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Advances in radiologic reporting with Computerized Language Information Processing (CLIP).

Computerized Language Information Processing (CLIP) is a system of radiologic reporting in which the user interacts with a computer keyboard and cathode-ray tube terminal to generate coded reports. The hierarchical medical classification on which the code is based permits rapid on-line compilation of reports of any degree of complexity. The system provides organized sets of pre-assembled statements that are rapidly accessed and modified for each examination. Although the reports are printed in English, they are held in the computer as a succinct code that is eminently suited for permanent storage and rapid retrieval.

Classification↗

Image presentation in digital radiology: perspectives on the emerging DICOM display function standard and its application.

DICOM (Digital Imaging and Communications in Medicine) Working Group XI, formerly called ACR/NEMA (American College of Radiology/National Electrical Manufacturers' Association) Working Group XI, is currently developing a display function standard. The main objective of the standard is to define mathematically a display function for all image presentation systems. As a secondary objective, the standard aims at providing similarity in gray-scale perception for a given image between display systems of different luminance and at facilitating efficient utilization of the available digital input levels of a display system. The design of the display function incorporates the concept of perceptual linearization. The proposed standard applies to monochrome image presentation devices such as cathode ray tube monitor-display controller systems and digital laser image printers. The standard does not eliminate the use of application-specific display functions but rather ensures their effectiveness. Neither does the standard guarantee equal information transfer between image presentation devices with different physical properties; it does, however, from the basis for applying image processing to compensate for such differences.

Data Display↗

A perceptually tempered display for digital mammograms.

The cathode ray tube of a workstation for use with digital mammograms was calibrated with a photometer to produce an input-output characteristic curve similar to the perceptually linear curve defined by a current display standard. Then, a test pattern consisting of bars of increasing intensity containing disks of decreasing contrast was used by an observer to estimate the minimal detectable contrast (MDC) at different levels of display luminance. The MDC was modeled by a parabola. The shape of the parabola was determined by the observer's perceptual responses, and the range was determined by the maximum and minimum pixel values of the breast parenchyma. As each mammogram was displayed, the contour of the breast was automatically found and pixels within the breast image were sampled to determine the pixel values that were used to compute the maximum and minimum pixel values. The parabola was integrated to determine the look-up table for the initial MDC-tempered display of the mammogram. Preliminary observer performance tests showed no significant differences in the accuracy and speed of three radiologists who read a set of mammograms when the MDC-tempered display was compared with the perceptually linear display.

Data Display↗

Acute cerebral infarction: effect of JPEG compression on detection at CT.

PURPOSE: To evaluate the effect of Joint Photographic Experts Group (JPEG) compression ratios of 10:1 and 20:1 on detection of acute cerebral infarction at computed tomography (CT). MATERIALS AND METHODS: CT images obtained in 25 patients with acute cerebral infarction and 25 patients with no lesions were compressed by means of a JPEG algorithm at ratios of 10:1 and 20:1. Normal and abnormal sections (on original and compressed images) were reviewed by using a color soft-copy computed monochrome cathode ray tube monitor. Five observers rated the presence or absence of a lesion with a 50-point scale (0, definitely absent; 25, equivocal; and 50, definitely present). Diagnostic accuracy was evaluated with receiver operating characteristic (ROC) curve analysis. Significant difference was defined as a P value less than.05 for the area tested with a two-tailed paired Student t test. RESULTS: At ROC analysis, no statistically significant difference was detected for all cases considered together (Az [area under the ROC curve] = 0.887 +/- 0.038 [mean +/- SD] on noncompressed images, Az = 0.897 +/- 0.038 on 10:1 compressed images, and Az = 0.842 +/- 0.073 on 20:1 compressed images; P >.05). CONCLUSION: JPEG compression at ratios of 10:1 and 20:1 was tolerated in the detection of acute cerebral infarction at CT.

Acute Disease↗

Irreversible JPEG compression of digital chest radiographs for primary interpretation: assessment of visually lossless threshold.

