Functional requirements as an integral part of the design and development process: summary and recommendations.

The Health Care Professional Workstation (HCPW) provides a portal to the health care system as a whole. Through this portal the health care professional must be able to carry out a wide variety of tasks in an integrated fashion. Traditional health care information systems have not been designed to support this kind of use, so the functional requirements development process must be capable of leading to an architecture and components for a system that will support such use. A variety of approaches may be employed to develop functional requirements, which may be used singly or in combination. Recommendations for this activity center on domain delineation, evaluation efforts to establish the most effective approaches, detailed functional requirement development, evaluation of the developed functional requirements, creation of shared resources, and education and training in the use of the tools and methodologies.

The emphysemas: radiologic-pathologic correlations.

There are several forms of emphysema that should be considered as distinct disease entities. No university accepted classification system of these forms exists, but correlations of autopsy findings in 1,823 cases over a 12-year period confirm that the radiographic and pathologic features of the emphysemas are readily understood when centrilobular, panlobular, paracicatricial, and localized types of the disease are recognized. Centrilobular emphysema associated with cigarette smoking is the most common form. Panlobular emphysema is associated with alpha 1-protease inhibitor deficiency and pathologically produces uniform enlargement of all air spaces, with a mild basilar predominance. Paracicatricial emphysema is seen adjacent to areas of parenchymal scarring. Localized emphysema represents focal enlargement or destruction of air spaces with otherwise normal lung. A clear understanding of the computed tomographic appearance of all forms of emphysema is essential for the correct diagnosis of parenchymal lung abnormalities.

Proposed multi-modality network to support image acquisition at remote sites.

There is a growing tendency for planners to permit non-radiologists to install isolated radiographic facilities with fluoroscopy in clinical specialty areas. These dedicated facilities are thereby frequently removed from support by radiology. Examples include endoscopy, urology, pulmonology, cardiology, surgery, intensive care, and orthopedics. A multi-modality network tying these remote sites to radiology can restore radiological support. Radiologists can participate in image acquisition procedures even though the procedures are no longer performed in the radiology department. A network also provides the isolated facility with technical support (laser printing, mass storage, etc.) that cannot be economically duplicated for each separate specialty site. A clinical model emphasizing the role of electronic networks in supporting image acquisition (in addition to image display) is undergoing the first phase of implementation at the Veterans Affairs Medical Center (VAMC) in Durham, North Carolina. The planned multi-modality network uses endoscopy as the acquisition model. Both the VAMC network and its extension to the sophisticated endoscopy suite at nearby Duke University Medical Center will be described.

Information integration for the imaging specialist.

Medical imaging is an information business of rapidly increasing complexity. Imaging practice and imaging information support systems are inseparable. How both operate and how they ought to operate can be considered productively in terms of system theory. This concluding article on some practical system principles, therefore, presents one way of thinking about the rest of the volume.

Introduction to computer systems in diagnostic radiology.

Diagnostic radiology is immensely complex. It involves a consultation process, patient handling to produce images, and advanced technology. Computers have been applied extensively to these processes, and examples are given of some of these applications. Fully integrated computerized radiology systems have been an elusive goal. Integrity of patient data is probably the key to integration. Progress in the field continues.

Computers and diagnostic radiology: the state of the art of meeting medical care objectives.

The term "state of the art" applied to medical technology should stimulate consideration of medical objectives as well as comparison of similar equipment. A communications model of the consult process is presented and examined using the diagnostic radiologist as the example. Examples of computer applications relating to the model are discussed, and some future possibilities for using computers to enhance the consultant's ability to meet medical objectives are suggested.