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PubMed2005

Impact of PACS and voice-recognition reporting on the education of radiology residents.

RATIONALE AND OBJECTIVES: The introduction of picture archiving and communication system (PACS) has decreased the time needed to interpret radiology examinations resulting in an increased workflow. Because of concerns that the increase in exam throughput and the use of voice recognition may have a negative impact upon radiology resident education, a survey was conducted to assess the impact of PACS and voice recognition. MATERIALS AND METHODS: Residents at four diagnostic radiology training programs were surveyed. Survey topics included resident demographics, didactic and technical issues, and areas for improvement. RESULTS: One hundred thirty-four residents were polled with 42 respondents (42/134, 31.3%). The majority have been using PACS for more than 1 year (29/41, 70.7%) to interpret 75-100% of cases (33/39, 84.6%). A majority believed PACS is a superior teaching tool to printed film (28/38, 73.7%). However, only a minority (9/40, 22.5%) indicated that PACS was always used to contain teaching files and to conduct departmental conferences (5/40, 12.5%). The majority of respondents believed PACS have decreased the time needed to interpret diagnostic examinations (33/41, 80.5%). A majority (80.6%, 25/31) indicated that voice recognition takes more time than the traditional dictation and transcription process, where 51.3% (20/39, 51.3%) felt that voice recognition works well less than 50% of the time. CONCLUSIONS: Residents believe that PACS has positively affected their learning experience but indicate that it can be better utilized for resident education. Residents believe that voice recognition is less reliable and more time consuming than the traditional dictation system.

Adult↗

PubMed2005

Designing better radiology workstations: impact of two user interfaces on interpretation errors and user satisfaction.

This paper presents our solution for supporting radiologists' interpretation of digital images by automating image presentation during sequential interpretation steps. We extended current hanging protocols with support for "stages" which reflect the presentation of digital information required to complete a single step within a complex task. We demonstrated the benefits of staging in a user experiment with 20 lay subjects involved in a comparative visual search for targets, similar to a radiology task of identifying anatomical abnormalities. We designed a task and a set of stimuli that allowed us to simulate the interpretation workflow from a typical radiology scenario-reading a chest radiography exam when a prior study is also available. The simulation was enabled by abstracting both the radiologist's task and the basic workstation navigation functionality. The staged interface was significantly faster than the traditional user interface, provided a 37% reduction in the interpretation errors, and improved user satisfaction.

Analysis of Variance↗

PubMed2005

Benefits of the DICOM modality performed procedure step.

A few years ago, the Digital Imaging and Communications in Medicine standard introduced a network transaction that is initiated by modality equipment, mainly at the beginning and at the end of the acquisition. This transaction, the Modality Performed Procedure Step (MPPS), is sent to the Picture Archiving and Communication System and/or to the Radiology Information System. It carries information about what really has been performed by the modality equipment during acquisition. In this paper, we present MPPS and discuss its benefits. We show how MPPS enables efficient radiology workflow and how it ensures accuracy and completeness of imaging information. We think our paper helps bridge the gap between MPPS implementation and deployment. By understanding all the MPPS benefits, the end user becomes aware of the great enhancement in patient care that this transaction provides.

Computer Communication Networks↗

PubMed2006

A HIPAA-compliant architecture for securing clinical images.

The Health Insurance Portability and Accountability Act (HIPAA, instituted April 2003) Security Standards mandate health institutions to protect health information against unauthorized use or disclosure. One approach to addressing this mandate is by utilizing user access control and generating audit trails of the various authorized as well as unauthorized user access of health data. Although most current clinical image systems [e.g., picture archiving and communication system (PACS)] have components that generate log files for application debugging purposes, there is a lack of methodology to obtain and synthesize the pertinent data from the large volumes of log data generated by these multiple components within a PACS. We have designed a HIPAA-compliant architecture specifically for tracking and auditing the image workflow of clinical imaging systems such as PACS. As an initial first step, we developed HIPAA-compliant auditing system (H-CAS) based on parts of this HIPAA-compliant architecture. H-CAS was implemented within a test-bed PACS simulator located in the Image Processing and Informatics lab at the University of Southern California. Evaluation scenarios were developed where different user types performed legal and illegal access of PACS image data within each of the different components in the PACS simulator. Results were based on whether the scenarios of unauthorized access were correctly identified and documented as well as on normal operational activity. Integration and implementation pitfalls were also noted and included.

