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Objective: The Virtual Naval Hospital (VNH) is a digital library designed to meet the information needs of U.S. Navy medical professionals. The goal of this study was to determine whether the VNH promoted health and improved patient care in a cost-effective manner.Design and Measurements: An economic analysis determining the costs and benefits from the perspective of the U.S. Navy was conducted. As part of this analysis, medical professionals were surveyed from February to August 2000.Results: Respondents used the VNH for a variety of professional activities (average, 8.2 h/wk). Respondents (70%) thought that VNH usage improved patient care. Medical providers thought it improved their diagnosis (70%) and treatment (60%). Respondents stated that the VNH affected 81 medical evacuations and 668 sick-in-quarter days. Overall content satisfaction was 94%. The VNH had a net savings of $143,848/yr and a cost/benefit ratio of 55.9%.Conclusions: The VNH has a beneficial impact on the Navy's health care system by improving health promotion and patient care and by being economically cost-effective. [ABSTRACT FROM AUTHOR]

Background: There is a dearth of artificial intelligence (AI) development and research dedicated to pediatric radiology. The newest iterations of large language models (LLMs) like ChatGPT can process image and video input in addition to text. They are thus theoretically capable of providing impressions of input radiological images., Objective: To assess the ability of multimodal LLMs to interpret pediatric radiological images., Materials and Methods: Thirty medically significant cases were collected and submitted to GPT-4 (OpenAI, San Francisco, CA), Gemini 1.5 Pro (Google, Mountain View, CA), and Claude 3 Opus (Anthropic, San Francisco, CA) with a short history for a total of 90 images. AI responses were recorded and independently assessed for accuracy by a resident and attending physician. 95% confidence intervals were determined using the adjusted Wald method., Results: Overall, the models correctly diagnosed 27.8% (25/90) of images (95% CI=19.5-37.8%), were partially correct for 13.3% (12/90) of images (95% CI=2.7-26.4%), and were incorrect for 58.9% (53/90) of images (95% CI=48.6-68.5%)., Conclusion: Multimodal LLMs are not yet capable of interpreting pediatric radiological images., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

A thyroid nodule detected clinically or incidentally at medical imaging is a common indication for ultrasonography (US) in the adult population. This scenario is less frequently the case in pediatric patients, and the approach to evaluation of thyroid nodules deserves modification in these patients because of the increased probability of malignancy in children, compared with adults. Evaluating a thyroid nodule with US in a systematic way requires familiarity with a number of features that can be assessed and the terms that the radiologist uses in each category. The probability of malignancy is influenced by certain features, and several models have emerged to integrate these details into an overall risk assessment to guide management and biopsy of thyroid nodules. Clinical features of thyroid cancer differ between pediatric and adult patients, and risk factors and certain genetic syndromes portend earlier manifestation of thyroid malignancy. This article provides a review of (a) US features of thyroid nodules with an emphasis on the predictive capacity for malignancy, focused on the pediatric age group when the data exist, (b) clinical information, including risk factors and genetic syndromes pertinent to the pediatric population, and (c) the state of the current literature and controversies in diagnosing and managing pediatric thyroid cancer. © RSNA, 2017.

Background: U.S. medical education has undergone numerous regulatory changes; to maintain educational consistency and quality, these changes must be met with innovative educational methods., Aim: A formative evaluation of a pediatric digital library (PDL) documenting its content and comparing it to 3 national medical education curricula was performed., Methods: The PDL's weekly cases are written using templates based on specific educational constructs. Cases (N = 150) were evaluated in November 2007. Data was tabulated by age group, specialty, symptom/presentation and disease/problem. Curriculum maps were developed from 3 national curricula and topics were mapped to one or more equivalent PDL topics. Data was tabulated for total national curriculum topics, mapped PDL topics and weekly cases., Results: The cases covered 100% of all pediatric age groups (N = 9) and specialties (N = 42). They covered 85% of the symptoms/problems (N = 127) and 37.2% of the diseases/problems (N = 707). Although the PDL was not explicitly designed to meet these national curricula standards, >80% of the topics in these curricula were covered., Conclusions: The PDL broadly covered national curricular standards and represents an unstructured pediatric curriculum. It offers a complementary and alternative educational method of medical education for educators and learners at all stages of professional development.

