Journal of Digital Imaging (J DIGIT IMAGING)

Publications in this journal

• Article: Adaptable fuzzy C-Means for improved classification as a preprocessing procedure of brain parcellation

  Ui-Cheul Yoon, June-Sic Kim, Jae-Seok Kim, In-Young Kim, Sun I. Kim
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  ABSTRACT: Parcellation, one of several brain analysis methods, is a procedure popular for subdividing the regions identified by segmentation into smaller topographically defined units. The fuzzy clustering algorithm is mainly used to preprocess parcellation into several segmentation methods, because it is very appropriate for the characteristics of magnetic resonance imaging (MRI), such as partial volume effect and intensity inhomogeneity. However, some gray matter, such as basal ganglia and thalamus, may be misclassified into the white matter class using the conventional fuzzy C-Means (FCM) algorithm. Parcellation has been nearly achieved through manual drawing, but it is a tedious and time-consuming process. We propose improved classification using successive fuzzy clustering and implementing the parcellation module with the modified graphic user interface (GUI) for the convenience of users.
  Journal of Digital Imaging 04/2012; 14:238-240.
• Article: Magnetic resonance imaging deformation-based segmentation of the hippocampus in patients with mesial temporal sclerosis and temporal lobe epilepsy

  Robert E. Hogan, Kevin E. Mark, Indrajit Choudhuri, Lei Wang, Sarang Joshi, Michael I. Miller, Richard D. Bucholz
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  ABSTRACT: We compared manual and automated segmentations of the hippocampus in patients with mesial temporal sclerosis. This comparison showed good precision of the deformation-based automated segmentations.
  Journal of Digital Imaging 04/2012; 13:217-218.
• Article: Medical image transmission on low-speed networks

  Dismer Ronda Betancourt, Aime Alvarez Roca, Osmany Ferrer Borges
  Journal of Digital Imaging 04/2012; 13:215-216.
• Article: Barton F. Branstetter 4th, Daniel L. Rubin, D. Scott Griffin, David L. Weiss (eds): Practical Imaging Informatics. Foundations and Applications for PACS Professionals

  Thomas M. Deserno
  Journal of Digital Imaging 04/2012; 25(1):11-13.
• Article: Letter to the Editor Re: PanCanadian Evaluation of Irreversible Compression Ratios (“Lossy” Compression) for Development of National Guidelines

  Geoff Norman, Peter Bak, Andre Matos, David A. Koff
  Journal of Digital Imaging 04/2012; 23(5):517-518.
• Article: Planning factors for developing an enterprise-wide picture archiving and communication system maintenance program

  Steven Staley, John Romlein, Anna K. Chacko, Ronald Wider
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  ABSTRACT: Picture archiving and communication system (PACS) maintenance on an individual site basis has historically been a complex and costly challenge. With the advent of enterprise-wide PACS projects such as the Virtual Radiology Environment (VRE) project, the challenge of a maintenance program with even more complexities has presented itself. The approach of the project management team for the VRE project is not one of reactive maintenance, but one of highly proactive planning and negotiations, in hopes of capitalizing on the economies of scale of an enterprise-wide PACS maintenance program. A proactive maintenance program is one aspect of life-cycle management. As with any capital acquisition, life-cycle management may be used to manage the specific project aspects related to PACS. The purpose of an enterprise-wide warranty and maintenance life-cycle management approach is to maintain PACS at its maximum operational efficiency and utilization levels through a flexible, shared, yet symbiotic relationship between local, regional, and vendor resources. These goals include providing maximum operational performance levels on a local, regional, and enterprise basis, while maintaining acceptable costs and resource utilization levels. This goal must be achieved without negatively impacting point of care activities, regardless of changes to the clinical business environment.
  Journal of Digital Imaging 04/2012; 13:228-229.
• Article: Quality-control issues on high-resolution diagnostic monitors