California↗

PubMed2006

Benefits of the DICOM structured report.

Recently, the digital imaging and communications in medicine (DICOM) standard introduced rules for the encoding, transmission, and storage of the imaging diagnostic report. This medical document can be stored and communicated with the images in picture archiving and communication system (PACS). It is a structured document that contains text with links to other data such as images, waveforms, and spatial or temporal coordinates. Its structure, along with its wide use of coded information, enables the semantic understanding of the data that is essential for the Electronic Healthcare Record deployment. In this article, we present DICOM Structured Report (SR) and discuss its benefits. We show how SR enables efficient radiology workflow, improves patient care, optimizes reimbursement, and enhances the radiology ergonomic working conditions. As structured input significantly alters the interpretation process, understanding all its benefits is necessary to support the change.

Forms and Records Control↗

PubMed2006

Use of a thin-section archive and enterprise 3D software for long-term storage of thin-slice CT data sets.

Rapid advances are changing the technology and applications of multidetector computed tomography (CT) scanners. The major increase in data associated with this new technology, however, breaks most commercial picture archiving and communication system (PACS) architectures by preventing them from delivering data in real time to radiologists and outside clinicians. We proposed a phased model for 3D workflow, installed a thin-slice archive and measured thin-slice data storage over a period of 5 months. A mean of 1,869 CT studies were stored per month, with an average of 643 images per study and a mean total volume of 588 GB/month. We also surveyed 48 radiologists to determine diagnostic use, impressions of thin-slice value, and requirements for retention times. The majority of radiologists thought thin slice was helpful for diagnosis and regularly used the application. Permanent storage of thin slice CT is likely to become best practice and a mission-critical pursuit for the health care enterprise.

Humans↗

PubMed2006

Creating an IHE ATNA-based audit repository.

Compliance with the Health Insurance Portability and Accountability Act (HIPAA) requires gathering audit information from picture archiving and communications systems (PACS) regarding evidence trails of human interactions. Until recently, most PACS users have had limited access to auditing information. Access required resources to handle manual inspection of audit logs, and access to proprietary databases was not always available. Some vendors now produce eXtensible Markup Language (XML) audit logs based on certain events occurring in PACS. However, it is up to the user to convert this information into an easily mined data repository supporting compliance and quality control. This process can be handled in multiple ways, which could mean different audit mechanisms depending on the PACS (or other hospital system) used. It is apparent that an organized method of dealing with audit information is needed. This help may be provided within the Integrating the Healthcare Environment (IHE) framework. The IHE initiative defines a set of profiles, actors, and transactions that create common scenarios for particular workflow processes. The Integration Profiles depict security as a fundamental requirement of the framework. Specifically, the Audit Trail and Node Authentication (ATNA) profile defines standards based mechanisms for securely transmitting and storing audit records in a central repository. The data structure defined by the profile provides a number of record types that capture different audit events. A general feasibility study for storing currently available PACS audit information following the profile is defined, and steps to an automated solution are discussed.

Feasibility Studies↗

PubMed2006

Web-based diagnostic imaging service using XML forms.

Traditionally, radiology has been conceived as a support department providing patient scanning services to the other clinical departments in a hospital. However, recent advancements in networking technology and related information systems such as picture archiving and communication system (PACS) and radiology information system (RIS) provide new opportunities for inventing different types of diagnostic imaging businesses such as teleradiology. In this article, we examined the business processes of currently operating imaging centers and proposed a prototype of an information system that can facilitate their workflows in a more efficient way. The principal component of our proposed system is a report management module built on extensible markup language (XML) technologies that allows much flexibility and convenience for both imaging technicians and radiologists.

