Realities of Teaching Radiology
Teaching radiology requires collecting interesting films which
demonstrate problems both commonly and uncommonly seen. This tried
and true method has a number of unpleasant realities associated with
it. In addition to the x-ray folders becoming numerous, bulky, and
difficult to keep track of, x-rays from one folder have an intriguing
tendency of winding up in an entirely different folder from the one
they start off in. Then there is the more serious problem of the
folders disappearing entirely as friends and colleagues "borrow" them
for their own lectures. Thus time is require to "maintain" the file.
There has to be a better way.
One answer is to store teaching films electronically. The Amiga
is ideally suited for digitizing, storing, and then rapidly re-
displaying them on any of the high quality 24 bit graphics boards
currently available. But where do these interesting cases come from
and how does one get them into the Amiga?
Enter the Amiga
For common problems, radiographs are readily available. These I
digitized using a Panasonic WV1410 video camera connected to the video
interface unit (VIU) of a GVP IV24 board, a vastly underrated
peripheral.
For less common problems, I digitized examples from standard
textbooks and articles using an Epson ES-800C flat bed scanner
controlled by ADPro (Elastic Reality) and interfaced to my Amiga 4000.
I stored these images on 150 MB removable Bernoulli disks which are
conveniently accessible both on my A4000 at home and on my A2000 which
I brought to the hospital because each has a Bernoulli drive attached.
Images thus collected were useful not only for creating the
"Basically Bone" teaching file, but also for generating the
photographic slides I need when I lecture on bone radiology. Because
my A4000 has the Bernoulli drive and the images I need but my A3000
has the Polaroid CI-3000 I use to make slides, I used SpectraLink
(Spectronics Ltd.) to network the two computers via the external
floppy disk ports. Thus my A3000 makes slides from the images I store
on my A4000. Pretty neat, I think. I found the network to be
extremely stable and can recommend it for applications such as this.
Time for Graphic Recall
Graphic Recall is a talented program. Using ADPro, it can make a
picture database from images in one or more files by creating small
icons of each. Although one has a choice of a variety of ECS and AGA
resolutions for the icons, I chose the ECS hires (640 x 400 pixel, 16
color) option as much of my development was actually on my A2000 at
work during lunch! I could then display full 256 grey scale
radiographs simply by clicking on the appropriate icon and using the
IVVIEW program that comes with the GVP IV24 board. (I did have to
write a two line AmigaDOS script program because I needed the "hires"
option for IVVIEW.)
I then used Graphic Recall's option of adding a text file to each
image. For each bone disease, I wrote a complete description
including the age and sex of persons usually affected, how it presents
clinically, how it looks radiographically, what diseases it must be
distinguished from, the prognosis, and much more! This gory (or
informative -- depends on your point of view!) can be hidden from the
student using the F10 key as a toggle switch.
So now you can begin to see one way the application can be used.
The teacher can select any databased image, display it on the IV24,
ask the student what he/she thinks the radiograph is all about, and
then let the student read about the bone disease using the F10 hot
key. The descriptive material can even be printed out for future
reference.
There Is Even More!
"Basically Bone" is even more powerful because it uses Graphic
Recall's search function which allows each image to be referenced by
up to 255 characters worth of "key words." A maximum of three key
words can be used for a search, one of which can be exclusionary.
This allows search options such as "NOT adult." Because one has to
achieve some degree of consistency in key word choice, Graphic Recall
provides the option of listing key words in a readily accessible
"dictionary." By using this dictionary, other users can know which
words to use for a search. This is a very powerful feature indeed.
As an illustration, suppose I wanted to see examples of childhood
diseases affecting the spine. I might search under "pediatric" and
"spine" perhaps after consulting the dictionary to see if these had
been used as key words. If the search were successful, I would then
have a list of all the examples I had archived under these descriptors
and have the option of looking at any image in the list. I might then
try to match the radiograph in my hand with the image on the monitor
to check for similarities. Thus "Basically Bone" could even have a
role in clinical diagnosis!
So Do They Like It?
Although the "Basically Bone" is still under construction -- and
it some sense is never finished because there are always new cases and
new things to say about them -- radiology residents are very
enthusiastic. Their goal is to learn and ultimately pass their
written and oral board examinations and are genuinely grateful for any
help they receive.
And the Future?
At some point I will put all the images on a CD ROM, making the
whole system more transportable and probably more reliable in the long
run. Of course, I'll make a version for AGA screens. I might also
database my chest radiographs -- I certainly have enough of them!
Writing up the cases is really a lot of work and, as I have hinted, is
basically being done in stolen moments. I am also working on other
Amiga applications as well.
I have kept in contact with the developer of Graphic Recall who
has included many customizations I have suggested. He has promised
additional enhancements to the program including linking sound files
to images and improved AREXX handling. I believe that he and all
Amiga developers deserve our support and encouragement by continuing
to purchase their products and showing applications based on them both
inside and outside the Amiga community. In this regard, I am
submitting a proposal to present "Basically Bone" at a major medical
convention in June, 1995.
July, 1995
Addendum (6/98) -- Added for the Web Edition
Graphic Recall in Practice
Take for example a case of chondrosarcoma of the humerus (arm)
(Figure 1).
Graphic Recall would make a thumbnail image of the radiograph
(Figure 2)
and include it in its database
(Figure 3).
Unlike other image databasing program, Graphic Recall allows
you to add a description to each image. In our example, this could
mean providing information about the radiographic appearance of
chondrosarcoma.
(Figure 4)
Very importantly, Graphic Recall allows you to locate and
display an image within its database based on keywords you have
selected as search parameters. The keywords should help
distinguish, in so far as possible, one image from the next.
For example, chondrosarcoma frequently is associated with
calcification that has a fluffy, "popcorn" appearance. If we use
"popcorn" as a keyword, we can search Graphic Recall's database for
all images having the keyword "popcorn."
(Figure 5)
When we do this, we find that not only do chondrosarcomas have
"popcorn" calcification but enchondromas also have this same feature.
This is important to know because enchondromas are benign while
chondrosarcomas are
malignant.
A very nice feature of Graphic Recall is its ability to
display multiple related (or unrelated) images on the same screen
for side-by-side comparison. Using a different example, that of
osteosarcoma, we can compare the nuclear medicine bone scan,
radiography, and CT (x-ray computed tomography) scan with the
pathology.
(Figure 6)
These examples illustrate how useful Graphic Recall is as an
image cataloging program .