A digital frame of reference for viewing digital images

Digital imaging is becoming widespread in diagnostic radiology. Most diagnostic digital images do not relate explicitly to the physical processes involved in their generation but are, in essence, a "pseudo" image generated from digital data using pre- and post-processing. Without knowledge of how the image was generated, there is a potential to misinterpret the image data. A new design of digitally generated graphic is presented that is intended to help maintain the frame of reference when viewing digitally processed images. The intention is that the digital frame of reference (DFOR) be included with all digitally processed images and be processed using the same factors as were used on the image. An unprocessed DFOR can then be displayed adjacent to the processed DFOR to re-introduce a frame of reference and to clearly illustrate the effect of any processes that have been applied to the image. This would allow the viewer to perceive any artefacts that may have been introduced into the image by the processing. This is particularly important where the image requires interpretation by the viewer, as in medical diagnosis. This paper presents a grey scale version of the DFOR that is suitable for applications such as medical imaging. The DFOR includes: grey scale from 0 to the maximum bit depth in 0%, 30%, 70% and 100% steps on a 50% background; the full frequency range from 0 to the Nyquist frequency; high, medium and low contrast boundaries; and linear/curvilinear features. The same method could be extended to any other digital image system and could be easily modified to include colour.     

Integrating digital systems: commitment and collaboration

One year ago, the radiology department at Ball Memorial Hospital, a 350-bed facility in Muncie, IN, was completely film-based. The need to support a new all-digital, 35-room emergency department (ED) hastened the facility's transition to a digital environment. Today, with the exception of mammography, the hospital's imaging services are now digital. To develop and implement the project, the hospital formed an internal implementation team. An independent consultant was also hired to evaluate the impact of these new technologies and to provide an estimated cost payback. After research, site visits, and vendor demonstrations, the hospital selected a single vendor for its picture archiving and communication system (PACS), digital radiography (DR), computed radiography (CR), and overall project management. The DR system was installed in the ED to provide digital image capture for a full range of trauma exams. The ED also initially began utilizing a Web-based PACS distribution originally implemented for after-hours teleradiology. The majority of the hospital's imaging studies are captured with 2 multi-cassette CR systems that serve 7 exam rooms in the radiology department. The hospital also installed remote operations panels to expedite entry of patient and exam information. Technologists readily embraced both CR and DR systems. The Web distribution system now transmits images to hospital-based computers and to 150 remote referring physicians. The PACS platform automatically e-mails key images and radiology reports to referring physicians. Authorized physicians can also request reports and images on an as-needed basis. The PACS vendor had previously performed multiple integrations with the radiology information system (RIS) vendor; the integration of PACS and RIS was extremely smooth. One of the critical components of a successful conversion is experienced, dedicated management. The hospital retained professional project management services to facilitate implementation and to ensure adequate training for all users.     

Integrating clinical education into the curriculum development process

Radiologic technology education consists of three components--didactic, laboratory, and clinical. For effective education to take place and for each program to meet its goal of preparing practitioners who have a firm theoretical foundation and are proficient technologically in radiologic technology, the three components must be integrated. Integration facilitates the transfer of theoretical and practical knowledge into the intellectual, psychomotor, and affective skills necessary for patient care. The totality of the integrated educational experience makes the competent professional. Integration of the educational components is best achieved by a systematic approach to curriculum development. The steps in the curriculum development process consist of (1) the formulation of a philosophy; (2) the establishment of competencies; (3) the identification of resources; (4) the development and sequencing of courses; (5) the identification of teaching strategies; and (6) evaluation. When the clinical component of the educational program is weighted appropriately and well-integrated into a systematic process of curriculum development, student learning is maximized and graduate professional performance is enhanced.     

An investigation into the effects of suboptimal viewing conditions in screen-film mammography

The ability of an observer to detect objects on a radiograph is influenced by the conditions under which the image is viewed. Therefore, to ensure that as much diagnostically relevant information as possible can be extracted from the image, it is important that satisfactory viewing conditions for the task are established and maintained. Factors that are thought to be important are the luminance of the image, glare and ambient light. Together, these factors lead to the formation of reflection on the image, which may degrade the observer's performance. The purpose of this study was to explore, in a systematic manner, the effect of the factors outlined above on the performance of an observer conducting a threshold contrast-detail diameter test. Each factor was investigated separately with attempts made to minimize the confounding effects of other factors. When examined individually, viewing box luminance, ambient light and glare were found to have little effect on the contrast-detail performance of the observers. Reflection was found to have a significant effect, particularly non-uniform reflection, and the magnitude of the effect was related to the contrast degradation factor and reflection modulation. These quantities, which are derived from basic photometric measurements, may be used to develop a protocol to assess viewing conditions in screen-film mammography.     

