Intention to use picture archiving and communication system and its predictors among physicians and nurses at specialized teaching hospitals in Amhara region, Northwest Ethiopia.

Background: Picture archiving and communication system is an innovation system in the health information that reduces costs, facilitates access to medical image, and improves workflow in radiology department. However, studies indicated that intention and usage of picture archiving and communication system is limited in middle-income and developing countries. Objective: This study aimed to assess the intention to use picture archiving and communication system and its predictors among physicians and nurses at specialized teaching hospitals in Amhara region, Northwest Ethiopia. Method: Institution-based cross-sectional study design was conducted from October 11 to November 12, 2023. Proportional allocation and a simple random sampling were used to select participants of the study. A self-administered structured English questionnaire was used, and a 5% pretest was performed. Data were entered into Epi data 4.6 and exported to SPSS 26 and AMOS 23. Descriptive and structural equation modeling analysis was performed. The hypothesis was tested using a path coefficient and a p-value <0.05. Results: About 54.7% (95%: CI: 50.9-58.4) of the participant intended to use picture archive and communication system with a 90.38% of response rate. Performance expectancy (ß = 0.146, p-value <0.05), perceived enjoyment (ß = 0.397, p-value <0.001), and computer literacy (ß = 0.191, p-value <0.001) had positive influence on intention to use picture archiving and communication system. Conclusions: Overall, more than half of physicians' and nurses' intention to use picture archiving and communication system were at hopeful stage for future. Performance expectancy, perceived enjoyment and computer literacy had direct positive effect on intention to use picture archiving and communication system among physicians and nurses. The designers, developers, and managers of the picture archiving and communication system should consider these variables. Furthermore, using this system can improve quality of health service through change workflow in to digital image, clinicians evaluate image more quickly and saving resources.

What is the appropriate measure of radiology workload: Study or image numbers?

INTRODUCTION: Previous studies assessing the volume of radiological studies rarely considered the corresponding number of images. We aimed to quantify the increases in study and image numbers per radiologist in a tertiary healthcare network to better understand the demands on imaging services. METHODS: Using the Picture Archiving and Communication System (PACS), the number of images per study was obtained for all diagnostic studies reported by in-house radiologists at a tertiary healthcare network in Melbourne, Australia, between January 2009 and December 2022. Payroll data was used to obtain the numbers of full-time equivalent radiologists. RESULTS: Across all modalities, there were 4,462,702 diagnostic studies and 1,116,311,209 images. The number of monthly studies increased from 17,235 to 35,152 (104%) over the study period. The number of monthly images increased from 1,120,832 to 13,353,056 (1091%), with computed tomography (CT) showing the greatest absolute increase of 9,395,653 images per month (1476%). There was no increase in the monthly studies per full-time equivalent radiologist; however, the number of monthly image slices per radiologist increased 399%, from 48,781 to 243,518 (Kendall Tau correlation coefficient 0.830, P-value < 0.0001). CONCLUSION: The number of monthly images per radiologist increased substantially from 2009 to 2022, despite a relatively constant number of monthly studies per radiologist. Our study suggests that using the number of studies as an isolated fundamental data set underestimates the true radiologist's workload. We propose that the increased volume of images examined by individual radiologists may more appropriately reflect true work demand and may add more weight to future workforce planning.

Implementation of a point-of-care ultrasound archiving system and governance framework in a UK physician-paramedic staffed helicopter emergency medical service.

