Development of an Eye-Tracking Image Manipulation System for Angiography: A Comparative Study.

RATIONALE AND OBJECTIVES: Appropriate image manipulation of angiographic image display systems during interventional radiology is performed by radiological technologists and/or nurses given instructions from radiologists. However, appropriate images might not be displayed because of communication errors. Therefore, we developed a manipulation system that uses an eye tracker. The study aimed to determine if an angiographic image display system can be manipulated as well by using an eye tracker as by using a mouse. MATERIALS AND METHODS: An angiographic image display system using an eye tracker to calculate the gaze position on the screen and state of fixation was developed. Fourteen radiological technologists participated in an observer study by manipulating 10 images for each of 5 typical cases frequently performed in angiography, such as renal tumor, cerebral aneurysm, liver tumor, uterine bleeding, and hypersplenism. We measured the time from the start to the end of manipulating a series of images required when using the eye tracker and the conventional mouse. In this study, the statistical processing was done using Excel and R and R studio. RESULTS: The average time required for all observers for completing all cases was significantly shorter when using the eye tracker than when using the mouse (10.4 ± 2.1 s and 16.9 ± 2.6 s, respectively; p< 0.001 by paired t test). CONCLUSION: Radiologists were able to manipulate an angiographic image display system directly by using the newly developed eye tracker system without touching contact devices, such as a mouse or angiography console. Therefore, communication error could be avoided.

Establishing community-based integrated care for elderly patients through interprofessional teamwork: a qualitative analysis.

BACKGROUND: Working in multidisciplinary teams is indispensable for ensuring high-quality care for elderly people in Japan's rapidly aging society. However, health professionals often experience difficulty collaborating in practice because of their different educational backgrounds, ideas, and the roles of each profession. In this qualitative descriptive study, we reveal how to build interdisciplinary collaboration in multidisciplinary teams. METHODS: Semi-structured interviews were conducted with a total of 26 medical professionals, including physicians, nurses, public health nurses, medical social workers, and clerical personnel. Each participant worked as a team member of community-based integrated care. The central topic of the interviews was what the participants needed to establish collaboration during the care of elderly residents. Each interview lasted for about 60 minutes. All the interviews were recorded, transcribed verbatim, and subjected to content analysis. RESULTS: The analysis yielded the following three categories concerning the necessary elements of building collaboration: 1) two types of meeting configuration; 2) building good communication; and 3) effective leadership. The two meetings described in the first category - "community care meetings" and "individual care meetings" - were aimed at bringing together the disciplines and discussing individual cases, respectively. Building good communication referred to the activities that help professionals understand each other's ideas and roles within community-based integrated care. Effective leadership referred to the presence of two distinctive human resources that could coordinate disciplines and move the team forward to achieve goals. CONCLUSION: Taken together, our results indicate that these three factors are important for establishing collaborative medical teams according to health professionals. Regular meetings and good communication facilitated by effective leadership can promote collaborative practice and mutual understanding between various professions.

Problem-based learning for radiological technologists: a comparison of student attitudes toward plain radiography.

BACKGROUND: Knowledge and skill expected of healthcare providers continues to increase alongside developments in medicine and healthcare. Problem-based learning (PBL) is therefore increasingly necessary in training courses for radiological technologists. However, it is necessary to evaluate the effects of PBL to completely introduce it in our education programs. As a Hypothesis, it seems that a change occurs in the student's attitudes by participating in PBL practical training. There is the Semantic Differential (SeD) technique as a method to identify student's attitudes. We conceived that PBL could be appropriately evaluated by using SeD technique. In this paper, we evaluated PBL for plain radiography practical training using the SeD technique. METHODS: Thirty-eight third-year students studying radiological technology participated. PBL was introduced to practical training in plain radiography positioning techniques. Five sessions lasting 5 h each were delivered over a 5-week period during November to December 2012. The clinical scenario was an emergency case with multiple trauma requiring plain radiography. Groups comprising approximately eight students created workflows for trauma radiography with consideration of diagnostic accuracy and patient safety. Furthermore, students groups conducted plain radiography on a patient phantom according to created workflows and were then guided by feedback from professional radiologists. All students answered SeD questionnaires to assess views on plain radiography before instruction to provide preliminary practical training reports and after completing practical training. RESULTS: The factors were identified using factor analysis of the questionnaires, which were answered before and after each practical training session. On evaluation of the relationships between factors and question items according to factor loading, we identified "reluctance", "confidence", and "exhaustion" as the predominant attitudes before practical training. Similarly, we identified "expectation", "self-efficacy", and "realness" as the predominant attitudes after practical training. The attitudes toward plain radiography changed before and after PBL practical training. CONCLUSIONS: The attitude of self-efficacy was noted after practical training, which incorporated PBL. Student self-efficacy was thought to increase through self-directed learning, which is one of the aims of PBL. Although the influences of other lectures and training, which were performed in parallel with the PBL practice training, were not completely excluded, and although the number of study participants was small, we were able to confirm the effects of PBL.

