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A multimedia medical communication link between a radiology department and an emergency department.

The most critical aspect of a radiologist's work is communicating his findings to the attending physician responsible for the patient's care. This is also the part of the process that is least well organized and the most subject to failure. At the University of Ottawa Medical Communications Research Centre we are investigating technical means to improving communications between radiologists and attending physicians. We first introduce the radiology communication service problem and show why it is essentially a multimedia communication problem. We then briefly describe a multimedia communication system designed and implemented by our research team. The multimedia system consists of several work stations linked by the Hospital's local area network (LAN). Each physician work station comprises a Compaq 386/20-Mhz microcomputer with 16 Mbytes of RAM, a 500-Mbyte image disk, and an image memory that drives a 1,000-line monochrome monitor. The images are digitized using a Konica laser-based film digitizer (2430 by 2000 10-bit pixels for a standard chest radiograph). The multimedia file server manager station is built around a PC-AT compatible with a Northern Telecom Meridian SL-1ST digital PBX and a Meridian Mail digital voice messaging system. This last device is used to store voice data and is linked via the PBX to the workstations' digital telephones. A Sytek 6,000 LAN links all work stations to the file server. All data, image, and graphic information is transmitted via this network, while the twisted pair connections linking the digital PBX to the telephone sets are used for transmitting voice data.(ABSTRACT TRUNCATED AT 250 WORDS)

Computer Communication Networks

CD-ROM multimedia. The step before virtual reality.

Applications developed using key multimedia elements are finding their way into a number of training and information exchange environments including the laparoscopy training market. Emerging multimedia-based applications range from procedural information for patients to interactive CD-ROM-based applications used to train highly skilled surgeons. These products are designed with a high level of interactivity that allows the surgeon to plan a surgical procedure, review detailed patient information and then merge that information into the surgical planning process. Using this new technology, a surgeon now has the ability to review CD-ROM-based course materials and efficiently meet continuing education requirements. The factor found most limiting in the development of multimedia-based applications for laparoscopy training is generally not the technology, but the limits placed on the technology because of one's reluctance to think beyond what is accepted as the norm. Properly implemented, multimedia applications developed for laparoscopy training reduce the cost and time associated with learning new materials, assist a user in retaining more of the information reviewed, and in many cases make the learning experience much more enjoyable.

Audiovisual Aids

Multimedia clinical examination: the time honoured art and science mirrored digitally.

In the recent years, multimedia has exhibited a tremendous presence in the personal computer market and it has exerted an influence in our homes and teaching institutions as well. To define it very simply, a multimedia PC is a personal computer capable of producing images and sound of reasonable quality by means of software toggles. This paper presents an Asymetrix Multimedia Toolbook application entitled Multimedia Clinical Examination (MCE) which harnesses the ability of affordable computers to create and display a variety of audiovisual media to supplement 'bed-side teaching' of elementary clinical methods which includes history taking and physical examination. MCE comprises a history taking module which helps in keeping track of the possible differential diagnoses and a physical examination module which shows digital videos of appropriate examination steps. The application runs on the Microsoft Windows platform.

Audiovisual Aids

Multimedia for clinical education in myocardial perfusion imaging.

Interactive multimedia has many advantages as a presentation medium for diagnostic imaging case studies, particularly for teaching digital imaging techniques such as myocardial perfusion imaging. Multimedia documents may incorporate interactive audiovisual presentations, sophisticated diagnostic images, anatomical illustrations, and text in medical instructional materials. The article describes a multimedia teaching atlas of SPECT and planar myocardial perfusion imaging delivered on Apple Macintosh II microcomputers, and discusses some of the advantages of delivering medical educational materials with interactive multimedia techniques.

Computer-Assisted Instruction

Multimedia cardiac catheterization record document system.

In this paper, we present the design and implementation of a multimedia cardiac catheterization record (CCR) system. A traditional CCR contains medical report, electrocardiograms, X-ray images, and possibly video sequences for angiograms. The physicians found it difficult to access and manage these multimedia information easily. Current advances in multimedia technology has made possible the authoring, storage and presentation of these medical information in a systematic and easily-accessible way. This paper discusses the background and rationale that led to the design and implementation of a cost-effective multimedia medical document system framework and prototype.

