Figure 1 - uploaded by Lorenzo Faggioni
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Axial CT image showing tiny contrast medium blush in the arterial phase in the pancreatoduodenal groove (arrows) as seen on the iPad (Apple Inc., Cupertino, CA) (a) and on the workstation (b), respectively. This finding was consistent with active arterial bleeding fed by pancreatoduodenal arteries, as subsequently confirmed by digital subtraction angiography.
Source publication
Objective:
To evaluate the effectiveness of the iPad (Apple Inc., Cupertino, CA) for two-dimensional (2D) reading of CT angiography (CTA) studies performed for suspected acute non-variceal gastrointestinal bleeding.
Methods:
24 CTA examinations of patients with suspected acute gastrointestinal bleeding confirmed (19/24, 79.2%) or ruled out (5/24...
Context in source publication
Context 1
... both image reading sessions, all readers had been instructed to mark all cases as positive or negative related to the CTA finding of active arterial bleeding (defined as contrast medium blush in the arterial phase growing in the subsequent post- contrast acquisitions), as well as to indicate the most likely source of bleeding in terms of the major artery likely feeding the suspected "culprit" vessel (classified as coeliac trunk, left/right gastric artery, gastroduodenal artery, pancreatoduodenal arter- ies, superior mesenteric artery and inferior mesenteric artery) (Figures 1-3). Any additional finding other than the suspected active arterial bleeding was ignored. ...
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Citations
... Some factors are hardly surprising, such as the time of day, the experience of the radiologist and the number of interruptions À others more puzzling, such as the size and luminescence of the screen, the use of key images in reporting, and the image order in the hanging protocol. (12)(13)(14)(15)(16)(17)(18) Given this complexity, it does not seem unreasonable to assume that the reading times when using AI can be differently affected in a clinical environment and a research environment. This seems supported by studies which find that CAD findings affect the reading times of individual radiologists differently. ...
Rational and Objectives
This study investigated how an AI tool impacted radiologists reading time for non-contrast chest CT exams.
Materials and Methods
An AI tool was implemented into the PACS reading workflow of non-contrast chest CT exams between April and May 2020. The reading time was recorded for one radiology resident and one radiology resident by an external observer. After each case radiologists answered questions regarding additional findings and perceived case overview. Reading times were recorded for 25 cases without and 20 cases with AI tool assistance for each reader. Differences in reading time with and without the AI tool were assessed using Welch's t-test for non-inferiority with non-inferiority limits defined as 100 seconds for the consultant and 200 seconds for the resident.
Results
The mean reading time for the radiology resident was not significantly affected by the AI tool (without AI 370s vs with AI 437s; +67s 95% CI -28s to +163s, p = 0.16). The reading time for the radiology consultant was also not significantly affected by the AI tool (without AI 366s vs with AI 380s; +13s (95% CI - -57s to 84s, p = 0.70). The AI tool led to additional actionable findings in 5/40 (12.5%) studies and better overview in 18/20 (90%) of studies for the resident.
Conclusion
A PACS based implementation of an AI tool for concurrent reading of chest CT exams did not increase reading time with additional actionable findings made as well as a perceived better case overview for the radiology resident.
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Introduction
Mobile devices and software are now available with sufficient computing power, speed and complexity to allow for real-time interpretation of radiology exams. In this paper, we perform a multivariable user study that investigates concordance of image-based diagnoses provided using mobile devices on the one hand and conventional workstations on the other hand.
Methods
We performed a between-subjects task-analysis using CT, MRI and radiography datasets. Moreover, we investigated the adequacy of the screen size, image quality, usability and the availability of the tools necessary for the analysis. Radiologists, members of several teams, participated in the experiment under real work conditions. A total of 64 studies with 93 main diagnoses were analyzed.
Results
Our results showed that 56 cases were classified with complete concordance (87.69%), 5 cases with almost complete concordance (7.69%) and 1 case (1.56%) with partial concordance. Only 2 studies presented discordance between the reports (3.07%). The main reason to explain the cause of those disagreements was the lack of multiplanar reconstruction tool in the mobile viewer. Screen size and image quality had no direct impact on the mobile diagnosis process.
Conclusion
We concluded that for images from emergency modalities, a mobile interface provides accurate interpretation and swift response, which could benefit patients' healthcare.
