Radiologists' Preferences for Just-in-Time Learning

Background Effective learning can occur at the point of care, when opportunities arise to acquire information and apply it to a clinical problem. To assess interest in point-of-care learning, we conducted a survey to explore radiologists' attitudes and preferences regarding the use of just-in-time learning (JITL) in radiology. Materials and Methods Following Institutional Review Board approval, we invited 104 current radiology residents and 86 radiologists in practice to participate in a 12-item Internet-based survey to assess their attitudes toward just-in-time learning. Voluntary participation in the survey was solicited by e-mail; respondents completed the survey on a web-based form. Results Seventy-nine physicians completed the questionnaire, including 47 radiology residents and 32 radiologists in practice; the overall response rate was 42%. Respondents generally expressed a strong interest for JITL: 96% indicated a willingness to try such a system, and 38% indicated that they definitely would use a JITL system. They expressed apreference for learning interventions of 5–10 min in length. Conclusions Current and recent radiology trainees have expressed a strong interest in just-in-time learning. The information from this survey should be useful in pursuing the design of learning interventions and systems for delivering just-in-time learning to radiologists.     

Automatically Correlating Clinical Findings and Body Locations in Radiology Reports Using MedLEE

In this paper, we describe and evaluate a system that extracts clinical findings and body locations from radiology reports and correlates them. The system uses Medical Language Extraction and Encoding System (MedLEE) to map the reports’ free text to structured semantic representations of their content. A lightweight reasoning engine extracts the clinical findings and body locations from MedLEE’s semantic representation and correlates them. Our study is illustrative for research in which existing natural language processing software is embedded in a larger system. We manually created a standard reference based on a corpus of neuro and breast radiology reports. The standard reference was used to evaluate the precision and recall of the proposed system and its modules. Our results indicate that the precision of our system is considerably better than its recall (82.32–91.37% vs. 35.67–45.91%). We conducted an error analysis and discuss here the practical usability of the system given its recall and precision performance.     

‘Wet Reads’ in the Age of PACS: Technical and Workflow Considerations for a Preliminary Report System

Communication between clinicians, technologists, and radi ologists has become more complex, with Picture Archiving and Communication Systems (PACS) now allowing the radiologist to be removed from the physical location of the patients and the site of imaging. With these changes, effective communication becomes an ongoing challenge. Efficient communication of study interpretations has also become a priority for radiologists as they struggle to maintain relevance and provide added value to patient care when clinicians have ready access to radiology images. The purpose of this paper is to share our experience in developing and implementing the Collaborative Notification System (CNS), a communication tool used to inform referring clinicians of urgent findings—a.k.a. “wet reads.” The system utilizes a system of web pages integrated into PACS for the sending and receiving of succinct messages to provide clinical information at the point of need. A second system of pager alerts provides notification of the need for such communication through a relatively unintrusive, one-way, acknowledged alert system. The CNS provides asynchronous, integrated communication for the reporting of urgent and emergent radiology findings in a complex, geographically distributed medical environment.     

Effective Metadata Discovery for Dynamic Filtering of Queries to a Radiology Image Search Engine

We sought to demonstrate the effectiveness of techniques to index radiology images using metadata discovered in their free-text figure captions. The ARRS GoldMiner™ image library incorporated 94,256 figures from 11,712 articles published in peer-reviewed online radiology journals. Algorithms were developed to discover metadata—age, sex, and imaging modality—from the figures’ free-text captions. Age was recorded in years, and was classified as infant (less than 2 years), child (2 to 17 years), or adult (18+ years). Each figure was assigned to one of eight imaging modalities. A random sample of 1,000 images was examined to measure accuracy of the metadata. The patient’s age was identified in 58,994 cases (63%), and the patient’s sex was identified in 58,427 cases (62%). An imaging modality was assigned to 80,402 (85%) of the figures. Based on the 1,000 sampled cases, recall values for age, sex, and imaging modality were 97.2%, 99.7%, and 86.4%, respectively. Precision values for age, sex, and imaging modality were 100%, 100%, and 97.2%, respectively. Automated techniques can accurately discover age, sex, and imaging modality metadata from captions of figures published in radiology journals. The metadata can be used to dynamically filter queries for an image search engine.     

