Iterative interim techniques for reduced costs and a better mammography workstation: an opinion.

The promise of digital mammography has focused considerable resources on the challenges of mammography workstations, but the risk of wasted time and resources in such efforts is very high. Although final testing of the workstation's image quality and ergonomics is common, a number of interim evaluation and refinement techniques can be applied throughout the design and development process. The use of such techniques holds potential not only to save time and money but also to produce a superior workstation.

A pilot study of eye movement during mammography interpretation: eyetracker results and workstation design implications.

Digital mammography can potentially improve mammography image and interpretation quality. On-line interpretation from a workstation may improve interpretation logistics and increase availability of comparison images. Interpretation of eight 4k- x 5k-pixel mammograms on two to four 2k- x 2.5k-pixel monitors is problematic because of the time spent in choosing which images display on which monitors, and zooming and roaming on individual images that are too large to display completely at full resolution. The authors used an eyetracker to measure radiologists viewing behavior during mammography interpretation with film on a viewbox. It was observed that a significant portion of the mammographers' time is spent viewing "comparison pairs" (typically two or more comparisons per case), such as the left mediolateral and craniocaudal images or old and new images. From the eyetracker measurements, we estimated that the number of image display, roam, and zoom operations decreases from an average of 64 for one monitor to 31 for four monitors, with the largest change going from one to two monitors. We also show that fewer monitors with a faster response time is superior to more monitors with a slower response time. Finally, the authors demonstrate the applicability of time-motion analysis to mammographic workstation design.

Interpretation time of serial chest CT examinations with stacked-metaphor workstation versus film alternator.

PURPOSE: Interpretation time of serial staging chest CT cases, which each contained current and previous examinations, with a simple prototype workstation called filmstack was experimentally compared with interpretation time with a film alternator. MATERIALS AND METHODS: The filmstack displayed a "stack" of sections for each examination; user controls allowed rapid selection of preset attenuation windows and both synchronized and unsynchronized scrolling. Eight radiologists were timed as they used the filmstack and the film alternator to interpret four ergonomically complex serial CT cases. RESULTS: All reports dictated on the basis of findings with filmstack and film were of acceptable clinical accuracy. The time to examine a case with filmstack was significantly faster than the time with film, including the time to load and unload the alternator (99% confidence [P = .01]). There was no statistically significant difference in interpretation time between filmstack and prehung film. CONCLUSION: Use of a low-cost stacked CT workstation with a single 1,024 x 1,024 monitor is an effective means of interpreting cases that require comparison of multiple CT examinations.

Eye movement during computed tomography interpretation: eyetracker results and image display-time implications.

Stacked displays hold the potential for accurate interpretation of multiple computed tomography (CT) studies on a low-cost workstation. But can such a display scroll as quickly as radiologists can move their eyes to the next image on a film? To address this question, eye-movement duration during CT chest interpretation was recorded using an electronic eye tracker. Adjacent eye movements (+/- 1 image in sequence) averaged 0.54 seconds. Time motion analysis indicates that a CT workstation using a stacked approach with a 0.2-second image display time and a simple interaction can display the next image in less than 0.4 seconds, so a stacked approach should allow a low-cost workstation to facilitate acceptable interpretation of multiple CT or magnetic resonance studies. However, nonadjacent eye movements is likely to take longer and radiologist behavior may be effected.

Computed tomography interpretations with a low-cost workstation: a timing study.

An ergonomically simple prototype workstation with two 900 x 1,100-pixel monitors capable of displaying eight full-resolution computed tomography (CT) images in 0.2 seconds, was compared with film for interpretation of computed tomographic images of the chest and abdomen. The hardware platform for this workstation cost less than $11,500 in 1993. A repeated-measures experiment was used to generate average interpretation times of 6.17 minutes for the workstation and 6.03 minutes for the film, including loading and unloading films, with three of the four subjects averaging about a minute longer for each workstation interpretation. All dictated reports were of clinically acceptable accuracy. All radiologists stated that workstations based on this design would be an acceptable clinical tool. However, observation suggested human working-memory strain among infrequent CT readers that could indicate the need for additional training. These data suggest that low-cost workstations can have practical application in interpretation of digital medical images such as CT, with the possibility of small increases in interpretation time.

How many screens does a CT workstation need?