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This study aimed to propose a pure web-based solution to serve users to access large-scale 3D medical volume anywhere with good user experience and complete details. A novel solution of the Master-Slave interaction mode was proposed, which absorbed advantages of remote volume rendering and surface rendering. On server side, we designed a message-responding mechanism to listen to interactive requests from clients ( Slave model) and to guide Master volume rendering. On client side, we used HTML5 to normalize user-interactive behaviors on Slave model and enhance the accuracy of behavior request and user-friendly experience. The results showed that more than four independent tasks (each with a data size of 249.4 MB) could be simultaneously carried out with a 100-KBps client bandwidth (extreme test); the first loading time was <12 s, and the response time of each behavior request for final high quality image remained at approximately 1 s, while the peak value of bandwidth was <50-KBps. Meanwhile, the FPS value for each client was ≥40. This solution could serve the users by rapidly accessing the application via one URL hyperlink without special software and hardware requirement in a diversified network environment and could be easily integrated into other telemedical systems seamlessly.
Hintergrund und Ziele Mobile Endgeräte wie Smartphones und Tablets sind Teil unseres Alltags und beeinflussen diesen im privaten sowie im beruflichen Umfeld. Auch der Medizin- und Gesundheitsbereich profitiert von einer Integration mobiler Geräte in den Arbeitsalltag. Vor Kurzem wurde eine neue Generation von Computertomographie-Systemen (CT-Systemen) mit einem Tablet als mobiler Benutzeroberfläche und kabelloser Fernsteuerung vorgestellt. Diese flexible Steuerung eines Computertomographen (CT) ermöglicht es, zum ersten Mal seit Erfindung der Computertomographie, einen neuen Ablauf bei der Bedienung zu entwickeln. Da die potenzielle Einführung eines Screening-Programms für die Lunge in naher Zukunft eine hohe Anzahl an Untersuchungen erforderlich machen könnte, ist der Ablauf der Thorax-CT-Untersuchungen hier besonders relevant. Ziel dieser Studie war es, die Auswirkungen eines Tablet-gestützten mobilen Workflows auf den Gesamtprozess einer Thorax-CT-Untersuchung im Vergleich zum konventionellen Workflow zu analysieren. Methoden Thorax-CT-Untersuchungen von insgesamt 98 konsekutiven Patienten wurden an dem neuen CT-System durchgeführt. Zur Ausstattung des CT Systems zählten eine vereinfachte Benutzeroberfläche für ein tragbares Tablet und eine mobile Fernsteuerung. Des Weiteren wurde ein Prototyp einer Strahlenschutzkabine entworfen und neben dem CT Gerät im Untersuchungsraum aufgebaut, sodass der medizinisch-technische Radiologieassistent (MTRA) auch während der Strahlenfreisetzung bei dem Patienten im Raum bleiben konnte. Die Einteilung der Patienten in die Kontrollgruppe (n = 51) und in die Untersuchungsgruppe (n = 47) erfolgte randomisiert, wobei alle Patienten am selben CT Gerät untersucht wurden. Der MTRA untersuchte die Patienten der Kontrollgruppe unter Verwendung des konventionellen Workflows an der Konsole und die Patienten der Untersuchungsgruppe mit dem neuen Tablet-gestützten mobilen Workflow. Im Untersuchungsraum waren zwei Fischaugenkameras und im Kontrollraum eine an der Decke installiert. Während der Untersuchungen verfolgten die Fischaugenkameras die Bewegungsabläufe des MTRA und zeichneten sie auf. Mithilfe einer speziellen Software, welche die Detektion der Bewegung sowohl in Form von relativer Dichte in Spurenkarten und Wärmebildern als auch in Form von Bereichszählungen wiedergab, konnten die Bewegungsabläufe des MTRA quantitativ bestimmt werden. Zudem wurde jeder einzelne Untersuchungsschritt mithilfe einer Stoppuhr manuell erfasst. Ergebnisse Bei Verwendung des Tablets wurde nahezu die Hälfte aller Bereichszählungen (48 %) im Untersuchungsraum detektiert. Im Vergleich dazu fand beim konventionellen Workflow nur ein Viertel (25 %) aller Bereichszählungen im Untersuchungsraum beim Patienten statt. Die Zeit, die der MTRA mit dem Patienten im selben Raum verbrachte, betrug beim konventionellen Workflow lediglich 03:06 Minuten (min) (29 % der Gesamtuntersuchungsdauer). Diese Zeit konnte beim Tablet gestützten mobilen Workflow auf 06:01 min (57 % der Gesamtuntersuchungsdauer) statistisch signifikant gesteigert werden (p < 0,05). Hiervon verbrachte der MTRA lediglich 