[Survey of the Requested Function for Quality Assurance System for Images (Kenzo System)].

As the use of filmless examination images, using various systems, has increased, and became common to perform KAKUTEI and save the images. In particular, the use of quality assurance system for images (Kenzo system) has increased to ensure the efficient performance of confirmed image. However, there has been no report showing what kind of function should be used or how to write the specifications of such a function in introducing the Kenzo system. Therefore, this study conducted a survey to the in-charge medical staff of medical institutions to provide "information included in the specifications when introducing medical systems". As a result, it is possible, through analyzing and clarifying the necessary functions of the Kenzo system, to apply it in medical institutions with various scales and workflows. The results indicate the person in charge was looking for functions, such as "coordination of information and image processing, securing the consistency of the information, and clarifying responsibility using the records of confirmed persons". We showed examples of how to describe these in the specifications.

AUTOMATIC ACQUISITION OF CT RADIATION DOSE DATA: USING THE DIAGNOSTIC REFERENCE LEVEL FOR RADIATION DOSE OPTIMIZATION.

The present work describes that we try to construct a system that collects dose information that performed CT examination from multiple facilities and unified management. The results of analysis are compared with other National diagnostic reference level (DRL), and the results are fed back to each facility and the cause of the abnormal value is investigated for dose optimization. Medical information collected 139 144 tests from 33 CT devices in 13 facilities. Although the DRL of this study is lower than that of Japan DRL, it was higher than the DRL of each country. When collecting all the examination, it is thought that the variation of the dose due to the error other than the intended imaging site is large. In future, we should continue to collect information in order to DRL renewal and we also think that it is desirable to collect information on physique and detailed scan region as well.

Construction of mammographic examination process ontology using bottom-up hierarchical task analysis.

Describing complex mammography examination processes is important for improving the quality of mammograms. It is often difficult for experienced radiologic technologists to explain the process because their techniques depend on their experience and intuition. In our previous study, we analyzed the process using a new bottom-up hierarchical task analysis and identified key components of the process. Leveraging the results of the previous study, the purpose of this study was to construct a mammographic examination process ontology to formally describe the relationships between the process and image evaluation criteria to improve the quality of mammograms. First, we identified and created root classes: task, plan, and clinical image evaluation (CIE). Second, we described an "is-a" relation referring to the result of the previous study and the structure of the CIE. Third, the procedural steps in the ontology were described using the new properties: "isPerformedBefore," "isPerformedAfter," and "isPerformedAfterIfNecessary." Finally, the relationships between tasks and CIEs were described using the "isAffectedBy" property to represent the influence of the process on image quality. In total, there were 219 classes in the ontology. By introducing new properties related to the process flow, a sophisticated mammography examination process could be visualized. In relationships between tasks and CIEs, it became clear that the tasks affecting the evaluation criteria related to positioning were greater in number than those for image quality. We developed a mammographic examination process ontology that makes knowledge explicit for a comprehensive mammography process. Our research will support education and help promote knowledge sharing about mammography examination expertise.

Development of Clinical Database System Specialized for Heavy Particle Therapy.

We have developed a data archiving system for study of charged particle therapy. We required a data-relation mechanism between electronic medical record system (EMR) and database system, because it needs to ensure the information consistency. This paper presents the investigation results of these techniques. The standards in the medical informatics field that we focus on are Integrating the Healthcare Enterprise (IHE) and 2) Health Level-7 (HL7) to archive the data. As a main cooperation function, we adapt 2 integration profiles of IHE as follows, 1) Patient Administration Management (PAM) Profile of IHE-ITI domain for patient demographic information reconciliation, 2) Enterprise Schedule Integration(ESI) profile of IHE-Radiation Oncology domain for order management between EMR and treatment management system(TMS). We also use HL7 Ver2.5 messages for exchanging the follow-up data and result of laboratory test. In the future, by implementation of this system cooperation, we will be able to ensure interoperability in the event of the EMR update.

Constructing mammography examination process ontology using affinity diagram and hierarchical task analysis.