A challenge today is how to deliver initial and continuing education on biodefense to military medical providers in a manner that can be integrated into their workflow and lifestyle. A summative evaluation of a prototypical biodefense digital library (BDL) and learning collaboratory was performed. The BDL posted daily links to biodefense news stories from January 2004 to December 2005. Four evaluations were completed, that is, content evaluation, curriculum comparison with a biodefense graduate program, usage evaluation, and impact factor analysis. News stories (N = 678) came from a broad range of authoritative national and international news sources (N = 178). News stories covered all of the categories in the required and elective formal biodefense graduate program courses. The BDL was consistently displayed on the first page of the top three Internet search engines, meaning that it was among the top 10 authoritative Internet sites on biodefense. Presenting biodefense news stories to busy military medical providers in an organized chronological fashion produces an unstructured biodefense educational curriculum that unfolds in practice and becomes an educational resource that is ultimately well regarded and may be efficient to use.

The use of two different educator-centric learning management systems (LMSs), Moodle and Manila, for radiology e-learning was formatively evaluated and the implications of the future use of LMSs in radiology education were explored. NeuroRAD, a neuroradiologic digital library and learning community, is implemented with Moodle, one of the most popular open-source educator-centric LMSs. Pediatric-Education.org, a pediatric digital library and learning community, is implemented with Manila, a commercial educator-centric LMS. Quantitative and qualitative analyses of these LMSs were performed with World Wide Web server log file statistical programs and user-submitted comment forms. In 2005, NeuroRAD was used by 9959 visitors, who read 98,495 pages of information, whereas PediatricEducation .org was used by 91,000 visitors, who read 186,000 pages of information. Visitors represented a wide spectrum of medical learners and used the sites to answer clinical questions; to prepare for lectures, conferences, and informal teaching sessions; and to stay up-to-date and prepare for examinations. Early results indicate that radiology learning communities can be implemented with educator-centric LMSs relatively easily and at low cost by radiologists with minimal computer expertise, and can find receptive and appreciative audiences. Online radiology learning communities could play a significant role in providing education to radiologists the world over throughout their careers., ((c) RSNA, 2007.)

Objective: The Virtual Naval Hospital (VNH) is a digital library designed to meet the information needs of U.S. Navy medical professionals. The goal of this study was to determine whether the VNH promoted health and improved patient care in a cost-effective manner., Design and Measurements: An economic analysis determining the costs and benefits from the perspective of the U.S. Navy was conducted. As part of this analysis, medical professionals were surveyed from February to August 2000., Results: Respondents used the VNH for a variety of professional activities (average, 8.2 h/wk). Respondents (70%) thought that VNH usage improved patient care. Medical providers thought it improved their diagnosis (70%) and treatment (60%). Respondents stated that the VNH affected 81 medical evacuations and 668 sick-in-quarter days. Overall content satisfaction was 94%. The VNH had a net savings of $143,848/yr and a cost/benefit ratio of 55.9%., Conclusions: The VNH has a beneficial impact on the Navy's health care system by improving health promotion and patient care and by being economically cost-effective.

Objective: To meet the information needs of isolated primary care providers and their patients in the US Navy, a digital health sciences library, the Virtual Naval Hospital, was created through a unique partnership between academia and government., Methods: The creation of the digital library was heavily influenced by the principles of user-centered design and made allowances for the nomadic nature of the digital library's patrons and the heterogeneous access they have to Internet bandwidth., Results: The result is a digital library that has been in operation since 1997, continues to expand in size, is heavily used, and is highly regarded by its patrons., Conclusions: The digital library is dedicated to delivering the right information at the right time to the right person so the right decision can be made, and therefore the Virtual Naval Hospital functions as a knowledge-management system for the US Navy Bureau of Medicine and Surgery.

Background: Computer-based patient simulations (CBPS) are common, effective, instructional methods for medical students, but have limitations. The goal of this project was to describe the development of a CBPS designed to overcome some of these limitations and to perform an online evaluation., Methods: In 1996, patients and families experiencing a common pediatric problem were interviewed, photographed and a chart review completed. A digital storytelling template was developed: 1. patient's story, evaluation and clinical course, 2. problem-based approach to the evaluation, and 3. discussion of disease process. The media was digitized and placed onto the Internet. The digital stories and a 10-question online survey were pilot tested. Online survey responses were collected from 1999-2003. Overall use of the digital stories was measured by computer server logs and by the number of hyperlinks to the CBPS., Results: Eight stories were created using this system. Over 4.5 years, 814,148 digital story pages were read by 362,351 users. Hyperlink citations from other websites to the CBPS were 108. Online survey respondents (N = 393) described the overall quality as excellent or very good (88.4%). The stores were clearly written (92%) at an appropriate level (91.4%). Respondents felt they could begin to evaluate a similar case presentation (95.4%), and would remember the case in the future (91%)., Conclusions: A new type of CBPS, the digital storytelling system, has been developed and evaluated which and appears to be successful in overcoming some of the limitations of earlier CBPS by featuring patient's stories in their own words, by focusing on problems rather than diseases, and by having stories that are quick for students to work through.