INTRODUCTION: There has been a rapid expansion in the use of point-of-care ultrasonography (POCUS) by emergency medical services (EMS). However, less than a third of UK EMS utilise imaging archiving for POCUS, and fewer review saved images as part of a clinical governance structure. This paper describes the implementation of a novel image archiving system and a robust clinical governance framework in our UK physician-paramedic staffed helicopter emergency medical service (HEMS). METHODS: A retrospective database review was conducted of all patients attended by East Anglian Air Ambulance (EAAA) between the introduction of a new POCUS device and image archiving system on 1 December 2020 to 31 January 2024. All patients with recorded POCUS examinations were included. Images from POCUS examinations at EAAA are archived on a cloud-based server, and retrospectively reviewed within 24 h by an EAAA POCUS supervisor. Image quality is graded using a 5-point Likert-type scale, agreement between reviewer and clinician is recorded and feedback is provided on scanning technique. T-tests were used to assess the difference in image quality between physicians and paramedics. Inter-rater reliability between reviewers and clinicians was assessed using Cohen's kappa (κ). RESULTS: During the study period, 5913 patients were attended by EAAA. Of these, 1097 patients had POCUS images recorded. The prevalence of POCUS during the study period was 18.6%. 1061 patient examinations underwent quality assurance (96.7%). The most common POCUS examination was echocardiography (60%), predominantly during cardiac arrest. The primary scanning clinician was a paramedic in 25.4% of POCUS examinations. Across all examination types; image quality was not significantly different between physicians and paramedics and agreement between reviewers and clinicians was strong (κ > 0.85). CONCLUSIONS: In this service evaluation study, we have described outcomes following the introduction of a new POCUS device, image archiving system and governance framework in our HEMS. Paramedics were the primary scanning clinician in a quarter of scans, with image quality comparable to physicians. Almost all scans underwent quality assurance and inter-rater reliability was strong between clinicians and reviewers. Further research is required to investigate the diagnostic accuracy of POCUS and to demonstrate the effect of utilising prehospital POCUS to refine diagnosis on clinical outcomes.

A specific and portable gene expression program underlies antigen archiving by lymphatic endothelial cells.

Antigens from protein subunit vaccination traffic from the tissue to the draining lymph node, either passively via the lymph or carried by dendritic cells at the local injection site. Lymph node (LN) lymphatic endothelial cells (LEC) actively acquire and archive foreign antigens, and archived antigen can be released during subsequent inflammatory stimulus to improve immune responses. Here, we answer questions about how LECs achieve durable antigen archiving and whether there are transcriptional signatures associated with LECs containing high levels of antigen. We used single cell sequencing in dissociated LN tissue to quantify antigen levels in LEC and dendritic cell populations at multiple timepoints after immunization, and used machine learning to define a unique transcriptional program within archiving LECs that can predict LEC archiving capacity in independent data sets. Finally, we validated this modeling, showing we could predict antigen archiving from a transcriptional dataset of CHIKV infected mice and demonstrated in vivo the accuracy of our prediction. Collectively, our findings establish a unique transcriptional program in LECs that promotes antigen archiving that can be translated to other systems.

Do Cone Beam CT Picture Archiving and Communication Systems Viewer Interfaces Meet the Expectations of Dental Professionals From a Usability Perspective?

Background Cone beam computed tomography (CBCT) has revolutionized dental and maxillofacial imaging by providing high-resolution 3D visualizations, essential for accurate diagnosis and treatment planning. Despite its clinical advancements, the usability of CBCT viewer interfaces, which play a crucial role in the effective interpretation of imaging data, remains a critical concern. Objective This study aims to evaluate the usability of a CBCT viewer interface in clinical settings, focusing on the effectiveness, efficiency, and satisfaction perspectives, to identify potential areas for improvement. Methods Twenty-two participants (N=22) were assigned the task of locating the mental foramen in a mandible dataset, selected randomly, using the multiplanar reconstruction (MPR) mode of a CBCT viewer interface on a local network. The task's effectiveness was gauged by the completion rate, while efficiency was measured through the duration of the task, the number of mouse clicks, and the cursor's path in both pixels and meters. Satisfaction or perceived usability was evaluated using the system usability scale (SUS-TR), and computer system usability questionnaire (T-CSUQ), among other scales, with participants also providing open-ended feedback. Demographic characteristics served as classification variables. Results All participants completed the given task. No demography-related differences in efficiency were observed. Perceived usability (SUS-TR: 60.68±19.58, T-CSUQ: 43.63±16.34) was below the industry standards, categorizing the system as a detractor. Commonly reported issues included accessing the MPR window, cursor behavior, and unclear error messages. The mean SUS-TR score negatively correlated with efficiency-related variables (p<0.05 for each). Conclusions The study's findings indicate that the CBCT viewer interface does not fully meet dental professionals' usability expectations, as evidenced by the task's completion rate, efficiency metrics, and below-average usability scores. Despite the successful task completion by all participants, the identified issues in interface design, such as difficulties in accessing the MPR window and unclear error messages, highlight significant areas for improvement. To enhance user satisfaction and efficiency, future developments of CBCT viewer interfaces should incorporate feedback from end-users and prioritize user-friendly design principles.

