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Softcopy Interpretation

Filmless Radiology


Radiologists have been looking at film images ever since Roentgen first discovered x-rays and obtained an image of his wife’s hand. However, since the 1980s, radiologists have leapt into the digital world and view images on computer monitors with increasing frequency. Picture archiving and communication systems (PACS), Cross-Enterprise Document Sharing for Imaging (XDS-1), and teleradiology networks are becoming commonplace, and many radiology residents currently are trained with digital rather than film displays.

For many radiologists, the technical details of network architectures, bandwidths, digital archives, and digital imaging and communications in medicine (DICOM) interface compatibility are of little concern. What is most important from the clinical perspective is that the required patient images are available when needed, are available quickly, and are of diagnostic quality. Of these, diagnostic quality may be the primary factor from the clinician’s standpoint (see the images below).

Example of a typical eye-position pattern of a rad

Example of a typical eye-position pattern of a radiologist searching a bone image for fractures. Each small circle represents a fixation or position where the eye lands. The lines indicate the order in which fixations were generated.

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Example of a typical eye-position pattern of a mam

Example of a typical eye-position pattern of a mammographer searching a breast image for microcalcifications and masses. The small circles represent fixations or locations where the eye lands. The lines indicate the order in which fixations were generated.

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Quality can be affected at a number of points in the digital chain before the final image is presented to the radiologist’s eye-brain system. Of most concern to the radiologist is the final step in this chain, the presentation of the clinical image on a display device, because this is what the radiologist examines and uses to make a diagnostic decision. Thus, radiologists must be aware of the issues that affect the display of digital radiographic images.

Recent research has focused on issues of privacy protection and security in the transmission of these images, including the use of chaotic maps
and watermarks.
Other researchers are focusing on establishing standardized and consistent reporting procedures.

Transition to monitors

As the transition from film to monitors began to take place, it became evident that, similar to many digital images, the radiographic image on the computer monitor did not appear the same as the image on film. Initially, radiologists were skeptical and did not trust digital displays for routine clinical use. Many perceptual and ergonomic issues arose when the use of film began to decrease. Compared with the traditional method of viewing film on a light box, monitors typically are less bright, have less spatial resolution, have less contrast (dynamic range), and have a limited viewing area.

These factors must be addressed, and researchers in medical image perception have begun to investigate them. Eventually, radiologists must ensure that switching to a different viewing medium neither negatively affects diagnostic accuracy nor significantly affects workflow. If adapting to and using a new type of workstation or viewing system takes too much time, radiologists are not likely to make the transition easily or quickly.

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