Background: Unsolicited electronic mail (e-mail) is e-mail sent to a physician from a person unknown to the physician, who is seeking professional help. The purpose of this project was to analyze unsolicited e-mails sent to a digital textbook author to: 1) characterize the e-mails, 2) determine what resources would be necessary to answer the e-mails, and 3) propose a standard approach to reply to e-mails in a helpful yet medicolegally-responsive manner., Materials and Methods: All e-mails (315) sent to a digital textbook author from October 1995 through October 1998 were abstracted. Variables included: date and location, sender type, patient age, subject, medical content, and resources necessary to answer the question. Data frequencies were obtained., Results: The most common location was the.com domain (47.6%). The most common senders were laypersons (66%). Overall, 44.4% of the e-mails concerned children. Detailed, patient-specific information was sent in 63.2% of the e-mails. The most common subjects were overviews of a disease or problem (32.4%), differential diagnosis (16.8%), and therapy/treatment questions (15.9%). The medical content covered a broad range of specialties. Specialists were overwhelmingly the resource necessary to answer the e-mails (74.9%)., Conclusions: Pediatricians with educational information on the Internet can expect an increase in the number of unsolicited e-mails as Internet usage expands. Laypersons regard even short passages to mean the author is an expert in that particular area. Pediatricians need to consider the ethical and medicolegal implications of responding to unsolicited e-mails. A nonpersonalized, standard e-mail reply is proposed that directs the sender to quality information resources that may be of further assistance. unsolicited electronic mail, e-mail, medical informatics, legal issues, ethical issues, digital libraries.

During the creation of a university digital library and press intended to serve as a medical reference and education tool for health care providers and their patients, six distinct and complex digital publishing challenges were encountered. Over nine years, through a multidisciplinary approach, solutions were devised to the challenges of digital content ownership, management, mirroring, translation, interactions with users, and archiving. The result is a unique, author-owned, internationally mirrored, university digital library and press that serves as an authoritative medical reference and education tool for users around the world. The purpose of this paper is to share the valuable digital publishing lessons learned and outline the challenges facing university digital libraries and presses.

Extracranial magnetic resonance angiography (MRA) was performed in 20 children to evaluate for various arterial and venous conditions. Time-of-flight and phase-contrast angiograms were constructed using a maximal-intensity-projection algorithm. The accuracy of MRA was comparable to Doppler ultrasound (n = 12) and conventional angiography (n = 3). MRA could provide an excellent mapping of patent (including collaterals) versus thrombosed vessels at sites not evaluated or inaccessible by sonography. Limitations included assessment of small and/or tortuous vessels, severely stenotic lesions, and very slow flow.

Study Objectives: Continuing medical education (CME) is meant to bridge the gap between new scientific observations and clinical practice. However, traditional CME has not been effective at altering the behaviors of physicians. One reason for this failure of traditional CME programs may be their inflexibility. In traditional CME, the clinician does not choose the topic, the pace of the program, or the place of learning, and the CME material cannot be easily delivered to the point of care where the clinician needs the information. Computers and computer networks have the potential to accomplish these goals. CME has begun to appear on the Internet; however, there have been few evaluations of its usefulness, acceptance, and effectiveness. Over the last 18 months, we have developed three on-line pulmonary CME programs, and we have delivered them on the Virtual Hospital, the University of Iowa's digital health sciences library on the Internet. We report our initial experience with this CME material., Design: We measured the frequency with which the Internet-delivered CME is accessed by monitoring page accessions and by using a log file analysis program (Analog 1.2.3; University of Cambridge Statistical Laboratory; Cambridge, UK). In addition, we collected all completed CME examinations and evaluation forms submitted by registered users., Measurements and Results: We have found that the frequency with which the Internet-delivered CME is accessed has continued to increase with time (2.3-fold increase over 18 months), that evaluations of technical and content issues are strongly favorable, and that some clinicians have been willing to pay to receive CME through the medium of the Internet., Conclusions: We feel that with adequate peer review and quality control, physicians will use the Internet-delivered CME. However, several obstacles to wide use remain. These obstacles include issues regarding training in using the Internet for physicians, reluctance of physicians to participate in on-line commerce, and the current unavailability of CME to be delivered in small-grained quantities to the point of care. As these issues are addressed, we feel that on-line CME will represent an increasingly important CME medium for clinicians.