PURPOSE: To determine if digital chest images could be compressed in a primary interpretation context without perceived loss of fidelity (below the visually lossless threshold) at transilluminated film or cathode ray tube (CRT) display. MATERIALS AND METHODS: One hundred forty-four posteroanterior radiographs were obtained with a digital chest radiography system. At both film and CRT display, an identified original image was presented side by side with a replicate, which was either an unaltered image or an image that had been Joint Photographic Experts Group (JPEG) compressed to 10:1, 20:1, or 50:1 and reconstructed. Each of the 10 readers indicated whether the replicate was "indistinguishable from the original" or "degraded" at clinical reading distance and at close inspection. The readers' ability to detect compressed images was examined for patterns; 95% CIs were used for statistical testing. RESULTS: With transilluminated film at clinical reading distance, readers were as likely to rate originals (48 [20%] of 240 readings) as degraded as they were to rate 20:1 replicates (106 [22%] of 480 readings) as degraded, but they frequently identified 50:1 replicates (283 [59%] of 480 readings) as degraded. At close inspection, 20:1 replicates (163 [34%] of 480 readings) were often identified as degraded, but 10:1 replicates (19 [8%] of 240 readings) were not identified as degraded more often than originals (17 [7%] of 240 readings). With CRT display, the results were nearly identical. CONCLUSION: At reading distance for primary interpretation, full-size digital chest radiographs that have been JPEG compressed to 10:1 or 20:1 and reconstructed are visually lossless at film or CRT display. Images compressed to 10:1 remain visually lossless at close inspection.

Algorithms↗

Effect of monitor luminance and ambient light on observer performance in soft-copy reading of digital chest radiographs.

PURPOSE: To examine the combined effects of monitor luminance and ambient light on observer performance for detecting abnormalities in a soft-copy interpretation of digital chest radiographs. MATERIALS AND METHODS: A total of 254 digital chest radiographs were displayed on a high-resolution cathode ray tube monitor at three luminance levels (25, 50, and 100 foot-lamberts) under three ambient light levels (0, 50, and 460 lux). Six chest radiologists reviewed each image in nine modes of combined luminance and ambient light. The observers were allowed to adjust the window width and level of the soft-copy images. The abnormalities included nodule, pneumothorax, and interstitial disease. Observer performance was analyzed in terms of the receiver operating characteristics. The observers reported their subjective level of visual fatigue with each viewing mode. A statistical test was conducted for each of the abnormalities and for fatigue score by using repeated-measures two-way analysis of variance with an interaction. RESULTS: The detection of nodules was the only reading that was affected by the ambient light with a statistically significant difference (P <.05). Otherwise, observer performance for detecting a nodule, pneumothorax, and interstitial disease was not significantly different in the nine-mode comparison. There was no evidence that the luminance of the monitors was related to the ambient light for any of the abnormalities. The fatigue score showed a statistically significant difference due to both the luminance and ambient light. CONCLUSION: When adequate window width and level are applied to soft-copy images, the primary diagnosis with chest radiographs on the monitor is unlikely to be affected under low ambient light and a monitor luminance of 25 foot-lamberts or more.

Computer Terminals↗

Observer performance with computer-generated images of 201Tl-Cl myocardial perfusion.

The effect of simple image processing on the interpretation of 201Tl-Cl myocardial perfusion images were evaluated by ROC analysis. Polaroid images of the cathode ray tube of an Anger camera and computer-processed transparent images recorded in color and shades of gray were examined by multiple observers. A total of 198 observer responses was accumulated for each of five image formats. The observer responses were compared with results established by coronary angiography. Better observer performance was obtained for all computer-generated images except in the region of low false positive values. The responses for color-scale formats were, in general, superior to those from the gray-scale formats. No significant improvement in observer performance resulted from the use of background subtraction with a rescaling of the 16-level gray scale to the residual information. When nine-point smoothing was applied to the color-scale display format, there was a poorer observer response.

Computers↗

Continuous image recording using gray-tone, dry-process silver paper.

