Optimizing analysis, visualization, and navigation of large image data sets: one 5000-section CT scan can ruin your whole day.

UNLABELLED The technology revolution in image acquisition, instrumentation, and methods has resulted in vast data sets that far outstrip the human observers' ability to view, digest, and interpret modern medical images by using traditional methods. This may require a paradigm shift in the radiologic interpretation process. As human observers, radiologists must search for, detect, and interpret targets. Potential interventions should be based on an understanding of human perceptual and attentional abilities and limitations. New technologies and tools already in use in other fields can be adapted to the health care environment to improve medical image analysis, visualization, and navigation through large data sets. This historical psychophysical and technical review touches on a broad range of disciplines but focuses mainly on the analysis, visualization, and navigation of image data performed during the interpretive process. Advanced postprocessing, including three-dimensional image display, multimodality image fusion, quantitative measures, and incorporation of innovative human-machine interfaces, will likely be the future. Successful new paradigms will integrate image and nonimage data, incorporate workflow considerations, and be informed by evidence-based practices. This overview is meant to heighten the awareness of the complexities and limitations of how radiologists interact with images, particularly the large image sets generated today. Also addressed is how human-machine interface and informatics technologies could combine to transform the interpretation process in the future to achieve safer and better quality care for patients and a more efficient and effective work environment for radiologists. SUPPLEMENTAL MATERIAL http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.11091276/-/DC1.

[1]  G D Rubin,et al.  STS-MIP: a new reconstruction technique for CT of the chest. , 1993, Journal of computer assisted tomography.

[2]  David G. Heath,et al.  Skeletal 3-D CT: advantages of volume rendering over surface rendering , 1996, Skeletal Radiology.

[3]  Cosme Furlong,et al.  Optoelectronic holographic otoscope for measurement of nano-displacements in tympanic membranes. , 2009, Journal of biomedical optics.

[4]  Hans Roehrig,et al.  Searching for nodules: what features attract attention and influence detection? , 2003, Academic radiology.

[5]  D. Chakraborty ROC curves predicted by a model of visual search , 2006, Physics in medicine and biology.

[6]  Charles R. Meyer,et al.  Demonstration of accuracy and clinical versatility of mutual information for automatic multimodality image fusion using affine and thin-plate spline warped geometric deformations , 1997, Medical Image Anal..

[7]  N. Jain,et al.  Ergonomics in radiology. , 2009, Clinical radiology.

[8]  Katherine P Andriole,et al.  Augmenting the impact of technology adoption with financial incentive to improve radiology report signature times. , 2010, Journal of the American College of Radiology : JACR.

[9]  Bhargav Raman,et al.  Radiology on handheld devices: image display, manipulation, and PACS integration issues. , 2004, Radiographics : a review publication of the Radiological Society of North America, Inc.

[10]  J. M. Wolfe,et al.  2.16 – Visual Search , 2008 .

[11]  D. Mikulis,et al.  Intravascular Functional Maps of Common Neurovascular Lesions Derived From Volumetric 4D CT Data , 2010, Investigative radiology.

[12]  Curtis P Langlotz,et al.  The radiology report of the future: a summary of the 2007 Intersociety Conference. , 2008, Journal of the American College of Radiology : JACR.

[13]  Andrew D. A. Maidment,et al.  Image quality in digital mammography: image acquisition. , 2006, Journal of the American College of Radiology : JACR.

[14]  S H Cornell,et al.  Time course of satisfaction of search. , 1991, Investigative radiology.

[15]  Benjamin D. Greenberg,et al.  An immersive virtual environment for DT-MRI volume visualization applications: a case study , 2001, Proceedings Visualization, 2001. VIS '01..

[16]  Patrik Langehanenberg,et al.  Automated three-dimensional tracking of living cells by digital holographic microscopy. , 2009, Journal of biomedical optics.

[17]  Philip F. Judy,et al.  Lesion detection and signal–to–noise ratio in CT images , 1981 .

[18]  R A Greenes,et al.  Form-based clinical input from a structured vocabulary: initial application in ultrasound reporting. , 1992, Proceedings. Symposium on Computer Applications in Medical Care.

[19]  Orazio Schillaci,et al.  Single-photon emission computed tomography/computed tomography in brain tumors. , 2007, Seminars in nuclear medicine.

[20]  Katherine P Andriole,et al.  Advanced image processing in the clinical arena: issues to consider. , 2006, Journal of the American College of Radiology : JACR.

[21]  J. P. Thomas,et al.  A signal detection model predicts the effects of set size on visual search accuracy for feature, conjunction, triple conjunction, and disjunction displays , 2000, Perception & psychophysics.

[22]  Håkan Geijer,et al.  Alternative User Interface Devices for Improved Navigation of CT Datasets , 2009, Journal of Digital Imaging.

[23]  Hitoshi Biwasaka,et al.  The applicability of holography in forensic identification: a fusion of the traditional optical technique and digital technique. , 2005, Journal of forensic sciences.

