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1.  An Automated DICOM Database Capable of Arbitrary Data Mining (Including Radiation Dose Indicators) for Quality Monitoring 
Journal of Digital Imaging  2010;24(2):223-233.
The U.S. National Press has brought to full public discussion concerns regarding the use of medical radiation, specifically x-ray computed tomography (CT), in diagnosis. A need exists for developing methods whereby assurance is given that all diagnostic medical radiation use is properly prescribed, and all patients’ radiation exposure is monitored. The “DICOM Index Tracker©” (DIT) transparently captures desired digital imaging and communications in medicine (DICOM) tags from CT, nuclear imaging equipment, and other DICOM devices across an enterprise. Its initial use is recording, monitoring, and providing automatic alerts to medical professionals of excursions beyond internally determined trigger action levels of radiation. A flexible knowledge base, aware of equipment in use, enables automatic alerts to system administrators of newly identified equipment models or software versions so that DIT can be adapted to the new equipment or software. A dosimetry module accepts mammography breast organ dose, skin air kerma values from XA modalities, exposure indices from computed radiography, etc. upon receipt. The American Association of Physicists in Medicine recommended a methodology for effective dose calculations which are performed with CT units having DICOM structured dose reports. Web interface reporting is provided for accessing the database in real-time. DIT is DICOM-compliant and, thus, is standardized for international comparisons. Automatic alerts currently in use include: email, cell phone text message, and internal pager text messaging. This system extends the utility of DICOM for standardizing the capturing and computing of radiation dose as well as other quality measures.
doi:10.1007/s10278-010-9329-y
PMCID: PMC3056966  PMID: 20824303
Data extraction; medical informatics applications; radiation dose; database management systems; knowledge base
3.  The standardized exposure index for digital radiography: an opportunity for optimization of radiation dose to the pediatric population 
Pediatric Radiology  2011;41(5):573-581.
The exposure index is currently a method by which digital radiography manufacturers provide feedback to the technologist regarding the estimated exposure on the detector, as a surrogate for image signal-to-noise ratio and an indirect indication of digital image quality. Unfortunately, there are as many exposure index values and methods as there are manufacturers, and in an environment with multiple vendors and a need to share data across institutions and dose registry databases, the situation is complicated. Fortunately, a new exposure index of digital X-ray imaging systems has been implemented. Developed concurrently by the International Electrotechnical Commission and the American Association of Physicists in Medicine in cooperation with digital radiography system manufacturers, the index has been implemented as an international standard. As explained, the exposure index does not indicate patient dose but rather a linearly proportional estimate of the incident radiation exposure to the detector. However, the use of the standardized exposure index and its associated target exposure index and deviation index values will likely lead to improved technologist performance in terms of uniformity and use of optimized radiographic techniques, leading to safer care of children needing radiographic examinations. Radiologists will benefit from standardized terminology, and institutions and clinics will be able to compare exposure index values with others through a national dose index registry database now under development. The Alliance for Radiation Safety in Pediatric Imaging, in its role as a benefactor of and advocate for the pediatric patient, is using the Image Gently campaign to disseminate information regarding the exposure index standard for digital radiography so that these benefits can be achieved in a rapid and effective manner.
doi:10.1007/s00247-010-1954-6
PMCID: PMC3076558  PMID: 21491197
Digital radiography; Digital radiography exposure index; Pediatric radiography radiation dose; Radiography exposure index standard; ACR dose index registry
4.  Transforming Medical Imaging: The First SCAR TRIP™ Conference 
Journal of Digital Imaging  2006;19(1):6-16.
The First Society for Computer Applications in Radiology (SCAR) Transforming the Radiological Interpretation Process (TRIP™) Conference and Workshop, “Transforming Medical Imaging” was held on January 31–February 1, 2005 in Bethesda, MD. Representatives from all areas of medical and scientific imaging—academia, research, industry, and government agencies—joined together to discuss the future of medical imaging and potential new ways to manage the explosion in numbers, size, and complexity of images generated by today's continually advancing imaging technologies. The two-day conference included plenary, scientific poster, and breakout sessions covering six major research areas related to TRIP™. These topic areas included human perception, image processing and computer-aided detection, data visualization, image set navigation and usability, databases and systems integration, and methodology evaluation and performance validation. The plenary presentations provided a general status review of each broad research field to use as a starting point for discussion in the breakout sessions, with emphasis on specific topics requiring further study. The goals for the breakout sessions were to define specific research questions in each topic area, to list the impediments to carrying out research in these fields, to suggest possible solutions and near- and distant-future directions for each general topic, and to report back to the general session. The scientific poster session provided another mechanism for presenting and discussing TRIP™-related research. This report summarizes each plenary and breakout session, and describes the group recommendations as to the issues facing the field, major impediments to progress, and the outlook for radiology in the short and long term. The conference helped refine the definition of the SCAR TRIP™ Initiative and the problems facing radiology with respect to the dramatic growth in medical imaging data, and it underscored a present and future need for the support of interdisciplinary translational research in radiology bridging bench-to-bedside. SCAR will continue to fund research grants exploring TRIP™ solutions. In addition, the organization proposes providing an infrastructure to foster collaborative research partnerships between SCAR corporate and academic members in the form of a TRIP™ Imaging Informatics Network (TRIPI2N).
