The development issues in medical image database development on the web consist of four issues: the Image as an Object, Background, User Interface, and Administrative.

The Image as an Object involves developing a protocol to determine which images will be included, how the images will be digitally prepared, and how the images will be described to provide access to and information about the image. We developed a systematic protocol for catalogers to follow to consider all the aspects about an object that should be considered. We adapted the MARC format for use in the database. We incorporated the Unified Medical Language System so that catalogers would use a standardized vocabulary. We also ran several tests to determine the size and format we should use for images in the database. Background issues are those that deal with the server side of the client--server design. These include the database platform and designs on server configurations. We selected Oracle as the database we would use, and used ODBC and WOW connectivity tools to connect web and Visual Basic interfaces with the database.

Interface issues address the client side of the relationship with respect to web development. These include the design of the data entry interface and the design of the retrieval interface that will be used to access the database and to display the query results. We wrote a Visual Basic interface that allows us to scan the slide, make adjustments to it, and at the same time enter descriptive and catalog information. We designed several versions of each of the two retrieval interfaces, one for medical students and one for physicians, and have incorporated users' suggestions in formative evaluations.

The Administrative issues include security, copyright, personnel to do the work, continuing development of the project, and leadership over the project. Security is designed to protect patient information by controlling the level of access to information by students in relation to the access of medical professionals. A disclaimer and labeling of images will be used to protect the copyrights of the images.

Decisions on one issue affect decisions on other issues. For instance, changes in the database affect the entry and retrieval interfaces. Changes in personnel involve documentation and retraining. By understanding the development issues and determining how they apply to the individual situation, the services that are desired, and the individuals that will be supported, there exists the potential for developing a quality medical image database that will be beneficial.