Objective: To optimally practice medicine, and to live healthy lives, providers and patients need convenient access to authoritative information. The goal of this study was to determine the information needs of naval primary care providers and patients at sea to aid development of a digital health sciences library for naval primary care providers and patients., Method: A literature-based needs assessment was conducted from articles identified using MEDLINE searching and U.S. Navy health care information sources. Recurring medical problems/diseases/topics were identified and categorized., Results: Eighty-one articles and books were reviewed and abstracted, representing a broad base of naval medicine. Twenty-one medical and surgical theme areas and 125 medical problems/diseases/topics were recurrently identified., Conclusions: The common naval medical problems identified are nearly identical to the common medical problems in the general population, have changed little from the 18th century, and were consistent with first-hand information from naval primary care providers.

Rationale and Objectives: The authors performed a baseline analysis of the information needs and information-seeking behaviors of on-call radiology residents to learn how to better serve their on-call information needs in the future., Materials and Methods: Print, electronic, and human information resources were made conveniently available to on-call radiology residents. A prospective, descriptive study was performed by using a modification of the critical incident technique to gather data from the residents every morning after being on call. Residents were asked to recall questions that arose, whether they sought answers to the questions, where they searched for answers, whether their search was successful, and whether they believed that patient care was affected., Results: The residents had 182 questions that encompassed all organ systems, imaging modalities, and aspects of radiologic practice. Residents sought answers to 138 of the 182 questions (76%) by using a wide variety of resources, with staff members and textbooks being the most common. They found answers to 114 of 138 questions (83%); 100 of the 114 (88%) answered questions affected patient care., Conclusion: The ideal way to meet the information needs of on-call radiology residents is to devise an authoritative information resource that is compatible with their information-seeking behaviors.

Background: To practice pediatric radiology optimally, radiologists need convenient access to organized and authoritative pediatric radiology information. The Internet has the potential for offering such convenient access, but the majority of information on it is poorly organized and of questionable authority., Objective: The goal of this project was to create and curate a pediatric radiology digital library that will make the Internet a useful reference tool for the radiologist at the point-of-care., Materials and Methods: A pediatric radiology digital library containing organized and authoritative pediatric radiology information from the Internet was created and has three components : (1) PediatricRadiology.com (http://pediatricradiology.com)--a catalog of pediatric radiology Web sites; (2) The MetaTextbook of Pediatric Radiology (http://www. vh.org/Providers/TeachingFiles/MetatextbookPedRad/MetaTBP edRad.html)--a catalog of pediatric radiology teaching file cases on the Internet; and (3) Paediapedia (http://www.vh. org/Providers/TeachingFiles/PAP/PAPHome.html)--an imaging encyclopedia of pediatric disease. The pediatric radiology digital library is curated regularly., Results: Over 7 months, 223,689 pages of information were read and 26,972 images were viewed in the pediatric radiology digital library by 69,866 individual users, with 20% of the users from outside the United States., Conclusion: Creating a pediatric radiology digital library that identifies and organizes authoritative pediatric radiology information and makes it conveniently available can allow radiologists to use the Internet productively as a reference tool.

Objective: To deliver optimal patient care and promote wellness, naval providers and patients require convenient access to medical information from isolated duty stations. The Internet can lower barriers to accessing information. The goal of this study was to determine the technical feasibility of using the Internet to deliver medical information to isolated naval points of care., Methods: A digital library for naval primary care providers and patients with an integrated, problem-based interface was developed. The Virtual Naval Hospital (http:/(/)www.vnh.org) was evaluated from sea, undersea, and shore., Results: The digital library was a popular resource. Access to it is currently limited because few ships have Internet access., Conclusions: The technical feasibility of delivering a digital library of medical information to the deckplates was proven. The digital library will realize its potential when satellite-based access to the Internet becomes available. In the interim, the digital library will also be distributed on CD-ROM.

Background: Digital health sciences library (DHSL) evaluation involves studying the usage of the DHSL by individuals as well as populations. The purpose of this study was to evaluate trends in overall usage of a DHSL as part of a process of continuous quality improvement in order to learn how to enhance a DHSL in order to meet its users' needs better., Methods: Web server log file analysis was performed on a prototype DHSL, the Virtual Hospital, using two log file analysis programs on data from the month of February over four consecutive years, 1995 to 1998., Results: Overall DHSL usage increased between 1995 and 1997 and leveled off in 1998. Fifteen percent of usage came from countries outside the United States. A broad spectrum of medical information for health care providers and patients was accessed and centered around specialty medical information., Conclusions: To be of optimal assistance to users, DHSLs should (1) contain a broad base of information on common and uncommon medical problems, (2) accommodate the needs of the significant percentage of users that are international through content translation and mirroring, and (3) ensure they are indexed and catalogued in the major Web search engines and Web general and medical indices so they can be easily found by users.