A method of recording continuous gray-tone images on dry-process silver paper from raster-scan video signals is described. The Tektronix 4634 image-forming module uses a fiber-optic faceplate cathode-ray tube to couple the light output onto the recording paper. The latent image is heat developed and presented in sheet form. An initial comparison between dry silver paper and conventional film for video-generated computed tomography and nuclear medicine examinations, shows little apparent difference in image quality. Considerable cost savings are possible when using dry silver paper. Additional cost savings are possible if multiple images can be recorded on each dry silver sheet.

Costs and Cost Analysis↗

Intraarterial digital subtraction angiography in diagnostic arteriography.

Intraarterial digital subtraction angiography (DSA) was performed in 133 diagnostic arteriographic procedures during a 10-month period. The increased contrast resolution of DSA permitted the use of a dilute (15%) contrast material. A significant reduction in contrast material dose compared with conventional film-screen arteriography and intravenous DSA was thus achieved. This was especially advantageous in patients with diminished renal function. The dilute contrast material also resulted in less patient discomfort. Subtracted images were available immediately on cathode ray tube display, resulting in faster procedures, and a considerable saving in film cost compared with conventional arteriography. It is concluded that intraarterial DSA is a useful technique that may replace conventional film-screen arteriography in many applications.

Angiography↗

Mammographic microcalcifications: detection with xerography, screen-film, and digitized film display.

Pulverized bone specks and aluminum oxide specks were measured by hand into sizes ranging from 0.2 mm to 1.0 mm and then arranged in clusters. These clusters were superimposed on a human breast tissue phantom, and xeromammograms and screen-film mammograms of the clusters were made. The screen-film mammograms were digitized using a high-resolution laser scanner and then displayed on cathode ray tube (CRT) monitors. Six radiologists independently counted the microcalcifications on the xeromammograms, the screen-film mammograms, and the digitized-film mammograms. The xeromammograms were examined with a magnifying glass; the screen-film images were examined with a magnifying glass and by hot light; and the digitized-film images were examined by electronic magnification and image processing. The bone speck size that corresponded to a mean 50% detectability level for each technique was as follows: xeromammography, 0.550 mm; digitized film, 0.573 mm; and screen-film, 0.661 mm. We postulate that electronic magnification and image processing with edge enhancement can improve the capability of screen-film mammography to enhance the detection of microcalcifications.

Breast Diseases↗

Clinical evaluation of irreversible image compression: analysis of chest imaging with computed radiography.

To implement a picture archiving and communication system, clinical evaluation of irreversible image compression with a newly developed modified two-dimensional discrete cosine transform (DCT) and bit-allocation technique was performed for chest images with computed radiography (CR). CR images were observed on a cathode-ray-tube monitor in a 1,024 X 1,536 matrix. One original and five reconstructed versions of the same images with compression ratios of 3:1, 6:1, 13:1, 19:1, and 31:1 were ranked according to quality. Test images with higher spatial frequency were ranked better than those with lower spatial frequency and the acceptable upper limit of the compression ratio was 19:1. In studies of receiver operating characteristics for scoring the presence or absence of nodules and linear shadows, the images with a compression ratio of 25:1 showed a statistical difference as compared with the other images with a compression ratio of 20:1 or less. Both studies show that plain CR chest images with a compression ratio of 10:1 are acceptable and, with use of an improved DCT technique, the upper limit of the compression ratio is 20:1.

Humans↗

Primary CT diagnosis of abdominal masses in a PACS environment.

Whether the display medium--film versus cathode ray tube (CRT)--affects observer performance during interpretation of computed tomographic (CT) images is an important research issue in these times of implementation and growth of picture archiving and communications systems in radiology. The authors performed a multiobserver receiver operating characteristic (ROC) study to determine the performance of radiologists who read abdominal CT studies displayed on film, as well as on a high-resolution workstation (video monitor) that made use of three different display modes. A total of 166 examinations were evaluated by eight radiologists, who recorded their ordinal confidence ratings of the demonstration of presence or absence of abdominal masses. ROC analysis showed small differences in the confidence ratings assigned by individual readers for the detection and interpretation tasks. Results for the group as a whole showed no significant reduction or improvement in observer performance when ratings for any one of the workstation display modes were analyzed. The results of this study demonstrate that current CRT display technology is adequate for enabling the primary detection of abdominal masses with CT examinations.