  Laurence F. Parr, Amanda L. Anderson, Brendan K. Glennon, Pamela Fetherston
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  ABSTRACT: Previous literature indicates a need for more data collection in the area of quality control of high-resolution diagnostic monitors. Throughout acceptance testing, which began in June 2000, stability of monitor calibration was analyzed. Although image quality on all monitors was found to be acceptable upon initial acceptance testing using VeriLUM software by Image Smiths, Inc (Germantown, MD), it was determined to be unacceptable during the clinical phase of acceptance testing. High-resolution monitors were evaluated for quality assurance on a weekly basis from installation through acceptance testing and beyond. During clinical utilization determination (CUD), monitor calibration was identified as a problem and the manufacturer returned and recalibrated all work-stations. From that time through final acceptance testing, high-resolution monitor calibration and monitor failure rate remained a problem. The monitor vendor then returned to the site to address these areas. Monitor defocus was still noticeable and calibration checks were increased to three times per week. White and black level drift on medium-resolution monitors had been attributed to raster size settings. Measurements of white and black level at several different size settings were taken to determine the effect of size on white and black level settings. Black level remained steady with size change. White level appeared to increase by 2.0 cd/m2 for every 0.1 inches decrease in horizontal raster size. This was determined not to be the cause of the observed brightness drift. Frequency of calibration/testing is an issue in a clinical environment. The increased frequency required at our site cannot be sustained. The medical physics division cannot provide dedicated personnel to conduct the quality-assurance testing on all monitors at this interval due to other physics commitments throughout the hospital. Monitor access is also an issue due to radiologists’ need to read images. Some workstations are in use 7 AM to 11 PM daily. An appropriate monitor calibration frequency must be established during acceptance testing to ensure unacceptable drift is not masked by excessive calibration frequency. Standards for acceptable black level and white level drift also need to be determined. The monitor vendor and hospital staff agree that currently, very small printed text is an acceptable method of determining monitor blur, however, a better method of determining monitor blur is being pursued. Although monitors may show acceptable quality during initial acceptance testing, they need to show sustained quality during the clinical acceptance testing phase. Defocus, black level, and white level are image quality concerns, which need to be evaluated during the clinical phase of acceptance testing. Image quality deficiencies can have a negative impact on patient care and raise serious medical-legal concerns. The attention to quality control required of the hospital staff needs to be realistic and not have a significant impact on radiology workflow.
  Journal of Digital Imaging 04/2012; 14:22-26.
• Article: Introduction to SCAR 2001: The 18th symposium for computer applications in radiology

  Byrn Williamson, Nicholas Hangiandreou, Steve Langer
  Journal of Digital Imaging 04/2012; 14:1-1.
• Article: Introduction to SCAR 2000: The 17th Symposium for Computer Applications in Radiology: “The Electronic Practice: Radiology and the Enterprise”

  Byrn Williamson, Nicholas Hangiandreou, Steve Langer
  Journal of Digital Imaging 04/2012; 13:1-1.
• Article: New aspects of using the structural graph-grammar based techniques for recognition of selected medical images

  Marek R. Ogiela, Ryszard Tadeusiewicz
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  ABSTRACT: This report will describe the application of syntactic pattern recognition methods for analysis of morphology and recognition of pathologic symptoms of chronic diseases such as upper urinary tract disorders. Detection of these lesions will be assisted by the special graph-grammar developed in our institute for efficient analysis and recognition of such lesions. We present key points of methodology and practical results of its application.
  Journal of Digital Imaging 04/2012; 14:231-232.
• Article: Digital practice planning/DICOM structured reporting digital radiology equipment acquisition and installation procedures: A team approach at mayo clinic, Rochester, MN

  Suzanne Ramthun, Claire E. Bender, Beth A. Schueler, Jerome Taubel, Nicholas J. Hangiandreou, Scott Williamson, Dan O’Neill, Doug Leimer, Michele Back
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  ABSTRACT: Digital imaging system integration is a complex process. A project team and a defined process for system planning, evaluation, and implementation can improve the chance for success. In this presentation, our project team relates their experiences.
  Journal of Digital Imaging 04/2012; 14:3-5.
• Article: Finding the optimal picture archvingand communciation system(PACS)architecture: A comparison of three PACS designs

