Creating an Interactive Radiology Community on the Internet

by

Michael Tobin, M.D., Ph.D.

Introduction

I have long wanted to create a virtual Radiology community on the Internet in which interested individuals from all over the world could "meet" and interpret challenging cases without the inconvenience and expense that travel can require.

Because of its many features, I chose the eGroups website as a home for my radiology community, AmiRad. The name "AmiRad," is a contraction of "Amiga," the computer system, originally developed by Commodore, Ltd. which I have used for many years, and "Rad," for radiologist. Figure 1

Creating an Internet community easily and inexpensively

Creating a special interest group, or community, on eGroups requires little more than naming, describing, and finally characterizing the group so that it can be listed in the eGroups directory. There is no charge on eGroups either to create a community or to use it. There are advertisements both on the website and on messages sent from eGroups, but these are not obtrusive. There is an option to have advertisements removed from e-mail for a nominal monthly fee.

Building a selected membership

I wanted to restrict my group to medical personnel, such as radiologists, doctors-in-training, medical students, and others I felt would have the interest, background, and need to know radiologic interpretation. eGroups allowed me to have AmiRad "moderated/restricted" as opposed to "open." Anyone indicating an interest in participating in AmiRad automatically generated an e-mail request to me from eGroups asking for permission to join.

Initially, I also opted to moderate, or approve, all messages before they could be posted to the bulletin board. I wanted discussions and disagreements to be lively yet civil and polite. After a brief trial of reviewing each and every potential post, I decided to relinquish my role as censor and allow the free speech and exchange of ideas that I wanted to encourage.

Useful Basic Features

I needed a service that would allow me to store medical images, post messages, and provide basic discussion. For each community, eGroups provides the following services:

  1. List of members -- Each community contains a list of current members and their e-mail addresses. This is necessary for sending messages and for encouraging group spirit and networking. Certain membership management functions, such as adding or deleting members and setting preferences for receipt of e-mail, are included.

  2. Files area -- eGroups allows each community a very generous 20 megabytes of storage in the "Files" area. This provided an ideal location to store medical images. Figure 2

  3. Chat area -- Group members can interact in near real-time by typing messages to each other. Previously, eGroups also offered "Talk" area, which allowed voice communication to those with a sound card and a microphone. This feature was subsequently removed during a renovation of the eGroups website.

  4. Calendar -- The calendar function allows members to keep track of group events, e.g., classes, discussions, etc. Reminders of events can be sent 24 hours before they occur.

  5. Other Functions -- eGroups provides several additional, potentially useful services, such as Links which allows creation of a list of relevant websites. These can be reached directly by clicking on their names. Database, another eGroups feature, provides editable templates for a variety of common uses, e.g., inventory, contact list, frequently asked questions (FAQ's), etc.

Recruiting members

Although individuals, such as friends and colleagues, can be declared members at the time a community is created, it is not necessary to do so. Members can be added at any time.

I advertised AmiRad on my website using code provided by eGroups. When prospective members select the "Join eGroups" button, they are re-directed to the eGroups website where they can register first for eGroups, and then for AmiRad.

Creating the AmiRad workplace

I selected images from among those that I encounter as a radiologist practicing in a New York City municipal hospital. I digitized the hard-copy films on which these images appear using an Epson Expression 636 scanner, equipped with a transparency unit. The scanner was attached to an Amiga 1200 computer, where the images were stored on the hard disk prior to uploading.

In the eGroups Files section, there is an option both to create folders and also to upload files. At regular intervals, I created folders and uploaded my cases into them. My intention was for group members to meet in the "Chat" area to discuss these cases at frequent intervals.

I posted meeting times and dates on the AmiRad bulletin board, with each member of the group automatically notified by e-mail.

Microsoft's NetMeeting

Although the services provided by the eGroups website are extensive, I also wanted functions such as video, voice, and the ability to share a desktop. These features are present in Microsoft's NetMeeting software which is freely downloadable. Figure 3

In order to integrate NetMeeting's functions into our AmiRad community, I asked group members to meet in AmiRad's chat area and then to launch NetMeeting while I did the same. I reminded them that they had to have ils2.cuseeme.com as their directory server so they could look up my name or else directly enter my IP address as a "direct-dial" number. Figure 4

I next launched IrfanView, a shareware image viewing program. I used the "sharing" option from the Tools menu of NetMeeting so that radiology images displayed by IrfanView on my computer screen could also be seen by the other group members. In order for the grey scale to be correct, Microsoft advises that the screen color depth be limited to 16 bits. Figure 5

Communicating with NetMeeting

Although NetMeeting has several ways for users to communicate, its simplest and most reliable method is its chat function, which is particularly useful when discussing images being viewed during desktop sharing. As with eGroups, chat means typing messages.

Using NetMeeting to communicate by voice is easily possible, even with a 56k modem. However, I found audio quality to vary throughout the day and also from day to day, leading me to believe that bandwidth issues are involved. I also found that my fastest computer (SONY VAIO FG-490, 650 MHz) gave the best results.

NetMeeting's video is currently less important for my teaching application. Transmitting still radiology images as video provides less detail than displaying them with IrfanView and viewing them as a shared application.

Additional ways of communicating

In addition to class meetings, I wanted to be able to communicate with AmiRad members at other times.

The solution I chose was the program ICQ, which allows AmiRad members to initiate a conversation with me via a chat window when I am online. As such, ICQ functions as an Internet messenger, similar to those offered by America Online (AOL) and Microsoft. From a teaching point of view, ICQ provides Internet "office hours" for AmiRad members who wish to avail themselves of the opportunity.

AmiRad until now

AmiRad has been in existence since December 1999, and continues to evolve. At the current time, the AmiRad community has approximately 20 members. As with any community, its ultimate success will depend on the time, energy, and commitment members are able to provide.

Because of the truly international composition of the AmiRad community, it has been difficult to choose a time suitable for all the members. Turn-out at any given meeting has been small. Some individuals have attempted to circumvent this difficulty by posting their answers on eGroups.

Conclusions

AmiRad provides an opportunity for those involved in interpreting radiologic studies to view and discuss a variety of challenging cases that they might not otherwise come across in their own practices. AmiRad may be of special value for those who are required to interpret a wide range of imaging studies but do not always have someone to confer with.

The need to for medical personnel to meet at a specific time is a limiting factor for attendance. AmiRad is, therefore, evolving in more time-independent ways.

AmiRad looks forward to the time when a single Internet service will provide all of the functionality it needs for non- commercial community management and real-time interactivity. It also awaits technical advances that will optimize Internet telephony and video for current user bandwidths.

Those interested in a more complete introduction Internet conferencing can consult the series of articles and links provided by About.com.

Final Words

Because Internet video and voice teleconferencing are undergoing rapid development, we can anticipate changes in the features provided by the applications discussed in this article. Indeed, eGroups is joining Yahoo! with eventual integration of at least some services. Physicians and other medical professionals may find Internet conferencing the wave of the future for communicating with each other and with their patients.

November, 2000

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