[An introduction and implementation of problem-based learning for radiography positioning training].

The knowledge of radiological technologists is expected to increase with medical development. However, it is impossible to impart all knowledge in a limited time frame. Problem-based learning (PBL) is a learning methodology to solve it. In the PBL, students can gain problem-solving abilities by acquiring necessary knowledge from clinical cases and applying them during practice. We here report to implement the PBL in radiography practice. This practice opened a course at 2nd semester of third-grade students in our school. The practice flow includes presentation of clinical case and a survey of necessary knowledge, group work, radiography, reflection through practice, and deliberation of different cases. The clinical case was the radiography of an emergency patient. The evaluation items were about knowledge, skill, and attitude. By the PBL practice, students could realize a clinical scene, and discover considerable points unwritten in textbooks.

[A pilot study of contrast medium dose reduction using low tube voltage and iterative reconstruction: computed tomography angiography of the head].

This study aimed to reduce contrast medium dose without reducing the diagnostic capability of computed tomography (CT) angiography of the head. We evaluated the advanced statistical iterative reconstruction (ASiR) settings to adjust to low tube voltage CT. A syringe phantom was constructed using dilute contrast medium and was imaged at tube voltages of 80-120 kV. The iodine volumes, CT values, and image noise were measured in these images. The noise-power spectrum and modulation transfer function were measured from quality assurance phantom images that had been obtained using the tube voltage selected after considering the image noise results as described above and reconstructed using different ASiR rate settings and convolution kernels. Our results suggested that imaging at 100 kV could reduce the contrast medium dose by 14%, compared with imaging at 120 kV, and that the resulting image quality could equal that of conventional imaging by performing reconstruction at a 40% ASiR rate and detail kernel.

[Development of an attitude-measurement questionnaire using the semantic differential technique: defining the attitudes of radiological technology students toward X-ray examination].

BACKGROUND: In general, it is difficult to objectively evaluate the results of an educational program. The semantic differential (SeD) technique, a methodology used to measure the connotative meaning of objects, words, and concepts, can, however, be applied to the evaluation of students' attitudes. In this study, we aimed to achieve an objective evaluation of the effects of radiological technology education. We therefore investigated the attitude of radiological students using the SeD technique. We focused on X-ray examinations in the field of radiological technology science. METHODS: Bipolar adjective scales were used for the SeD questionnaire. To create the questionnaire, appropriate adjectives were selected from past reports of X-ray examination practice. The participants were 32 senior students at Hokkaido University at the Division of Radiological Technology at the School of Medicine's Department of Health Sciences. All the participants completed the questionnaire. The study was conducted in early June 2012. Attitudes toward X-ray examination were identified using a factor analysis of 11 adjectives. RESULTS: The factor analysis revealed the following three attitudes: feelings of expectation, responsibility, and resistance. Knowledge regarding the attitudes that students have toward X-ray examination will prove useful for evaluating the effects of educational intervention. In this study, a sampling bias may have occurred due to the small sample size; however, no other biases were observed.

A pilot study measuring changes in student impressions before and after clinical training using a questionnaire based on the semantic differential technique.

Students with a positive impression of their studies can become more motivated. This study measured the learning impact of clinical training by comparing student impressions before and after clinical training. The study included 32 students of radiological technology in their final year with the Division of Radiological Science and Technology, Department of Health Sciences, School of Medicine, Hokkaido University. To measure student impressions of x-ray examination training, we developed a questionnaire using the semantic differential technique. The resulting factor analysis identified 2 factors that accounted for 44.9% of the 10 bipolar adjective scales. Factor 1 represented a "resistance" impression of x-ray examination training, and factor 2 represented a "responsibility" impression. The differences in factor scores before and after the clinical training suggest that student impressions are affected by clinical training.

Care-seeking behavior of Japanese gynecological cancer survivors suffering from adverse effects.