Ambulatory Care Facilities↗

PubMed2006

Evaluation of the use of CD-ROM upload into the PACS or institutional web server.

PURPOSE: Patient data are increasingly distributed between hospitals using CD-ROMs instead of actual films. This introduces problems because different viewers from different vendors are provided, and sometimes viewers are unusable because local software installation is not allowed. In 2004, we started to facilitate the incorporation of CD-ROM data into the normal workflow of the hospital by using commercially available software to perform patient reconciliation based on the DICOM (digital imaging and communication in medicine) modality worklist. The purpose of the current study is to evaluate this new procedure. METHODS AND MATERIALS: A questionnaire was sent to all users to evaluate the satisfaction with the current facility and to evaluate possible improvements. Several quality parameters on speed and satisfaction were rated on a 5-point scale (1 = bad to 5 = excellent). RESULTS: Replies from 17 different respondents were evaluated, accounting for an average of 76 CD-ROMs per week. Mean (median) results showed a score of 3.6 (4) for handling time, 3.4 (4) for archival of second opinion data, 3.8 (median 4) for archival of external data onto the web server, and 4.5 (median 5) for the overall performance of the current procedure. CONCLUSION: Although some improvements can be made, storage of the study data from CDs from outpatients into PACS (picture archiving and communication system) and web server already provides for an existing need. Using this service, physicians can access the data with ease and familiarity. User satisfaction with the provided solution is high.

CD-ROM↗

PubMed2006

Realigning clinical and economic incentives to support depression management within a medicaid population: the Colorado access experience.

The authors describe their experiences in developing an economically sustainable depression care management program within Colorado Access, a non-profit Medicaid health plan. They describe high rates of mental health issues, medical comorbidities, and psychosocial barriers to care within the plan's Medicaid population. They discuss how the company redirected resources to incorporate depression care management into an intensive care management program focused on high-cost members with multiple chronic medical conditions. This strategy allowed Colorado Access to cost effectively care manage a targeted group of high-cost Medicaid recipients across multiple primary care physician (PCP) practices without requiring changes in provider workflow.

Colorado↗

PubMed2005

A support vector machine approach to classify human cytochrome P450 3A4 inhibitors.

The cytochrome P450 (CYP) enzyme superfamily plays a major role in the metabolism of commercially available drugs. Inhibition of these enzymes by a drug may result in a plasma level increase of another drug, thus leading to unwanted drug-drug interactions when two or more drugs are coadministered. Therefore, fast and reliable in silico methods predicting CYP inhibition from calculated molecular properties are an important tool which can be applied to assess both already synthesized as well as virtual compounds. We have studied the performance of support vector machines (SVMs) to classify compounds according to their potency to inhibit CYP3A4. The data set for model generation consists of more than 1300 structural diverse drug-like research molecules which were divided into training and test sets. The predictive power of SVMs crucially depends on a careful selection of parameters specifying the kernel function and the penalty for misclassifications. In this study we have investigated a procedure to identify a valid set of SVM parameters which is based on a sampling of the parameter space on a regular grid. From this set of parameters, either single SVMs or SVM committees were trained to distinguish between strong and weak inhibitors or to achieve a more realistic three-class assignment, with one class representing medium inhibitors. This workflow was studied for several kernel functions and descriptor sets. All SVM models performed significantly better than PLS-DA models which were generated from the corresponding descriptor sets. As a very promising result, simple two-dimensional (2D) descriptors yield a three-class model which correctly classifies more than 70% of the test set. Our work illustrates that SVMs used in combination with simple 2D descriptors provide a very effective and reliable tool which allows a fast assessment of CYP3A4 inhibition potency in an early in silico filtering process.