Background: Rural physicians need access to digital health sciences libraries (DHSLs) that is easy and reasonably rapid. The goal of this project was to study rural hospitals' access to a DHSL on the Internet, by comparing differing access speeds with differing costs and their acceptability for retrieving text, image, and video information in a DHSL., Methods: DHSL system response time was measured at three different times during the day over three different types of network connections (T1, Frame Relay, Modem). Text, image, and video information was retrieved. Costs were determined for installation and operation of the different types of network connections., Results: System response times were consistent at the three different testing times for each media type retrieved by each of the three network connection types. System response times for text retrieval met literature standards for all connections. Image retrieval met literature standards for T1 and Frame relay connections. No connection met literature standards for video retrieval., Conclusions: High speed access to DHSLs is preferable; Frame relay connections provide substantively similar service as T1 connections at less cost. However, access via modem to a DHSL can provide access to the majority of information--text--in a DHSL with an acceptable system response time.

Background: Rural physicians need access to quality medical information, but accessing information is difficult in rural settings. Digital health sciences libraries (DHSLs) offer the potential to make information more accessible to rural physicians. A telemedicine network was deployed to six rural hospitals in Iowa. Computers were installed allowing access to a DHSL and training sessions were held. The purpose of this study was to examine the barriers to use of a DHSL by rural physicians., Methods: Approximately one year after deployment of the telemedicine network, physicians were surveyed using a modified critical incident technique., Results: Seventy percent of the eligible physicians responded and 33% had used the DHSL. Primary barriers included insufficient training, being too time consuming to use, and distance of computers from physicians' practice sites. Non-DHSL users cited the difficulty of using the DHSL as their greatest barrier, while DHSL users cited the quality of the information resources., Conclusions: This study identifies a number of barriers that exist to rural physicians use of a DHSL. Potential solutions to these barriers are discussed. DHSLs will finally reach their potential when they can be delivered by easy to use handheld computers seamlessly integrated into the rural physician's workflow.

Background: The goal of this prospective, cross-sectional study was to determine the user demographics of a digital health sciences library (DHSL), motives for use, the nature of users information requests, and success rate in finding answers., Methods: The content of 500 consecutive electronic mail messages (e-mails) submitted to a DHSL were analyzed using a predetermined coding scheme. Data were entered into a database and frequency analysis was performed., Results: The number of information requests from the 500 e-mail messages was 751. The largest sender category was patients and laypersons followed by students, then physicians. Motivations for use were primarily medical advice (42.8%) and patient care (13.8%). E-mail subject areas were mainly medical (61.8%) and technical (20.6%). Answers to information requests were found 54.3% of the time and senders felt the DHSL was valuable (97.8%)., Conclusions: A DHSL is a valuable medical resource. DHSLs must serve the broad information needs of patients and laypersons in addition to health care providers. Developers and managers of DHSLs can use this information to guide future development of DHSL information content and services, as has been done at The University of Iowa.

A university and its faculty encompass a wealth of content, which is often freely supplied to commercial publishers who profit from it. Emerging digital library technology holds promise for allowing the creation of digital libraries and digital presses that can allow faculty and universities to bypass commercial publishers, retain control of their content, and distribute it directly to users, allowing the university and faculty to better serve their constituencies. The purpose of this paper is to show how this can be done. A methodology for overcoming the technical, social, political, and economic barriers involved in creating, distributing and organizing a digital library was developed, implemented, and refined over seven years. Over the seven years, 120 textbooks and booklets were placed in the Virtual Hospital digital library, from 159 authors in twenty-nine departments and four colleges at The University of Iowa. The digital library received extensive use by individuals around the world. A new paradigm for academic publishing was created, involving a university and faculty owned peer reviewed digital press implemented using digital library technology. The concept has been embraced by The University of Iowa, and it has pledged to sustain the digital press in order to allow. The University of Iowa to fulfill its mission of creating, organizing, and disseminating information better.

Physicians and patients need convenient access to quality medical information. This study's goal was to place a medical resource on the World-Wide Web (WWW), allow access to it through a simple to use interface, and analyze the usage of such a resource. The Family Practice Handbook (TFPH) was digitized and placed onto the WWW. Usage data was obtained from June 1995-June 1996. 118,804 individuals accessed TFPH viewing 409,711 pages of information. A broad spectrum of topics was accessed. TFPH proved to be an extremely popular resource, servicing the broad information needs of an international audience. These preliminary findings suggest the future promise of Internet medical resources.