[Construction of a Temporary Radiological Image Viewing Network for Large-scale Disasters].

The Ministry of Health, Labor and Welfare mandated the creation of the business continuity plan (BCP) for disaster key hospitals on March 31, 2017. Supposing the hospital information system (HIS) failure occurred, the picture archiving and communication system (PACS) also suffers obstacles, we assumed building a new network was necessary for radiological examination images. The purpose of this study was to investigate whether building a new network for radiological examination images is necessary in an emergency. Using wireless fidelity (Wi-Fi), the new network consisting of one image server and two tablet terminals A and B was constructed. The study measured the portable image transfer time for various stages of the network. The results were as follows: Transfer time from the mobile X-ray unit to the image server was 4.12±0.86 s, that from the image server to the tablet device A was 5.14±0.71 s, and that from the image server to the tablet device B was 7.32±1.66 s. Therefore, the new network configuration can provide a reliable means of accessing radiological images during emergency situations when the HIS and PACS may experience obstacles or failures.

Community recommendations on cryoEM data archiving and validation.

In January 2020, a workshop was held at EMBL-EBI (Hinxton, UK) to discuss data requirements for the deposition and validation of cryoEM structures, with a focus on single-particle analysis. The meeting was attended by 47 experts in data processing, model building and refinement, validation, and archiving of such structures. This report describes the workshop's motivation and history, the topics discussed, and the resulting consensus recommendations. Some challenges for future methods-development efforts in this area are also highlighted, as is the implementation to date of some of the recommendations.

Improving Medical Photography in a Level 1 Trauma Center by Implementing a Specialized Smartphone-Based App in Comparison to the Usage of Digital Cameras: Prospective Panel Study.

BACKGROUND: Medical photography plays a pivotal role in modern health care, serving multiple purposes ranging from patient care to medical documentation and education. Specifically, it aids in wound management, surgical planning, and medical training. While digital cameras have traditionally been used, smartphones equipped with specialized apps present an intriguing alternative. Smartphones offer several advantages, including increased usability and efficiency and the capability to uphold medicolegal standards more effectively and consistently. OBJECTIVE: This study aims to assess whether implementing a specialized smartphone app could lead to more frequent and efficient use of medical photography. METHODS: We carried out this study as a comprehensive single-center panel investigation at a level 1 trauma center, encompassing various settings including the emergency department, operating theaters, and surgical wards, over a 6-month period from June to November 2020. Using weekly questionnaires, health care providers were asked about their experiences and preferences with using both digital cameras and smartphones equipped with a specialized medical photography app. Parameters such as the frequency of use, time taken for image upload, and general usability were assessed. RESULTS: A total of 65 questionnaires were assessed for digital camera use and 68 for smartphone use. Usage increased significantly by 5.4 (SD 1.9) times per week (95% CI 1.7-9.2; P=.005) when the smartphone was used. The time it took to upload pictures to the clinical picture and archiving system was significantly shorter for the app (mean 1.8, SD 1.2 min) than for the camera (mean 14.9, SD 24.0 h; P<.001). Smartphone usage also outperformed the digital camera in terms of technical failure (4.4% vs 9.7%; P=.04) and for the technical process of archiving (P<.001) pictures to the picture archiving and communication system (PACS) and display images (P<.001) from it. No difference was found in regard to the photographer's intent (P=.31) or reasoning (P=.94) behind the pictures. Additionally, the study highlighted that potential concerns regarding data security and patient confidentiality were also better addressed through the smartphone app, given its encryption capabilities and password protection. CONCLUSIONS: Specialized smartphone apps provide a secure, rapid, and user-friendly platform for medical photography, showing significant advantages over traditional digital cameras. This study supports the notion that these apps not only have the potential to improve patient care, particularly in the realm of wound management, but also offer substantial medicolegal and economic benefits. Future research should focus on additional aspects such as patient comfort and preference, image resolution, and the quality of photographs, as well as seek to corroborate these findings through a larger sample size.

