The organizational implications of medical imaging in the context of Malaysian hospitals

This research investigated the implementation and use of medical imaging in the context of Malaysian hospitals. In this report medical imaging refers to PACS, RIS/HIS and imaging modalities which are linked through a computer network. The study examined how the internal context of a hospital and its external context together influenced the implementation of medical imaging, and how this in turn shaped organizational roles and relationships within the hospital itself. It further investigated how the implementation of the technology in one hospital affected its implementation in another hospital. The research used systems theory as the theoretical framework for the study. Methodologically, the study used a case-based approach and multiple methods to obtain data. The case studies included two hospital-based radiology departments in Malaysia. The outcomes of the research suggest that the implementation of medical imaging in community hospitals is shaped by the external context particularly the role played by the Ministry of Health. Furthermore, influences from both the internal and external contexts have a substantial impact on the process of implementing medical imaging and the extent of the benefits that the organization can gain. In the context of roles and social relationships, the findings revealed that the routine use of medical imaging has substantially affected radiographers’ roles, and the social relationships between non clinical personnel and clinicians. This study found no change in the relationship between radiographers and radiologists. Finally, the approaches to implementation taken in the hospitals studied were found to influence those taken by other hospitals. Overall, this study makes three important contributions. Firstly, it extends Barley’s (1986, 1990) research by explicitly demonstrating that the organization’s internal and external contexts together shape the implementation and use of technology, that the processes of implementing and using technology impact upon roles, relationships and networks and that a role-based approach alone is inadequate to examine the outcomes of deploying an advanced technology. Secondly, this study contends that scalability of technology in the context of developing countries is not necessarily linear. Finally, this study offers practical contributions that can benefit healthcare organizations in Malaysia

Comparison of magnetic resonance spectroscopy, proton density fat fraction and histological analysis in the quantification of liver steatosis in children and adolescents

AIM: To establish a threshold value for liver fat content between healthy children and those with non-alcoholic fatty liver disease (NAFLD) by using magnetic resonance imaging (MRI), with liver biopsy serving as a reference standard. METHODS: The study was approved by the local ethics committee, and written informed consent was obtained from all participants and their legal guardians before the study began. Twenty-seven children with NAFLD underwent liver biopsy to assess the presence of nonalcoholic steatohepatitis. The assessment of liver fat fraction was performed using MRI, with a high field magnet and 2D gradient-echo and multiple-echo T1-weighted sequence with low flip angle and single-voxel point-resolved ¹H MR-Spectroscopy (¹H-MRS), corrected for T1 and T2* decays. Receiver operating characteristic curve analysis was used to determine the best cut-off value. Lin coefficient test was used to evaluate the correlation between histology, MRS and MRI-PDFF. A Mann-Whitney U-test and multivariate analysis were performed to analyze the continuous variables. RESULTS: According to MRS, the threshold value between healthy children and those with NAFLD is 6%; using MRI-PDFF, a cut-off value of 3.5% is suggested. The Lin analysis revealed a good fit between the histology and MRS as well as MRI-PDFF. CONCLUSION: MRS is an accurate and precise method for detecting NAFLD in children

Focal Spot, Spring 1998

https://digitalcommons.wustl.edu/focal_spot_archives/1078/thumbnail.jp

A study to understand the acceptance of DICOM Structured Reports on Breast Imaging

Purpose: To create a Digital Imaging and Communication in Medicine Structured Reports (DICOM-SR) Repository and compare the acceptance of Free Text (FT) versus Structured Reports (SR) in communication of Breast Imaging findings. Materials and Methods: It was conceptualized the MamoCatalogue to the structuring of the Reports and the SR were converted into DICOM-SR and integrated with Dicoogle. After that, seven representative Breast Imaging Reports were selected and evaluated by a group of 25 Physicians. Each Physician evaluated the seven Reports, in FT and SR with a 3 months timelag, about their, Structure, Clarity and assertiveness, Diagnostic/Recommendations, Easiness of reading, Full reading, Partially reading with Breast Imaging Reporting and Data System (BI-RADS) focus and Ambiguity. Results: A DICOM-SR Repository was created and the assessment of the acceptance of the FT vs. SR revealed that there is a global trend favoring FT. Nevertheless, a group wise analysis revealed that for Gynaecologists and General Practitioners (GP) the differences between FT and SR weren't significant, unlike what happens with Radiologists. Conclusion: The DICOM-SR Repository allows the query/retrieve data for Reports and the communication with Gynaecologists and GP by SR was satisfactory. Although, Radiologists acceptance must be reinforced upon global communication and management strategy

Quantitative assessment of diffusion-weighted MR imaging in patients with primary rectal cancer: Correlation with FDG-PET/CT

