Review of interdisciplinary online-image-databases and their usability in medical education

Images play a significant role in medical teaching. They can get prospective physicians acquainted with specific pathological changes as early as possible and they support training their diagnostic eye. The latest improvements in Web-Based-Training offer extensive features for cost-effective studying adjustable to the individual student's requirements. However, many web-sites provide only qualitatively heterogeneous data and a limited inventory of images. This generally complicates any systematic access to the information the student requires.During the last years, several projects were initiated trying to overcome these difficulties. Web-Portals should provide access to large sets of images in a centralized manner while encompassing several medical subjects. For five of these portals their applicability for medical education was investigated considering structure, navigation and search mechanisms. Some notable approaches to implementing the various search functions were observed. However, some sites have room for improvement concerning quality of content as well as clarity of presentation and navigation. Based on the problems discovered and the approaches found, a catalogue of requirements was compiled for creating a Web-Portal to optimally support medical education

A web based cross-platform application for teleconsultation in radiology

The growing complexity of radiologic examinations and interventional procedures requires frequent exchange of knowledge. Consequently a simple way to share and discuss patient images between radiology experts and with colleagues from other medical disciplines is needed. Aims of this work were the development and initial performance evaluation of a fast and user friendly, platform independent teleconsultation system for medical imaging. A local back end system receives DICOM images and generates anonymized JPEG files that are uploaded to an internet webserver. The front end running on that webserver comprises an image viewer with a specially developed pointer element for indicating findings to collaborative partners. The front end that uses only standard web technologies works on a variety of different platforms, mobile devices and desktop computers. Images can be accessed by simply calling up a special internet address in a web browser that may be exchanged between users (e.g. via email). A speed evaluation of the system showed good results: For example the preparation and upload of a standard head CT took less than 21 seconds. The data volume of the same series and the viewer application could be transferred to a mobile phone in less than 42 seconds via a UMTS network or in less than 3 seconds via a HSPA network. The presented system with its minimal hard- and software requirements, its simplicity and platform independence might be a promising tool in the increasingly important area of teleconsultation

Morphology of the distal thoracic duct and the right lymphatic duct in different head and neck pathologies: an imaging based study

Background The purpose of this study was to assess the influence of head and neck pathologies on the detection rate, configuration and diameter of the thoracic duct (TD) and right lymphatic duct (RLD) in computed tomography (CT) of the head and neck. Methods One hundred ninety-seven patients were divided into the subgroups "healthy", "benign disease" and "malignant disease". The interpretation of the images was performed at a slice thickness of 3 mm in the axial and coronal plane. In each case we looked for the distal part of the TD and RLD respectively and subsequently evaluated their configuration (tubular, sacciform, dendritic) as well as their maximum diameter and correlated the results with age, gender and diagnosis group. Results The detection rate in the study population was 81.2 % for the TD and 64.2 % for the RLD and did not differ significantly in any of the subgroups. The predominant configuration was tubular. The configuration distribution did not differ significantly between the diagnosis groups. The mean diameter of the TD was 4.79 ± 2.41 mm and that of the RLD was 3.98 ± 1.96 mm. No significant influence of a diagnosis on the diameter could be determined. Conclusions There is no significant influence of head/neck pathologies on the CT detection rate, morphology or size of the TD and RLD. However our study emphasizes that both the RLD and the TD are detectable in the majority of routine head and neck CTs and therefore reading physicians and radiologists should be familiar with their various imaging appearances

Practicability of Hygienic Wrapping of Touchscreen Operated Mobile Devices in a Clinical Setting

Background: To prove effectiveness of wrapping tablet computers in order to reduce microbiological contamination and to evaluate whether a plastic bag-covered tablet leads to impaired user satisfaction or touchscreen functionality. Materials and Methods: Within a period of 11 days 115 patients were provided with a tablet computer while waiting for their magnetic resonance imaging examination. Every day the contamination of the surface of the tablet was determined before the first and after the final use. Before the device was handed over to a patient, it was enclosed in a customized single-use plastic bag, which was analyzed for bacterial contamination after each use. A questionnaire was applied to determine whether the plastic bag impairs the user satisfaction and the functionality of the touchscreen. Results: Following the use by patients the outside of the plastic bags was found to be contaminated with various bacteria (657.5 6 368.5 colony forming units/day); some of them were potentially pathogenic. In contrast, the plastic bag covered surface of the tablet was significantly less contaminated (1.7 6 1.9 colony forming units/day). Likewise, unused plastic bags did not show any contamination. 11% of the patients reported problems with the functionality of the touchscreen. These patients admitted that they had never used a tablet or a smartphone before. Conclusions: Tablets get severely contaminated during usage in a clinical setting. Wrapping with a customized single-use plastic bag significantly reduces microbiological contamination of the device, protects patients from the acquisition of potentially pathogenic bacteria and hardly impairs the user satisfaction and the functionality of the touchscreen

Practicability of hygienic wrapping of touchscreen operated mobile devices in a clinical setting.