Community recommendations on cryoEM data archiving and validation: Outcomes of a wwPDB/EMDB workshop on cryoEM data management, deposition and validation.

In January 2020, a workshop was held at EMBL-EBI (Hinxton, UK) to discuss data requirements for deposition and validation of cryoEM structures, with a focus on single-particle analysis. The meeting was attended by 47 experts in data processing, model building and refinement, validation, and archiving of such structures. This report describes the workshop's motivation and history, the topics discussed, and consensus recommendations resulting from the workshop. Some challenges for future methods-development efforts in this area are also highlighted, as is the implementation to date of some of the recommendations.

Vaccine-induced antigen archiving enhances local memory CD8+ T cell responses following an unrelated viral infection.

Viral and vaccine antigens persist or are archived in lymph node stromal cells (LNSC) such as lymphatic endothelial cells (LEC) and fibroblastic reticular cells (FRC). Here, we find that, during the time frame of antigen archiving, LEC apoptosis caused by a second, but unrelated, innate immune stimulus such as vaccina viral infection or CpG DNA administration boosted memory CD8+ T cells specific to the archived antigen. In contrast to "bystander" activation associated with unrelated infections, the memory CD8+ T cells specific to the vaccine archived antigen were significantly higher than memory CD8+ T cells of a different antigen specificity. Finally, the boosted memory CD8+ T cells resulted in increased protection against Listeria monocytogenes expressing the vaccine antigen, but only for the duration that the vaccine antigen was archived. These findings outline a novel mechanism by which LNSC archived antigens, in addition to bystander activation, can augment memory CD8+ T cell responses during repeated inflammatory insults.

Vaccination with mycobacterial lipid loaded nanoparticle leads to lipid antigen persistence and memory differentiation of antigen-specific T cells.

Mycobacterium tuberculosis (Mtb) infection elicits both protein and lipid antigen-specific T cell responses. However, the incorporation of lipid antigens into subunit vaccine strategies and formulations has been underexplored, and the characteristics of vaccine-induced Mtb lipid-specific memory T cells have remained elusive. Mycolic acid (MA), a major lipid component of the Mtb cell wall, is presented by human CD1b molecules to unconventional T cell subsets. These MA-specific CD1b-restricted T cells have been detected in the blood and disease sites of Mtb-infected individuals, suggesting that MA is a promising lipid antigen for incorporation into multicomponent subunit vaccines. In this study, we utilized the enhanced stability of bicontinuous nanospheres (BCN) to efficiently encapsulate MA for in vivo delivery to MA-specific T cells, both alone and in combination with an immunodominant Mtb protein antigen (Ag85B). Pulmonary administration of MA-loaded BCN (MA-BCN) elicited MA-specific T cell responses in humanized CD1 transgenic mice. Simultaneous delivery of MA and Ag85B within BCN activated both MA- and Ag85B-specific T cells. Notably, pulmonary vaccination with MA-Ag85B-BCN resulted in the persistence of MA, but not Ag85B, within alveolar macrophages in the lung. Vaccination of MA-BCN through intravenous or subcutaneous route, or with attenuated Mtb likewise reproduced MA persistence. Moreover, MA-specific T cells in MA-BCN-vaccinated mice differentiated into a T follicular helper-like phenotype. Overall, the BCN platform allows for the dual encapsulation and in vivo activation of lipid and protein antigen-specific T cells and leads to persistent lipid depots that could offer long-lasting immune responses.

Quantifying Clinically Meaningful Point-of-Care Ultrasound Interpretation Discrepancies Using an Emergency Department Quality Assurance Program.