Cardiac Catheterization

Filmless multimedia display following cardiac catheterization.

In traditional cardiac catheterization laboratories, anatomic images are acquired onto 35-mm cine film and presented in series with related information days, weeks, or months later to an audience of decision-makers. These data are projected onto a convenient light-colored wall or silver screen, while echocardiograms and electrophysiologic data are displayed using small single-user computer monitors. This presentation format is not ideal, because full audience participation is not fostered, image quality may be degraded, and small computer screens can be adequataly visualized only by those individuals immediately in front of them. Modern video multimedia systems now make an ideal data presentation format practical, in which all types of media including digitally acquired angiograms can be displayed in parallel with full annotation, using large diagonal multisync color monitors. This communication discusses how to design a multimedia conference center in which remotely acquired filmless digital images can be displayed and processed together with all other pertinent cardiac multimedia to a large audience.

Cardiac Catheterization

Multimedia system based on programmed instruction in medical genetics: construction and evaluation.

A multimedia system used as an auxiliary didactic tool for teaching medical genetics, HGEN, is based on non-linear programmed instruction and multimedia. HGEN was implemented in layers for PC compatible using MULTIMEDIA TOOLBOOK and DELPHI. It includes basic medical genetics concepts (inheritance patterns and cytogenetics) and it is based on multiple choice questions with images, diagrams and animations. The student-program interaction occurs by choosing an alternative in a question and receiving a specific answer as feedback and additional information. Links send the students to a glossary, to short descriptions of diseases used as examples, or to references for further studies. In order to evaluate the performance of the HGEN the authors used two questionnaires: (a) about the students' background in using computers; and (b) the system efficiency as a didactic tool, the software quality and user satisfaction. HGEN was used by 63 students from three medical schools and it was considered efficient as a learning tool (100%). Furthermore the implementation of a navigation map for frequencies analysis of followed path enable the study to detect structure and content inadequacies that could be correct for version 1.1 and proved to be an efficient tool to optimize a didactic software.

Computer-Assisted Instruction

Acceptance by Swedish users of a multimedia program for primary and secondary prevention of malignant melanoma.

BACKGROUND: In Sweden, the incidence of malignant melanoma of the skin is rapidly increasing, and the disease is now one of the ten most common tumor types. The objectives were to apply multimedia techniques to increase public knowledge about malignant melanoma and its risk factors, to increase awareness of preventive measures, and to make people more disposed to change their sunbathing habits. METHODS: A trilingual (Swedish, English, and German) multimedia program was developed for two target groups, health care personnel and the general public, with a total of >500 "pages" in each language. User reactions were studied on-site at a municipal pharmacy and library, where the program was available in a kiosk with touch-screen. RESULTS: Practically all 274 users interviewed found the program easy to use and understand. 92% identified one or more of the recommendations given. 66% found the program information "worrying," and 29%--mainly young women-instantly declared that they were going to change their sun-exposure behaviors. No correlation to skin type was found. CONCLUSIONS: A multimedia program of the present design seems to be a useful tool for health promotion.

Adult

Multimedia benchmarking analysis for three risk assessment models: RESRAD, MMSOILS, and MEPAS.

This paper is one in a series that describes results of a benchmarking analysis initiated by the Department of Energy (DOE) and the United States Environmental Protection Agency (EPA). An overview of the study is provided in a companion paper by Laniak et al. presented in this journal issue. The three models used in the study--RESRAD (DOE), MMSOILS (EPA), and MEPAS (DOE)--represent analytically-based tools that are used by the respective agencies for performing human exposure and health risk assessments. Both single media and multimedia benchmarking scenarios were developed and executed. In this paper, the multimedia scenario is examined. That scenario consists of a hypothetical landfill that initially contained uranium-238 and methylene chloride. The multimedia models predict the fate of these contaminants, plus the progeny of uranium-238, through the unsaturated zone, saturated zone, surface water, and atmosphere. Carcinogenic risks are calculated from exposure to the contaminants via multiple pathways. Results of the tests show that differences in model endpoint estimates arise from both differences in the models' mathematical formulations and assumptions related to the implementation of the scenarios.