[24]  R A Greenes,et al.  Evaluation of UltraSTAR: performance of a collaborative structured data entry system. , 1994, Proceedings. Symposium on Computer Applications in Medical Care.

[25]  H L Kundel,et al.  Visual search patterns and experience with radiological images. , 1972, Radiology.

[26]  Richard L Morin Cross-sectional imaging: a technology crisis upon us. , 2006, Journal of the American College of Radiology : JACR.

[27]  Katherine P. Andriole,et al.  Integrating Multiple Clinical Information Systems using the Java Message Service Framework to Enable the Delivery of Urgent Exam Results at the Point of Care , 2005, Journal of Digital Imaging.

[28]  Richard L. Morin,et al.  Transforming Medical Imaging: The First SCAR TRIP™ Conference , 2006, Journal of Digital Imaging.

[29]  H L Kundel,et al.  Finding lung nodules with and without comparative visual scanning , 1981, Perception & psychophysics.

[30]  Patrick J. Green,et al.  Clinical applications for stereoscopic 3‐D displays , 2007 .

[31]  K. Doi,et al.  Effect of a computer-aided diagnosis scheme on radiologists' performance in detection of lung nodules on radiographs. , 1996, Radiology.

[32]  Abraham Lin,et al.  Initial observations of electronic medical record usage during CT and MRI interpretation: Frequency of use and impact on workflow. , 2010, AJR. American journal of roentgenology.

[33]  Bruce I. Reiner,et al.  Addressing the Coming Radiology Crisis—The Society for Computer Applications in Radiology Transforming the Radiological Interpretation Process (TRIP™) Initiative , 2004, Journal of Digital Imaging.

[34]  K. Berbaum,et al.  Satisfaction of search in diagnostic radiology. , 1989, Investigative radiology.

[35]  Maryellen L Giger,et al.  Prevalence scaling: applications to an intelligent workstation for the diagnosis of breast cancer. , 2008, Academic radiology.

[36]  David E. Avrin,et al.  Computers in imaging and health care: Now and in the future , 2000, Journal of Digital Imaging.

[37]  Evangelos Mirlis,et al.  Color holography to produce highly realistic three-dimensional images. , 2008, Applied optics.

[38]  Ehsan Samei,et al.  Digital mammography image quality: image display. , 2006, Journal of the American College of Radiology : JACR.

[39]  Carl J. D'Orsi,et al.  Stereoscopic Digital Mammography: Improved Accuracy of Lesion Detection in Breast Cancer Screening , 2008, Digital Mammography / IWDM.

[40]  W. C. Spackman Correspondence , 1921, The Indian medical gazette.

[41]  Jeremy M. Wolfe,et al.  26.5 brief comms NEW , 2005 .

[42]  Hiroshi Honda,et al.  Time Course of Satisfaction of Search , 1990 .

[43]  David W Bates,et al.  Communicating critical test results: safe practice recommendations. , 2005, Joint Commission journal on quality and patient safety.

[44]  J Fernàndez-Bayó,et al.  Distributing medical images with internet technologies: a DICOM web server and a DICOM java viewer. , 2000, Radiographics : a review publication of the Radiological Society of North America, Inc.

[45]  Kunio Doi,et al.  Computer-aided diagnosis in medical imaging: Historical review, current status and future potential , 2007, Comput. Medical Imaging Graph..

[46]  J. Greene Design and development of a new facility for teaching and research in clinical anatomy , 2009, Anatomical sciences education.

[47]  Charles E. Kahn,et al.  ACCF/ACR/AHA/ASE/ASNC/HRS/NASCI/RSNA/SAIP/SCAI/SCCT/SCMR 2008 Health Policy Statement on Structured Reporting in Cardiovascular Imaging. , 2009, Journal of the American College of Cardiology.

[48]  Suresh Senan,et al.  Improving target delineation on 4-dimensional CT scans in stage I NSCLC using a deformable registration tool. , 2010, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[49]  Sandy Napel,et al.  Automated generation of curved planar reformations from volume data: method and evaluation. , 2002, Radiology.

[50]  Kevin S Berbaum,et al.  Does computer-aided diagnosis for lung tumors change satisfaction of search in chest radiography? , 2007, Academic radiology.

[51]  J. Wolfe,et al.  What attributes guide the deployment of visual attention and how do they do it? , 2004, Nature Reviews Neuroscience.

[52]  V.R.S Mani,et al.  Survey of Medical Image Registration , 2013 .

[53]  Ramin Khorasani,et al.  Cloud computing: what is it and could it be useful? , 2010, Journal of the American College of Radiology : JACR.

[54]  J. Palmer Attention in Visual Search: Distinguishing Four Causes of a Set-Size Effect , 1995 .

[55]  Claudia Mello-Thoms,et al.  Using gaze-tracking data and mixture distribution analysis to support a holistic model for the detection of cancers on mammograms. , 2008, Academic radiology.

[56]  Max A. Viergever,et al.  A survey of medical image registration , 1998, Medical Image Anal..