SPR Online (http:@www.pedrad.org) is a recently developed digital representation of the Society for Pediatric Radiology (SPR) that enables physicians to access pertinent information and services on the Internet. SPR Online was organized on the basis of the five main services of the SPR, which include Administration, Patient Care, Education, Research, and Meetings. For each service, related content from the SPR was digitized and placed onto SPR Online. Usage over a 12-month period was evaluated with server log file analysis. A total of 3,209 users accessed SPR Online, viewing 11,246 pages of information. A wide variety of information was accessed, with that from the Education, Administration, and Meetings services being the most popular. Fifteen percent of users came from foreign countries. As a virtual professional society, SPR Online greatly enhances the power and scope of the SPR and has proved to be a popular resource, meeting the diverse information needs of an international community of pediatric radiologists.

As part of a digital health sciences library's continuous quality improvement process, a digital textbook of common medical problems was created which contained links to authoritative medical information on the Internet for patients and health care providers. The accomplishments of this project were the: 1) Identification of 50 common medical problems, 2) Development of a methodology for identifying authoritative medical information related to these problems, 3) Creation of a digital textbook containing links to this information with a problem-based interface, 4) Development of a methodology to allow local peer review of this information, and 5) Evaluation of the use of the information and the local peer review methodology.

Rationale and Objectives: The authors assessed the radiologic educational content of a pediatric morning report teaching conference to determine ways of improving radiologic education of pediatric residents., Materials and Methods: The authors conducted a prospective, observational study from September 1995 to June 1996. Data collected from conference case presentations included types of radiologic studies shown and unanswered radiologic questions., Results: During 388 case presentations, 559 radiologic studies were shown. Imaging modalities most commonly shown were plain radiography, computed tomography (CT), and ultrasound. The most common types of images shown were chest and abdominal plain radiographs and head CT scans. Common unanswered questions concerned radiologic study indications and techniques and radiologic appearance of diseases., Conclusion: Pediatric residents must learn basic radiologic interpretation methods, imaging approaches to common problems, and ways of using the radiologist as a consultant. A large part of their radiologic education occurs in morning report, from nonradiologists. Participating in a morning report is an important way for radiologists to enhance the education of primary care residents.

Objective: We performed a field study and subsequent laboratory investigation of pediatric radiology at a small rural hospital. Our investigation had three components: to describe the characteristics of pediatric radiology in a rural primary care facility, to test the diagnostic accuracy of interpretation of pediatric images transmitted by teleradiology, and to compare relative diagnostic accuracy of general and pediatric radiologists who interpreted pediatric images at a rural institution., Materials and Methods: All 196 pediatric radiographs obtained during a 4-month period comprised the database from which we determined practice characteristics. Reports of 153 unselected cases interpreted by general radiologists using teleradiology were compared with interpretation of the same cases by a pediatric radiologist who interpreted the original radiographs. Discrepant cases were further investigated by a receiver-operating-characteristic curve experiment in which general and pediatric radiologists interpreted each case twice: once viewing teleradiologic images and once viewing the original radiographs at another setting. We then compared interpretive accuracy of observers and techniques., Results: The pediatric radiographs were predominantly simple examinations for common acute disease, particularly pneumonia and fractures. Discrepancies of interpretation between teleradiology and original radiographs, which occurred in 13% of images, showed no significant difference in accuracy of interpretation for either teleradiologic images or original radiographs. Likewise, we found no significant advantage for accuracy of interpretation by general or pediatric radiologists. Receiver-operating-characteristic analysis of 18 discrepant cases showed slightly increased accuracy for interpretation of original radiographs by pediatric subspecialists., Conclusion: Simple pediatric radiographs obtained at a rural primary care institution and transmitted by teleradiology can be adequately interpreted by general radiologists.

Researchers at the University of Iowa are developing an integrated academic information management system (IAIMS) for use on the World Wide Web. The focus is on integrating continuing medical education (CME) into the clinicians' daily work and incorporating consumer health information into patients' life styles. Phase I of the project consists of loosely integrating patients' data, printed library information, and digital library information. Phase II consists of more tightly integrating the three types of information, and Phase III consists of awarding CME credits for reviewing educational, material at the point of patient care, when it has the most potential for improving outcomes. This IAIMS serves a statewide population. Its design and evolution have been heavily influenced by user-centered evaluation.