  Wyatt M. Tellis, Katherine P. Andriole
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  ABSTRACT: Purpose: At present, there are two basic picture archiving and communication system (PACS) architectures: centralized with a central cache and controller, and distributed with a distributed cache and central controller. A third architecture proposed here is an autonomous one with a distributed cache and no controller. This report will investigate the performance (as measured be central processing unit [CPU] and networkload, scalability, and examination retrieval and display latency) of these three types.Methods: The distributed PACS architecture will be simulated using an IM PAX R3.5 (AGFA, Ridgefield Park, NJ) PACS, while the centralized design will be simulated using an IMPAX R4 (AGFA) PACS. The autonomous system will be designed and implementedin-house. The autonomous system consists of two types of entities: basic components such as acquisition gateways, display stations, and long-term archives, and registry servers, which store global state information about the individual PACS components. The key feature of the autonomous system will be the replacement of the central PACS controller by the registry servers. In this scenario the registry servers monitor the interactions between the components, but do not directly govern them. Instead each component will contain the application logic it requires and will use the state information from the registry servers to take the appropriate action, such as routing images, prefetching studies, and expiring images from near line cache. In addition the routing of examinations will be optimized to reduce the duplication of image data. Display stations will be categorized by specialty (neuroradiology, pediatrics, chest, etc) and will retrieve studies for display on demand from intermediate servers dedicated to the corresponding specialty. Studies will be routed only to the intermediate servers and not to display stations.Results: By distributing the application logic, an autonomous PACS architecture can provide increased fault tolerance and therefore increased uptime. In addition, the lack of a central controller and the use of intermediate servers improve the scalability of the system, as well as reduce CPU and network loads.
  Journal of Digital Imaging 04/2012; 14:72-76.
• Article: Can radiologic images be incorporated into the electronic patient record?

  Keith J. Dreyer, Amit Mehta, James Thrall
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  ABSTRACT: As radiology makes advances toward filmlessness, all of medicine is headed, just as rapidly, toward paperless transmission As radiology makes advances toward filmlessness, all of medicine is headed, just as rapidly, toward paperless transmission of patient information. While there are obvious advantages to this electronic approach, and several standards to conform to of patient information. While there are obvious advantages to this electronic approach, and several standards to conform to for the transmission of textual (Health Level 7 [HL-7]) and image (Digital Imaging and Communications in Medicine [DICOM]) for the transmission of textual (Health Level 7 [HL-7]) and image (Digital Imaging and Communications in Medicine [DICOM]) data, it is the integration of these two data sets that is clinically essential and yet poorly defined. This report defines data, it is the integration of these two data sets that is clinically essential and yet poorly defined. This report defines an approach for, and the successful implementation of, the integration of radiologic image data with textual data contained an approach for, and the successful implementation of, the integration of radiologic image data with textual data contained within the electronic patient record (EPR) through the use of standard internet protocols. Incorporation of medical images within the electronic patient record (EPR) through the use of standard internet protocols. Incorporation of medical images in the EPR has proven to be critical to the successful deployment of picture archiving and communications systems (PACS) and in the EPR has proven to be critical to the successful deployment of picture archiving and communications systems (PACS) and the reduction of film consumption at Massachusetts General Hospital (MGH). Since the installation of the first internet-based the reduction of film consumption at Massachusetts General Hospital (MGH). Since the installation of the first internet-based Image Data Repository (IDR) at MGH in 1995, the system has adequately served to meet the needs of clinical requests by both Image Data Repository (IDR) at MGH in 1995, the system has adequately served to meet the needs of clinical requests by both radiology-only browser users and users of the EPR. It has drastically reduced the need for film and provided concurrent display radiology-only browser users and users of the EPR. It has drastically reduced the need for film and provided concurrent display of images and text throughout the institution and beyond. *** DIRECT SUPPORT *** A00RM031 00009 of images and text throughout the institution and beyond. *** DIRECT SUPPORT *** A00RM031 00009
  Journal of Digital Imaging 04/2012; 13:138-141.
• Article: Development, Implementation, and Multicenter Clinical Validation of the TeleDICOM—Advanced, Interactive Teleconsultation System

