June 30, 2008

Online Tools
By Dan Harvey
Radiology Today
Vol. 9 No. 13 P. 8

Radiology resident Roland Talanow, MD, PhD, develops Web-based software for education and clinical applications.

For the past three years, Roland Talanow, MD, PhD, has made the rounds at the major annual meetings demonstrating the viability and value of the software programs he has developed. These Web-based computer programs have garnered awards from some of those societies, but they also have generated significant impact in educational and clinical areas of radiology.

Talanow began developing the programs with support from EduRad, a nonprofit organization dedicated to advancing education in medicine and radiology, when he recognized the enormous possibilities that the Internet provided. Now in the final year of his radiology residency at the Cleveland Clinic Foundation, Talanow is working toward subspecialization in nuclear medicine and medical informatics. He first recognized his career path about six years ago when he attended medical school in his native Germany. “I started creating Web-based educational programs when I realized the easy, global access that the Internet presented,” he recalls.

Computer-Enhanced Annotation
He began by creating Web sites for fellow medical students. Then, when he came to the United States for his residency, he built on the sites he had developed. “By then, I recognized the huge potential in radiology for information gathering, distribution, and editing tools,” he says. “That’s essentially why and how I created the Annotate program.”

Annotate, an innovative education tool that earned Talanow awards from the Radiological Society of North America and the International Congress of Radiology, is essentially an individualized annotation and image editing program easily accessible over the Internet. The software is available for free at www.annotate.org.

Talanow developed the software program as a universal tool, available any time and from any Internet-connected computer, that would allow users to create and change annotations and presentations in real time. Prior to its development, no such program existed. “I sought to create a relatively easy-to-use and accessible tool that quickly creates interactive annotations and teaching files and dynamic presentations,” he says.

Talanow points out that hospitals and universities can use the program to create case presentations and interactive teaching files, while individuals can design their own cases or edit images. He describes the innovation as a more efficient way to distribute huge amounts of information. “One of the problems I addressed with its creation is that static images only provide limited information. Annotated images provide a lot more specific information, which is extremely and increasingly important in radiology,” he explains.

Talanow designed Annotate for versatility. It functions as an autonomous program, or it can be used as a tool that complements other programs. “If you have a favorite desktop application that you’ve been using for a long time and you don’t want to switch to another program, Annotate lets you create and/or edit cases or images and export them in your desired format. You may then work with the data in your favorite program,” he says.

As with all of the Web-based tools Talanow has designed, Annotate requires no installation or plug-ins. Further, Talanow developed the program to meet users’ specific needs; he equipped it with more than 50 custom-defined system preferences that enable them to change appearances and functionalities.

But one of the program’s biggest benefits is that it is geared for computer users without any advanced programming skills. For one thing, users don’t have to create image editing and source codes, as the program provides those automatically. “For someone who doesn’t have extensive knowledge of computers and graphics, interactive annotation can be difficult to create, but this tool does it all,” says Talanow.

Users can upload images, create teaching files related to a case, and create color-coded annotations on the fly. “For instance, if you have an image with accompanying text that describes the pathology, the program automatically creates hyperlinks and only shows annotations specific to the displayed image,” says Talanow. Further, there’s no need for file transfers after the users make changes.

Interactive Electronic Teacher
Talanow developed another educational tool—the Radiology Teacher—that, on the surface, appears similar to Annotate. This Web-based tool, available at www.radiologyteacher.com, enables users to create interactive teaching files for presentations and teaching purposes in real time and user-tailored fashion. Again, the Internet provides global accessibility, and the tool is designed for authors with general computer skills and experience.

Radiology Teacher subdivides into seven areas: case edit, image edit, annotation edit, quiz edit, presentation edit, preferences, and viewing areas. Case editing lets authors create, edit, and delete cases and save and delete images accompanied with descriptions. The image editing function allows individual changes on images to enhance their appearance. With annotation editing, users can create image annotations by cross-linking to the Annotate program.

In the quiz edit area, users can write quizzes for individual cases. Presentation editing makes it possible for users to design complex presentations from their cases and offers more than 50 program functions that enable individualization. Finally, the viewing area presents individual cases and presentations to users.

Pediatric Tool
For pediatric radiology, Talanow developed PedRad, an Internet-based, multilingual, interactive radiology publication, communication, and teaching platform. PedRad is available at www.pedrad.info.

Open sourced and case oriented, PedRad was developed in response to the dearth of Web-based pediatric radiology platforms that allow for the free exchange of radiological knowledge in an open forum or possess their own databases. Education is provided in several ways: cases without initial diagnosis, multiple choice quizzes, direct selection from a variety of menus, and interactive discussion forums.

PedRad is subdivided into four main areas: authors, users, education, and interactive communication. The author’s area provides a user-friendly, fast case submission system. After a peer review, cases are automatically integrated and presented in different modes for teaching purposes. The users’ area features a search option for viewing cases and article summations. Its search function operates as easily as well-known engines such as Google.

The educational area presents cases in fashions that foster continuing education and knowledge acquisition. The interactive communication area presents unclear cases and questions related to existing cases. These automatically appear in a general discussion forum after case presentations.

PedRad.info, which runs on a 1.1-gigahertz Pentium processor with Linux as its operating system and Apache as its Web server, can easily be adapted by other radiological subspecialties. Its scripting languages include Perl, JavaScript, and DHTML. Minimum user requirements are a common Internet browser and a 28.8-kilobyte modem. “I’ve recently updated it with a new feature that allows users to employ cases as teaching files and with a radiology search engine called ‘Case of the Day,’” adds Talanow.

