Post on 02-Jan-2016
Influence of Enhanced
Visualization Processing (EVP) of Chest Images
on Workflow
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
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
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
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
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%)
Current Hypothesis
EVP will improve workflow Reduce use image processing Reduce time using processing Reduce overall viewing time
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
Reading Procedure Did not alter normal reading routine
• Used window/level etc.
• Used zoom
• Reports dictated
• Proceeded own pace
Observation Digital video security camera VCR Date & time stamp Radiologists turned on Showed ID badge to camera
Panasonic WV-BP330- 768 x 494 pixels- 30 frames/sec- SNR = 50 dB- Minimum illumination0.08 lx at F1.4 with automatic gain on
Sony VCR& Monitor
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
Viewing Time
0
10
20
30
40
50
60
70
80M
ean
Vie
win
g T
ime
(sec
)
Rad 1 Rad 2 Rad 3 Rad 4
KodakFuji
F = 6.271, p = 0.0135 all readersF = 13.58, p = 0.0003 # 4 out
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
Zoom Time
0
10
20
30
40
50
60
70M
ean
Vie
win
g T
ime
(sec
)
Used Not Used
KodakFuji
Zoom : F = 9.26, p = 0.0028Modality : F = 9.19, p = 0.0029
Processing Time
0
10
20
30
40
50
60
70
80
90M
ean
Vie
win
g T
ime
(sec
)
Used Not Used
KodakFuji
Processing : F = 17.61, p < 0.0001
Modality : F = 18.73, p < 0.0001
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
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