Novel digital forensic readiness technique in the cloud environment

This paper examines the design and implementation of a feasible technique for performing Digital Forensic Readiness (DFR) in cloud computing environments. The approach employs a modified obfuscated Non-Malicious Botnet (NMB) whose functionality operates as a distributed forensic Agent-Based Solution (ABS) in a cloud environment with capabilities of performing forensic logging for DFR purposes. Under basic Service Level Agreements (SLAs), this proactive technique allows any organization to perform DFR in the cloud without interfering with operations and functionalities of the existing cloud architecture or infrastructure and the collected file metadata. Based on the evaluation discussed, the effectiveness of our approach is presented as the easiest way of conducting DFR in the cloud environment as stipulated in the ISO/IEC 27043: 2015 international standard, which is a standard of information technology, security techniques and incident investigation principles and processes. Through this technique, digital forensic analysts are able to maximize the potential use of digital evidence while minimizing the cost of conducting DFR. As a result of this process, the time and cost needed to conduct a Digital Forensic Investigation (DFI) is saved. As a consequence, the technique helps the law enforcement, forensic analysts and Digital Forensic Investigators (DFIs) during post-event response and in a court of law to develop a hypothesis in order to prove or disprove a fact during an investigative process, if there is an occurrence of a security incident. Experimental results of the developed prototype are described which conclude that the technique is effective in improving the planning and preparation of pre-incident detection during digital crime investigations. In spite of that, a comparison with other existing forensic readiness models has been conducted to show the effectiveness of the previously proposed Cloud Forensic Readiness as a Service (CFRaaS) model.     

The effect of viewing a virtual environment through a head-mounted display on balance

IntroductionIn the next few years, several head-mounted displays (HMD) will be publicly released making virtual reality more accessible. HMD are expected to be widely popular at home for gaming but also in clinical settings, notably for training and rehabilitation. HMD can be used in both seated and standing positions; however, presently, the impact of HMD on balance remains largely unknown. It is therefore crucial to examine the impact of viewing a virtual environment through a HMD on standing balance.ObjectivesTo compare static and dynamic balance in a virtual environment perceived through a HMD and the physical environment. The visual representation of the virtual environment was based on filmed image of the physical environment and was therefore highly similar.DesignThis is an observational study in healthy adults.ResultsNo significant difference was observed between the two environments for static balance. However, dynamic balance was more perturbed in the virtual environment when compared to that of the physical environment.ConclusionsHMD should be used with caution because of its detrimental impact on dynamic balance. Sensorimotor conflict possibly explains the impact of HMD on balance.     

Integrating forensic anthropology into disaster victim identification

This paper will provide mass fatality emergency planners, police, medical examiners, coroners and other Disaster Victim Identification (DVI) personnel ways to integrate forensic anthropologists into DVI operations and demonstrate how anthropological contributions have improved DVI projects. In mass disaster situations, anthropologists have traditionally been limited to developing biological profiles from skeletal remains. Over the past decade, however, anthropologists’ involvement in DVI has extended well beyond this traditional role as they have taken on increasingly diverse tasks and responsibilities. Anthropological involvement in DVI operations is often dictated by an incident’s specific characteristics, particularly events involving extensive fragmentation, commingling, or other forms of compromised remains. This paper will provide examples from recent DVI incidents to illustrate the operational utility of anthropologists in the DVI context. The points where it is most beneficial to integrate anthropologists into the DVI process include: (1) during recovery at the disaster scene; (2) at the triage station as remains are brought into the mortuary; and (3) in conducting the reconciliation process. Particular attention will be paid to quality control and quality assurance measures anthropologists have developed and implemented for DVI projects. Overall, this paper will explain how anthropological expertise can be used to increase accuracy in DVI while reducing the project’s cost and duration.     

Integrating your radiology information system in a complex computing environment

Radiology departments are a major source of important information regarding patient care. Such information is valuable in its own right but also provides significant added value when correlated with other information, including other clinical diagnoses, therapies, utilization, costs of care and outcomes. In the past, hospitals/imaging centers have typically sought the "best" RIS to meet the needs of the department and its user constituencies (physicians, nurses, medical records, etc.). Function and feature drove the RIS selection process. "Best of breed" was the rallying cry. Having multiple systems and vendors requires information systems and departmental staff to maintain expertise and support in each system and to interact with each vendor. The best-of-breed approach has a number of hidden costs. Before buying, ask "Is the best-of-breed RIS so much better than a more integrated solution that the support and integration efforts are worth it?" This is a complex question involving true needs, perceived needs, wants (justifiable or not), ego, politics, institutional future plans and more. Effective integration in a complex computing environment involves both technical processes and people processes. A cooperative, team-oriented process with the appropriate allocation of staff functions based on expertise and experience is needed. In general, the radiology department is best able to manage operations of the RIS. The information systems department should retain responsibility for housing the RIS computer and performing routine backup procedures as well as monitoring RIS performance. Both organizations can contribute to a highly successful integrated system operation based on their respective knowledge and experience. The IHE (Integrating the Healthcare Enterprise) is a joint initiative of the RSNA and HIMSS (Healthcare Information Systems Society) to stimulate the integration of information and imaging systems. The initiative will promote enterprise-wide sharing of data via established standards. The organizations, at their annual national meetings, will provide a visible forum and showcase of integration capabilities (most recently at HIMSS 2000).     

