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New medical image display devices or processes are commonly evaluated by anecdotal reports or subjective evaluations which are informative and relatively easy to acquire but do not provide quantitative nieasures. On the other hand, experinients eniploying ROC analysis, yield quantitative measurements but are very laborious and demand pathological proof of outcome. We have designed and are employing a new approach, which we have termed "agreement experiments," to quantitatively test the equivalence of observer performance on two systems. This was specifically developed to test whether a radiologist using a new display technique, which has some clear advantages over the standard technique, will detect and interpret diagnostic signs as he would with the standard display technique. Agreement experiments use checklists and confidence ratings to measure how well two radiologists agree on the presence of diagnostic signs when both view images on the standard display. This yields a baseline measure of agreement. Agreement measurements are then obtained when the two radiologists view cases using the new display, or display method, compared to the standard technique. If the levels of agreement when one reads from the new and one reads from the standard display are not statistically different from the baseline measures of agreement, we conclude the two systems are equivalent in conveying diagnostic signs. We will report on an experiment using this test. The experiment compares the agreement of radiological findings for chest CT studies viewed on the conventional multiformat film/lightbox to agreement of radiological findings from chest CT images presented on a multiple screen video system. The study consists of 80 chest CT studies. The results were an 86% to 81% agreement between the two viewing modalities which fell within our criteria of showing agreement.© (1990) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

The revolution in data handling associated with digital systems has excited the medical world into considering replacing existing methods. The integration of digital with analogue video systems into a complete electronic communications network holds tremendous promise. One area where these changes will have significant impact is in medical imaging. The potential of more and better information being,obtained from current studies, more rapid access to studies, intercomparison of images from different modalities, savings in space and equipment, reduced procedure time, improved communication in a distributed department, remote image consultation, and timely data base for management are only some of the advantages that can accrue from proper use of electronic systems. In the hospital, the traditional radiology department is becoming a medical imaging de-partment. To effect a change from the ubiquitous silver halide film base system into a more electronic department will necessitate much experimentation. At the University of North Carolina we are attempting to involve the entire department in these endeavors as well as others such as biomedical engineering, computer science and traditional clinical areas. To facilitate this, a management system has been developed and is being used. The system, our architectural draft of a future department and the initial problems and questions which have arisen from implementing a prototype system will be the subject of this report.© (1982) COPYRIGHT SPIE--The International Society for Optical Engineering. Downloading of the abstract is permitted for personal use only.

A prototype electronic picture information and communication system (PACS) should provide a means to gain practical experience in the use of video communications within a medical center, as well as provide a mechanism to accommodate sophisticated video applications in conjunction with clinical procedures. Such a system under current development at The University of North Carolina, will be described. Installation of the system will initially be within the confines of the radiology area; however it will be expanded to include other medical center locations once an appropriate system has been fully developed and verified.Dr. Edward Staab, presented an overview, describing radiology departmental PACS philosophy and program development. This report will expound upon the development of the prototype PACS to include conceptual approaches for a departmental design technique, communications network development, and test programs and project progress to-date.IntroductionThe University of North Carolina, prototype PACS project has as its initial objective the evaluation of PACS system configurations and components in a clinical environment. This system is being implemented within the North Carolina Memorial Hospital, Radiology Department. Individual PACS modules, including reading stations, picture storage devices, and picture processors are being established and are to be evaluated within a clinical environment. PACS operational parameters are to be evaluated as to their acceptability in 'supporting each individual medical imaging modality. While this approach will provide immediate clinical benefits, initially the main thrust is on evaluation and flexible modification. The system will provide objective operational data as a basis for planning system improvements. Expansion of the prototype PACS can be accomplished by the addition of PACS modules within each department section, as well as providing remote displays within appropriate areas.Over the next decade, we hope to create a PACS, which will provide the following operational capabilities:rapid access to imagesrapid access to data from non-imaging studiesrapid intercomparison of images from different modalitiesdecreased radiation dosage to patients and personnelsavings in space, equipment and personnelreduced procedure timeimproved communications in a distributed departmentremote image consultationThe following will discuss three major issues in the design of a system that can achieve these capabilities by successive evaluation and modification: "(1) Radiology physical plant design, (2) a broad band picture information communications network, and (3) implementation of PACS test programs."Radiology physical plant designPACS systems will change the physical constraints on a radiology department. Presently these constraints include:Radiology examination rooms and support areas must be nearby to enable handling, processing and examination of patients (patient throughput).X-ray film reading areas should be arranged for direct access to examination rooms, yet should provide for physical access to other reading areas for communications among radiologists and with outside clinical housestaff.