A Webtextbook for the Teaching of Radiology Concepts and Interpretation to Senior Medical Students and Interns.

Stan G. Alexander, M.D.

Indiana University School of Medicine

Abstract:

The Indiana University School of Medicine is the second largest medical school in North America. Each senior student (about 170 per year) experiences a required one-month clerkship in radiology. The clerkship has traditionally consisted of a combination of seminars, lectures, assigned text readings, handouts and film library self-directed study. About two years ago the course instructor attended two introductory courses in HTML programming offered by Indiana University - Purdue University at Indianapolis (IUPUI). The benefits of using HTML and the WWW for delivery of course materials and syllabus were immediately apparent and the creation of an online course called the, "Radiology Survival Manual" ("RSM") is now in its earliest stages and is an integral part of the clerkship's curriculum. The "RSM" will replace all film library cases, some seminar and lectures events and will serve as a comprehensive text for the course and we expect will also serve as a "world-wide" resource since it is intended to be freely accessible via the Web.

The URL for the webtextbook is: http://www.indyrad.iupui.edu/public/alexanders/rsm/home.html

Digital display, retrieval and storage of medical images are replacing film. The transition from printed media to electronic media for teaching about medical images is timely. The

"RSM" is designed to display medical images in realistic formats similar to those that a physician will routinely see in practice. When appropriate the images are displayed in actual size on an 800 x 600 screen size. Images are displayed on black backgrounds to

diminish extraneous light from hitting the retina.

In order to overcome bandwidth limitations on an image-intense site images are "pre-loaded" into the user's cache so that no page requires more than a 10 second "wait-time" using a 26K connection. The medical images are edited and modified as necessary for clarity to the novice learner. Extraneous artifacts are removed using graphics software. Distracting technical information often seen on high-tech images is removed. Anatomy or pathology is enhanced so as to be easily digested by the beginner.

In addition to medical images the site is illustration-intense as well. High quality renderings of anatomy and pathology provide foundations for medical image interpretations. Shockwave Flash files and animated GIFS provide motion illustrations of pathologic events and describe image-guided procedures.

Content has been developed from experiences over a 5-year period with senior medical students. We feel that we have an intimate knowledge of their entry-level of knowledge after 5-years of observation. Common misperceptions and questions can be anticipated from these experiences and the website is targeted to address predicable misunderstandings. Instructional transactions are integrated into the site by using imagemaps, Flash movies and post-tests to help test competence and reinforce confidence in image interpretation.

The webtextbook has been developed up to this point exclusively by M.D. and medical student talent. No programmers or professional medical illustrators have been employed. Initially HTML coding was done using NOTEPAD, but now most new units are coded using ALLAIRE'S HOMESITE 4.0. Most images are JPEG formats with some GIF's. Medical image preparation is performed using ADOBE PHOTOSHOP 5.0. PHOTOSHOP is also the software used to generate the illustrations. Animated GIF's have been created with the GIF CONSTRUCTION SET 32. Imagemaps were developed using LIVE IMAGE. MACROMEDIA'S FLASH 4 has been used to generate animations and will be used more extensively in the future now that our experience with it has increased and its

potential has become evident.

The webtextbook requires the user to have INTERNET EXPLORER 4.0 or NETSCAPE 4.0 (or higher versions). (MSIE 4 is preferred.) Any pentium-class computer and a modem connection of 26K or higher should be adequate. Ideally the user should use a 17-inch screen size, but 15-inch is acceptable. Display needs to be capable of more than 256 colors (e.g. TRUE COLOR or HIGH COLOR). Users are advised to view their monitors in darkened rooms (similar to the radiology department) to be able to maximize eye-monitor efficiency. Users are also advised to adjust display font size to SMALL FONTS.

Benefit in Attending Session:

The participant will see techniques and problem-solving for displaying medical imaging for teaching purposes on the internet. Optimization of images for display and downloading will be

demonstrated. Designs and templates will be presented. Software and hardware requirements will be demonstrated.

PRIMARY AUTHOR'S INFORMATION

Stan G. Alexander, M.D., Asst. Clinical Professor of Radiology

Dept. of Radiology

Wishard Hospital

1001 West 10th Street

Indianapolis, IN 46202

Telephone Number: (317) 630-6134

Fax Number: (317) 630-7053

E-mail address: stalexan@iupui.edu