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11-76 The effects of radiology clerkships on medical student perceptions about radiology
P u r p o s e : With the widespread implementation of high speed campug wide networks at teaching institutions, an intranet based hypertext m a r k u p language (HTML) teaching file b e c o m e s a viable method to present cross sectional anatomy images for educational purposes. Obtaining digital images in a non-picture archiving and c o m m u n i c a t i o n s s y s t e m (PACS) environment has traditionally involved the filming and subsequent digitizing of images. This is not optimal as it often results is large files with limited bit depth and is labor intensive. This paper presents an approach that uses c o m m e r cially available software on a PC or M a c platform to allow direct transfer o f images f r o m a D I C O M modality to a PC. The images are then edited and saved in a standard file format for u s e in presentations. This eliminates,the need to film and then re-digitize images and preserves the full bit depth of the original modality. Additionally, instructional cases can be kept on a file server for use by all personnel and the images are not lost if s o m e o n e r e m o v e s the film from the department. This paper describes the process of acquiring, installing and configuring a D I C O M server on a PC and the basics o f modality configuration to allow D I C O M transfer to the PC as well as editing and conversion software options currently available. M e t h o d s : A n I B M PC running W i n d o w s N T was configured as a D I C O M server using a p r o g r a m called Digital Jacket from D e s A c c Inc., Chicago, IL. This permitted direct D I C O M transfer from CR, angio, C T and M R I scanners after appropriate configuration changes. The images were converted to standard GIF or JPEG formats u s i n g standard PC or M a c based image editing and conversion software, both commercial and public domain options will be presented. T h e images could then be used in standard presentation software and be m a d e available on an intranet server prior to lectures.
11-74 The Use of Dynamic HTML to Provide an Internetbased "Electronic Book" in GI Radiology M i c h a e l A. Blake, M B B C h , Boston Medical Center, Boston, MA, Gavin J. Blake, M D , Martin Schranz, M D , R o b i n Gibney, M D , D e r m o t E. Malone, M D P u r p o s e : To m a k e use of dynamic Hypertext Markup L a n g u a g e (HTML) to create a highly interactive and intuitive teaching prog r a m in gastrointestinal radiology. M a t e r i a l s a n d Methods: Information is provided on each region of the gastrointestinal (GI) tract with progressively m o r e detail available sequentially. T h e m a i n content is loaded d y n a m i c a l l y f r o m the server into an inline frame. This m a i n content loads external pages containing detailed information and references into a second inline frame by a process k n o w n as data binding. JavaScript statements e m b e d d e d in the H T M L page also optimize interactivity. Processing o f the u s e r ' s r e s p o n s e s occurs on the client's computer, reducing time-consuming server-client contact. Multimedia capabilities such as filters were used freely throughout to e n h a n c e the presentation of data. Results: D y n a m i c H T M L and Javascript have been combined to present an interactive GI radiology m a n u a l that is intuitive and infinitely expandable. The program m a y operate on any operating syst e m supporting a fourth generation browser. A self-assessment mode is also provided with questions relating to the content o f the tutor. Conclusion: A n interactive W e b - b a s e d "electronic book" in GI radiology is thus presented with a d y n a m i c layout that is widely linked to global resources. This educational tool is freely available on h t t p : / / w w w . m c q s . c o n g a b d o m e n .
11-75 A J A V A Application for Review of the ACR's Radiologic Learning File Jeffrey M. Levsky, BS, Northwestern University Medical School, Chicago, IL, D a v i d S. Channin, M D P u r p o s e : T h e Internet and private intranets based on Internet technologies are b e c o m i n g the de facto standard for transmitting information including that used for teaching purposes in all fields o f edu-
cation including medicine. The goal of this project was to m a k e the Radiologic Learning File available across an intranet, using a platform independent, browser based m e c h a n i s m . M a t e r i a l s and Methods: The Java language was used to implem e n t a small program that displays case images and text in a fast, user-friendly manner. T h e viewer was optimized for speed. Utilities for incorporating n e w cases into the s y s t e m were also developed. Results: T h e b r o w s e r is n o w in u s e by radiology residents. T h e b r o w s e r r u n s in any e n v i r o n m e n t with Internet and Java support, including s y s t e m s with limited display resolution and l o w - b a n d width m o d e m connections. It contains i n f o r m a t i o n f r o m eight o f nine currently released L e a r n i n g File C D - R O M s , a m o u n t i n g to s o m e 2500 cases. Conclusion: T h e official m e a n s o f distribution o f the Learning File is the C D - R O M . Physical m e d i a such as C D - R O M s , are inherently limited in their use. J A V A provides a powerful tool for platform independent access to electronic content. N e w business m o d e l s are needed to permit electronic access to copyrighted medical reference materials.