The appearance of pulmonary nodules in a child with a solid malignancy undergoing chemotherapy is a clinically worrisome event. The diagnosis in such cases is not always metastatic disease, and the differential diagnosis should include granulomatous disease, atelectasis, pneumonia, inflammatory pseudotumor, hamartoma, radiation pneumonitis, and bronchiolitis obliterans with organizing pneumonia. There is no consistent radiologic feature to help distinguish benign from malignant causes of these new lesions. However, repeat chest CT 4-6 weeks after the lesions are first noted can be used to track lesion progression and may obviate the need for biopsy.

Physicians in the clinical setting remain isolated from important sources of medical information. The authors have created a multimedia database known as The Virtual Hospital that improves access to current medical data, which is used to improve patient care decisions. The Virtual Hospital is a digital health sciences library stored on a server (computer) at The University of Iowa and delivered via the Internet to inexpensive personal computers in the workplace. The emerging standard of the World Wide Web is used to provide cross-platform distribution.

We report central pontine myelinolysis in orthotopic liver transplant patients. Sequential MR imaging of these patients with central pontine myelinolysis shows progressive decrease of T2-weighted MR signal in the pons, which may not resolve despite complete neurologic recovery.

Objective: To compare the instructional effectiveness and efficiency of a pediatric multimedia textbook (MMTB) with that of a standard lecture and of a printed textbook in a prospective, interinstitutional study., Design: Randomized, prospective cohort., Settings: An urban and a rural medical school affiliated with tertiary care hospitals., Population: Third- and fourth-year medical students from June 1992 to June 1993. INTERVENTIONS/OUTCOME MEASURES: Students were randomized to one of four treatment groups: (1) computer-aided instruction with MMTBs (n = 39), (2) traditional lecture (n = 39), (3) printed textbook (n = 39), or (4) a control group (n = 62). Only the control group was pretested. Following their randomized instruction, all groups were tested via a 26-question multiple-choice test. Statistical analysis was accomplished by analysis of variance of mean post-test scores. The amount of time that students spent with each educational intervention was recorded., Results: Three hundred two students were eligible for the study, 267 entered the study, and 179 completed the study. The instructional effectiveness of the MMTB was greater than that of the lecture (P < .05), and it was the same as that of the printed textbook. All instructional methods were more effective than the control group (P < .05). The instructional efficiency of the MMTB was equal to that of the lecture and of the printed textbook. The subjective response to the MMTB instruction was positive., Conclusion: The MMTBs constitute an educationally sound alternative instructional method and have a promising future in medical education.

Radiologists need constant, convenient access to current information throughout the course of their daily work. Today most learning in radiology is obtained from the printed word in books, journals, and teaching files, supplemented by the spoken word in lectures and conferences. Although learning from printed material and lectures has been proved efficacious over time, these media share the disadvantage of not being conveniently available for reference during the course of daily work at the alternator or in the examination room when accurate and up-to-date information is needed the most. As a result, many important questions about patient care go unanswered. We have developed a technique--hand-held digital books--to lower this barrier to searching and retrieval. When radiologists have a digital library that can be carried with them, they will be able to incorporate current radiology information into their daily decision making. We describe a technique for creating hand-held digital books and their future use in radiology.

A high quality film-based teaching file requires effort and expense to create and maintain. The effort is worthwhile because film collections are important vehicles for increasing a radiologist's personal data base of clinical experience. Expert clinical reasoning is to a large extent the process of comparing a current case to a data base of individual cases available in memory. A teaching file would be most helpful if it were available at the view box where it could be used to extend a radiologist's clinical experience. Unfortunately, a film-based file is confined to one area, usually remote from the view box. In addition, searching though a film file is difficult, the films wear out over time, and films are easily lost or stolen. Our goal is the creation of a thoracic imaging teaching file that solves these problems by providing a digital collection of images, videos, and text that can be used in the work place by many users simultaneously. The first part of this teaching file is now continuously available locally within our department and globally to users of the Internet.

Objective: The purpose of this project was to create an approach for global radiology multimedia publishing using the internet that would address the two largest problems facing radiology multimedia publishers today: the high percentage of radiologists who are computer novices and the variety of personal computers (Macintosh, Microsoft Windows/IBM-PC, X-Windows, Amiga) whose software is incompatible., Materials and Methods: We developed a client/server approach to multimedia publishing, the networked multimedia textbook, that has a simple booklike user interface to facilitate use by computer novices. Once created, a networked multimedia textbook can be viewed on all current popular personal computers. The networked multimedia textbook is based on the internet, World-Wide Web, Mosaic, and Wide Area Information Servers software technologies, all of which are in the public domain., Results: We created six radiology networked multimedia textbooks., Conclusion: This networked multimedia textbook approach for the global distribution of multimedia radiology information brings the benefits of multimedia publishing on the Internet to radiologists today.