BACKGROUND: To prove effectiveness of wrapping tablet computers in order to reduce microbiological contamination and to evaluate whether a plastic bag-covered tablet leads to impaired user satisfaction or touchscreen functionality. MATERIALS AND METHODS: Within a period of 11 days 115 patients were provided with a tablet computer while waiting for their magnetic resonance imaging examination. Every day the contamination of the surface of the tablet was determined before the first and after the final use. Before the device was handed over to a patient, it was enclosed in a customized single-use plastic bag, which was analyzed for bacterial contamination after each use. A questionnaire was applied to determine whether the plastic bag impairs the user satisfaction and the functionality of the touchscreen. RESULTS: Following the use by patients the outside of the plastic bags was found to be contaminated with various bacteria (657.5 ± 368.5 colony forming units/day); some of them were potentially pathogenic. In contrast, the plastic bag covered surface of the tablet was significantly less contaminated (1.7 ± 1.9 colony forming units/day). Likewise, unused plastic bags did not show any contamination. 11% of the patients reported problems with the functionality of the touchscreen. These patients admitted that they had never used a tablet or a smartphone before. CONCLUSIONS: Tablets get severely contaminated during usage in a clinical setting. Wrapping with a customized single-use plastic bag significantly reduces microbiological contamination of the device, protects patients from the acquisition of potentially pathogenic bacteria and hardly impairs the user satisfaction and the functionality of the touchscreen

Successful Multidisciplinary Treatment with Secondary Metastatic Liver Resection after Downsizing by Palliative Second-Line Treatment of Colorectal Cancer: A Curative Option

Introduction: The prognostic outcome following progression after palliative first-line treatment for patients suffering from metastatic colorectal adenocarcinoma is generally poor. Long-term relapse-free survival with palliative second-line treatment may be achieved in only a limited number of individual cases. Case Report: A 37-year-old patient presented with bilobar liver metastases of colon cancer confirmed by histology with wild-type K-RAS (exon 2). Due to progressive disease after eight cycles of first-line therapy with FOLFIRI plus cetuximab, second-line chemotherapy with modified FOLFOX4 (mFOLFOX4) plus bevacizumab was initiated. During four cycles of mFOLFOX4 plus bevacizumab (2 months), no higher-grade toxicity occurred. Liver MRI with contrast medium revealed downsizing of the segment II/III metastases, as well as regressive, small, faint, hardly definable lesions in segments VI and IVb. The interdisciplinary tumor board of the University of Erlangen thus decided to perform resection of the liver metastases. Segments II and III were resected, and the liver metastases in segments IVa and VI were excised (R0). Histopathology confirmed three of the R0-resected metastases to be completely necrotic, with residual scarring. As perioperative therapy, four additional cycles of mFOLFOX4 plus bevacizumab were administered postoperatively. No higher-grade toxicity was observed. Three years after the initial diagnosis, the patient is relapse free, professionally fully reintegrated, and has an excellent performance status. Conclusion: Patients suffering from metastatic colorectal cancer may benefit from multidisciplinary treatment with secondary metastatic liver resection after downsizing by palliative second-line treatment. In individual cases, patients may even have a curative treatment option, provided that close interdisciplinary collaboration exists

Microbial contamination of the surface of the tablet and of the outside of the used plastic bags.

<p>Logarithmic presentation of the mean microbial contamination (colony forming units, CFUs) of the surface of the tablet computer before the initial and after the final use of each day and of the outside of the plastic bags of each day. Mean values ± standard deviations are shown. Samples were taken from three defined regions of interest (ROIs; ROI A  =  central touchscreen, ROI B  =  home button and its adjacent area, ROI C  =  upper central backside).</p

Classification, prevalence and medical relevance of the bacteria found on the outside of used plastic bags. Prevalence [%] is shown in brackets.

<p>(1) unless inoculated into wounds or into the blood stream via catheters.</p><p>Classification, prevalence and medical relevance of the bacteria found on the outside of used plastic bags. Prevalence [%] is shown in brackets.</p

Experience of the participants with a personal computer (PC) and touchscreen operated devices (n = 100).

<p>Experience of the participants with a personal computer (PC) and touchscreen operated devices (n  =  100).</p

Microbial contamination (colony forming units = CFUs) of the surface of the tablet computer was determined twice every day, before initial and after final usage (100 users in 11 days).

<p>Samples were taken from three defined regions of interest (ROIs; ROI A  =  central touchscreen, ROI B  =  home button and its adjacent area, ROI C  =  upper central backside).</p><p>Microbial contamination (colony forming units  =  CFUs) of the surface of the tablet computer was determined twice every day, before initial and after final usage (100 users in 11 days).</p