Computer-Aided Design↗

PubMed2006

PHASE: a new engine for pharmacophore perception, 3D QSAR model development, and 3D database screening: 1. Methodology and preliminary results.

We introduce PHASE, a highly flexible system for common pharmacophore identification and assessment, 3D QSAR model development, and 3D database creation and searching. The primary workflows and tasks supported by PHASE are described, and details of the underlying scientific methodologies are provided. Using results from previously published investigations, PHASE is compared directly to other ligand-based software for its ability to identify target pharmacophores, rationalize structure-activity data, and predict activities of external compounds.

Computer Simulation↗

PubMed2006

Designing a decision support system for existing clinical organizational structures: considerations from a rheumatology clinic.

The aim of this study was to identify the social and organizational requirements for a decision support system (DSS) to be implemented in a clinical rheumatology setting, utilizing data-mining techniques. Field observations and focus group interviews were used for data collection. The decision-making was found to be situated, patient-focused, and long-term in nature. At the same time, the main part of peer-to-peer communication was informal. Patient records were involved in almost every decision. The conclusion is that the main challenges, when introducing a DSS at a rheumatology unit, are adapting the system to informal communication structures and integrating it with patient records. Considering incentive structures, understanding workflow and incorporating awareness are relevant issues when addressing these issues in future studies.

Adolescent↗

PubMed2006

Scoring of KDR kinase inhibitors: using interaction energy as a guide for ranking.

Within a congeneric series of ATP-competitive KDR kinase inhibitors, we determined that the IC(50) values, which span four orders of magnitude, correlated best with the calculated ligand-protein interaction energy using the Merck Molecular Force Field (MMFFs(94)). Using the ligand-protein interaction energy as a guide, we outline a workflow to rank order virtual KDR kinase inhibitors prior to synthesis. When structural information of the target is available, the ability to score molecules a priori can be used to rationally select reagents. Our implementation allows one to select thousands of readily available reagents, enumerate compounds in multiple poses and score molecules in the active site of a protein within a few hours. In our experience, virtual library enumeration is best used when a correlation between computed descriptors/properties and IC(50) or K (i) values has been established.

Binding Sites↗

PubMed2026

DNA methylation biomarkers for early detection of ovarian cancer.

Ovarian cancer (OC) remains difficult to detect at an early stage, and current screening approaches using CA125 and transvaginal ultrasonography have not demonstrated sufficient benefit for population screening. DNA methylation is a promising biomarker class because epigenetic alterations may arise early in tumourigenesis, can be detected in circulating cell-free DNA (cfDNA), and may provide tissue-of-origin information. This review critically evaluates recent evidence on DNA methylation biomarkers for early OC detection. PubMed/MEDLINE, Web of Science, and Scopus were searched for studies published between January 2020 and September 2025, supplemented by selected earlier studies of biological or methodological relevance. Evidence was synthesised across single-gene biomarkers, multi-locus panels, genome-wide signatures, assay platforms, and machine-learning classifiers, with emphasis on early-stage performance, histological representation, comparator populations, analytical methodology, and validation design. Single-gene markers such as BRCA1, RASSF1A, OPCML, HOXA9, and HIC1 show variable performance, while multi-gene and classifier-based approaches generally provide stronger discrimination. However, many studies remain limited by retrospective case-control designs, small FIGO stage I-II subsets, predominance of serous disease, and insufficient prospective validation. Integration with CA125 may improve sensitivity but can reduce specificity, which is critical in low-prevalence screening. Clinical translation will therefore require minimal and reproducible methylation signatures, standardised low-input cfDNA workflows, rigorous external validation, and prospective longitudinal evaluation in intended-use populations.

Humans↗

PubMed2026

Secondary metabolite profiling of rare Micromonospora spp. from cold desert of NW Himalayas via multi-omics analysis.

