The construction of coherent mental representations supports learning and decision-making [ 18 , 19 ]. Hence, although medical images play an important role in making good decisions on the diagnosis of particular case, medical consultation between physicians and radiologists would become more meaningful if tools were available that not only displayed medical images on their consoles but also supported the integration of written words, spoken words, and images.
Advances in multimedia technologies and applications and the availability of high-speed bandwidth internet have increased the utilisation of multimedia in healthcare such as supplementary materials to demonstrate the ideal practice of procedures [ 20 , 21 ] and resources to help students prepare for the clinical examinations [ 22 , 23 ] and to orient residents and students to the operations of hospital departments, and it has also been integrated into electronic medical records [ 24 ].
A number of works extended existing teleradiology systems with multimedia components to support interaction [ 25 , 26 ], collaboration [ 27 ], or advanced visualisation [ 28 ]. However, the multimedia components have not been efficiently integrated into a single healthcare system [ 29 ], and the value of integration for effective interaction and knowledge exchange between referring physicians and radiologists has not been tested.
In this paper we present a real-time multimedia interactive teleradiology management system MTMS to support physicians' diagnoses.
Henzinger, and W. Kevin Jackson. NeXTSTEP, with its Interface Builder tool along with the AppKit and other object-oriented libraries, provided so much rich functionality out of the box that they raised the developer up to the twentieth floor, claimed Jobs. Author information Article notes Copyright and License information Disclaimer. Cyrano allowed real-time programs to be created by simply drawing flowcharts. Six user observation sessions took place. Scheduling algorithms for multiprogramming in a hard-real-time environment.
MTMS provides real-time interaction using several modes video, audio, and text , and offers a display of radiographic images, image annotation tools, an archiving and retrieving system, real-time interaction, and an audio reporting feature. This is achieved through full integration and controllability of advanced technologies in multimedia—video and audio transmission, image compression and processing, and voice recognition, all in a single application and in real time.
The developed system is particularly useful in providing immediate diagnosis for a remote medical care center. The system provides remote consultation in such a way that both the referring physician and radiologist can review the same image and discuss it with each other by the dialog window using various modes.
Local healthcare institutions, in particular, primary and secondary care centers, provide lower quality healthcare services because of the lack of experienced staff and adequate technical resources [ 30 ]. This means patients have to be transferred to hospitals with appropriate facilities for diagnosis and treatment.
These transfers are costly and time-consuming [ 31 ]. Traditional, text-only radiology reports are the major, and often only, means of communication between radiologists and their referring clinicians [ 32 ]. Although advances in image display and distribution have made some radiology images more readily available to referring physicians, the increase in imaging data generated increases the need for direct involvement of experts in real time [ 33 ]. A number of solutions have been provided to connect referring physicians in remote areas with radiologists, as will be described in Section 1.
However, many physicians are skeptical about the value of remote consultation and remain in favour of face-to-face consultation. In order to respond to the physicians' concerns, we developed and tested a real-time interactive multimedia teleradiology system. The main goal of MTMS is to serve less well-equipped medical institutions by supporting teleradiology with a number of integrated multimedia tools, in order to improve the quality and efficiency of diagnosis in regular and emergency cases.
Our main contribution in this paper is to 1 leverage multimedia technological advances to improve the interaction and achievement of referring physicians, 2 evaluate the performance of a multilayered integration-based architectural design, and 3 quantify referring physicians' perceived value of real-time multimode interaction with radiologists in improving radiologists' satisfaction and in improving their effectiveness.
A number of teleradiology management systems exist for commercial use. The following services are provided by XRAYLINE: the ability to view images and report online, preview exam results for referred patients, access images at any time from personal computers with a browser and internet connection, download exams, and access local personal archive servers, which can store, forward, query, and retrieve exams from different modalities or other servers.
Miner Miracles Ltd. It provides a management system in digital radiology and teleradiology, security network and maintenance, consultancy, and help desk assistance tracking. MxiPACS [ 34 ] provides teleradiology management system services.
It provides several services such as image viewing and sending of images. The features also include manipulation tools and the facility to download image exams and reports.
This method does not require both parties to be present at the same time. It is a consultation in an asynchronous mode rather than real-time mode [ 8 ]. Various researchers have focused on interactive televideo ITV methodology in implementing teleradiology [ 25 — 29 , 35 ].
Formal Specification. Correctness verification of real-time programs, T Szmuc. LOTOS based derivation methodology in the PRODAT project, A Fernandez et al. Real-Time Programming , edited by A. Crespo and J.A. de la Puente. ( Proceedings of the 15th IFAC/IFIP Workshop, Valencia, Spain.
ITV involves video conferencing and more advanced technology. Physicians can be present in primary care on one side and radiologists must be present at the same time on the other side of the encounter. It is also called the real-time method and simulates real-world interaction with patients [ 8 ].
However, to our knowledge, no research has evaluated the value of ITV teleradiology systems as perceived by referring physicians. This experimental study is the first to assess the effects of real-time multimode interactive teleradiology to physicians' satisfaction and patient care in Saudi Arabia. MTMS is designed to test a number of assumptions relevant to physician-radiologist interaction extracted from various research papers.