Purpose: The aim of the study was to assess correlations between parameters on diffusionweighted imaging and 2-deoxy-2-[ 18F]fluoro-D-glucose- positron emission tomography/computed tomography (FDG-PET/CT) in rectal cancer. Procedures: Thirty-three consecutive patients with pathologically confirmed rectal adenocarcinoma were included in this study. Apparent diffusion coefficient (ADC) maps were generated to calculate ADC mean (average ADC), ADC min (lowest ADC), tumor volume, and total diffusivity index (TDI). PET/CT exams were performed within 1 week of magnetic resonance imaging. Standardized uptake values (SUVs) were normalized to the injected FDG dose and body weight. SUV max (maximum SUV), SUV mean (average SUV), tumor volume, and total lesion glycolysis (TLG) were calculated using a 50% threshold. Results: Significant negative correlations were found between ADC min and SUV max (r=-0.450, p=0.009), and between ADC mean and SUV mean (r=-0.402, p=0.020). A significant positive correlation was found between TDI and TLG (r=0.634, p<0.001). Conclusion: The significant negative correlations between ADC and SUV suggest an association between tumor cellularity and metabolic activity in primary rectal adenocarcinoma. © Academy of Molecular Imaging and Society for Molecular Imaging, 2010.published_or_final_versionSpringer Open Choice, 21 Feb 201

Gesture-Controlled Interface for Contactless Control of Various Computer Programs with a Hooking-Based Keyboard and Mouse-Mapping Technique in the Operating Room

We developed a contactless interface that exploits hand gestures to effectively control medical images in the operating room. We developed an in-house program called GestureHook that exploits message hooking techniques to convert gestures into specific functions. For quantitative evaluation of this program, we used gestures to control images of a dynamic biliary CT study and compared the results with those of a mouse (8.54±1.77 s to 5.29±1.00 s; p<0.001) and measured the recognition rates of specific gestures and the success rates of tasks based on clinical scenarios. For clinical applications, this program was set up in the operating room to browse images for plastic surgery. A surgeon browsed images from three different programs: CT images from a PACS program, volume-rendered images from a 3D PACS program, and surgical planning photographs from a basic image viewing program. All programs could be seamlessly controlled by gestures and motions. This approach can control all operating room programs without source code modification and provide surgeons with a new way to safely browse through images and easily switch applications during surgical procedures

Using computer-aided detection in mammography as a decision support

Contains fulltext : 87548.pdf (publisher's version ) (Closed access)OBJECTIVE: To evaluate an interactive computer-aided detection (CAD) system for reading mammograms to improve decision making. METHODS: A dedicated mammographic workstation has been developed in which readers can probe image locations for the presence of CAD information. If present, CAD findings are displayed with the computed malignancy rating. A reader study was conducted in which four screening radiologists and five non-radiologists participated to study the effect of this system on detection performance. The participants read 120 cases of which 40 cases had a malignant mass that was missed at the original screening. The readers read each mammogram both with and without CAD in separate sessions. Each reader reported localized findings and assigned a malignancy score per finding. Mean sensitivity was computed in an interval of false-positive fractions less than 10%. RESULTS: Mean sensitivity was 25.1% in the sessions without CAD and 34.8% in the CAD-assisted sessions. The increase in detection performance was significant (p = 0.012). Average reading time was 84.7 +/- 61.5 s/case in the unaided sessions and was not significantly higher when interactive CAD was used (85.9 +/- 57.8 s/case). CONCLUSION: Interactive use of CAD in mammography may be more effective than traditional CAD for improving mass detection without affecting reading time.1 oktober 201

Information Technologies for the Healthcare Delivery System

That modern healthcare requires information technology to be efficient and fully effective is evident if one spends any time observing the delivery of institutional health care. Consider the observation of a practitioner of the discipline, David M. Eddy, MD, PhD, voiced in Clinical Decision Making, JAMA 263:1265-75, 1990, . . .All confirm what would be expected from common sense: The complexity of modern medicine exceeds the inherent limitations of the unaided human mind. The goal of this thesis is to identify the technological factors that are required to enable a fully sufficient application of information technology (IT) to the modern institutional practice of medicine. Perhaps the epitome of healthcare IT is the fully integrated, fully electronic patient medical record. Although, in 1991 the Institute of Medicine called for such a record to be standard technology by 2001, it has still not materialized. The author will argue that some of the technology and standards that are pre-requisite for this achievement have now arrived, while others are still evolving to fully sufficient levels. The paper will concentrate primarily on the health care system in the United States, although much of what is contained is applicable to a large degree, around the world. The paper will illustrate certain of these pre-requisite IT factors by discussing the actual installation of a major health care computer system at the University of Rochester Medical Center (URMC) in Rochester, New York. This system is a Picture Archiving and Communications System (PACS). As the name implies, PACS is a system of capturing health care images in digital format, storing them and communicating them to users throughout the enterprise