Accurate Determination of Imaging Modality using an Ensemble of Text- and Image-Based Classifiers

Imaging modality can aid retrieval of medical images for clinical practice, research, and education. We evaluated whether an ensemble classifier could outperform its constituent individual classifiers in determining the modality of figures from radiology journals. Seventeen automated classifiers analyzed 77,495 images from two radiology journals. Each classifier assigned one of eight imaging modalities—computed tomography, graphic, magnetic resonance imaging, nuclear medicine, positron emission tomography, photograph, ultrasound, or radiograph—to each image based on visual and/or textual information. Three physicians determined the modality of 5,000 randomly selected images as a reference standard. A “Simple Vote” ensemble classifier assigned each image to the modality that received the greatest number of individual classifiers’ votes. A “Weighted Vote” classifier weighted each individual classifier’s vote based on performance over a training set. For each image, this classifier’s output was the imaging modality that received the greatest weighted vote score. We measured precision, recall, and F score (the harmonic mean of precision and recall) for each classifier. Individual classifiers’ F scores ranged from 0.184 to 0.892. The simple vote and weighted vote classifiers correctly assigned 4,565 images (F score, 0.913; 95% confidence interval, 0.905–0.921) and 4,672 images (F score, 0.934; 95% confidence interval, 0.927–0.941), respectively. The weighted vote classifier performed significantly better than all individual classifiers. An ensemble classifier correctly determined the imaging modality of 93% of figures in our sample. The imaging modality of figures published in radiology journals can be determined with high accuracy, which will improve systems for image retrieval.     

Medical students' approaches to learning anatomy: Students' experiences and relations to the learning environment

To examine students' perceptions and experiences of learning anatomy, an on‐line Likert‐style questionnaire was administered during 2006 to students reading a Bachelor of Medicine 4‐ and 5‐year program (n = 256, 23.8%). Statistical analysis found that students predominantly felt that understanding anatomy and working with human cadaveric material were very important in becoming a doctor. Students reported that working on cadaveric specimens was an effective way of learning anatomy, and also found the amount of anatomy they needed to learn to be daunting. Student responses were correlated with their approaches to learning [Approaches to Studying Inventory for Students (ASSIST)] scores using a Kruskal Wallis test. Significant relationships between the approach to learning anatomy adopted and students' perception and experience of anatomy were found. A deep approach to learning anatomy correlated with students who reported that the most effective way of learning anatomy in the dissecting room was to get their hands in and feel for structures, who used anatomical terms and language at clinical opportunities, and who frequently used their anatomy‐radiology knowledge in clinical situations. A surface approach to learning anatomy was associated with elements, such as students finding anatomy learning daunting and not seeing the point to it. The outcomes provide clear associations between students' perception of the anatomy learning environment, the approach to learning adopted, and the anatomy activities in which students engage. The findings highlight that understanding and applying anatomical knowledge are best accomplished by the adoption of a deep approach to learning. Clin. Anat. 23:101–103, 2010. © 2009 Wiley‐Liss, Inc.     

Characteristics of Neurological Status and the Electroencephalogram in Nuclear Power Station Control Operators

A total of 105 control operators at the Kursk nuclear power station were studied: 45 after working shifts (study group) and 60 on rest days (reference group). These investigations showed that operators’ work shifts had significant influences on the functional state of the nervous system, promoting the appearance or exacerbation of autonomic dysfunction. In some cases, work shifts increased arterial blood pressure to risk levels for the development of cerebrovascular disease. The effects of nuclear power station operators’ work shifts on brain bioelectrical activity included a decrease in the proportion of unaltered EEG traces, along with increases in the spectral power densities of the α rhythm in the parietal leads and the θ rhythm in the posterior temporal and parietal leads. The origin of these changes may be related to both fatigue and the effects of adverse industrial factors. It is suggested that clinical observation of power station operators should be supplemented by assessments of autonomic dysfunction and measurement of the spectral power densities of the α and θ rhythms in the parietal and posterior temporal leads.     