Air Pollutants, Radioactive

Content preauthoring: preparing medical imaging information for multimedia authoring and quizzing.

Recent advances in multimedia development software and related hardware have given professionals and nonprofessionals tremendous power and flexibility to create multimedia education and training programs. Nevertheless, content organization remains a key and often neglected component of program development. Content preauthoring puts findings, diagnoses, differential diagnoses, and other standard radiologic concepts into a format that fosters logical program layout, centralized remediation, record keeping, decreased data entry, a variety of user levels, easy addition of cases, and linkage to a question-generating program. The goal of content preauthoring is to organize radiologic material into a hierarchical or spreadsheet-based structure that provides a logical basis for software design. By separating content design from software authoring, both processes become more manageable. This approach is applicable to visually oriented topics that focus on identification. The highly structured, goal-oriented nature of the method makes it particularly suitable for newcomers to multimedia authoring.

Authorship

Extending the multimedia patient record across the wide area network.

The Dept. of Veterans Affairs is developing and testing a wide area medical network with multimedia capabilities for coordination and consolidation of medical services across locations. The system is composed of multimedia information systems at individual medical centers connected by a high speed wide area network. The DHCP Imaging System, which has been in clinical use for six years, provides storage management and workstation acquisition and display of the multimedia data. Teleconsulting capability using a variety of mechanisms' is being prototyped and tested to meet medical staffing and consultation needs.

Computer Communication Networks

Multimedia anatomy and physiology lectures for nursing students.

The use of the multimedia computer and projector can provide the lecturer who teaches anatomy and physiology to nursing students with a very powerful educational tool. The recent explosion in the number of Internet sites has resulted in a huge resource base of illustrations, photos, x-rays, and film clips, which are useful for anatomy and physiology multimedia presentations. These allow nursing students to be instructed in a clear, colorful, and dynamic fashion. This article shows how to put together anatomy and physiology multimedia presentations quickly and easily, and reviews some of the key sites on the Internet that provide resources suitable for lectures to nursing students.

Anatomy

[A multimedia echocardiographic archive].

The widespread diffusion of echocardiography requires to rationalize clinical examination archives; the recent improvement in computer processing speed and the addition of image processing capabilities on standard personal computer by using multimedia technology provide a low-cost solution to improve video digital acquisition and base management. Furthermore, the diffusion of computer networks supports the possibility of sending images in digital format from a work station to another. In this study we describe the setting-up of a system for echocardiographic image acquisition, storage, base management and analysis based on a standard multimedia Macintosh personal computer using readily available not-dedicated software. We tested the overall efficiency of this system in terms of time required to perform hardware and software procedures, storage capacity of the archive and possibility to exchange information with other wire-linked computer work-stations or via modem. This system has proven to require an acceptable time to perform all the procedures showing a high level of connectivity with other standard personal computer work-stations; however, some limitations with regard to time required in sending via modem long movie files need to be pointed out. In conclusion, in our experience new multimedia personal computer could offer to every physician with a minimum informatic knowledge the well known advantages of digital-video, at a reasonable cost.

Archives

A new teaching tool for dental and medical schools: multimedia CD-ROM on dental and skeletal development.

Multimedia teaching tools in Medicine are still very rare. Their presentation on a CD-ROM format is part of the emerging technologies in Medical Informatics. The Multimedia material presented here on Dental and Skeletal Development is mostly a Database and a Tutorial. The Database, which contains more than 2000 hand/wrist radiographs, is mostly intended for Pediatricians, Endocrinologists, Forensic Dentists and Physicians, as well as for Orthodontists and Pedodontists. The material is the result of 20-year of Longitudinal Growth study of children in Montreal. In this Multimedia CD-ROM, the research results are used for Medical teaching purposes.

Bone Development

Multimedia in the radiology environment: current concept.

