"WWW.MDTF.ORG": a World Wide Web forum for developing open-architecture, freely distributed, digital teaching file software by participant consensus.

PURPOSE: To foster a community supported evaluation processes for open-source digital teaching file (DTF) development and maintenance. The mechanisms used to support this process will include standard web browsers, web servers, forum software, and custom additions to the forum software to potentially enable a mediated voting protocol. The web server will also serve as a focal point for beta and release software distribution, which is the desired end-goal of this process. CONCLUSIONS: We foresee that www.mdtf.org will provide for widespread distribution of open source DTF software that will include function and interface design decisions from community participation on the website forums.

Distance learning in the digital environment.

The expansion of radiology departments and divisions often can not occur in adjacent geographic locations. This leads to a greater separation of staff and residents, as well as workers in similar divisions. This makes traditional teaching difficult in academic institutions. The economic drive forcing many departments to investigate more isolated outpatient imaging centers has further hindered the ability to continue effective academic training at many facilities. The ability to easily share a digital environment across physical distance can greatly enhance the teaching experience, as well as be a valuable tool for consultation and case discussion with referring clinicians. The transition to a filmless environment with picture archiving and communication systems (PACS) can be utilized for distance learning in addition to the clinical arena. It is possible to take advantage of the digital transformation to PACS and case-viewing browser programs to conduct improved interactions with referring clinicians as well as radiologic teaching with relatively minimal hardware and software demands. The integration of web-based teleradiology programs with business networking software can be used for effective distance learning in the digital environment, sufficiently closing the distance on our rapidly expanding departments. This same technology allows for greater interaction with referring clinicians for real-time consultation and enhanced case discussion to entrench a supportive referral base for the radiologic community.

A simple mechanism for sharing and transporting medical digital case information across disparate computer language and data storage environments.

It is challenging to remotely share generic medical case information without an agreed upon definition of a medical digital teaching file (DTF). By utilizing an application of the extensible markup language (XML) called web-distributed data exchange (WDDX) along with an agreed upon WDDX structure, it is technically easy to share or syndicate medical case DTFs across computing environments that use different information models and computer languages. Thus, this easily implemented technology offers us an immediately available means to share and increase the value of scientific knowledge.

The evolution of filmless radiology teaching.

PURPOSE: The transition from hard-copy film to the picture archiving and communication systems (PACS) arena is often a long and difficult path, but the complete transformation to the digital environment does not end with the successful clinical practice utilizing PACS. The next hurdle for academic institutions is similar changes in the teaching field. The loss of hardcopy films can greatly hinder the radiology teaching file and teaching conference experiences. The next step in our growth is the conversion to digital teaching files and conferences. The original work 10 years ago with utilizing computers linked with laser disks and magneto-optical media, have now evolved into complex networks with expanding and relatively cheap storage media, such as CD-ROM and easily to navigate graphic-user interfaces such as hypertext markup language (HTML) and extensible markup language (XML), for use with multimedia teaching tools. CONCLUSIONS: The transition into the digital arena for radiology education and interdepartmental conferences can be accomplished through several different paths. These include direct transfer of images into a presentation program, as well as exportation of images into suitable image file formats for later use. There is also the ability to expand the PACS network to include conference rooms. Similar training and teaching can allow radiologists to transition into the digital environment for future digital teaching file creation as well as correlative radiology interdepartmental conferences.

Adobe acrobat: an alternative electronic teaching file construction methodology independent of HTML restrictions.

The goal of the project was to create a method by which an in-house digital teaching file could be constructed that was simple, inexpensive, independent of hypertext markup language (HTML) restrictions, and appears identical on multiple platforms. To accomplish this, Microsoft PowerPoint and Adobe Acrobat were used in succession to assemble digital teaching files in the Acrobat portable document file format. They were then verified to appear identically on computers running Windows, Macintosh Operating Systems (OS), and the Silicon Graphics Unix-based OS as either a free-standing file using Acrobat Reader software or from within a browser window using the Acrobat browser plug-in. This latter display method yields a file viewed through a browser window, yet remains independent of underlying HTML restrictions, which may confer an advantage over simple HTML teaching file construction. Thus, a hybrid of HTML-distributed Adobe Acrobat generated WWW documents may be a viable alternative for digital teaching file construction and distribution.

Intramedullary and spinal canal tumors in patients with neurofibromatosis 2: MR imaging findings and correlation with genotype.

PURPOSE: To determine the appearance of spinal tumors on magnetic resonance (MR) images of patients with neurofibromatosis 2 (NF2), to assess the biologic behavior of these tumors, and to determine the correlation between NF2 germline mutations and these tumors. MATERIALS AND METHODS: Spinal MR images in 49 patients with NF2 were reviewed retrospectively. Intramedullary and intradural extramedullary tumors were counted, and imaging features and growth patterns of intramedullary tumors were determined. Medical records were reviewed for spinal tumor surgery. Data on spinal tumors and NF2 germline mutations in 37 patients from 19 families were analyzed for genotype-phenotype correlation. RESULTS: Thirty-one patients (63%) had spinal tumors: Twenty-six (53%) had intramedullary tumors, 27 (55%) had intradural extramedullary tumors, and 22 (45%) had at least one tumor of each type. Three (12%) patients with intramedullary tumors versus 16 (59%) with extramedullary tumors had undergone surgery for the respective types of tumors. Compared with patients with all other types of mutations, a higher percentage of patients with nonsense and frameshift mutations had intramedullary tumors (P <.025); these patients also had higher mean numbers of all tumors (P <.001), intramedullary tumors (P <.001), and nerve sheath tumors (NSTs) (P <.001). CONCLUSION: In patients with NF2 and spinal tumors, extramedullary tumors (predominantly NSTs) were present in higher numbers and were associated with more surgery than were intramedullary tumors. Our data suggest that the association between nonsense and frameshift mutations and severe NF2 may extend to specific categories of spinal tumors.