The role of motivation in the performance of conditioned reflex switching of a maze skill in response to substitution of food reward quality in ants of the species Myrmica rubra

The characteristics of learning in ants — active Myrmica rubra foragers — were studied in a maze at different levels of colony carbohydrate food need with reinforcement consisting of carbohydrate (sugar syrup) or protein (pupae of Lasius niger ants). Measures of the maze skill during learning reinforced with syrup were somewhat worse than those during learning reinforced with pupae, especially in terms of time-based measures. Ants were able to modify the acquired conditioned reflex reaction when the quality of reinforcement changed. At high levels of food need (“ hungry” colony), substitution of syrup with larvae and vice versa was followed by transformation of the previously formed skill; this occurred at both experimental periods (training and testing). At low levels of motivation (“sated colony”), the optimized maze habit formed with protein reinforcement was replaced in the test with carbohydrate reinforcement by a “stochastic,” unoptimized behavior with a dominance of investigative activity. These experiments demonstrated that conditioned reflex switching can occur in higher social insects — ants — in which the different forms depend on the level of colony need for food and, respectively, on the level of social food-related motivation of forager ants. The special importance of using the switch activating the corresponding motivational system before changing the reinforcement food quality is emphasized. __________ Translated from Zhurnal Vysshei Nervnoi Deyatel’nosti imeni I. P. Pavlova, Vol. 55, No. 6, pp. 833–841, November–December, 2005.     

Comparison of Techniques for Correction of Magnification of Pelvic X-rays for Hip Surgery Planning

The aim of this study was to develop an accurate method for correction of magnification of pelvic x-rays to enhance accuracy of hip surgery planning. All investigated methods aim at estimating the anteroposterior location of the hip joint in supine position to correctly position a reference object for correction of magnification. An existing method—which is currently being used in clinical practice in our clinics—is based on estimating the position of the hip joint by palpation of the greater trochanter. It is only moderately accurate and difficult to execute reliably in clinical practice. To develop a new method, 99 patients who already had a hip implant in situ were included; this enabled determining the true location of the hip joint deducted from the magnification of the prosthesis. Physical examination was used to obtain predictor variables possibly associated with the height of the hip joint. This included a simple dynamic hip joint examination to estimate the position of the center of rotation. Prediction equations were then constructed using regression analysis. The performance of these prediction equations was compared with the performance of the existing protocol. The mean absolute error in predicting the height of the hip joint center using the old method was 20 mm (range −79 mm to +46 mm). This was 11 mm for the new method (−32 mm to +39 mm). The prediction equation is: height (mm) = 34 + 1/2 abdominal circumference (cm). The newly developed prediction equation is a superior method for predicting the height of the hip joint center for correction of magnification of pelvic x-rays. We recommend its implementation in the departments of radiology and orthopedic surgery.     

Who PACS a Punch? The Role of the Picture Archiving and Communication System/Radiology Information System (PACS/RIS) in Quantifying Experiential Learning in Radiology Residency

The clinical logbook is the currently accepted tool for evaluating experiential learning (EL) in postgraduate radiology training programs internationally. The role of the picture archiving and communication system/radiology information system (PACS/RIS) in defining the complete EL portfolio of radiology residents has not been explored. To conduct a PACS/RIS-based analysis of the comprehensive clinical outputs of radiology residents, and to correlate outputs with residency recruitment criteria and exit examination performance. Retrospective, customized searches of the institutional PACS/RIS were conducted to determine the clinical outputs of radiology residents completing a standardized 4-year training program at a single institution in a middle-income country. The association between outputs and prior-to-residency radiology experience, prior-to residency completion of the primary examination, and performance in the exit examination were determined. Fifteen residents were included. Average clinical output was 8286 cases, with a wide range (6268-10460). Total output was not associated with first-time exit examination success (p=0.16). Residents with prior radiology experience tended to greater success at first exit examination attempt (10/11, 91% versus 2/4, 50%; p=0.09), despite lower average outputs (8138 versus 8695). Outputs were not associated with prior completion of the radiology primary examination (8263 versus 8378; p=0.87). This first PACS/RIS-based analysis of the complete clinical outputs of any radiology residency training program provides important baseline educational data, with the potential to inform discourses on specialty training internationally. It demonstrates the potential for the modern PACS/RIS to supersede the traditional logbook and to serve as a comprehensive EL portfolio for radiology residents.     

Applying problem-based learning to the teaching of anatomy: the example of Harvard Medical School

The introduction of problem-based learning techniques into the teaching of anatomy has been subject to great controversies. This paper debates the rationale behind this concept using the example of the curriculum of Harvard Medical School in which problem-based learning techniques have been used during the past 20 years. The anatomy curriculum is covered during the eight first weeks of the medical studies, and is an original combination of discussions of clinical cases in small groups, and work in gross anatomy, histology and radiology laboratories. The lectures are reduced to the minimum and emphasize general concepts. In this setting, the learning of anatomy is mostly led by students who have prepared for the different laboratory sessions and tutorials. The implementation of problem-based learning to the teaching of anatomy requires a close follow-up of each student with regular feedbacks on his work. Tutorials must be considered as a cornerstone between lectures and work in laboratories. Traditional aspects of the teaching of anatomy, such as work in dissection laboratories, are given an important role as they are aimed to clear-up misunderstood points. Further studies are required to compare at the long term the level of medical students who learned anatomy in a problem based versus traditional learning setting.     