Abdominal Neoplasms↗

Thickness-equalization processing for mammographic images.

A digital postprocessing technique was used to compensate for the limitations of laser film or cathode-ray-tube devices used to display digital mammograms. An algorithm identified and equalized for the large change in digital signal caused by the reduction in thickness at the margin of the compressed breast. The resulting images reflected only breast composition, and so the number of gray levels needed to display the processed image was greatly reduced, which facilitated presentation and analysis.

Female↗

AAPM/RSNA tutorial on equipment selection: PACS equipment overview: display systems.

Display systems are key components of the digital radiology department. Current display systems for medical imaging are based on cathode-ray tubes (CRTs) or active-matrix liquid crystal displays (AMLCDs). The CRT is a cathodoluminescent display: Light is generated by exciting a luminescent material with energetic electrons. AMLCDs are light-modulating devices that form the image in the screen by controlling the transparency of individual display pixels. Many image quality aspects of CRTs are determined by the way the pixel luminance is generated in the cathodoluminescent screen. The resolution properties of AMLCDs are much better than those of CRTs. In CRT devices, phosphor granularity and raster scanning patterns are the main components of spatial noise. In AMLCDs, the most notable feature of the noise characteristic is the subpixel structure of complex pixel designs used in medical displays. The small-spot contrast of CRTs is dominated mainly by veiling glare and reflections of ambient illumination. In addition to display reflectance, the contrast of medical AMLCDs is affected by crosstalk and by variations of the luminance at off-normal viewing angles.

Data Display↗

AAPM/RSNA physics tutorial for residents: technological and psychophysical considerations for digital mammographic displays.

Digital mammography is gradually replacing screen-film analog mammography, a transition driven by a desire to improve the efficiency and possibly the quality of the interpretation of mammograms. Digital mammography involves the use of electronic display devices to display the mammograms. Currently, two electronic technologies are used to display digital mammograms: the cathode-ray tube (CRT) and liquid crystal display (LCD). CRT and LCD devices have imaging characteristics markedly different from those of transilluminated film, which has conventionally been used to display analog mammograms. Consequently, the transition to digital mammography necessitates consideration of a number of psychophysical factors pertaining to effective display of mammograms. Some of these factors are related to specific performance characteristics of the display devices, whereas others are related to inherent characteristics of the human visual system. The main psychophysical factors that affect the interpretation of medical images are contrast, resolution, and noise. Optimal display of mammograms is achieved by taking these factors into consideration and by using time-efficient, intuitive, and reader-specific user interfaces. Because display devices are susceptible to variations in hardware and calibration and to degradation over time, acceptance testing and quality control testing are necessary to maintain an adequate level of display quality.

Artifacts↗

Gasser and Graham and spinal cord electrophysiology.

This year marks the 50th anniversary of the publication of the pioneering electrophysiological study of the spinal cord by H. S. Gasser and H. T. Graham (Am. J. Physiol. 103: 303-320, 1983). Gasser and Graham's paper is of historical interest, because it was the first study of the spinal cord to use a cathode ray tube. It is of scientific interest, because their careful recordings and insightful interpretations laid the groundwork for subsequent studies of spinal cord electrophysiology in anesthetized animals and, more recently, for the interpretation of noninvasive spinal cord recordings in awake, intact humans.

Animals↗

Postnatal development of receptive field surround inhibition in kitten dorsal lateral geniculate nucleus.

