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The networked multimedia textbook: distributing radiology multimedia information across the Internet.

OBJECTIVE: The purpose of this project was to create an approach for global radiology multimedia publishing using the internet that would address the two largest problems facing radiology multimedia publishers today: the high percentage of radiologists who are computer novices and the variety of personal computers (Macintosh, Microsoft Windows/IBM-PC, X-Windows, Amiga) whose software is incompatible. MATERIALS AND METHODS: We developed a client/server approach to multimedia publishing, the networked multimedia textbook, that has a simple booklike user interface to facilitate use by computer novices. Once created, a networked multimedia textbook can be viewed on all current popular personal computers. The networked multimedia textbook is based on the internet, World-Wide Web, Mosaic, and Wide Area Information Servers software technologies, all of which are in the public domain. RESULTS: We created six radiology networked multimedia textbooks. CONCLUSION: This networked multimedia textbook approach for the global distribution of multimedia radiology information brings the benefits of multimedia publishing on the Internet to radiologists today.

Computer Communication Networks

An approach to the creation of multimedia textbooks for radiology instruction.

We developed a standardized approach for creating computerized multimedia textbooks based on four principles: (1) multimedia textbooks should resemble printed books, (2) the creation of multimedia textbooks should be relatively inexpensive, (3) multimedia textbooks should be completely digital, and (4) the construction of multimedia textbooks should be simple. To facilitate this approach, an inexpensive, user-friendly multimedia authoring tool called The Annotator was used. The Annotator, a Hypercard-based program that runs on any Macintosh computer, helps authors rapidly create sophisticated radiologic multimedia textbooks. This program provides a textbooklike shell that can be filled with digitized media (video clips, audio clips, images, and text). This approach, which is applicable to any multimedia hardware platform, allows the authorship of multimedia textbooks that can be easily transported to any future multimedia platform.

Computer Graphics

The effect of a multimedia interactive tutorial on learning endodontic problem-solving.

New technology may create additional opportunities for learning in dental education. One of these new features is a multimedia approach, courseware combining sound, text, stills and video with interactive learning. A multimedia program was developed to train dental students and dental practitioners in decision making and problem solving in endodontics. This study compared the effects of the multimedia program with a more traditional approach consisting of written information, without interaction. 28, 4th-year dental students at the University of Kentucky in Lexington, KY, USA were randomly assigned to the multimedia or the text-based groups. They were given a written pre-test using 2 cases of dental pain and were instructed to study independently using either the multimedia program (group A) or the written information (group B). No restrictions were imposed on the amount of time to be invested, and the total study time was recorded for each student. 3 weeks after the pre-test, the students completed the post-test. A total of 18 students completed both the pre-test and the post-test and their scores were included in the final data. Statistical analysis of the average scores using paired t-tests revealed no significant difference between the performance of the students in either group, indicating that the multimedia approach to learning endodontic problem solving may successfully replace traditional learning strategies.

CD-I

The instructional effectiveness of a radiology multimedia textbook (HyperLung) versus a standard lecture.

RATIONALE AND OBJECTIVES: Information overload is a significant problem for the modern radiologist. This prospective study compares the instructional effectiveness of a multimedia textbook (HyperLung) with a lecture. HyperLung is a radiologic multimedia textbook about imaging diffuse lung disease created using a multimedia authoring tool, the Annotator (the University of Iowa Second Look Computing, Iowa City, IA), on the Apple Macintosh computer (Apple Computer, Cupertino, CA). METHODS: Forty-nine staff physicians and residents in the Department of Radiology were randomized to receive instruction either by HyperLung or by a lecture. The instructional content was the same in both groups, and both groups were tested before and after instruction. The actual time spent in each instructional situation was recorded. RESULTS: The instructional effectiveness of the multimedia textbook and lecture was equal. The instructional efficiency of HyperLung was only 60% of the lecture. Users of the multimedia textbook found it enjoyable and straightforward to use. CONCLUSIONS: Multimedia textbooks have a promising future in radiology education.

Education, Medical, Continuing

Computer-generated graphical presentations: use of multimedia to enhance communication.

Personal computers may be used to create, store, and deliver graphical presentations. With computer-generated combinations of the five media (text, images, sound, video, and animation)--that is, multimedia presentations--the effectiveness of message delivery can be greatly increased. The basic tools are (1) a personal computer; (2) presentation software; and (3) a projector to enlarge the monitor images for audience viewing. Use of this new method has grown rapidly in the business-conference world, but has yet to gain widespread acceptance at medical meetings. We review herein the rationale for multimedia presentations in medicine (vis-à-vis traditional slide shows) as an improved means for increasing audience attention, comprehension, and retention. The evolution of multimedia is traced from earliest times to the present. The steps involved in making a multimedia presentation are summarized, emphasizing advances in technology that bring the new method within practical reach of busy physicians. Specific attention is given to software, digital image processing, storage devices, and delivery methods. Our development of a urology multimedia presentation--delivered May 4, 1996, before the Society for Urology and Engineering and now Internet-accessible at http://www.usrf.org--was the impetus for this work.