Developmental dyslexia: an update

Dyslexia is the most common and carefully studied of the learning disabilities in school-age children. It is characterized by a marked impairment in the development of reading skills, and affects a large number of people (5–10%). Reading difficulties may also arise from poor vision, emotional problems, decreased hearing ability, and behavioral disorders, such as attention-deficit hyperactivity (ADHD). Although many areas of the brain are involved in reading, analysis of postmortem brain specimens by a variety of imaging techniques most consistently suggests that deficiency within a specific component of the language system—the phonologic module—in the temporo-parietal-occipital brain region underlies dyslexia. It is a highly familial and heritable disorder with susceptibility loci on chromosomes 1, 2, 3, 6, 11, 13, 15 and 18. Recently, four candidate genes (KIAA 0319, DYX1C1, DCDC2 and ROBO1) are shown to be associated with dyslexia. Although some of these results are controversial because of the genetic heterogeneity of the disorder, the available evidence suggests that dyslexia could be due to the abnormal migration and maturation of neurons during early development. Interestingly, in spite of genetic heterogeneity, the pathology appears to involve common phonological coding deficits. The condition can be managed by a highly structured educational training exercise.     

Influence of Radiology Report Format on Reading Time and Comprehension

This study examined whether radiology report format influences reading time and comprehension of information. Three reports were reformatted to conventional free text, structured text organized by organ system, and hierarchical structured text organized by clinical significance. Five attending radiologists, five radiology residents, five internal medicine attendings, and five internal medicine residents read the reports and answered a series of questions about them. Reading was timed and participants reported reading preferences. For reading time, there was no significant effect for format, but there was for attending versus resident, and radiology versus internal medicine. For percent correct scores, there was no significant effect for report format or for attending versus resident, but there was for radiology versus internal medicine with the radiologists scoring better overall. Report format does not appear to impact viewing time or percent correct answers, but there are differences in both for specialty and level of experience. There were also differences between the four groups of participants with respect to what they focus on in a radiology report and how they read reports (skim versus read in detail). There may not be a “one-size-fits-all” radiology report format as individual preferences differ widely.     

INDIAM—An e-Learning System for the Interpretation of Mammograms

We propose the design of a teaching system named Interpretation and Diagnosis of Mammograms (INDIAM) for training students in the interpretation of mammograms and diagnosis of breast cancer. The proposed system integrates an illustrated tutorial on radiology of the breast, that is, mammography, which uses education techniques to guide the user (doctors, students, or researchers) through various concepts related to the diagnosis of breast cancer. The user can obtain informative text about specific subjects, access a library of bibliographic references, and retrieve cases from a mammographic database that are similar to a query case on hand. The information of each case stored in the mammographic database includes the radiological findings, the clinical history, the lifestyle of the patient, and complementary exams. The breast cancer tutorial is linked to a module that simulates the analysis and diagnosis of a mammogram. The tutorial incorporates tools for helping the user to evaluate his or her knowledge about a specific subject by using the education system or by simulating a diagnosis with appropriate feedback in case of error. The system also makes available digital image processing tools that allow the user to draw the contour of a lesion, the contour of the breast, or identify a cluster of calcifications in a given mammogram. The contours provided by the user are submitted to the system for evaluation. The teaching system is integrated with AMDI—An Indexed Atlas of Digital Mammograms—that includes case studies, e-learning, and research systems. All the resources are accessible via the Web.     

Evaluation of an E-Learning Distance Education System in the Graduate School of Medical Sciences of Tottori University

Three years have passed since the introduction of a new e-learning system as part of the graduate study program in the Faculty of Medicine of Tottori University. To improve this system, a survey was conducted among graduate students and faculty members to evaluate it. The subjects of the study were 138 graduate students (in the doctoral programs in Medical Science, 1st- and 2nd-term doctoral programs in Life Science, 1st- and 2nd-term doctoral programs in the Institute of Regenerative Medicine and Biofunction, and Clinical Psychology) as well as 108 faculty of the Graduate School of Medical Sciences of Tottori University. Graduate students reported that the e-learning education system is adequate and that they are satisfied to an above average level. The reasons for dissatisfaction with the system were roughly divided into 3 categories: “contents”, “system” and “student reports”. This e-learning system is still at an early stage of development, but we are pushing forward to improve this in anticipation of increasing the use of web learning modalities in the future.     