We recorded the responses to visual stimulation of single neurons in the A-layers of the dorsal lateral geniculate nucleus (LGNd) of 4- to 5-wk-old kittens and adult cats. Visual stimuli were generated on a cathode-ray tube (CRT) display and consisted of circular spots and annuli whose contrast was twice the threshold for each neuron and was modulated about a background luminance of 28 cd/m2 at 0.5 Hz. Neural responses were collected as interspike intervals and displayed as instantaneous firing rates for individual trials. From the responses to a series of sizes of spot stimuli, area-response functions were constructed and used to derive a quantitative measure of the strength of the receptive field (RF) surround inhibition of each neuron, the spatial density minimum ([SDmin[). To separate neural from optical factors that affect measurements of surround inhibition, published values for the posterior nodal distances of the kitten and adult eye were used to scale stimuli in terms of the retinal area subtended. Of 153 kitten and 95 adult LGNd neurons studied, the responses to a complete series of spot stimuli of different sizes (areas) were obtained for 52 kitten neurons [44 with linear spatial summation (L) and 8 with nonlinear spatial summation (NL)] and 45 adult (24 X-and 21 Y-) neurons. In addition, intracellular recordings were made from 30 of the kitten neurons that were filled iontophoretically with horseradish peroxidase (HRP) and were evaluated structurally. In the adult, neurons were classified as X-or Y-cells on the basis of a battery of physiological properties, including linearity of spatial summation, latency to electrical stimulation of the optic chiasm, and ability to respond reliably to rapidly moving stimuli. Kitten neuronal responses allowed them to be clearly identified as exhibiting linear or nonlinear spatial summation, but application of additional criteria produced ambiguous results for classification into X-or Y-categories. Kitten L or NL neurons showed differences typical of adult X-and Y-cells on some [e.g., RF center size (P less than 0.01)] but not other [e.g., latency to stimulation of optic chiasm (P greater than 0.40)] properties. In addition, by direct comparison of morphological features with these physiological responses, some kitten cells with adult X-cell physiological properties on these tests were found to have typical adult Y-cell somadendritic structure.(ABSTRACT TRUNCATED AT 400 WORDS)

Age Factors↗

The role of D1-dopamine receptor in working memory: local injections of dopamine antagonists into the prefrontal cortex of rhesus monkeys performing an oculomotor delayed-response task.

1. To examine the role of dopamine receptors in the prefrontal cortex (PFC) on working memory, we injected dopamine antagonists (SCH23390, SCH39166, haloperidol, sulpiride, and raclopride) locally into the dorsolateral PFC in two monkeys trained to perform an oculomotor delayed-response (ODR) task. In the ODR task, monkeys fixate a central spot on a cathode ray tube (CRT) monitor while a visual cue is briefly (300 ms) presented in one of several peripheral locations in the visual field. After a delay of 1.5-6 s, the fixation spot is turned off, instructing the monkey to move its eyes to the target location that had been indicated by the visuospatial cue before the delay. Each monkey also performed a control task in which the cue remained on during the delay period. In this task the monkey's response was sensory rather than memory guided. 2. Local intracerebral injection of the selective dopamine antagonists SCH23390 (10-80 micrograms) and SCH39166 (1-5 micrograms) and/or the nonselective dopamine antagonist haloperidol (10-100 micrograms) induced deficits in ODR task performance at a total of 22 sites in the dorsolateral PFC. The deficit was characterized by a decrease in the accuracy of the memory-guided saccade as well as an increase in the latency of the response. The deficit usually appeared within 1-3 min after the injection, reached a peak at 20-40 min, and recovered at 60-90 min. 3. Performance change was restricted to a few specific target locations, which varied with the injection site and were most often contralateral to the injection site. 4. The degree of impairment in the ODR task occasioned by the injection of the dopamine antagonists was sensitive to the duration of delay; longer delays were associated with larger decreases in the accuracy and delayed onset of the memory-guided saccade. 5. The deficit was dose dependent; higher doses induced larger errors and increases in the onset of the memory-guided saccade. 6. Dopamine antagonists did not affect performance on the control task, which required the same eye movements but was sensory guided. Thus, in the same experimental session in which ODR performance was impaired, the accuracy and the latency of the sensory-guided saccades were normal for every target location.(ABSTRACT TRUNCATED AT 400 WORDS)

Animals↗