INTRODUCTION: The genus Micromonospora is a prolific producer of specialized metabolites with pharmacological and agronomic relevance. Natural products derived from the genus Micromonospora have a distinctive chemical diversity and enormous therapeutic potential, thus represent a potential source for drugs and drug leads. OBJECTIVE: To explore the biosynthetic potential of four Micromonospora strains isolated from cold desert of NW Himalayas through genome mining and to correlate predicted biosynthetic gene clusters with chemical features detected by untargeted LC-HRMS metabolomics. METHOD: High-quality genomes were annotated for BGCs and matched against untargeted LC-HRMS features (peak picking, alignment, and annotation to chemical classes). Each isolate was grown in triplicate, and fermented broth was pooled for further metabolomic studies. RESULTS: By integrating genomic and metabolomic approaches, specialized biosynthetic gene clusters and strain-based putative metabolite classes were identified. LRS1 showed elevated xanthines (RiPP/siderophore), LRS3 had phenolic glycosides (hybrid PKS/NRPS), LRS4 showed 70-fold hydroxycinnamate enrichment (Type II PKS), and LRS5 displayed p-benzoquinone enrichment (Type III PKS). The metabolite profile of each strain aligned with its predicted biosynthetic gene cluster composition. CONCLUSION: Under a single growth regime, each Micromonospora strain exhibits a distinct metabolomic profile. This metabologenomics workflow can be further explored to isolate specialized metabolites with potential therapeutic and agricultural value.

Micromonospora↗

PubMed2026

Artificial Intelligence and Machine Learning Applications in Fibromuscular Dysplasia: Transforming Diagnosis, Risk Stratification, and Clinical Decision-Making.

Fibromuscular dysplasia (FMD) is a non-atherosclerotic vascular disorder with heterogeneous presentations, making diagnosis and management highly dependent on imaging and clinical expertise. This narrative review examines how artificial intelligence (AI) and machine learning (ML) are transforming FMD care. AI-enhanced imaging, particularly convolutional neural network-based analysis, improves detection of the characteristic "string-of-beads" pattern on CT angiography, magnetic resonance angiography, and ultrasound, although FMD-specific validation remains limited. ML models facilitate risk stratification, prediction of disease progression, and early identification of complications such as aneurysms and stroke by integrating clinical, imaging, and genomic data. AI-driven clinical decision support systems further enable personalized treatment selection through pharmacogenomic insights and robot-assisted interventions. Despite promising real-world applications, challenges persist, including limited large-scale datasets, workflow integration, regulatory barriers, and algorithmic bias affecting underrepresented populations. Future advances in explainable AI, federated learning, and digital health integration may enable a shift toward predictive, patient-centered FMD management.

Humans↗

PubMed2025

Prevalence of intronic repeat expansions in the RFC1 gene in Polish patients with cerebellar syndrome.

Cerebellar ataxia with neuropathy and vestibular areflexia syndrome (CANVAS) is a recessively inherited neurodegenerative ataxic disorder, which has been associated with intronic biallelic repeat expansions in the RFC1 gene. Our objective was to assess retrospectively the prevalence of CANVAS in Polish population. We screened 2523 Polish patients in whom other repeat expansions were excluded. To determine the repeat expansions in the RFC1 gene in patients, we performed RFC1-flanking PCR and repeat primed PCR (RP-PCR) and to measure the size of the expansion we used Southern blotting and optical genome mapping to compare the results. We have observed the biallelic pathogenic motif/unit AAGGG expansions in 4.6% and expansions of non-pathogenic motifs AAAAG, AAAGG in 25% patients of our studied population. This is the first large-scale cohort study that confirms the relatively frequent occurrence of the CANVAS in Polish population. To increase the current diagnostics of late-onset ataxias within an unexplained molecular background, we suggest involving the RFC1 repeat expansions analysis to the routine diagnostic workflow.

Humans↗