RadMonitor: Radiology Operations Data Mining in Real Time

This paper describes the web-based visualization interface of RadMonitor, a platform-independent web application designed to help manage the complexity of information flow within a health care enterprise. The system eavesdrops on Health Layer 7 traffic and parses statistical operational information into a database. The information is then presented to the user as a treemap—a graphical visualization scheme that simplifies the display of hierarchical information. While RadMonitor has been implemented for the purpose of analyzing radiology operations, its XML backend allows it to be reused for virtually any other hierarchical data set.     

Credentialing Imaging Informatics Professionals: Creation of Items for the CIIP Examination

The First Society for Computer Applications in Radiology (SCAR) Transforming the Radiological Interpretation Process (TRIP™) Conference and Workshop, “Transforming Medical Imaging” was held on January 31–February 1, 2005 in Bethesda, MD. Representatives from all areas of medical and scientific imaging—academia, research, industry, and government agencies—joined together to discuss the future of medical imaging and potential new ways to manage the explosion in numbers, size, and complexity of images generated by today's continually advancing imaging technologies. The two-day conference included plenary, scientific poster, and breakout sessions covering six major research areas related to TRIP™. These topic areas included human perception, image processing and computer-aided detection, data visualization, image set navigation and usability, databases and systems integration, and methodology evaluation and performance validation. The plenary presentations provided a general status review of each broad research field to use as a starting point for discussion in the breakout sessions, with emphasis on specific topics requiring further study. The goals for the breakout sessions were to define specific research questions in each topic area, to list the impediments to carrying out research in these fields, to suggest possible solutions and near- and distant-future directions for each general topic, and to report back to the general session. The scientific poster session provided another mechanism for presenting and discussing TRIP™-related research. This report summarizes each plenary and breakout session, and describes the group recommendations as to the issues facing the field, major impediments to progress, and the outlook for radiology in the short and long term. The conference helped refine the definition of the SCAR TRIP™ Initiative and the problems facing radiology with respect to the dramatic growth in medical imaging data, and it underscored a present and future need for the support of interdisciplinary translational research in radiology bridging bench-to-bedside. SCAR will continue to fund research grants exploring TRIP™ solutions. In addition, the organization proposes providing an infrastructure to foster collaborative research partnerships between SCAR corporate and academic members in the form of a TRIP™ Imaging Informatics Network (TRIPI²N). SCAR TRIP™ Subcommittee: Richard L. Morin, Ph.D., Chair, TRIP™ Subcommittee; Katherine P. Andriole, Ph.D., Chair, Research and Development Committee; John A. Carrino, M.D., M.P.H.; Bradley J. Erickson, M.D., Ph.D.; Steven C. Horii, M.D.; Elizabeth A. Krupinski, Ph.D.; David W. Piraino, M.D.; J. Anthony Seibert, Ph.D.; Eliot L. Siegel, M.D.     

Effectiveness of interprofessional shared decision-making training: A mixed-method study

ObjectiveThis study evaluated the learning effects and examined the participants’ perceptions of an interprofessional shared decision-making (IP-SDM) training program.MethodsThis mixed-method study used a quasi-experimental pretest–posttest design in the quantitative phase and semi-structured interviews in the qualitative phase. The 6-week curriculum design, based on Kolb’s experiential learning cycle, consisted of two simulated objective structured clinical examinations with standardized patients and blended teaching methods through various course modules.ResultsA total of 39 multidisciplinary healthcare personnel completed the 6-week training program, and 32 of them participated in qualitative interviews. The IP-SDM training program effectively improved the SDM process competency of the participants from the perspectives of the participants, standardized patients, and clinical teachers. The interviews illustrated how the curriculum design enhanced learning; the effectiveness results indicated improvements in learners’ attitude, knowledge, skills, and teamwork.ConclusionThis IP-SDM training program improved multidisciplinary healthcare personnel’s competency, self-efficacy, and intention to engage in IP-SDM.Practice implicationsApplying Kolb's experiential learning cycle and blended teaching methods to develop and implement the IP-SDM training program can improve multidisciplinary healthcare personnel’s knowledge, attitude, skills, and teamwork in IP-SDM.