Debra Rundle
University of Pennsylvania Medical Center

WWW Based Interactive Radiology

ABSTRACT

Today Mosaic can be used to interface your personal computer to the world wide web of servers. Information can be accessed from these servers through Mosaic by touching hot linked text. These links embed textual descriptions and images into the Mosaic window. A new helper program, called MapServe, extends this function to include a point and click interface. Features within pictures can be outlined and descriptions be linked to those features, accomplishing a more interactive connection to online information. This demonstration is specific to radiology, pathology, and anatomy (slices from the Visible Human) but other still images can be used as well.

PAPER

Debra Rundle, MSBE, John Clarke, MD, Mary Hochman, MD, and Maryellyn Gilfeather, MD

Over the past five years, internet use is booming at a tremendous rate. Today there are over 70,000 servers world wide accessible through the world wide web (www). Searching through the vast data accessible from these servers is a daunting task, much like navigating the ocean in a small ship. However, once a student accesses an island of information, he or she has the ability to link to other similar services through client applications like Mosaic which use hyperlinked text, html (hypertext markup language).

How do we, medical educators, exploit the www to augment or change medical education as it is practiced today. Our medical students and residents today are barraged with more information than ever before. How do we focus our students limiting the www so they may use it in the most expedient manner? Hence hyperlinked text does have the drawback whereby students can become lost in the web, essentially wasting valuable time. My suggestion is to provide more structured tools that augment the powerful hyperlinked interface. One of the latest and most powerful tools with respect to radiology education is image mapping server software.

From our university based radiology department we supply an internet accessible server, http://www.rad.upenn.edu/, which offers department information for outsiders as well as controlled access to educational materials only available to department members. This server is accessible to the www hence students may use information within our department or from home through a slip connection.

Our radiology server is equipped with image mapping server software which turns an html page with a radiograph image into an interactive, radiology anatomy lesson. The advantage to the student is unlimited access to an online, interactive atlas at any time during the day, anywhere within the department, and on any computer (Mosaic and the image map tools run on Sun, Macintosh, and IBM computers).

The advantage to the educator is that she/he needs to put together an anatomy lesson only once. A student may then interact with the radiographs using a point and click interface without the need for the educator to be there when the student is ready to review the material.

An interactive radiograph is made up of three components: the image (a radiograph stored in GIF format), the map (generated by a helper program), and html files which describe the outlined areas, figure 1. The process is completed in several steps. First the www server must be augmented with the appropriate image map software.

If the server is UNIX based, image map software is available from CERN or NCSA at software is ttpL//www.w3.org/hypertext/WWW/aemon/User/CGI/HTImageDoc.html, http://hoohoo.ncsa.uiuc.edu/docs/setup/admin/Imagemap.html respectively. Macintosh servers are also available from MacImageMap and MapServe at http://weyl.zibberlin.de/ imagemap/macimagemap.htmlhttp://www.spub.ksu.edu/other/machttp_tools/mapserve/mapserve.sit.hqx. Second maps must be created that effectively superimpose outlined anatomic structures over the image. Please note that MapServe for the Macintosh and ImageMap from NCSA have the same mapping format and the maps and images can be used interchangeably. On the Macintosh a helper program, called WebMap, can be used to create polygon, rectangle, circle, oval, and point outlines on an image. This program supplies tools to draw these shapes over an image. It also generates a map file containing the points outlining a structure and the html file link which explains that structure, figure 2. I use a commercial program to create the polygon outlines. Canvas is most flexible because of its ability to edit polygon shapes. I copy the Canvas file contents into a program I created called ImageMap converter, written in SuperCard. This program creates maps and structures my customized html file explanations. Third html files are created and filled with appropriate descriptive material. Fourth, all files are uploaded onto the server.

I would like to offer some cautionary notes. Map files created on a Macintosh computer will not work simply as text files but must be converted to UNIX using the utility, otherwise ImageMap will not operate properly. Also nonclosed polygons will cause map errors.

Acknowledgments: I acknowledge Eric Feingold and Katherine Gordon for their reliable UNIX server knowledge and network support.

Figure 1 Interactive Radiograph Components
Image SagKnee.GIF
Map SagKnee.map
html files anterior_tibial_artery.html
biceps_femoris.html
default.html

Figure 2 - MAP file example
default /rundle/MRI/default.html
poly /rundle/MRI/quadriceps_tendon.html 100,0 98,29 94,54 92,77 87,97 81,115 76,133 76,148 80,170 85,192 90,208 100,227 103,233 111,230 105,219 95,199 90,181 87,162 84,145 85,132 93,123 101,117 106,110 109,102 110,86 112,63 113,48 118,33 119,14 121,0 100,0
poly /rundle/MRI/femur.html 171,0 170,15 169,41 168,70 167,89 169,105 169,118 171,128 167,135 165,143 163,149 163,157 160,163 157,167 156,179 156,188 160,196 164,206 168,213 173,223 181,232 188,238 197,244 207,250 218,256 229,259 240,261 255,262 268,261 284,262 303,261 320,255 332,243 340,231 340,216 336,200 332,189 328,178 321,170 310,164 299,154 289,147 278,130 275,111 274,94 272,69 272,43 270,19 269,0 171,0

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