doi:10.1007/s10278-006-9712-x
PMCID: PMC3043951  PMID: 16511675
Large data sets; radiological image interpretation paradigm; medical imaging informatics
5.  Editorial: TRIPTM Update 
Journal of Digital Imaging  2004;17(2):78-79.
doi:10.1007/s10278-004-1008-4
PMCID: PMC3043970  PMID: 15108031
6.  Editorial: An Update on the SCAR TRIP™ Initiative 
Journal of Digital Imaging  2003;16(2):171-172.
doi:10.1007/s10278-003-6051-z
PMCID: PMC3233728  PMID: 14765516
7.  Computed radiograpy printing problems: A quantitative, observer-independent solution 
Journal of Digital Imaging  2000;13(Suppl 1):43-44.
Even though facilities using computed radiography (CR) operate in an electronic environment, the production of hard-copy films is still necessary during the transition period, as well as for particular needs following complete implementation. We have implemented a quantitative technique to match the response of printed CR film with that of previous screen/film combinations. A stepwedge is radiographed using the conventional system. The same stepwedge is then radiographed (same geometry and technique) using the CR system. Following processing and printing, the plot of optical density versus step for the CR system is compared with that of the screen/film system. Adjustments are made to the printing parameters until the response curves are identical. All other translation tables in the system are set to be linear. This has proven to be a valuable technique for us and provides CR printed image quality that is equivalent to that of our previous screen/film combinations.
doi:10.1007/BF03167622
PMCID: PMC3453244  PMID: 10847360
8.  The implementation of speech recognition in an electronic radiology practice 
Journal of Digital Imaging  2000;13(Suppl 1):153-154.
For both efficiency and economic reasons, our practice (200,000 examinations) has converted all remote dictation to speech recognition transcription (PowerScribe, L & H, Burlington, MA). The design criteria included complete automation to the existing radiology information system (RIS), with full RIS capabilities immediately available following dictation. All dictations for computed tomography, magnetic resonance imaging, ultrasound, and nuclear medicine were converted from remote transcription to speech recognition over a 2-week period (following a 4-week installation phase and 8 days of training). The average turnaround time for these reports decreased from approximately 2 hours to less than 1 minute. Reports are then sent to the institutional Electronic Medical Record and are available throughout all facilities in a nominal 2 minutes. Speech recognition rates were suprisingly high, although certain phrases caused consistent difficulties and certain staff required retraining. This presents our analysis of both successful and problematic areas during our design and implementation, as well as statistical performance analyses.
doi:10.1007/BF03167649
PMCID: PMC3453266  PMID: 10847387
9.  Fracture interpretation using electronic presentation: A comparison 
Journal of Digital Imaging  2000;13(1):13-18.
The purposes of this study were to determine whether (1) fractures are interpreted differently after digitization and electronic presentation; (2) there are differences in accuracy between screen radiographs and electronic presentation; (3) differences in interpretation are a function of monitor resolution; and (4) differences in interpretation between radiographs and electronic images relate to radiological subspecialty. Forty cases with fractures of varying degrees of subtlety and 35 cases without fractures were interpreted. Radiographs were digitized with 2 different systems and displayed on 3 monitors of different spatial resolution. Four radiologists, with varying experience, were asked to decide whether fractures were present, absent, or they were uncertain. Accuracy of interpretation increased with improved electronic image presentation and monitor resolution. The sensitivity, specificity, and accuracy of fracture detection on System A were 63%, 98%, and 78%, respectively. The results were 72%, 98%, and 84% with System B. System C results were 81%, 97%, and 88% with Lumiscan 75, and 82%, 96%, and 88% with Lumiscan 150. Sensitivity, specificity, and accuracy results of the original radiograph interpretation were 89%, 95%, and 92%. Results were significantly different for System A. No significant differences were found for the other systems compared with film radiographs. System A did not have adequate monitors for interpretation of subtle fractures. Systems B and C were capable of displaying even subtle fractures. Our initial results indicate that interpretation with high-quality 1K×1K monitors is substantially similar to radiograph interpretation.
doi:10.1007/BF03168335
PMCID: PMC3453432  PMID: 10696596
diagnostic radiology; observer performance; fractures; images; interpretation; display; 40.41; picture archiving and communication systems

Results 1-9 (9)