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1.  Standards for Business Analytics and Departmental Workflow 
Journal of Digital Imaging  2012;26(1):53-57.
Efficient workflow is essential for a successful business. However, there is relatively little literature on analytical tools and standards for defining workflow and measuring workflow efficiency. Here, we describe an effort to define a workflow lexicon for medical imaging departments, including the rationale, the process, and the resulting lexicon.
PMCID: PMC3553366  PMID: 23065122
Workflow; Cost-effectiveness; Controlled vocabulary; Data mining; Radiology workflow; Workflow re-engineering
2.  Imaging Informatics: Challenges in Multi-site Imaging Trials 
Journal of Digital Imaging  2010;24(1):151-159.
Multi-site imaging research has several specialized needs that are substantially different from what is commonly available in clinical imaging systems. An attempt to address these concerns is being led by several institutes including the National Institutes of Health and the National Cancer Institute. With the exception of results reporting (which has an infrastructure for standard reports, albeit with several competing lexicons), medical imaging has been largely standardized by the efforts of DICOM, HL7, and IHE. What are not well developed in this area are the tools required for multi-site imaging collaboration and data mining. The goal of this paper is to identify existing clinical interoperability methods that can be used to harmonize the research and clinical worlds, and identify gaps where they exist. To do so, we will detail the approaches of a specific multi-site trial, point out the current deficiencies and workarounds developed in that trial, and finally point to work that seeks to address multi-site imaging challenges.
PMCID: PMC3046789  PMID: 20306113
Clinical information systems; clinical trial; controlled vocabulary
3.  DCMTB: A Virtual Appliance DICOM Toolbox 
Journal of Digital Imaging  2009;23(6):681-688.
Medical Imaging has been fortunate to see an avalanche of free and open source software become available in the last several years. Applications have been written to enable image viewing/storage/analysis/processing, DICOM and HL7 message parsing, results aggregation, anonymization, and more. While robust, many of these packages are difficult to install and configure. Our group desired an approach that would mitigate the efforts required to use these packages across different projects. We found such a solution in the context of using virtual machines.
PMCID: PMC3046693  PMID: 19705204
DICOM; HL7; virtualization
4.  Sustainable IT Budgeting: A Method to Determine Not to Exceed Values for Annual Infrastructure Purchases 
Picture-archiving and communication systems are complex entities, but at core they consist of compute processors that are networked together to store and retrieve objects. Therein lay fundamental aspects of both performance benchmarking and predicting future costs, provided one can accurately predict trends in both exam volumes and sizes. Hence, determining the correct amount of capital to reserve annually for the information technology infrastructure can be a difficult process for the administrator of a medical center. Both exam volumes and sizes tend to increase over time. In addition, users demand more compute-intensive applications and expect exam delivery to the desktop to be ever timelier despite the increase in size. Against this, storage, compute, and networking costs tend to decrease over time for the same performance level. At the end of the day, the question of whether to budget more or less capital for next year’s infrastructure is not trivial. This paper develops a methodology that uses current baseline data to predict the “ampleness” of a budget to meet future needs.
PMCID: PMC3043708  PMID: 18521669
Price/performance ratio; PACS; IT budgeting
5.  Issues Surrounding PACS Archiving to External, Third-Party DICOM Archives 
In larger health care imaging institutions, it is becoming increasingly obvious that separate image archives for every department are not cost effective or scalable. The solution is to have each department’s picture archiving communication system (PACS) have only a local cache, and archive to an enterprise archive that drives a universal clinical viewer. It sounds simple, but how many PACS can truly work with a third-party Integration of the Health Care Enterprise Compliant Image Archive? The answer is somewhat disappointing.
PMCID: PMC3043671  PMID: 18449605
PACS; IHE Actors; enterprise archiving
6.  ROC Study of Four LCD Displays Under Typical Medical Center Lighting Conditions 
Journal of Digital Imaging  2006;19(1):30-40.