  Andrzej Gackowski, Łukasz Czekierda, Anton Chrustowicz, Jacek Cała, Michał Nowak, Jerzy Sadowski, Piotr Podolec, Mieczysław Pasowicz, Krzysztof Zieliński
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  ABSTRACT: There is a need to make medical diagnosis available to critically ill patients on-site, without the necessity of time-consuming and risky transportation to larger reference hospitals. The teleconsultation of medical images is possible with the use of Internet-based TeleDICOM software developed in Krakow, Poland. Interactive consultation between two or more centers offers real-time voice communication, visualization of synchronized Digital Imaging and Communications in Medicine images, and use of interactive pointers and specific calculation tools. If direct interaction between physicians is not needed, the system can also be used in “offline” mode. In 2006, TeleDICOM was successfully deployed in the John Paul II Hospital in Krakow as well as a dozen other cooperating medical centers throughout southeast Poland. It is used for routine referral for cardiosurgical procedures. Aims of the study were to evaluate the image quality, software stability, constant availability, data transmission speed, and quality of real-time synchronized viewing of the images during the TeleDICOM teleconsultation; to evaluate the clinical utility of the TeleDICOM system; and to analyze the compatibility of TeleDICOM with the storage data formats of various imaging machine manufacturers. The analysis of angiographic offline teleconsultations was based on 918 patients referred remotely for coronary artery bypass grafting (CABG). The echocardiographic teleconsultations were performed during 63 live interactive consultations, several of them were presented to live during medical conferences. Measurement tools of the TeleDICOM software were tested against original measurement tools of echocardiographic machines from four different manufacturers. As a result of TeleDICOM consultation, a CABG decision was made in 806 of 918 patients consulted (87.8%). In remaining 12 patients, medical therapy or percutaneous angioplasty was recommended. CABG was performed in 98.6% of the admitted patients. Treatment decisions were changed after admission in 1.4% of patients—however, in all cases, it was not related to analysis of angiography data but rather to the change of clinical condition of the patients. All medical personnel involved in both offline and interactive teleconsultations judged the system positively in all assessed aspects. Lesser scores were observed only in the centers connected by slower networks. Measurements performed in the ECHO-TeleDICOM module were accurate as compared with those performed on a standard echo-machine (correlation r > 0.980, p < 0.001), independently of the echocardiograph model. Conclusion: This study demonstrates that telemedicine can improve patients' management using a clinically effective teleconsultation system. The TeleDICOM system is suited for professional use in the field of cardiovascular disease. It is also prepared for remote live demonstrations of clinical cases during large medical meetings. Key wordsTelemedicine–angiography–cardiac imaging–clinical application–computers in medicine–digital image management–image analysis–ultrasonography
  Journal of Digital Imaging 04/2012; 24(3):541-551.
• Article: Upgrading legacy systems for the integrating the healthcare enterprise (IHE) initiatative

  Brian J. Cavanaugh, Harry T. Garland, Bernard L. Hayes
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  ABSTRACT: As technology vendors have adopted standardized communication protocols, including Digital Imaging and Communications in Medicine (DICOM) and Health Level 7 (HL7), interconnectivity between various devices has been simplified. The recent Integrating the Healthcare Enterprise (IHE) initiative will further promote the use of standards for interconnectivity. Until these standards are universally accepted, we must live in a transitional world where some components will communicate without any modification, while others require upgrades to allow them to meet the new standards. In designing and implementing the network at University of California Los Angeles (UCLA) Medical Center, some integration problems were found that are common to the industry. Creating departmental workflow with only a limited number of acquisition devices supporting the DICOM worklist was the initial problem addressed. Although many manufacturers provide this function for their new scanners, upgrading existing equipment is often cost-prohibitive. To ensure the quality of the demographic information in the image data and the workflow of the system, third-party worklist components were required to upgrade the legacy acquisition devices. These worklist components provided a standards-compliant facade on top of the legacy equipment, allowing seamless integration with the remainder of the network. To support the distribution of worklist information and the feedback of procedure status, a bidirectional HL7/ DICOM protocol bridge was required. Although many radiology information system (RIS) manufacturers will be providing native DICOM capabilities in future product releases, the majority of current RIS installations have no DICOM functionality. Similar to the legacy scanners, the HL7/DICOM bridge provided a DICOM-compliant facade to the non-DICOM RIS. The additional use of web-based technology for worklist display further extended flexibility of this facade. We have demonstrated standards-compliant facade technology allowing legacy components to operate seamlessly in an IHE environment at a fraction of the cost of upgrading to new equipment.
  Journal of Digital Imaging 04/2012; 13:180-182.
• Article: Lesion characterization using vessel permeability map to new blood pool contrast agent calculated from dynamic magnetic resonance images