Computerized scientific exhibit utilization: observations from infoRAD at the radiologic society of North America Scientific Assembly.

No publication has discussed utilization of computer scientific exhibits (CSE) at national symposia, despite their growing numbers. The hypothesis of this project was that, when given a choice, viewers initially would prefer a more conventional paper presentation of a scientific exhibit over that of an electronic presentation. A nearly identical paper version of the introductory screen to an infoRAD CSE was placed adjacent to the workstation. Utilization of the paper introduction, computer introduction, and both, as well as subsequent behavior, was recorded. Of 67 visitors, initial user choice was 56.7% paper and 43.3% computer. Over the entire time at the exhibit 25.4% only looked at the handout, 25.4% only at the computer, and 49.3% perused both. Only 10.5% completed the entire exhibit, and 0.94% of total registrants visited the CSE. Overall, 74.7% perused the CSE when leaving the exhibit area. Upon arrival, viewers preferred the more conventional paper presentation, confirming the project hypothesis. Surprisingly, about 75% eventually perused at least a portion of the computer presentation. Although a small fraction of Radiologic Society of North America (RSNA) registrants visited the CSE, the findings presented are promising and suggest that CSE presence at national meetings is justifiable, providing a "first step" toward CME outcomes analysis of CSE. Overall, these findings are promising and suggest that computer scientific exhibit presence at national meetings is justifiable.

Incidental findings on brain magnetic resonance imaging from 1000 asymptomatic volunteers.

CONTEXT: Previous reports have discussed incidental disease found on brain magnetic resonance imaging (MRI) scans that had been requested for an unrelated clinical concern or symptom, resulting in a selection bias for disease. However, the prevalence of unexpected abnormalities has not been studied in a healthy population. OBJECTIVE: To evaluate the prevalence of incidental findings on brain MRI scans obtained for a healthy, asymptomatic population without selection bias. DESIGN, SETTING, AND PARTICIPANTS: Retrospective analysis of brain MRI scans obtained between May 17, 1996, and July 25, 1997, from 1000 volunteers who participated as control subjects for various research protocols at the National Institutes of Health. All participants (age range, 3-83 years; 54.6% male) were determined to be healthy and asymptomatic by physician examination and participant history. MAIN OUTCOME MEASURE: Prevalence of abnormalities on brain MRI by category of finding (no referral necessary, routine referral, urgent referral [within 1 week of study], and immediate referral [within 1 to several days of study]). RESULTS: Eighty-two percent of the MRI results were normal. Of the 18% demonstrating incidental abnormal findings, 15.1% required no referral; 1.8%, routine referral; 1.1%, urgent referral; and 0%, immediate referral. In subjects grouped for urgent referral, 2 confirmed primary brain tumors (and a possible but unconfirmed third) were found, demonstrating a prevalence of at least 0.2%. CONCLUSION: Asymptomatic subjects present with a variety of abnormalities, providing valuable information on disease prevalence in a presumed healthy population. A small percentage of these findings require urgent medical attention and/or additional studies.

Pituitary involvement by Wegener's granulomatosis: a report of two cases.

We describe two cases of pituitary involvement by Wegener's granulomatosis. At initial presentation, or during subsequent disease "flares," a pattern of pituitary abnormality was suggested. During periods of remission, we found the pituitary returned to a nearly normal appearance. Loss of the normal posterior pituitary T1 hyper-intensity matched a clinical persistence of diabetes insipidus, suggesting there is permanent damage to this structure by the initial disease process.

Carbonic Anhydrase Activity in Isolated Chloroplasts of Wild-Type and High-CO2-Dependent Mutants of Chlamydomonas reinhardtii as Studied by a New Assay.

In an assay of carbonic anhydrase (CA), NAH14CO3 soltution at the bottom of a sealed vessel releases 14CO2, which diffuses to the top of the vessel to be assimilated by photosynthesizing Chlamydomonas reinhardtii cells that have been adapted to a low-CO2 environment. The assay is initiated by illuminating the cells and is stopped by turning the light off and killing the cells with acid. Enzyme activity was estimated from acid-stable radioactivity. With bovine CA, 1.5 Wilbur-Anderson units (WAU) was consistently measured at 5- to 6-fold above background. Sonicated whole cells of air-adapted wild-type C. reinhardtii had 740 [plus or minus] 12.4 WAU/mg chlorophyll (Chl). Sonicated chloroplasts from a mixotrophically grown wall-less strain, cw-15, had 35.5 [plus or minus] 2.6 WAU/mg Chl, whereas chloroplasts from wall-less external CA mutant strain cia5/cw-15 had 33.8 [plus or minus] 1.9 WAU/mg Chl. Sonicated chloroplasts from the wall-less mutant strain cia-3/cw-15, believed to lack an internal CA, had 2.8 [plus or minus] 3.2 WAU/mg Chl. Sonicated whole cells from cia3/cw-15 had 2.8 [plus or minus] 7.8 WAU/mg Chl. Acetazolamide, ethoxyzolamide, and p-aminomethylbenzene sulfonamide (Mafenide) at 100 [mu]M inhibited CA in sonicated chloroplasts from cia-5/cw-15. Treatment at 80[deg]C for 10 min inhibited this CA activity by 90.8 [plus or minus] 3.6%. Thus, a sensitive 14C assay has confirmed the presence of a CA in cw-15 and cia-5/cw-15 chloroplasts and the lack of a CA in cia-3/cw-15 chloroplasts. Our results indicate that HCO3- is the inorganic carbon species that is accumulated by chloroplasts of Chlamydomonas and that chloroplastic CA is responsible for the majority of internal CA activity.