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

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60

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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

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50

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70M

ean

Vie

win

g T

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(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

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70

80

90M

ean

Vie

win

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(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