Mammography is complex and difficult for beginner radiologic technologists (RTs) because knowledge and technical skills rely on one's experience, and it is often difficult for experienced RTs to verbally explain the process to co-workers or beginners. The purpose of this study was to construct a mammography examination process ontology for knowledge sharing among RTs and propose a new ontology construction method using an affinity diagram (AD) and hierarchical task analysis (HTA). First, tasks collected by brainstorming were clustered and connected using the AD. Subsequently, a hierarchical structure was constructed based on the clusters and relations determined in the AD. Finally, a mammography process ontology was determined based on the relations noted in the AD and HTA. As a result, the ontology contained 203 classes and 669 relations.

Forecasting the absolute and relative shortage of physicians in Japan using a system dynamics model approach.

BACKGROUND: In Japan, a shortage of physicians, who serve a key role in healthcare provision, has been pointed out as a major medical issue. The healthcare workforce policy planner should consider future dynamic changes in physician numbers. The purpose of this study was to propose a physician supply forecasting methodology by applying system dynamics modeling to estimate future absolute and relative numbers of physicians. METHOD: We constructed a forecasting model using a system dynamics approach. Forecasting the number of physician was performed for all clinical physician and OB/GYN specialists. Moreover, we conducted evaluation of sufficiency for the number of physicians and sensitivity analysis. RESULT & CONCLUSION: As a result, it was forecast that the number of physicians would increase during 2008-2030 and the shortage would resolve at 2026 for all clinical physicians. However, the shortage would not resolve for the period covered. This suggests a need for measures for reconsidering the allocation system of new entry physicians to resolve maldistribution between medical departments, in addition, for increasing the overall number of clinical physicians.

The number of Japanese radiologic technologists will be increased in 40 years.

It is essential to predict the long-term supply and demand for the number of radiologic technologists as medical resources. However, it is difficult to predict the number of Japanese radiologic technologists due to complex and intertwining factors. Our purpose in this study was to predict the future number of radiologic technologists using the concept of system dynamics (SD), and to clarify the effects of relevant factors. In order to estimate the number of Japanese radiologic technologists, we constructed a flow diagram using the concept of SD. We simulated the number of radiologic technologists for the following 4 cases: maintaining the status quo, a change in the pass rate for the national examination, a change in the post-graduate employment rate, and a change in the rate of continuing education. The result for the predicted number of radiologic technologists was 50,509 in 20 years, which is 4,394 (9.5%) more than the present number, and 50,166 in 40 years, which is 4,051 (8.8%) more than the present number. For the factors influencing the number of technologists, the influence of the pass rate on the national examination and that of the rate for post-graduate employment was larger than that of the rate of continuing education in graduate school. The number of Japanese radiologic technologists will increase until 2033 and decrease until 2042, and it does not change after 2042 in case of maintaining the status quo. Implementing the concept of SD allowed us easily to clarify the factors influencing the predicted number of radiologic technologists.

Filmless versus film-based systems in radiographic examination costs: an activity-based costing method.

BACKGROUND: Since the shift from a radiographic film-based system to that of a filmless system, the change in radiographic examination costs and costs structure have been undetermined. The activity-based costing (ABC) method measures the cost and performance of activities, resources, and cost objects. The purpose of this study is to identify the cost structure of a radiographic examination comparing a filmless system to that of a film-based system using the ABC method. METHODS: We calculated the costs of radiographic examinations for both a filmless and a film-based system, and assessed the costs or cost components by simulating radiographic examinations in a health clinic. The cost objects of the radiographic examinations included lumbar (six views), knee (three views), wrist (two views), and other. Indirect costs were allocated to cost objects using the ABC method. RESULTS: The costs of a radiographic examination using a filmless system are as follows: lumbar 2,085 yen; knee 1,599 yen; wrist 1,165 yen; and other 1,641 yen. The costs for a film-based system are: lumbar 3,407 yen; knee 2,257 yen; wrist 1,602 yen; and other 2,521 yen. The primary activities were "calling patient," "explanation of scan," "take photographs," and "aftercare" for both filmless and film-based systems. The cost of these activities cost represented 36.0% of the total cost for a filmless system and 23.6% of a film-based system. CONCLUSIONS: The costs of radiographic examinations using a filmless system and a film-based system were calculated using the ABC method. Our results provide clear evidence that the filmless system is more effective than the film-based system in providing greater value services directly to patients.

