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Influence of Enhanced Visualization Processing EVP of Chest Images on Workflow

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Influence of Enhanced Visualization Processing EVP of Chest Images on Workflow

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    1. Influence of Enhanced Visualization Processing (EVP) of Chest Images on Workflow

    2. PROJECT PARTICIPANTS Elizabeth Krupinski, PhD 1 Martin Radvany, MD 2 Alan Levy, MD 2 Daniel Ballenger, MD 2 Jonathan Tucker, PhD 2 Anna Chacko, MD 2 Richard VanMetter, PhD 3 1 University of Arizona Tucson, AZ 2 Brook Army Medical Center San Antonio, TX 3 Kodak Health Imaging Rochester, NY

    3. EVP Increase latitude without reducing contrast needed for diagnostic details? Acquire CR images traditional way Process with Kodak CR system Default processing with nonlinear edge enhancement

    4. EVP Automatic tone scaling algorithm PTONE (perceptual tone scale) Image analysis Tone scale generation Tone scale application Utilizes Perceptual Linearization EVP applied after analysis & generation, before application

    5. EVP Divides image low & high-frequency component images Contrast low-frequency reduced, increasing the latitude Contrast high-frequency enhanced, preserving diagnostic detail Images recombined & PTONE applied

    6. Preference Study Van Metter & Foos SPIE 1999 70 images, 10 radiologist Side-by-side comparison EVP satisfactory or better than control images (92.6% vs 55.6%) More control images unsatisfactory (4.0% vs 0.6%)

    7. Current Hypothesis EVP will improve workflow Reduce use image processing Reduce time using processing Reduce overall viewing time

    8. Materials & Methods BAMC summer 2000 Kodak CR 400 System with EVP Fuji CR system without EVP Portable chest images - 4 ICUs 1 ICU each day for Kodak => mix of both each day R & L lead markers on Kodak Send through PACS

    10. Reading Procedure Did not alter normal reading routine Used window/level etc. Used zoom Reports dictated Proceeded own pace

    11. Observation Digital video security camera VCR Date & time stamp Radiologists turned on Showed ID badge to camera

    13. Data Analysis 66 Kodak & 75 Fuji cases 4 radiologists 1 = 23 Kodak, 25 Fuji 2 = 21 Kodak, 25 Fuji 3 = 17 Kodak, 22 Fuji 4 = 5 Kodak, 3 Fuji Videotapes reviewed: viewing time & frequency use of image processing

    14. Viewing Time

    15. Zoom & Processing Zoom 64% Kodak cases & 69% Fuji cases X2 = 0.51, df = 1, p > 0.05 Window/level etc. 35% Kodak cases & 41% Fuji cases X2 = 0.49, df = 1, p > 0.05 No significant differences in usage frequency

    16. Zoom Time

    17. Processing Time

    18. Conclusions Workflow significantly improved with EVP ~ 13 sec on average / case Savings of 22 minutes / 100 cases Does not reduce frequency of image processing use Time associated with use is reduced significantly

    19. Caveats Not a diagnostic accuracy study ROC study could address this Used only chest images from the ICU Image & diagnostic task may influence EVP impact on workflow

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