Communication

Fine-needle aspiration cytology of the breast: a preliminary report on telepathology through Internet multimedia electronic mail.

Telepathology is a field of telemedicine that enables the exchange of histologic and cytologic images for consultations among pathologists of two or more remote institutions, through a suitable communication channel. The Internet can connect several scientific and medical institutions because of the existence of a set of standard protocols that allow different computers to communicate; multimedia electronic mail is one such protocol, which allows asynchronous transmission of multimedia documents, i.e., including text, images, movies, and sounds. The aim of the present article is to test a novel approach in which Internet multimedia electronic mail is used as a communication medium to obtain an asynchronous telepathology tool for remote consultation. To assess the diagnostic validity of the method, 48 cases of fine-needle aspiration cytology of breast lesions were sent from Udine to Trento, Italy. Comparisons between local and remote diagnoses, and cytologic diagnoses versus subsequent histologic reports demonstrated that Internet multimedia electronic mail is suitable for remote consultation. Internet multimedia electronic mail thus presents an additional diagnostic tool that is easy to use, available on a wide range of computers, and inexpensive, because its cost is independent of distance.

Biopsy, Needle

Guidelines for developing interactive multimedia. Applications in nurse education.

In an environment of increasing economic constraint, it is necessary for nurse educators to design and implement cost-effective teaching and learning strategies. Computer-based interactive multimedia applications in education have been touted as a cost- and time-effective method of providing a dynamic, information rich, learning environment. Given the profusion of this type of media in the general marketplace, an increasing number of educators are now wishing to develop specific computerized multimedia applications for use in nurse education. Accounts of a number of such developments exist in the literature. However, there is a dearth of literature outlining the processes involved in interactive multimedia production. It would, therefore, appear timely to address issues related to multimedia development. Based on the author's experiences, this article will offer a number of practical suggestions for the development of interactive multimedia applications in nursing education.

Education, Nursing

A multimedia perioperative record keeper for clinical research.

OBJECTIVE: To develop a multimedia perioperative recordkeeper that provides: 1. synchronous, real-time acquisition of multimedia data, 2. on-line access to the patient's chart data, and 3. advanced data analysis capabilities through integrated, multimedia database and analysis applications. DESIGN: To minimize cost and development time, the system design utilized industry standard hardware components and graphical. software development tools. The system was configured to use a Pentium PC complemented with a variety of hardware interfaces to external data sources. These sources included physiologic monitors with data in digital, analog, video, and audio as well as paper-based formats. DEVELOPMENT: The development process was guided by trials in over 80 clinical cases and by the critiques from numerous users. As a result of this process, a suite of custom software applications were created to meet the design goals. The Perioperative Data Acquisition application manages data collection from a variety of physiological monitors. The Charter application provides for rapid creation of an electronic medical record from the patient's paper-based chart and investigator's notes. The Multimedia Medical Database application provides a relational database for the organization and management of multimedia data. The Triscreen application provides an integrated data analysis environment with simultaneous, full-motion data display. CONCLUSION: With recent technological advances in PC power, data acquisition hardware, and software development tools, the clinical researcher now has the ability to collect and examine a more complete perioperative record. It is hoped that the description of the MPR and its development process will assist and encourage others to advance these tools for perioperative research.

Database Management Systems

Multimedia radiological reports: creation and playback.

Multimedia radiological reports tie together radiographic images and operations on these images with textual, vocal, or graphic annotation. The result is an animated presentation of the radiological examination report. A temporal representation for a multimedia radiological report that describes the temporal behavior of the animated report is introduced. The temporal behavior specifies the synchronization requirements for the coordinated presentation of the multimedia report components. The temporal behavior is encoded in a temporal semantic network that is a network of temporally ordered nodes, where each node represents some primitive behavior. Automatic creation of the multimedia radiological report consists of the capture, interpretation, and storage of the temporal semantics of the radiologist's reporting session in terms of a set of primitive behaviors. Automatic playback of the multimedia radiological report is the orderly traversal of the temporal semantic network, invoking the behavior associated with each of the nodes in the temporal order described by the interconnecting arcs.