00:59 min (9 % der Gesamtuntersuchungsdauer) in der Strahlenschutzkabine und stand somit während dieser Zeit nicht in direktem Kontakt mit dem Patienten. Dennoch waren auch in diesem Zeitraum Sprach- und Sichtkontakt sichergestellt. Beim mobilen Workflow konnte der MTRA einen größeren Arbeitsbereich nutzen. Dies wurde durch die Spurenkarten und Wärmebilder ersichtlich und belegte eine erhöhte Bewegungs-freiheit des MTRA während der Untersuchung. Der geringe Zeitunterschied der Gesamtuntersuchungsdauer zwischen der Kontrollgruppe (Median: 10:50 min) und der Untersuchungsgruppe (Median: 10:35 min) war statistisch nicht signifikant (p = 0,29). Schlussfolgerung Beim mobilen Workflow profitiert der MTRA insbesondere von einer gesteigerten Bewegungsfreiheit, da die meisten Untersuchungsschritte flexibel im Untersuchungsraum und somit in der Nähe des Patienten durchgeführt werden. Die Zeit, die mit dem Patienten gemeinsam im selben Raum verbracht wird, ist im Vergleich zum konventionellen Workflow signifikant verlängert. Die Gesamtuntersuchungsdauer wird dadurch jedoch nicht beeinflusst.
Objective:
To compare the diagnostic accuracy of medical-grade and calibrated consumer-grade digital displays for the detection of subtle bone fissures.
Methods:
Three experienced radiologists assessed 96 digital radiographs, 40 without and 56 with subtle bone fissures, for the presence or absence of fissures in various bones using one consumer-grade and two medical-grade displays calibrated according to the DICOM-Grayscale Standard Display Function. The reference standard was consensus reading. Subjective image quality was also assessed by the three readers. Statistical analysis was performed using receiver operating characteristic analysis and by calculating the sensitivity, specificity, and Youden's J for each combination of reader and display. Cohen's unweighted kappa was calculated to assess inter-rater agreement. Subjective image quality was compared using the Wilcoxon signed-rank test.
Results:
No significant differences were found for the assessment of subjective image quality. Diagnostic performance was similar across all readers and displays, with Youden's J ranging from 0.443 to 0.661. The differences were influenced more by the reader than by the display used for the assessment.
Conclusion:
No significant differences were found between medical-grade and calibrated consumer-grade displays with regard to their diagnostic performance in assessing subtle bone fissures. Calibrated consumer-grade displays may be sufficient for most radiological examinations.
Key points:
• Diagnostic performance of calibrated consumer-grade displays is comparable to medical-grade displays. • There is no significant difference with regard to subjective image quality. • Use of calibrated consumer-grade displays could cut display costs by 60-80%.
The feasibility of remote reading of coronary CT examinations on tablet computers has not been evaluated. The purpose of this study is to evaluate the accuracy of coronary CT angiography reading using an iPad compared to standard 3D workstations. Fifty coronary CT angiography exams, including a spectrum of coronary artery disease and anatomic variants, were reviewed. Coronary CT angiography exams were interpreted by two readers independently on an iPad application (Siemens Webviewer) and a clinical 3D workstation at sessions 2 weeks apart. Studies were scored per vessel for severity of stenosis on a 0-3 scale (0 none, 1 <50 %, 2 ≥50-69 %, 3 ≥70 %). Coronary anomalies were recorded. A consensus read by two experienced cardiac imagers was used as the reference standard. Level of agreement with the reference for iPad and 3D workstations was compared. Multivariate logistic regression was used to analyze the relationship between agreement and display type and to adjust for inter-reader differences. For both readers, there was no significant difference in agreement with the reference standard for per-vessel stenosis scores using either the 3D workstation or the iPad. In a multivariable logistic regression analysis including reader, workstation, and vessel as co-variates, there was no significant association between workstation type or reader and agreement with the reference standard (p > 0.05). Both readers identified 100 % of coronary anomalies using each technique. Reading of coronary CT angiography examinations on the iPad had no influence on stenosis assessment compared to the standard clinical workstation.