OBJECTIVES: Emergency medicine professional associations recommend that quality assurance (QA) programs be implemented wherever emergency department (ED) point-of-care ultrasound (POCUS) is in use. The purpose of this study is to identify the rate of clinically meaningful interpretation discrepancies between initial ED POCUS interpretation and a gold standard using a QA program in a Canadian academic ED. METHODS: All POCUS examinations completed in our ED are subject to a QA process. The results of all POCUS examinations undergoing this process from July 1, 2014, to June 30, 2015, were retrospectively reviewed. Four blinded abstractors collected data with a standardized tool after a training session. Information regarding patient demographics, POCUS indication, emergency physician initial POCUS interpretation, physician POCUS expertise, the presence of an interpretation discrepancy, and whether the discrepancy was clinically meaningful was abstracted. The proportion of interpretation discrepancies, clinically meaningful discrepancies, discrepancies requiring remedial action, and differences in discrepancy rates between non-expert and expert sonographers were analyzed. RESULTS: A total of 2,869 POCUS studies were included for review, with 2,668 in the final data set after exclusions. In total, only 1.4% of all scans contained an interpretation discrepancy. The rate of clinically meaningful discrepancies was 0.5%, and the rate of scans requiring remedial action was 0.1%. Overall, 85.5% of all scans were performed by four POCUS expert physicians, with the remainder by a non-expert. Scans performed by non-expert sonographers were significantly more prone to discrepancies than those performed by experts. No single scan indication was more prone to discrepancy. CONCLUSIONS: The overall ED POCUS interpretation discrepancy rate and clinically meaningful discrepancy rate identified using our QA process were very low. The findings are limited by the small group of expert sonographers completing most scans.

Combining Register and Radiological Visits Data Allows to Reliably Identify Incident Wrist Fractures.

Purpose: To evaluate how comprehensively wrist fractures can be tracked from the national medical registers, and to propose a method for complementing the register data using time stamps of wrist radiography visits recorded in the radiological image archive. Patients and Methods: For the Kuopio Osteoporosis Risk Factor and Prevention Study (OSTPRE) cohort of 14220 post-menopausal women, we analysed the data from the Care Register for Health Care, Register for Primary Health Care Visits, self-reports, radiological image archive PACS, and patient records to identify the wrist fractures occurred between 2011 and 2021. Using this gold standard of fractures, we validated the coverage of the registers and image archive and created algorithms to automatically identify fracture events from the registers and/or metadata of wrist radiography visits. Results: We show that wrist fractures cannot be comprehensively identified based on national registers. To remedy this, our proposed method of combining register and image archive data can lift the coverage from 81% to 94% and reduce false discoveries from 6% to 2%. Conclusion: The proposed method offers a more reliable way of gathering fracture information. Comprehensive fracture identification is essential in many research settings, such as incidence statistics, prevention studies, and risk assessment models.

The Cold Futures of Mouse Genetics: Modes of Strain Cryopreservation Since the 1970s.

Cryopreservation, or the freezing of embryos or sperm, has become a routine part of many research projects involving laboratory mice. In this article, we combine historical and sociological methods to produce a cryopolitical analysis of this less explored aspect of animal research. We provide a longitudinal account of mouse embryo and semen storage and uses in the UK and show that cryopreservation enabled researchers to overcome particular challenges-fears of strain loss, societal disapproval, and genetic drift-in ways which enabled the continued existence of strains and contributed to the scaling up of mouse research since World War II. We use the theoretical lens of cryopolitics to explore three different, yet overlapping, cryopolitical strategies that we identify. All share the ability to ensure the continued maintenance of genetically defined strains without the need for continually breeding colonies of mice. We argue that, in contrast to more common imaginaries of species conservation, the cryopolitical rationale can best be understood as purposefully not letting the strain die without requiring animals to live. The ability to freeze mice, then, had the potential to unsettle who the objects of care are in mouse research, from individual animals to the concept of the strain itself.

Public archiving of volume EM data.

Volume electron microscopy (vEM) techniques produce scientifically important datasets which are time and resource intensive to generate (Peddie et al., 2022). Public archival of such datasets, usually described in the literature, provides many benefits to the data depositors, to those making use of research results based on the datasets, and to the vEM community at large, both now and in the future. In this chapter we discuss these benefits, explain how EMBL-EBI's image data services support archival of both vEM and correlative imaging data, and discuss how future developments will unlock more value from these vEM datasets.

[Display Performance of X-ray Image Output from DICOM-embedded Printer to Paper-based Hard Copy Print: Comparison with X-ray Image on LCD].