BACKGROUND: Post-treatment follow-up visits for gynecological cancer survivors should provide opportunities for management of adverse physical/psychological effects of therapy and early recurrence detection. However, the adequacy of such visits in Japan is poorly documented. We qualitatively explored care-seeking experiences of Japanese gynecological cancer survivors and deduced factors influencing care-seeking behaviors and treatment access. METHODS: We conducted 4 semi-structured focus groups comprising altogether 28 Japanese gynecological cancer survivors to collect a variety of participants' post-treatment care-seeking behaviors through active interaction with participants. Factors influencing access to treatment for adverse effects were analyzed qualitatively. RESULTS: Survivors sought care through specialty clinic visits when regular post-treatment gynecological follow-ups were inadequate or when symptoms seemed to be non-treatment related. Information provided by hospital staff during initial treatment influenced patients' understanding and response to adverse effects. Lack of knowledge and inaccurate symptom interpretation delayed help-seeking, exacerbating symptoms. Gynecologists' attitudes during follow-ups frequently led survivors to cope with symptoms on their own. Information from mass media, Internet, and support groups helped patients understand symptoms and facilitated care seeking. CONCLUSIONS: Post-treatment adverse effects are often untreated during follow-up visits. Awareness of possible post-treatment adverse effects is important for gynecological cancer survivors in order to obtain appropriate care if the need arises. Consultation during the follow-up visit is essential for continuity in care.

[Questions that radiography students have regarding X-ray photography: a qualitative study].

OBJECTIVE: To improve lectures and training programs on X-ray photography, we aimed to determine the questions that radiography students have regarding X-ray photography. METHODS: We collected text data from questions on X-ray photography in radiography student reports after an X-ray photography training program. The text data were analyzed using content analysis. Codes were assigned to segments and they were categorized according to similarities. RESULTS: From 111 reports, 348 questions were collected. Four categories and 47 subcategories were obtained. The "Required Knowledge" category comprised subcategories concerning knowledge for the X-ray photography including X-ray radiography methodology and disease knowledge. The "Radiography Service" category comprised subcategories concerning radiographers' responsibilities in a hospital including the role of radiographer and the extent of responsibilities. The "Radiographers' Challenges" category comprised subcategories concerning unusual situations radiographers encounter at work including accurate positioning and communication with patients. The "Patient Types" category comprised subcategories concerning patients in whom X-ray photography was considered difficult including pediatric patients and patients with serious conditions. Questions related to subcategories in "Radiographers' Challenges" and "Patient Types" were interrelated. Radiography students had concerns regarding whether they would be able to handle difficult patients efficiently in clinical situations. CONCLUSION: We were able to suggest the re-orientation of radiography education according to students' intellectual appetite regarding X-ray radiography.

Filmless versus film-based systems in radiographic examination costs: an activity-based costing method.

BACKGROUND: Since the shift from a radiographic film-based system to that of a filmless system, the change in radiographic examination costs and costs structure have been undetermined. The activity-based costing (ABC) method measures the cost and performance of activities, resources, and cost objects. The purpose of this study is to identify the cost structure of a radiographic examination comparing a filmless system to that of a film-based system using the ABC method. METHODS: We calculated the costs of radiographic examinations for both a filmless and a film-based system, and assessed the costs or cost components by simulating radiographic examinations in a health clinic. The cost objects of the radiographic examinations included lumbar (six views), knee (three views), wrist (two views), and other. Indirect costs were allocated to cost objects using the ABC method. RESULTS: The costs of a radiographic examination using a filmless system are as follows: lumbar 2,085 yen; knee 1,599 yen; wrist 1,165 yen; and other 1,641 yen. The costs for a film-based system are: lumbar 3,407 yen; knee 2,257 yen; wrist 1,602 yen; and other 2,521 yen. The primary activities were "calling patient," "explanation of scan," "take photographs," and "aftercare" for both filmless and film-based systems. The cost of these activities cost represented 36.0% of the total cost for a filmless system and 23.6% of a film-based system. CONCLUSIONS: The costs of radiographic examinations using a filmless system and a film-based system were calculated using the ABC method. Our results provide clear evidence that the filmless system is more effective than the film-based system in providing greater value services directly to patients.

Willingness to pay for municipality hospital services in rural Japan: a contingent valuation study.

