An integrated medical image database and retrieval system using a web application server.

Visual communication equipments were developed early by radiologists for the transmission of analog signals, whereas today's transmission systems are based on digitization of the radiograph. For teletransmission of dental radiographs, it is essential to assess the diagnostic accuracy of various spatial and gray-scale resolutions. Each of 83 dry mandibles was divided into four regions. By random assignment it was decided for each region whether or not a hole should be drilled. Intraoral radiographs (3 x 4 cm) were performed of each region and interpreted. The radiographs were thereafter recorded by a video camera connected to an IBM-PC. The personal computer held a hardware digitization card defined at a 512 x 512 spatial resolution with the possibility of selecting varying gray-scale resolutions. All radiographs were assessed in resolutions with 256 (8 bit), 128 (7 bit), 64 (6 bit), and 32 (5 bit) shades of gray. In no case was the original radiograph more accurate than the 512 x 512 x 8 resolution. In two of the regions evaluated, the images providing 32 shades of gray were less accurate (percentage of true positives and negatives) than the other resolutions (P less than 0.05) while in one region resolutions of 8 bit depth (256 shades of gray) provided a significantly greater accuracy than did the original radiograph and the other image resolutions (P less than 0.05). This was due to fewer false negative scores and was not followed by an increase in false positive scores. It can be concluded that a 512 x 512 spatial resolution is satisfactory for the detection of bone lesions in digitized intraoral radiographs and that 64 shades of gray provide an equally good diagnostic accuracy as do the original radiograph. This might be relevant when transmission times are of importance.

Effect of varying gray‐scale resolution for detectability of bone lesions in intraoral radiographs digitized for teletransmission

Diagnostic performance of a teleradiology system in primary health care

1.2.1 The Cochrane library The Cochrane Collaboration was established in 1993 and named for the British epidemiologist Archie Cochrane. It is an international non-profit making organization which publishes online evidence about health care in the Cochrane Library including almost 5000 systematic Cochrane Reviews. Cochrane Reviews of treatment interventions are usually restricted to randomized controlled trials (RCTs) because this is the best study design to avoid bias. The Cochrane Library is free in developing countries, in the United Kingdom (where the NHS pays for it) and in Australia (paid for by the Federal Government). In the United States, access requires a subscription, but many libraries and hospitals subscribe so that it is readily available to many clinicians. The Cochrane Library website is http://www.thecochranelibrary.com/. For the evidence for an intervention, search the Cochrane Library (Figure 1.1) first by typing your topic into the box marked SEARCH THE COCHRANE LIBRARY and clicking on Go. Try different search terms because they will give different information. 1.2.2 Medline and PubMed PubMed is provided free by the US National Library of Medicine and the National Institutes of Health and gives access to the comprehensive database Medline to anyone with internet access. The website is http:// www.pubmed.gov/. The best approach to find evidence is to use the Clinical Queries option in PubMed. Click on Clinical Queries, under PubMed Tools, currently in the centre of the PubMed home page (Figure 1.2), which brings up a new screen (Figure 1.3). Enter your search terms into the Search box and click on SEARCH. PubMed automatically finds RCTs in the first column (set the Category to “therapy” and Scope to “narrow” to find RCTs) and systematic reviews including Cochrane reviews in the middle column (Figure 1.3). Ignore the third column (only used by geneticists). Experiment with search terms until you find the best ways of expanding or narrowing the search to find what you want.

The search for evidence

Teleradiology has come a long way, from analog transmission systems using slow-scan television over standard telephone lines, to present-day, commercially available, microcomputer-based, low-resolution teleradiology systems. However, there exists a need to address the high-resolution end of the medical imaging categories, namely chest radiographs and mammograms, to firmly establish teleradiology. The availability of high-resolution image digitizers, display units, and digital hard copiers has made high-resolution digital teleradiology a feasible concept. Although the use of satellite channels can speed up the transmission of radiographic image data, with widespread acceptance of high-resolution teleradiology systems in the foreseeable future, the sheer amount of data involved in this field will give rise to problems of data transmission and storage. Data compression schemes can bring down the amount of data handled and can have a great economic impact on future teleradiology systems. We have developed a number of compression techniques for reversible compression of medical images. Our experiments have shown that lossless compression of the order of 4:1 is possible for a class of high-resolution medical images. Use of pattern recognition techniques offers the potential to bring down these data rates even further. We plan to use these techniques in a prototype high-resolution teleradiology system being developed. In this paper, we trace some of the developments in teleradiology and image data compression, and present a perspective for teleradiology in the 1990s.

/pdf/high-resolution-digital-teleradiology-a-perspective-2t26auuz68.pdf

High-resolution digital teleradiology: a perspective.

A laboratory evaluation of a microcomputer-based teleradiology system is described. The system used state-of-the-art hardware, and provided for contrast and brightness control by the consulting radiologists. The transmitted, digitized images were compared with conventional radiographs. The radiologists' scores for findings, impressions, and confidence levels were significantly lower for radiographic images viewed on the teleradiology system. However, the quality of the images provided by the teleradiology system was high enough to warrant further study, especially since microcomputer-based teleradiology offers the advantage of providing access to radiology services for rural areas and small hospitals.

Teleradiology: an evaluation of a microcomputer-based system.

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Teleradiology: an evaluation of a microcomputer-based system.