Development of terminology for mammographic techniques for radiological technologists.

We are developing a mammographic ontology to share knowledge of the mammographic domain for radiologic technologists, with the aim of improving mammographic techniques. As a first step in constructing the ontology, we used mammography reference books to establish mammographic terminology for identifying currently available knowledge. This study proceeded in three steps: (1) determination of the domain and scope of the terminology, (2) lexical extraction, and (3) construction of hierarchical structures. We extracted terms mainly from three reference books and constructed the hierarchical structures manually. We compared features of the terms extracted from the three reference books. We constructed a terminology consisting of 440 subclasses grouped into 19 top-level classes: anatomic entity, image quality factor, findings, material, risk, breast, histological classification of breast tumors, role, foreign body, mammographic technique, physics, purpose of mammography examination, explanation of mammography examination, image development, abbreviation, quality control, equipment, interpretation, and evaluation of clinical imaging. The number of terms that occurred in the subclasses varied depending on which reference book was used. We developed a terminology of mammographic techniques for radiologic technologists consisting of 440 terms.

Quantitative evaluation of expression difference in report assignments between nursing and radiologic technology departments.

Our purpose in this study was to investigate the expression differences in report assignments between students in nursing and radiologic technology departments. We have known that faculties could identify differences, such as word usage, through grading their students' assignments. However, there are no reports in the literature dealing with expression differences in vocabulary usage in medical informatics education based on statistical techniques or other quantitative measures. The report assignment asked for students' opinions in the event that they found a rare case of a disease in a hospital after they graduated from professional school. We processed student report data automatically, and we applied the space vector model and TF/IDF (term frequency/inverse document frequency) scoring to 129 report assignments. The similarity-score distributions among the assignments for these two departments were close to normal. We focused on the sets of terms that occurred exclusively in either department. For terms such as "radiation therapy" or "communication skills" that occurred in the radiologic technology department, the TF/IDF score was 8.01. The same score was obtained for terms such as "privacy guidelines" or "consent of patients" that occurred in the nursing department. These results will help faculties to provide a better education based on identified expression differences from students' background knowledge.

Quantitative analysis of ontology research articles in the radiologic domain.

To investigate the most advanced ontology research in health care and its impact on the radiologic domain, we proposed a concept identification and abstraction technique called "Concept Step". This technique identifies a MeSH term, medical subject headings used in PubMed, in a sentence and climbs up through its hierarchy to reach an abstract concept. We developed original Java software to implement this technique. We tested it on 2,774 abstracts in health-care ontology research retrieved from MEDLINE on 23 October 2008. The total number of MeSH terms was 112,690. We counted a total of 33 MeSH terms (0.029%) in the radiologic domain. The most frequently occurring term was "radiology", which occurred 21 times in the article set. Other frequent terms were "magnetic resonance imaging" and "tomography", the counts of which were 4 and 3, respectively. A pair plot showed no correlation among the MeSH categories "Analytical Diagnostic and Therapeutic Techniques and Equipment", "Anatomy", "Biological Sciences", and "Chemicals and Drugs". We conclude that ontology research is well established in the biomedical domain, and that further study is required in the radiologic domain.

[Evaluation factors for CR system introduction using AHP and simulation].

Medical institutions usually find it difficult to select computed radiography (CR) equipment because of the involvement of many complicated factors such as operability, processing time, and price. The analytic hierarchy process (AHP) is often applied in complex decision and evaluation situations. This study quantitatively evaluates the institution's selection criteria of equipment using AHP. The AHP model of this study consisted of 3 levels: the goal, 6 evaluations, and 3 alternatives. Processing time, price operability, picture quality, connectivity, and equipment size were considered as the criteria for decision marking. We simulated alteration of priority of evaluations by changing the weight of pricing between 0 and 1. Results showed that price and connectivity accounted for 60% of the total weight. On excluding operability, the difference in weight between equipment was 1.16 times; the priority of processing time was 1.36 times; and the priority of price was 1.37 times. In the same way, when considering operability, the difference in weight between equipment was 0.36 times, the priority of processing time was 0.45 times, and the priority of price was 0.11 times.