BACKGROUND: The Japanese healthcare system has undergone reforms to address the struggles that municipality hospitals face. Reform guidelines clearly define criteria for administrative improvement. However, criteria to evaluate the demand for healthcare provisions in rural Japan, including the needs of rural residents for municipality hospitals in particular have not been specified. The purpose of this paper is to measure residents' willingness to pay (WTP) for municipality hospital services using the contingent valuation method, and to evaluate municipality hospital valuation on the basis of WTP. K town, located in the Hokkaido prefecture of Japan, was selected as the location for this study. Participants were recruited by a town hall healthcare administrator, hospital and clinic staff, and a local dentist. Participants were asked what amount they would be willing to pay as taxes to continue accessing the services of the municipality hospital for one year by using open-ended questions in face-to-face interviews. FINDINGS: Forty-eight residents were initially recruited, and 40 participants were selected for the study (response rate 83%). As compared to K town's population, this data slanted toward the elderly, although there was no significant difference in frequency among the characteristics. The median WTP was estimated at 39,484 yen ($438.71), with a 95% confidence interval 27,806-55,437 yen ($308.95-615.96). Logistic regression revealed no significant factors affecting WTP. CONCLUSIONS: If the total amount of residents' WTP for the municipality hospital were to be estimated by this result, it would calculate with 129,586,000 yen ($1,439,844). This is approximately equal to the amount of money to be transferred from the general account of the government of K town, more than one-half of the town tax of K town, and about two-fold in comparison to Japan as a whole. This showed that K town's residents placed a high valuation on the municipality hospital, which nearly equalled the amount that the K town government provided to the municipality hospital to cover its annual deficit. K town residents had come to expect not only general clinical practice, but also emergency medical services and night practice provided by their own town's municipality hospital. WTP can be used as a measure of hospital evaluation because it reflects the importance of the hospital to the residents in its region.

[Hierarchy structuring for mammography technique by interpretive structural modeling method].

Participation in screening mammography is currently desired in Japan because of the increase in breast cancer morbidity. However, the pain and discomfort of mammography is recognized as a significant deterrent for women considering this examination. Thus quick procedures, sufficient experience, and advanced skills are required for radiologic technologists. The aim of this study was to make the point of imaging techniques explicit and to help understand the complicated procedure. We interviewed 3 technologists who were highly skilled in mammography, and 14 factors were retrieved by using brainstorming and the KJ method. We then applied Interpretive Structural Modeling (ISM) to the factors and developed a hierarchical concept structure. The result showed a six-layer hierarchy whose top node was explanation of the entire procedure on mammography. Male technologists were related to as a negative factor. Factors concerned with explanation were at the upper node. We gave attention to X-ray techniques and considerations. The findings will help beginners improve their skills.

[Developing and evaluating an auto-retrieval algorithm for abbreviations in academic articles].

The purpose of this study was to develop an automated acquisition support for the semantics of abbreviations and evaluate its performance with respect to academic articles. Our goal was to support the maintenance of an institution-specific semantics inventory for abbreviations on a continuous basis. We retrieved articles from MEDLINE with the keyword "Liver [MeSH]," and 100 abstracts were randomly selected. Abbreviations and their full forms were retrieved using original Java software based on the following rules. (1) Searching the parentheses in the abstracts, the words inside the parentheses were retrieved as "INNER" and the words in front of the parentheses were retrieved as "OUTER." (2) Matching rules, such as whether the first characters of INNER and OUTER were the same. (3) If the words satisfied the conditions stated at (2), INNER was saved as the abbreviation and OUTER as the full form. Performance was manually evaluated by two graduate students and a radiologist. Of the 165 pairs of abbreviations and full forms that were obtained, 145 (87.9%) constituted correct matches.

Semantic distribution study of noun*noun compounds in the Japanese CT clinical reports.

The purpose of this study is to investigate the distribution of the semantic relationships between the two atomic medical terms of the noun-noun compounds extracted from the clinical documents in Japanese. Only 29.9% of the compounds had the UMLS semantic relation defined (mainly including "location_of" and "adjacent_to"). The results indicated that the semantic relations defined in the UMLS semantic network are not enough for describing the noun-noun medical compounds extracted from the Japanese clinical reports.

Model analysis for optimal allocation of pediatric emergency center.

Optimal allocation of Pediatric Emergency Centers was simulated using both Min-Sum model and Min-Max model, based on the travel distance and child population of Hokkaido prefecture, Japan. Our result should be helpful to select the optimal number and allocation of PECs in the actual scene of decision making, where the financial restriction exists.

[Development of a radioactive pharmaceuticals management system using a Web-based system].

Systems for recording data on radiopharmaceuticals have changed following the Medical Care Law on concentration limits of radioisotopes in drainage, exhaust gas, and the atmosphere. A Web-based system that includes a patient information subsystem, DICOM imaging subsystem, and laboratory order subsystem has been developed for the receipt, use, stock prescription, disposal, and accounting of radiopharmaceuticals was developed using a Web-based system in order to simplify radiation safety management operations such as changes and additions to record book forms. In verifying the usefulness of the system and its recording and search times, it was found that the new Web-based system provides superior performance.