  Soojeong Kim, Jong Hyo Kim, Woo Kyung Moon, Byoung Goo Min
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  ABSTRACT: Use of contrast enhancement in conjunction with magnetic resonance (MR) imaging provides a means to evaluate tissue function, as well as morphology. Moreover, physiologic properties derived from kinetic analysis of dynamic contrast-enhanced data can improve the specificity of MR examinations. In this study, quantitative analysis of microvascular characteristics based on dynamic MR imaging were performed both for malignant and benign lesions using two types of contrast agents (CAs). A new MR macromolecular contrast medium (MMCM), 24 gadolinium-tetraazacyclododecanetetraacetic acid (DOTA)-dendrimer, was found to have a greater ability to distinguish benign from malignant lesions. When a blood pool agent was used, permeability differences in the two types of lesions were the most significant findings among all parameters considered.
  Journal of Digital Imaging 04/2012; 13:193-195.
• Article: One Year’s Results from a Server-Based System for Performing Reject Analysis and Exposure Analysis in Computed Radiography

  A. Kyle Jones, Raimund Polman, Charles E. Willis, S. Jeff Shepard
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  ABSTRACT: Rejected images represent both unnecessary radiation exposure to patients and inefficiency in the imaging operation. Rejected images are inherent to projection radiography, where patient positioning and alignment are integral components of image quality. Patient motion and artifacts unique to digital image receptor technology can result in rejected images also. We present a centralized, server-based solution for the collection, archival, and distribution of rejected image and exposure indicator data that automates the data collection process. Reject analysis program (RAP) and exposure indicator data were collected and analyzed during a 1-year period. RAP data were sorted both by reason for repetition and body part examined. Data were also stratified by clinical area for further investigation. The monthly composite reject rate for our institution fluctuated between 8% and 10%. Positioning errors were the main cause of repeated images (77.3%). Stratification of data by clinical area revealed that areas where computed radiography (CR) is seldom used suffer from higher reject rates than areas where it is used frequently. S values were log-normally distributed for examinations performed under either manual or automatic exposure control. The distributions were positively skewed and leptokurtic. S value decreases due to radiologic technology student rotations, and CR plate reader calibrations were observed. Our data demonstrate that reject analysis is still necessary and useful in the era of digital imaging. It is vital though that analysis be combined with exposure indicator analysis, as digital radiography is not self-policing in terms of exposure. When combined, the two programs are a powerful tool for quality assurance. Key wordsComputed radiography–data collection–data mining–quality assurance–quality control–radiography–statistic analysis–radiation dose–reject analysis–repeat analysis–exposure analysis
  Journal of Digital Imaging 04/2012; 24(2):243-255.
• Article: A study for watermark methods appropriate to medical images

  Yongho Cho, Bonghwan Ahn, Jae-Seok Kim, In-Young Kim, Sun I. Kim
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  ABSTRACT: The network system, including the picture archiving and communication system (PACS), is essential in hospital and medical imaging fields these days. Many medical images are accessed and processed on the web, as well as in PACS. Therefore, any possible accidents caused by the illegal modification of medical images must be prevented. Digital image water-mark techniques have been proposed as a method to protect against illegal copying or modification of copyrighted material. Invisible signatures made by a digital image watermarking technique can be a solution to these problems. However, medical images have some different characteristics from normal digital images in that one must not corrupt the information contained in the original medical images. In this study, we suggest modified watermark methods appropriate for medical image processing and communication system that prevent clinically important data contained in original images from being corrupted.
  Journal of Digital Imaging 04/2012; 14:184-186.
• Article: Comparisons of different contrast resolution effects on a computer-aided detection system intended to cluster microcalcifications detected in dense breast images

  Fátima L. S. Nunes, Hamero Schiabel, Mauricio C. Escarpinati, Cláudio E. Góes
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  ABSTRACT: Clustered microcalcifications, which are frequently an important signal of possible cancer, are usually hidden in dense breast images, adding more difficulty in mammogram medical analysis. In this work we evaluate the performance of a previously developed computer-aided detection scheme, modified for application to dense breast images. The main focus of this investigation was on the effect of different contrast resolutions on the processing performance. We have processed dense breast images digitized with a and 12 bits to evaluate the performance of this computer-aided detection scheme with different contrast resolutions. As expected, for most of the 12·bit images, the number of detected signals was greater or at least equal to that of the 8·bit images.
  Journal of Digital Imaging 04/2012; 14:217-219.