床旁数字X线胸部高千伏摄影在重症监护病房的应用

目的探讨床旁数字化X线摄影（digital radiography,DR）胸部高千伏摄影在重症监护病房（ICU）患者的应用价值。方法在ICU患者床旁DR胸部正位摄影中,把研究对象随机分为对照组和实验组．对照组摄片条件为管电压80kv,曝光量10～16mAs;实验组摄片条件为管电压125kV,曝光量1．8-2．0mAs．评价影像质量及患者辐射剂量。结果经计算实验组甲级片、乙级片百分率均高于对照组,影像质量实验组比对照组好。实验组患者所受辐射剂量明显小于对照组,差异有统计学意义（P〈0．05）。结论在ICU病房中用DR行胸部摄影,采用高千伏技术在提高影像质量,降低曝光量,减少受检者辐射剂量等方面有明显优势。     

Resolution requirements for monitor viewing of digital flat-panel detector radiographs: a contrast detail analysis

With the introduction of digital flat-panel detector systems into clinical practice, the still unresolved question of resolution requirements for picture archiving communication system (PACS) workstation monitors has gained new momentum. This contrast detail analysis was thus performed to define the differences in observer performance in the detection of small low-contrast objects on clinical 1K and 2K monitor workstations. Images of the CDRAD 2.0 phantom were acquired at varying exposures on an indirect-type digital flat-panel detector. Three observers evaluated a total of 15 images each with respect to the threshold contrast for each detail size. The numbers of correctly identified objects were determined for all image subsets. No significant difference in the correct detection ratio was detected among the observers; however, the difference between the two types of workstations (1K vs 2K monitors) despite less than 3% was significant at a 95% confidence level. Slight but statistically significant differences exist in the detection of low-contrast nodular details visualized on 1K- and 2K-monitor workstations. Further work is needed to see if this result holds true also for comparison of clinical flat-panel detector images and may, for example, exert an influence on the diagnostic accuracy of chest X-ray readings. Electronic Publication     

Integrating emergency medicine residents into a well-established helicopter program

INTRODUCTION: The institution of an emergency medicine residency in a university-affiliated Level 1 trauma center in July 1993 provided a challenge to develop a curriculum and on-line learning experience for emergency medicine residents in a well-established helicopter program. The purpose of this study was to survey flight crew members, emergency medicine at tending physicians, and emergency medicine residents on the anticipated roles and educational experience of integrating the emergency medicine residents from a new emergency medicine residency into the flight crew of a well-established helicopter program. METHODS: A survey consisting of multiple choice, Likert scale, and open-ended questions was distributed to flight crew members (RN, RT, pilots, communication specialists, EM attendings, and EM residents [n=72]). RESULTS: 92% of surveys were returned. These surveys identified specific issues of concern and those areas believed to be of academic importance for the emergency medicine residents. CONCLUSIONS: The results of this study allowed for the creation and implementation of a progressive flight experience for EM residents that incorporates increasing responsibility on the flight crew as experience is gained.     

Introduction of concurrent processes into the digital forensic investigation process

Performing a digital forensic investigation requires a formalised process to be followed. It also requires that certain principles are applied, such as preserving of digital evidence and documenting actions. The need for a harmonised and standardised digital forensic investigation process has been recognised in the digital forensics community and much scientific work has been undertaken to produce digital forensic investigation process models, albeit with many disparities within the different models. The problem is that these existing models do not include any processes dealing explicitly with concurrent digital forensic principles. This leaves room for human error and omissions, as there is a lack of clear guidelines on the implementation of digital forensic principles. This paper proposes the introduction of concurrent processes into the digital forensic investigation process model. The authors define concurrent processes as the actions that should be conducted in parallel with other processes within the digital forensic investigation process, with the aim to fulfil digital forensic investigation principles. The concept of concurrent processes is a novel contribution that aims to enable more efficient and effective digital forensic investigations, while reducing the risk of human error and omissions that result in digital evidence being contaminated.