Rationale and Objectives: The purpose of this prospective randomized study was to compare the long-term instructional effectiveness of a computer-based radiology multimedia textbook (MMTB) with that of a traditional lecture., Methods: Volunteer faculty/fellows and residents were randomly assigned to either a computer-based MMTB group or to a lecture group. The course content for each instructional group was the same. Pretests, posttests, and 1-year long-term retention tests were administered to both groups. The same 10 questions were on all tests. The resulting data were analyzed using analysis of variance procedures available on the Statistical Analysis System., Results: A comparison of the long-term instructional effectiveness of an MMTB versus a lecture showed that the MMTB computer instructional method was at least comparable in spite of the initial short-term appearance of lecture superiority., Conclusion: These results suggest a promising future for MMTB and other forms of computer-based education in radiologic instruction for medical students and radiologists.

Medical training in radiology should be viewed as a continuum that begins in medical school and proceeds throughout the years in practice. Unfortunately, there are significant barriers to providing continuing medical education. One key barrier is the physical separation between the information source and the workplace. A multimedia medical library distributed via wide area networks has been developed that provides needed information at the point of use. The distribution software (Mosaic) that makes this project possible is found in the public domain.

Textbooks are now available via computers. These new electronic or multimedia textbooks appears similar to conventional books but differ in function. In addition to text and images, they contain video and audio clips and allow readers to interact with the content. Multimedia textbooks contain digital media, can be quickly and inexpensively updated and repurposed for lectures and handouts, and are available on-line via computer networks for distance learning. We present the concept of computer-generated multimedia text-books; describe their creation by an easy-to-use, sophisticated authoring system; and describe the underlying instructional design approach to guide future authors of multimedia textbooks.

Educational Technology Network (ET Net) is a free, easy to use, on-line computer conferencing system organized and funded by the National Library of Medicine that is accessible via the SprintNet (SprintNet, Reston, VA) and Internet (Merit, Ann Arbor, MI) computer networks. It is dedicated to helping bring together, in a single continuously running electronic forum, developers and users of computer applications in the health sciences, including radiology. ET Net uses the Caucus computer conferencing software (Camber-Roth, Troy, NY) running on a microcomputer. This microcomputer is located in the National Library of Medicine's Lister Hill National Center for Biomedical Communications and is directly connected to the SprintNet and the Internet networks. The advanced computer conferencing software of ET Net allows individuals who are separated in space and time to unite electronically to participate, at any time, in interactive discussions on applications of computers in radiology. A computer conferencing system such as ET Net allows radiologists to maintain contact with colleagues on a regular basis when they are not physically together. Topics of discussion on ET Net encompass all applications of computers in radiological practice, research, and education. ET Net has been in successful operation for 3 years and has a promising future aiding radiologists in the exchange of information pertaining to applications of computers in radiology.

Rationale and Objectives: Information overload is a significant problem for the modern radiologist. This prospective study compares the instructional effectiveness of a multimedia textbook (HyperLung) with a lecture. HyperLung is a radiologic multimedia textbook about imaging diffuse lung disease created using a multimedia authoring tool, the Annotator (the University of Iowa Second Look Computing, Iowa City, IA), on the Apple Macintosh computer (Apple Computer, Cupertino, CA)., Methods: Forty-nine staff physicians and residents in the Department of Radiology were randomized to receive instruction either by HyperLung or by a lecture. The instructional content was the same in both groups, and both groups were tested before and after instruction. The actual time spent in each instructional situation was recorded., Results: The instructional effectiveness of the multimedia textbook and lecture was equal. The instructional efficiency of HyperLung was only 60% of the lecture. Users of the multimedia textbook found it enjoyable and straightforward to use., Conclusions: Multimedia textbooks have a promising future in radiology education.

We developed a standardized approach for creating computerized multimedia textbooks based on four principles: (1) multimedia textbooks should resemble printed books, (2) the creation of multimedia textbooks should be relatively inexpensive, (3) multimedia textbooks should be completely digital, and (4) the construction of multimedia textbooks should be simple. To facilitate this approach, an inexpensive, user-friendly multimedia authoring tool called The Annotator was used. The Annotator, a Hypercard-based program that runs on any Macintosh computer, helps authors rapidly create sophisticated radiologic multimedia textbooks. This program provides a textbooklike shell that can be filled with digitized media (video clips, audio clips, images, and text). This approach, which is applicable to any multimedia hardware platform, allows the authorship of multimedia textbooks that can be easily transported to any future multimedia platform.