11-76 T h e E f f e c t s of Radiology C l e r k s h i p s on M e d i c a l Student Perceptions about Radiology Jac D. Scheiner, MD, Rhode Island Hospital, Providence, RI, Robert A. Novelline, MD, N a n c y Clements, P h D P u r p o s e : T h e effects o f radiology clerkships on medical student perceptions about radiology were investigated. Materials a n d Methods: Consecutive medical students at Rhode Island Hospital ( B r o w n U n i v e r s i t y School o f Medicine) and M a s sachusetts General Hospital (Harvard M e d i c a l School) c o m p l e t e d pre and post radiology clerkship s u r v e y s c o n c e r n i n g perceptions about radiology. Results: 77 survey sets were completed. Students were asked to list their m a i n educational goals. The most c o m m o n were image interpretation (42%) and work-ups (40%). These abilities significantly improved on the post clerkship surveys. These surveys also demonstrated a statistically significant increase in the perceived optimal duration o f the clerkship. 11 times as m a n y students thought it should last longer as opposed to shorter. Perceived likelihood of bec o m i n g a radiologist increased on the post clerkship surveys, although this was only significant for students from one hospital. C o n c l u s i o n : O u r radiology clerkships significantly i m p r o v e d m e d i c a l student confidence in their m a i n educational goals (image interpretation and work-ups), and significantly increased the perceived optimal clerkship duration. T h e perceived likelihood o f b e c o m i n g a radiologist increased overall, although this increase was only significant for students f r o m one hospital, i m p l y i n g that radiology clerkship experience m a y not be the d e t e r m i n i n g factor in this decision.
11-77 Using Internet Services for Emergent CT Images: Support for the On-Call Resident Dale S. Glass, MD, LBJ General Hospital, Houston, TX, Vinh T. Le, MD, R a n d y D. Ernst, MD, Titus R. Koenig, MD, Cynthia I. Caskey, M D Purpose: To determine if commercially available software and hardware with easily accessible internet services can efficiently access C T images. Materials a n d M e t h o d s : A n i m a g e access s y s t e m was installed in the general reading r o o m consisting of L I N U X operating system, M e d W e b D I C O M imaging m a n a g e m e n t software, Netscape B r o w s e r and commercially available personal c o m p u t e r equipment. C T studies were automatically networked to the system. T i m e required for E R residents to obtain films for interpretation of 50 C T studies were recorded and compared, with the time required to retrieve 50 C T studies on the M e d W e b system. Discrepancies between interpretations were noted during m o r n i n g readout. At
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11-74 The Use of Dynamic HTML to Provide an Internetbased "Electronic Book" in GI Radiology M i c h a e l A. Blake, M B B C h , Boston Medical Center, Boston, MA, Gavin J. Blake, M D , Martin Schranz, M D , R o b i n Gibney, M D , D e r m o t E. Malone, M D P u r p o s e : To m a k e use of dynamic Hypertext Markup L a n g u a g e (HTML) to create a highly interactive and intuitive teaching prog r a m in gastrointestinal radiology. M a t e r i a l s a n d Methods: Information is provided on each region of the gastrointestinal (GI) tract with progressively m o r e detail available sequentially. T h e m a i n content is loaded d y n a m i c a l l y f r o m the server into an inline frame. This m a i n content loads external pages containing detailed information and references into a second inline frame by a process k n o w n as data binding. JavaScript statements e m b e d d e d in the H T M L page also optimize interactivity. Processing o f the u s e r ' s r e s p o n s e s occurs on the client's computer, reducing time-consuming server-client contact. Multimedia capabilities such as filters were used freely throughout to e n h a n c e the presentation of data. Results: D y n a m i c H T M L and Javascript have been combined to present an interactive GI radiology m a n u a l that is intuitive and infinitely expandable. The program m a y operate on any operating syst e m supporting a fourth generation browser. A self-assessment mode is also provided with questions relating to the content o f the tutor. Conclusion: A n interactive W e b - b a s e d "electronic book" in GI radiology is thus presented with a d y n a m i c layout that is widely linked to global resources. This educational tool is freely available on h t t p : / / w w w . m c q s . c o n g a b d o m e n .