Multimedia has different meanings according to its context. Here, multimedia in the radiology environment is defined as the integration of multiple radiology and medical information systems to facilitate the practice of radiology. These information systems include the hospital information system, radiology information system, picture archiving and communication systems, voice reporting, library information systems, and electronic mail and file systems. The concept of multimedia within the context of integration of these database systems will be presented. An example is given on how to access these information systems by a radiologist's desktop personal computer.

Database Management Systems

The efficacy of a multimedia educational campaign to increase the use of eye care services.

PURPOSE: Effective eye care, both preventive and problem-directed, requires that patients actually see trained eye care providers. The authors examined the impact of a multimedia campaign on patient behavior in using eye care. METHODS: The authors surveyed 2000 individuals 1 year after they mailed in a contrast sensitivity screening card during a focused multimedia educational campaign. The response rate was 39%, allowing precision of estimates to +/- 4%. FINDINGS: Those who failed the screening test were much more likely to have had an eye examination in the year after the campaign and were much more likely to have seen an ophthalmologist for their care. Other important factors significantly related to using eye care services were: having had prior examinations, having a non-ophthalmologist physician, and having a history of cancer or macular degeneration. Importantly, 22% of those who failed the screening test thought they had had normal results when asked 1 year later. CONCLUSIONS: A focused multimedia campaign combined with interactive patient involvement can directly increase the use of eye care services. In addition, such care is much more likely to be delivered by ophthalmologist as opposed to other providers.

Contrast Sensitivity

A comparison of multimedia and standard advanced cardiac life support learning.

OBJECTIVES: To compare student performance after Multimedia ACLS Learning System (MM) education compared with that after standard (ST) ACLS education. METHODS: Final-year medical students were divided into 2 groups based on convenience scheduling and given ACLS instruction either in a standard format or with the MM course. The sizes of the small groups and the times in small-group instruction were identical. All students were evaluated with the same 50-item multiple-choice written examination, a structured evaluation immediately after the management of a mock cardiac arrest, and a second structured evaluation of the same mock arrest (videotaped) by an instructor blinded to the education method. Students were assigned a mark from 1 to 5 in each of 4 domains: assessment, immediate priorities, continual assessment, and leadership. RESULTS: 75 students took the MM and 38 took the ST course. The mean +/- SD mark for the multiple-choice test was 89.3 +/- 4.9% (MM) vs 89.3 +/- 4.8% (ST); the on-site mock arrest evaluation mark (20 maximum) was 14.1 +/- 2.5 (MM) vs 14.1 +/- 2.0 (ST); and the blinded mock arrest evaluation was 13.1 +/- 2.9 (MM) vs 14.4 +/- 2.9 (ST) (p = 0.024). 1/75 (MM) vs 0/38 (ST) did not successfully complete the on-site mock arrest evaluation. More students in the MM group (46% vs 25%) required multiple attempts to successfully complete the mock arrest evaluation (p < 0.02). CONCLUSION: In medical students with no previous ACLS training, structured access to the multimedia ACLS Learning System provides immediate educational outcomes similar to those of a standard ACLS course. Multimedia computer-interactive learning should be enhanced with a short period of hands-on practice.

British Columbia

Authenticity in learning: multimedia design projects in the social studies for students with disabilities.

Proponents of educational reform highlight the importance of creating instructional environments that encourage students' active involvement in the learning process. To be so involved, students with and without disabilities must construct knowledge, evaluate the products of their work, and engage in the design of solutions to authentic problems. We believe that these goals are especially important for students with disabilities, many of whom are passive learners who experience difficulty with the flexible use of knowledge and skills. Our analysis of the research evidence leads us to conclude that students' thinking skills and attitudes are enhanced when they collaborate in the solution of authentic problems. We view the social skills curriculum as a rich source of authentic problems that affords opportunities to promote thinking by enabling argument about controversial issues. Further, we contend that educational multimedia are potentially powerful tools for constructing knowledge, especially when used in collaborative project-based instructional environments, or multimedia design projects. We review evidence about the efficacy of multimedia design projects in promoting students' construction of knowledge, thinking, and problem solving, and discuss some potential challenges to the efficacy of this approach.

Audiovisual Aids