A considerable number of prototype and commercial workstations have been developed during the last 10 years for electronic display of computed tomographic (CT) images during clinical interpretation. These CT workstations have varied widely in the number and size of monitors available for the display of the medical images ranging from a single 1,024 x 1,204-pixel monitor, to eight 2,500 x 2,000-pixel monitors. Image display times also have varied considerably, ranging from as fast as .11 seconds, to as slow as 26 seconds to fill a single monitor. No consensus has formed in the workstation community with regard to display area and response time requirements. To address this issue, we have constructed a time-motion model of CT interpretation. Model accuracy is experimentally verified with three workstations as well as with the film alternator. In general, CT interpretations with an electronic workstation become faster as display area increases and display time decreases. Results can be used by workstation designers and purchasers to roughly estimate differences in interpretation speeds among contending CT workstation designs.

Real-time radiologist review of remote ultrasound using low-cost video and voice.

RATIONALE AND OBJECTIVES: A radiologist practicing remote ultrasound occasionally needs to review a case in real time before releasing the patient. The authors conducted a pilot study to evaluate one solution in which the radiologist views real-time images on a video monitor while conversing with the technologist via a headset telephone. METHODS: Two experienced ultrasonographers and five technologies participated in a 5-week pilot study in adjacent rooms. RESULTS: Subjective assessment indicated that the system could function well enough for use at a remote site. CONCLUSIONS: Although this technology appears effective, an ongoing training environment is recommended.

Interpretation of CT studies: single-screen workstation versus film alternator.

A prototype single-screen workstation with a 2,048 x 2,560-pixel high-brightness monitor, 0.11-second image display time, and simple ergonomic design was compared to a conventional horizontal film alternator in diagnostic interpretation of chest computed tomography (CT) studies. Four radiologists used either the workstation or film alternator in interpretation of studies obtained in 10 patients. A counterbalanced within-subject repeated measures experimental design was used. Response times were analyzed for both methods of interpretation. Grades of excellent, acceptable, and unacceptable were assigned by a blinded "grader" to reports of the radiologists. The average time needed for an interpretation at the workstation was 5.65 minutes. No interpretations were graded unacceptable. Retrospective power analysis showed that 16 observers rather than four would have been required to show that use of the workstation was faster than the alternator. With this 95% confidence interval, the workstation interpretation time is clinically equivalent to that with the alternator. These data show that this type of workstation has practical application in interpretation of CT, magnetic resonance imaging, and ultrasound studies.

Computer human interaction for image information systems.

Increasingly images are being incorporated into computer-information systems, allowing faster and more reliable access to legal documents, fingerprints, medical images, and so on. But designing viable computer-human interactions (CHI) for image-information systems can be particularly difficult. This article presents an overall approach to developing viable image CHI involving user metaphors for comprehending image data, and methods for locating, accessing, and displaying computer images. Since medical-image applications involve almost all image display problems, a medical-image radiology-workstation application is used as a driving example to present critical image CHI issues.

A study of radiologists viewing multiple computed tomography examinations using an eyetracking device.

Understanding the scan patterns radiologists use to view medical images is critical to the design of image viewing devices. In this study, an eyetracker, a device for recording eye and head movement, was used to determine the scan patterns during the interpretation of single and multiple computed tomographic (CT) examinations presented on a four-over-four viewbox. CT examinations were used because they represent complex viewing situations. In two separate studies, radiologists viewed patient folders containing single or multiple CT chest examinations and dictated a report. Eye movement was recorded with an eyetracker and video camera. After mounting the films in order, radiologists generally started with a sequential scan through the entire examination, followed by careful viewing of two to four clusters of three to six images, followed by dictation. These results indicate that a well designed radiology workstation should provide an image index, sufficient display area to simultaneously view 10 or more images, random and sequential movement through the examination, image comparison, and image marking.

Medical image work stations: functions and implementation.

Electronic work stations are becoming a standard means of presenting medical images for diagnosis and consultation, and they will become more wide-spread as picture archiving and communication systems (PACS) come into use. These work stations must allow the user both to perceive the patterns necessary for accurate diagnosis and to "navigate" efficiently within large sets of related images, ie, quickly find and compare desired images. The work stations must operate without a feeling of "fraction" and have an affordable cost. In this report we survey the tasks and system objectives, first regarding the perceptual needs and second with respect to the navigational needs. We then survey the technology available to satisfy these needs and conclude with a list of needed research and technology that can be expected or should be provided in the future.

Effective presentation of medical images on an electronic display station.

In summary, the following should be parts of a useful system for electronic medical image display. 1. All display scales should be linearized. 2. Contrast Limited Adaptive Histogram Equalization should be applied to all slices as they arrive at display. 3. A screen or portion thereof should be dedicated to a low-sampled index of all slices, and navigation among the slices should be accomplished by reference to this index. 4. One second access to any slice or group of slices from the index should be provided.