11-75 A J A V A Application for Review of the ACR's Radiologic Learning File Jeffrey M. Levsky, BS, Northwestern University Medical School, Chicago, IL, D a v i d S. Channin, M D P u r p o s e : T h e Internet and private intranets based on Internet technologies are b e c o m i n g the de facto standard for transmitting information including that used for teaching purposes in all fields o f edu-
cation including medicine. The goal of this project was to m a k e the Radiologic Learning File available across an intranet, using a platform independent, browser based m e c h a n i s m . M a t e r i a l s and Methods: The Java language was used to implem e n t a small program that displays case images and text in a fast, user-friendly manner. T h e viewer was optimized for speed. Utilities for incorporating n e w cases into the s y s t e m were also developed. Results: T h e b r o w s e r is n o w in u s e by radiology residents. T h e b r o w s e r r u n s in any e n v i r o n m e n t with Internet and Java support, including s y s t e m s with limited display resolution and l o w - b a n d width m o d e m connections. It contains i n f o r m a t i o n f r o m eight o f nine currently released L e a r n i n g File C D - R O M s , a m o u n t i n g to s o m e 2500 cases. Conclusion: T h e official m e a n s o f distribution o f the Learning File is the C D - R O M . Physical m e d i a such as C D - R O M s , are inherently limited in their use. J A V A provides a powerful tool for platform independent access to electronic content. N e w business m o d e l s are needed to permit electronic access to copyrighted medical reference materials.
11-76 T h e E f f e c t s of Radiology C l e r k s h i p s on M e d i c a l Student Perceptions about Radiology Jac D. Scheiner, MD, Rhode Island Hospital, Providence, RI, Robert A. Novelline, MD, N a n c y Clements, P h D P u r p o s e : T h e effects o f radiology clerkships on medical student perceptions about radiology were investigated. Materials a n d Methods: Consecutive medical students at Rhode Island Hospital ( B r o w n U n i v e r s i t y School o f Medicine) and M a s sachusetts General Hospital (Harvard M e d i c a l School) c o m p l e t e d pre and post radiology clerkship s u r v e y s c o n c e r n i n g perceptions about radiology. Results: 77 survey sets were completed. Students were asked to list their m a i n educational goals. The most c o m m o n were image interpretation (42%) and work-ups (40%). These abilities significantly improved on the post clerkship surveys. These surveys also demonstrated a statistically significant increase in the perceived optimal duration o f the clerkship. 11 times as m a n y students thought it should last longer as opposed to shorter. Perceived likelihood of bec o m i n g a radiologist increased on the post clerkship surveys, although this was only significant for students from one hospital. C o n c l u s i o n : O u r radiology clerkships significantly i m p r o v e d m e d i c a l student confidence in their m a i n educational goals (image interpretation and work-ups), and significantly increased the perceived optimal clerkship duration. T h e perceived likelihood o f b e c o m i n g a radiologist increased overall, although this increase was only significant for students f r o m one hospital, i m p l y i n g that radiology clerkship experience m a y not be the d e t e r m i n i n g factor in this decision.
11-77 Using Internet Services for Emergent CT Images: Support for the On-Call Resident Dale S. Glass, MD, LBJ General Hospital, Houston, TX, Vinh T. Le, MD, R a n d y D. Ernst, MD, Titus R. Koenig, MD, Cynthia I. Caskey, M D Purpose: To determine if commercially available software and hardware with easily accessible internet services can efficiently access C T images. Materials a n d M e t h o d s : A n i m a g e access s y s t e m was installed in the general reading r o o m consisting of L I N U X operating system, M e d W e b D I C O M imaging m a n a g e m e n t software, Netscape B r o w s e r and commercially available personal c o m p u t e r equipment. C T studies were automatically networked to the system. T i m e required for E R residents to obtain films for interpretation of 50 C T studies were recorded and compared, with the time required to retrieve 50 C T studies on the M e d W e b system. Discrepancies between interpretations were noted during m o r n i n g readout. At
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