Artificial Intelligence

Interactive multimedia for prenatal ultrasound training.

This demonstration project examines the utility of interactive multimedia for prenatal ultrasound training. A laser-disc library was linked to a three-dimensional (3-D) heart model and other computer-based training materials through interactive multimedia. A testing module presented ultrasound anomalies and related questions to house-staff physicians through the image library. Users were asked to evaluate these training materials on the basis of perceived instructional value, question content, subjects covered, graphics interface, and ease of use; users were also asked for their comments. House-staff physicians indicated that they consider interactive multimedia to be a helpful adjunct to their core fetal imaging rotation. During a 9-month period, 16 house-staff physicians correctly diagnosed 78 +/- 4% of unknown cases presented through the testing module. The 3-D heart model was also perceived to be a useful teaching aid for spatial orientation skills. Our findings suggest that interactive multimedia and volume visualization models can be used to supplement traditional prenatal ultrasound training. The system provides a broad exposure to ultrasound anomalies, increases opportunities for postnatal correlation, emphasizes motion video for ultrasound training, encourages development of independent diagnostic ability, and helps physicians understand anatomic orientation. We hypothesize that interactive multimedia-based tutorials provide a better overall training experience for house-staff physicians. However, these supplementary methods will require formal evaluation of effectiveness to better understand their potential educational impact.

Computer Simulation

Multimedia E-mail systems for computer-assisted radiological communication.

In the film-based organization of communicating radiological results to the referring physician, the different media (text, images, graphics, voice) are separated. When using computer technology, multimedia reports containing links between these different media can be used. This changes the way radiological reports are generated, accessed, and possibly discussed. We performed experiments in a clinical setting using two different metaphors for communicating multimedia information. In the 'paper metaphor', labels in the report text are linked to annotations in selected images. In the 'slide presentation metaphor', annotated images are presented synchronously to a spoken report. With both systems additional interaction between radiologist and referring physician is supported using multimedia 'electronic mail'. The experiments indicate that multimedia does not only significantly increase the efficiency of information transfer, but also has the potential to make reporting itself more efficient. Given that the amount of image-related information keeps growing, multimedia links are a promising method to give efficient access to the most relevant information.

Computer Graphics

Interactive multimedia dental education: the next five years and beyond.

This presentation is intended to provide "Ten Good Reasons" why interactive multimedia should play a major role in both undergraduate curriculum and graduate level continuing education in the next five years. Multimedia is currently best presented on CD-ROM disks, but virtual reality, interactive television, video-desktop conferencing, and Internet applications will become available before the end of the century. Many dental schools, associations and private companies have already entered the development and production of dental multimedia titles, and it is anticipated that schools and dentists will soon be constrained to purchase multimedia capable systems to take advantage of the "Ten Good Reasons." Guidelines are given to those who desire to publish material in interactive multimedia format. A vision of the future is presented.

CD-ROM

An overview of a multimedia benchmarking analysis for three risk assessment models: RESRAD, MMSOILS, and MEPAS.

Multimedia modelers from the United States Environmental Protection Agency (EPA) and the United States Department of Energy (DOE) collaborated to conduct a detailed and quantitative benchmarking analysis of three multimedia models. The three models--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. The study is performed by individuals who participate directly in the ongoing design, development, and application of the models. Model form and function are compared by applying the models to a series of hypothetical problems, first isolating individual modules (e.g., atmospheric, surface water, groundwater) and then simulating multimedia-based risk resulting from contaminant release from a single source to multiple environmental media. Study results show that the models differ with respect to environmental processes included (i.e., model features) and the mathematical formulation and assumptions related to the implementation of solutions. Depending on the application, numerical estimates resulting from the models may vary over several orders-of-magnitude. On the other hand, two or more differences may offset each other such that model predictions are virtually equal. The conclusion from these results is that multimedia models are complex due to the integration of the many components of a risk assessment and this complexity must be fully appreciated during each step of the modeling process (i.e., model selection, problem conceptualization, model application, and interpretation of results).

Air Pollutants

The multimedia textbook. A revolutionary tool for pediatric education.

Textbooks are now available via computers. These new electronic or multimedia textbooks appears similar to conventional books but differ in function. In addition to text and images, they contain video and audio clips and allow readers to interact with the content. Multimedia textbooks contain digital media, can be quickly and inexpensively updated and repurposed for lectures and handouts, and are available on-line via computer networks for distance learning. We present the concept of computer-generated multimedia text-books; describe their creation by an easy-to-use, sophisticated authoring system; and describe the underlying instructional design approach to guide future authors of multimedia textbooks.

Computer-Assisted Instruction

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