Physicians desire accurate and timely reports over those that are well-organised [ 36 , 37 ]. Real-time consultation between physician and radiologist is essential [ 38 ]. Visual, audio, and textual information needs to be accessed synchronously to improve patient care [ 39 ]. Enhanced personal interaction increases physician satisfaction [ 38 , 40 ].
This can be achieved through rich multimodal interaction. Multimode interaction increases physician effectiveness in clinical performance [ 39 , 40 ]. Access to previous examinations is needed [ 38 ]. The online MTMS provides an environment and platform to support referring physicians and clinicians in remote areas or less well-equipped medical care centers Figure 1.
MTMS provides two categories of features: medical case management and user management. The medical case management system provides the following features: establish a medical case, add radiographic images and reports to the medical case, annotate images using text and shapes to highlight interesting areas in real time, provide real-time interaction using various media modes, compress and archive medical cases, view cases with different levels of granularity, search and browse medical cases using advanced search criteria, develop radiology reports and document conversation using voice recognition, assign and unassign medical case to a radiologist in a radiology facility location, and view X-ray images in a special Digital Imaging and Communications in Medicine DICOM viewer [ 41 ].
The architectural design satisfies the functional and nonfunctional system requirements. It establishes the basic structural framework that identifies the major components of a system and communication between these components. This project was developed using a multilayer integration-based architecture Figure 2. The multilayers are the communication layer, application layer, multimedia tool layers, and user interface layer. The tool integration architecture helps to optimise the overall functionality of the system by using prebuilt applications or tools across a network.
In addition, it allows quick development of the system and delivers a more efficient and accessible application. MTMS integrates four multimedia supporting tools to achieve the goals and objectives of this system. This enables the radiographic images to be transferred, received, and stored in a patient database or other archives.
Speech recognition: a software that recognises the voice and converts it to text. It gives the radiologist the opportunity to develop a report automatically and attach it to a medical case using voice and hence reduces the user's keystrokes and the time and effort involved in typing. Teleconferencing: an application with many features like video call, audio call, and instant messaging. It provides the referring physician and the radiologist with a tool for real-time communication so they can discuss medical cases. To experiment and test the introduced concept, a prototype was developed using C programming language and Microsoft.
Net framework 3.
leondumoulin.nl/language/fire/the-great-lake-drabble.php NET framework was chosen for its large library and its support for several programming languages, which allows language interoperability. In addition to this, the. System integration is about successfully putting together parts of systems or subsystems to work as one unit to perform what the system was intended to do. MTMS joins the functions of a set of subsystems or software through integrating a number of tools to produce a unified system that supports the requirements of the system.
MTMS takes the advantages and power of existing tools, which saves time and effort in the implementation phase. MTMS integrates Skype v5. This is required to integrate the radiographic images in the displayed form and to enable their storage in the database. Microsoft Speech Recognition allows radiologists to record medical reports easily and faster. Figure 3 shows one of the physician's screens. The screen is composed of four main sections: the radiographic images display area, the patient's information, the case report area, and the case details.
A variety of experiments and tests were carried out in Saudi Arabia from June to January on the system to explore its functionality and to identify any problems. The experiments were performed to show 1 how the system performs technically and 2 how the end-users perceive the value of the system, in particular, to identify referring physicians' preferences about integrating multimedia tools with teleradiology systems to facilitate real-time and enhanced interaction, and to quantify their perceived value of this system compared with text-based communication alone.
A user observation technique was used for user interface testing. This involved watching and listening carefully to users as they worked with the product. Two categories of users participated in the user interface test: eight physicians and three radiologists. Six user observation sessions took place.
Users were asked to perform a total of 20 tasks selected to test the functional and nonfunctional system requirements of the system. The following tasks were performed: conduct simple and advanced search for a medical case, retrieve archived medical case, view the medical case at different granularities, add a medical case, upload a number of radiographic images, enter a radiology report, establish real-time interaction using voice, video, and text, and support interaction with annotation tools.
Corrective actions were taken to reduce the errors made. The majority of participants viewed each case between one to three times and spent sufficient time on the content. The overall familiarity with the system helped in decreasing the time required and errors made in performing tasks. As regards testing the performance of the speech recognition system, ten radiology reports were tested. Language and size of the report were the only criteria for report selection.
On average a report of words was developed in 2. This was quite acceptable compared with the time and effort saved.
Software training increases the accuracy of speech recognition results. To quantify the referring physicians' perceived value of multimedia technologies and to test the assumptions that referring physicians would value real-time rich interactivity with radiologists, a survey was designed.
Physicians were provided with a full description of the system and a link to try the system. They briefly analysed a patient case to initiate a consultation with a radiologist. The patient cases were delivered in two different modes: text-only reports and full integrated mode text, verbal, image, and real-time interaction. A web-based survey was developed and administered to a test sample of three physicians and then revised.
Experts evaluated the survey for clarity and comprehensiveness. The survey included 25 questions and open-ended comments on advantages and disadvantages of the system and difficulties faced while using it.