[57]  Yael Edan,et al.  Technical Brief: A Gesture-based Tool for Sterile Browsing of Radiology Images , 2008, J. Am. Medical Informatics Assoc..

[58]  Michael W Freckleton,et al.  Informatics in radiology (infoRAD): introduction to the language of three-dimensional imaging with multidetector CT. , 2005, Radiographics : a review publication of the Radiological Society of North America, Inc.

[59]  Jacqueline Brunetti,et al.  Technical aspects of positron emission tomography/computed tomography fusion planning. , 2008, Seminars in nuclear medicine.

[60]  M A Vannan,et al.  Volumetric multiplexed transmission holography of the heart with echocardiographic data. , 1995, Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography.

[61]  Jesse Lin,et al.  Methods for identifying changes in radiologists' behavioral operating point of sensitivity-specificity trade-offs within an ROC study of the use of computer-aided detection of lung cancer , 2001, SPIE Medical Imaging.

[62]  H. McAdams,et al.  Multiplanar and three-dimensional imaging of the thorax. , 2003, Radiologic clinics of North America.

[63]  G Allan Johnson,et al.  Lung perfusion imaging in small animals using 4D micro-CT at heartbeat temporal resolution. , 2009, Medical physics.

[64]  M. Freedman State-of-the-art screening for lung cancer (part 1): the chest radiograph. , 2004, Thoracic surgery clinics.

[65]  Nancy Knight,et al.  Radiology reporting, past, present, and future: the radiologist's perspective. , 2007, Journal of the American College of Radiology : JACR.

[66]  U. Neisser VISUAL SEARCH. , 1964, Scientific American.

[67]  Jeremy M. Wolfe,et al.  Rare targets are often missed in visual search , 2005 .

[68]  Curtis P Langlotz,et al.  A framework for improving radiology reporting. , 2005, Journal of the American College of Radiology : JACR.

[69]  H L Kundel,et al.  Satisfaction of search (SOS) , 1992, Investigative radiology.

[70]  E. Conant,et al.  Holistic component of image perception in mammogram interpretation: gaze-tracking study. , 2007, Radiology.

[71]  Khan M Siddiqui,et al.  Radiologist assessment of PACS user interface devices. , 2006, Journal of the American College of Radiology : JACR.

[72]  S. Rankin,et al.  Spiral CT: vascular applications. , 1998, European journal of radiology.

[73]  Katherine P Andriole,et al.  Paradigms of perception in clinical practice. , 2006, Journal of the American College of Radiology : JACR.

[74]  P F Judy,et al.  Detection of noisy visual targets: Models for the effects of spatial uncertainty and signal-to-noise ratio , 1981, Perception & psychophysics.

[75]  F. Pinto,et al.  Dynamic three-dimensional echocardiography: a new era in ultrasound technology. , 1997, Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology.

[76]  K. Camphausen,et al.  Advances in 4D Medical Imaging and 4D Radiation Therapy , 2008, Technology in cancer research & treatment.

[77]  Orazio Schillaci,et al.  Single-photon emission computed tomography/computed tomography in abdominal diseases. , 2007, Seminars in nuclear medicine.

[78]  William Hendee,et al.  The Handbook of Medical Image Perception and Techniques. , 2010, Medical physics.

[79]  David Gur,et al.  Prevalence effect in a laboratory environment. , 2003, Radiology.

[80]  Elizabeth A Krupinski,et al.  Digital radiography image quality: image processing and display. , 2007, Journal of the American College of Radiology.

[81]  C J Sutherland,et al.  Depiction of Pelvic Fractures Using 3D Volumetric Holography: Comparison of Plain X‐Ray and CT , 1995, Journal of computer assisted tomography.

[82]  Jianguo Zhang,et al.  PACS and Web-based image distribution and display. , 2003, Computerized medical imaging and graphics : the official journal of the Computerized Medical Imaging Society.

[83]  P R Goddard,et al.  Ergonomics of digital imaging. , 2005, The British journal of radiology.

[84]  Christian Lovis,et al.  Enterprise-wide PACS: beyond radiology, an architecture to manage all medical images. , 2005, Academic radiology.

[85]  David Gur,et al.  From the laboratory to the clinic: the "prevalence effect". , 2003, Academic radiology.

[86]  G D Rubin,et al.  Volumetric analysis of volumetric data: achieving a paradigm shift. , 1996, Radiology.

[87]  Geoffrey D Rubin,et al.  3-D imaging with MDCT. , 2003, European journal of radiology.

[88]  Mel Siegel,et al.  Real-time tomographic holography for augmented reality. , 2010, Optics letters.

[89]  Richard H Wiggins,et al.  Handheld computers in radiology. , 2003, Radiographics : a review publication of the Radiological Society of North America, Inc.

[90]  Susumu Kandatsu,et al.  Informatics in Radiology (infoRAD): mobile wireless DICOM server system and PDA with high-resolution display: feasibility of group work for radiologists. , 2005, Radiographics : a review publication of the Radiological Society of North America, Inc.