure time was 55% (range 2-90%), although 17 dentists stated that no reduction was achieved. Approximately half of the sensor users also used film and 38% of the SP users. Film was used more often for bitewing examination by the sensor users (27%) than by the SP users (4%). Mean time saved by the sensor users was 36 min/day (range 10-120) and by the SP users 25 min/day (range 5-120). CONCLUSIONS: The majority of dentists felt that digital image quality was the same or better than film and exposure and examination times were reduced. However, technical problems and repairs were common.

Compact Disks↗

Perception of detail and greyscale range in X-ray fluoroscopy images captured with a personal computer and frame-grabber.

OBJECTIVE: To assess the dynamic range of radiological images captured with a personal computer frame-grabbing system coupled to an X-ray fluoroscopy machine. METHODS: A 386DX-40 MHz, IBM compatible, computer with an SVGA monochrome graphics subsystem and a 387 co-processor, installed with a Screen Machine frame-grabber and controlled by a program specially written was used. Various systems were examined and the observer's perceptions of the results assessed. RESULTS: The dynamic range available to an ordinary X-ray fluoroscopy system was found to be restricted to about 750 mV. Similar measurements showed that the dynamic range was always restricted to 3/4-1/2 of the full available signal because of a high value of the dark voltage of the TV camera's target on all seven systems measured. The dynamic range of the computer-frame grabber system was found to be significantly wider than the Image Intensifier-TV camera chain but, surprisingly, it was affected by the type of file format used for image storing on disk. Clinical images from a barium meal examination as well as CT images captured after optimisation of the frame-grabber were found to contain large quantities of noise in the first two least significant bit planes making them redundant and limiting the grey levels needed for image display to less than 64. This number was also less than the 80 grey levels that could be discriminated by the human eye on the computer monitor. CONCLUSIONS: It was concluded that 6 bit digitisation would have been sufficient for image capture. The advantages of the wider dynamic range of the frame-grabber and the processing capabilities of the computer were tested for the possibility of improving the perception of detail. However, the results were negative. The limiting spatial resolution measured with a variable density bar pattern at all magnifications was about 0.4 lp/mm lower from that measured directly on the fluoroscopic screen. A detail perception test had the same result. The perception success was significantly lower with the digital images at all but the highest of the exposure rates and despite the use of image processing filters.

Artifacts↗

Performance of computer-controlled infusion of propofol: an evaluation of five pharmacokinetic parameter sets.

Computer-controlled infusion of propofol is used with increasing frequency for the induction and maintenance of anesthesia. The performance of computer-controlled infusion devices is highly dependent on how well the implemented pharmacokinetic parameter set matches the pharmacokinetics of the patient. This study examined the performance of a computer-controlled infusion device when provided with five different pharmacokinetic parameter sets of propofol in female patients. The infusion rate-time data that had been stored on a disk from 19 female patients who had been given propofol by computer-controlled infusion, using the pharmacokinetic parameter set from Gepts et al. (Anesth Analg 1987;66:1256-63), were entered into a computer simulation program to recalculate predicted propofol concentrations that would have been obtained with four other pharmacokinetic parameter (Shafer et al., Anesthesiology 1988;69:348-56; Kirkpatrick et al., Br J Anesth 1988;60:146-50; Cockshott et al., Br J Anesth 1987;59:941P; Tackley et al., Br J Anesth, 1989;62:46-53) sets of propofol, had these been implemented. The performance error (PE) was determined for each measured blood propofol concentration, on the basis of each of the five pharmacokinetic parameter sets. Then, for each of the five pharmacokinetic parameter sets, the performance in the population was determined by the median absolute performance error (MDAPE), the median performance error (MDPE), the wobble (the median absolute deviation of each PE from the MDPE), and the divergence (the percentage change of the absolute PE with time). The MDPE and MDAPE were compared between the parameter sets by the multisample median test. The initially used pharmacokinetic parameter set from Gepts et al. resulted in a MDPE of 24% and MDAPE of 26%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