Nine observers reviewed a previously assembled library of 320 chest computed radiography (CR) images. Observers participated in four sessions, reading a different 1/4 of the sample on each of four liquid crystal displays: a 2-megapixel (MP) consumer color display, a 2-MP business color display, a 2-MP medical-grade gray display, and a 3-MP gray display. Each display was calibrated according to the DICOM Part 14 standard. The viewing application required observer login, then randomized the order of the subsample seen on the display, and timed the responses of the observer to render a 1–5 judgment on the absence or presence of ILD on chest CRs. Selections of 1–2 were considered negative, 3 was indeterminate, and 4–5 were positive. The order of viewing sessions was also randomized for each observer. The experiment was conducted under controlled lighting, temperature, and sound conditions to mimic conditions typically found in a patient examination room. Lighting was indirect, and illuminance at the display face was 195 ± 8% lux and was monitored over the course of the experiment. The average observer sensitivity for the 2 MP color consumer, 2 MP business color, 2 MP gray, and 3 MP gray displays were 83.7%, 84.1%, 85.5%, and 86.7%, respectively. The only pairwise significant difference was between the 2-MP consumer color and the 2-MP gray (P = 0.05). Effect of order within a session was not signitfficant (P = 0.21): period 1 (84.3%), period 2 (86.2%), period 3 (85.4%), period 4 (84.1%). Observer specificity for the various displays was not statistically significant (P = 0.21). Finally, a timing analysis showed no significant difference between the displays for the user group (P = 0.13), ranging from 5.3 s (2 MP color business) to 5.9 s (3 MP Gray). There was, however, a reduction in time over the study that was significant (P <<< 0.001) for all users; the group average decreased from 6.5 to 4.7 s per image. Physical measurements of the resolution, contrast, and noise properties of the displays were acquired. Most notably, the noise of the displays varied by 3.5× between the lowest and highest noise displays. Differences in display noise were indicative of observer performance. However, the large difference in the magnitude of the noise was not predictive of the small difference (3%) in the observer sensitivity for various displays. This is likely because detection of interstitial lung disease is limited by “““““anatomical noise””” rather than display or x-ray image noise.
PMCID: PMC3043952  PMID: 16249836
ROC; image quality; displays; interstitial lung disease
7.  SCAR R&D Symposium 2003: Comparing the Efficacy of 5-MP CRT Versus 3-MP LCD in the Evaluation of Interstitial Lung Disease  
Journal of Digital Imaging  2004;17(3):149-157.
The efficacy of two medical-grade, self-calibrating, gray scale displays were compared with regard to impact on sensitivity and specificity for the detection of interstitial lung disease (ILD) on computed radiographs (CR). The displays were a 5-megapixel (MP) cathode ray tube (CRT) device and a 3-MP liquid crystal display (LCD). A sample consisting of 230 anteroposterior (AP), posteroanterior (PA), and lateral views of the chest with CT-proven findings characteristic for ILD as well as 80 normal images were compared. This double-blinded trial produced a sample sufficient to detect if the sensitivity of the LCD was 10% or more reduced (one-sided) from the “gold standard” CRT display. Both displays were calibrated to the DICOM gray scale standard and the coefficient of variation of the luminance function varied less than 2% during the study. Five board-certified radiologists specializing in thoracic radiology interpreted the sample on both displays and the intraobserver Az (area under the ROC curve) showed no significant correlation to the display used. In addition, an interobserver kappa analysis showed that the relative disagreement between any observer pair remained relatively constant between displays, and thus was display invariant. This study demonstrated there is no significant change in observer performance sensitivity on 5-MP CRT versus 3-MP LCD displays for CR examinations demonstrating ILD of the chest.
PMCID: PMC3046602  PMID: 15534750
ROC; kappa; image quality; displays; interstitial lung disease; receiver operating characteristic
10.  Aspects of computer security: A primer 
Journal of Digital Imaging  1999;12(3):114-131.
As health care organizations continue on the path toward total digital operations, a topic often raised but not clearly understood is that of computer security. The reason for this is simply the vastness of the topic. Computers and networks are complex, and each service offered is a potential security hole. This article describes for the lay person the fundamental points of computer operation, how these can be points attacked, and how these attacks can be foiled—or at least detected. In addition, a taxonomy that should aid system administrators to evaluate and strengthen their systems is described.
PMCID: PMC3452437  PMID: 10461574
computer security; encryption; RSA; public key; Satan; Tripwire; Virtual Private Networks
12.  A brief review of human perception factors in digital displays for picture archiving and communications systems 
Journal of Digital Imaging  1997;10(4):158-168.
The purpose of this review is to further inform radiologists, physicists, technologists, and engineers working with digital image display devices of issues related to human perception. This article will briefly review the effects of several factors in human perception that are specifically relevant to a digital display environment. These factors include the following: the spatial and contrast resolution of the display device; back-ground luminance level and luminance range of the display system; brightness uniformity; extraneous light in the reading room; displayed field size; viewing distance; image motion and monitor flickering; signal to noise ratio of the displayed image; magnification functions; and the user interface. After reviewing the perception study results, a checklist of desirable features and quality assurance issues for a digital display workstation are presented as an appendix.
PMCID: PMC3452987  PMID: 9399169
picture archiving and communications systems (PACS); quality assurance/control; visual perception; evaluation
13.  An evaluation of ten digital image review workstations 
Journal of Digital Imaging  1997;10(2):65-78.
A suite of performance tests are defined and performed on a total of 10 primary diagnostic image review workstations. System architectures, user interface, image manipulation tools, and data retrieval rates are discussed and analyzed. Performance timings are normalized to MB/sec to remove image file size dependencies from the data analysis. Although it is likely that some performance and capacity data may be dated as this article goes to press, it is hoped that the test definitions, methodology, and baseline data will aid those contemplating equipment purchases to make a more informed choice.
PMCID: PMC3453000  PMID: 9165421
PACS; teleradiology; workstations; performance evaluation; computers; radiology

Results 1-13 (13)