PURPOSE: We have been using a paper-based hard copy print (paper print) system of X-ray images, in which digital imaging and communications in medicine (DICOM) data can be directly output on papers from medical imaging systems or from a picture archiving and communication system (PACS) server, and they are utilized as patient referral materials or for preoperative planning. The purpose of this study was to compare the display performance of X-ray images on the printed paper and that on the liquid crystal display (LCD). METHODS: We measured contrast response to verify consistency of image appearance on both display systems. The contrast resolution was assessed by a CDRAD phantom. The spatial resolution was assessed by an X-ray test chart. RESULTS: The contrast response of the paper printer was not concordant with the grayscale standard display function (GSDF). The difference between the measured contrast response and the ideal GSDF on the paper was large in the high-density area. The low-contrast resolution on the paper was inferior to that on the LCD. The spatial resolving power on the paper was superior to that on the LCD. CONCLUSION: The display performance of the paper printer for X-ray images was clarified. X-ray images printed on the paper should be used carefully taking account of their characteristics of display performance.

Clinicians' perspective of picture archiving and communication systems at Charlotte Maxeke Johannesburg Academic Hospital.

Background: Picture archiving and communication systems (PACS) are now an established means of capturing, storing, distribution and viewing of all radiology images. The study was conducted in a quaternary hospital, Charlotte Maxeke Johannesburg Academic Hospital (CMJAH), part of the University of the Witwatersrand teaching circuit, in South Africa. Objectives: To measure the clinicians' perceived benefits and challenges of PACS. To document perceived views on how the current PACS can be improved. Method: This was a cross-sectional observational study over a period of 5 months from September 2021 to January 2022 carried out at CMJAH. Questionnaires were distributed to referring clinicians with PACS experience. Descriptive statistics was conducted. Categorical variables were presented as frequency and percentages. The continuous variables were presented as means ± standard deviation. Results: A survey with a response rate of 54% found the benefits most reported by clinicians were improved patient care, less time needed to review an exam, improved image comparison and consultation efficiency. With respect to perceived challenges, the unavailability of images at the bedside, problems with access and the lack of advanced image manipulating software were noted. The most frequent recommendations on improvements focused on the aforementioned challenges. Conclusion: Hospital-wide PACS was viewed beneficial by most clinicians. Nonetheless, there are a few aspects that deserve attention to improve the functionality and access of the system. Contribution: The findings will assist in future hospital or provincial-wide PACS deployment projects.

Concept for a Basic ISO 14721 Archive Information Package for Clinical Studies.

Secondary use of medical data for research is desirable for intrinsic, ethical and financial reasons. In this context, the question becomes relevant as to how such datasets are to be made accessible to a larger target group in the long term. Typically, datasets are not extracted ad hoc from the primary systems, because they are processed qualitatively (FAIR data). Special data repositories are currently being built for this purpose. This paper examines the requirements for the reuse of clinical trial data in a data repository utilizing the Open Archiving Information System (OAIS) reference model. In particular, a concept for an Archive Information Package (AIP) is developed with the central focus on a cost-effective trade-off between the effort of creation for the data producer and the comprehensibility of the data for the data consumer.

InSpectra - A platform for identifying emerging chemical threats.

Non-target analysis (NTA) employing high-resolution mass spectrometry (HRMS) coupled with liquid chromatography is increasingly being used to identify chemicals of biological relevance. HRMS datasets are large and complex making the identification of potentially relevant chemicals extremely challenging. As they are recorded in vendor-specific formats, interpreting them is often reliant on vendor-specific software that may not accommodate advancements in data processing. Here we present InSpectra, a vendor independent automated platform for the systematic detection of newly identified emerging chemical threats. InSpectra is web-based, open-source/access and modular providing highly flexible and extensible NTA and suspect screening workflows. As a cloud-based platform, InSpectra exploits parallel computing and big data archiving capabilities with a focus for sharing and community curation of HRMS data. InSpectra offers a reproducible and transparent approach for the identification, tracking and prioritisation of emerging chemical threats.

On the Long-term Archiving of Research Data.

Accessing research data at any time is what FAIR (Findable Accessible Interoperable Reusable) data sharing aims to achieve at scale. Yet, we argue that it is not sustainable to keep accumulating and maintaining all datasets for rapid access, considering the monetary and ecological cost of maintaining repositories. Here, we address the issue of cold data storage: when to dispose of data for offline storage, how can this be done while maintaining FAIR principles and who should be responsible for cold archiving and long-term preservation.