PubMed Made Easy
Anyone who has used PubMed understands its intricacies. As such, Talanow developed the PubMed Reader (available at www.pubmedreader.com) that essentially makes PubMed searches more efficient. One problem that a typical PubMed user encounters is the sneaking suspicion that they just don’t know how to deploy the service correctly. In response, Talanow developed the PubMed Reader, which was introduced at RSNA 2006, as a tool that provides immediate and uncomplicated access to the PubMed database for specific topics.

Operating on a 700-megahertz Pentium II quad processor with Microsoft Server 2003 as its operating system, and with Perl, JavaScript, and DHTML script languages, the program provides access independent of a user’s location. Further, the user doesn’t have to repeatedly redefine search criteria, a benefit that accelerates research and daily workflow.

The program enables users to create multiple search criteria and save them in a personal profile. Information is obtained via an RSS feed from the PubMed database and provided to the user as HTML code in a custom-defined Web site format.

“It’s a valuable research tool and not just for radiologists,” says Talanow. “Every scientist or researcher looking to obtain the most updated scientific, biological, and medical information can benefit from it. It doesn’t replace PubMed, but it enhances PubMed features.”

He describes its genesis: “Let’s say you’re involved in a research project and need information related to a specific topic, such as new treatments, technologies, or drugs, and you need to check PubMed to see if there are any new, relevant publications. PubMed allows you to save the search as an RSS feed. But it’s a static feature that can’t be changed. If you wanted to add another search term or tighten or broaden your search, you’d have to create an entirely new RSS feed. Well, this bothered me and drove me to develop the PubMed Reader.”

Basically, Talanow’s resulting innovation enables users to employ the same search while saving the frequently used search and any number of searches they want. “They’d always be available, and you could change them whenever you want,” he says.

Further, the export function enables users to export their searches in several ways. “You can save them in your ‘favorites’ or even on your desktop,” he says. “Also, by placing it on your desktop, you wouldn’t even have to enter PubMed.gov to see what’s new. You’d only need to double click on the desktop icon and, on the fly, it reveals updated information related to your frequent search.”

Clinical Tools
But Talanow’s innovations aren’t restricted to education. He developed a cancer-staging tool (available at www.cancerstaging.info) designed to address staging’s complexities. The program makes staging common female pelvic malignancies easier and more accurate. “Staging classification, which describes that anatomic spread of a particular malignancy, is complicated and difficult to understand, not just for beginning radiologists but experienced clinicians,” Talanow says.

But accurate staging is critical, he adds, as it provides valuable prognostic information and determines the most appropriate therapy. “If you do it wrong, you can hurt the patient. Therefore, I developed a comprehensive, Web-based solution that aids clinicians in accurate staging of common female pelvic cancers—including cervical, ovarian, uterine, and endometrial—based on image findings.”

The program enables users to select staging parameters such as tumor extension, nodule state, and the existence of metastases. “When you select the findings, you get on-the-fly results that enable more accurate staging,” says Talanow.

The tool helps increase staging accuracy and speed workflow. Based on Perl and JavaScript, the customized program is easily integrated into a user’s daily workflow from any monitor or PACS station. Another unique feature is that it enables users to customize their own staging tools. “You can go into preferences and, with the export function, you can export the staging tool and place it as a shortcut or short letter code onto your desktop,” explains Talanow. “That way, you don’t have to keep going into the cancerstaging.info Web site. You can directly access the staging tool without having to always log in. This helps make the workflow as smooth as possible.”

Moreover, the program provides hyperlinks to more informative and in-depth Web sites, as well as the latest publications and news related to specific cancers.

Talanow frequently upgrades the tool by adding program features and information about other cancer types. For instance, he has integrated a lung cancer-staging tool he developed that is available at www.lung-cancer.net and operates similarly to the cancer-staging tool.

“Ideally, the staging site will become a comprehensive cancer Web site where all common cancers would be staged,” says Talanow.

Originally set up as a customized tool that facilitates quick and accurate staging of common lung cancers based on image findings, lung-cancers.net provides tumor classification information based on the Collaborative Staging Network. “Even though it has been combined with the female cancer tool, it still operates separately,” says Talanow.

Free Access
Talanow emphasizes that, as all his tools are Internet accessible, they are free; no fee is attached to usage. He strongly reiterates that they are easy to use: “That needs emphasizing. No installation is required, so they can be placed on any workstation. That’s an important consideration. In many medical institutions, radiologists don’t have the administrative rights to install new programs. These programs get around that barrier.”

Talanow indicates that the level of interest for his tools runs high, especially with radiology teachers. “I’m seeing about 2,000 registered users for different programs, and the PedRad is attracting between 500 and 800 visitors each day, so that is pretty impressive and very gratifying,” he says.

As far as impact, he expects that PubMed Reader and PedRad will benefit the scientific and medical communities. The cancer-staging tools, he believes, will not only enhance education, especially for people new to the radiology field, but ultimately make clinicians more secure and confident in their staging. “As such, the cancer-staging tools will be high-impact devices,” he comments. “It will help reduce mistakes. If you underestimate or overestimate the disease, you can do a patient serious harm.”

Aside from the numerous awards his tools have collected, the response from educators and clinicians has been encouraging.

“From my experience, all of the programs have not only proved beneficial, but they have generated very positive feedback,” Talanow says.

— Dan Harvey is a freelance writer based in Wilmington, Del., and a frequent contributor to Radiology Today.