Radiology and the Internet
Antony R. Goldstone MB, ChB (Hons) and Andrew F. Scarsbrook FRCR
Department of Radiology, St James's University Hospital, Leeds
Teaching Hospitals NHS Trust, Leeds, UK
Address for correspondence:
Dr Andrew F. Scarsbrook FRCR
Consultant Radiologist & Nuclear Medicine Physician
Department of Radiology
St. James's University Hospital
Beckett Street
Leeds, LS9 7DG, United Kingdom
Tel: +441132064047
Fax: +441132064691
Email: andrew.scarsbrook@leedsth.nhs.uk
Abstract
There are a vast array of Web-based resources of potential use to radiologists. The quality is variable, and much time can be wasted trying to sort 'the wheat from the chaff'. This article will present a pragmatic approach for radiology professionals wishing to optimise their use of the Internet in daily working practice. First, more effective methods of Internet searching will be described, then simple tools allowing you to keep up-to-date with the latest developments in the field will be illustrated. Finally, a selection of the highest quality radiological Web sites in cardiovascular imaging will be highlighted.
Introduction
The explosion in quality content combined with technological advances over the past decade has created a revolution in radiology on the Internet. The Web now plays a pivotal and ever increasing role in radiological education and research in conjunction with more conventional teaching methods and resources[1,2]. As a group, radiologists are ideally placed to benefit from the rapid technological advances in medical imaging and informatics[3]. However. there is often no quality control of Web content and resources, and low-quality, non–peer-reviewed, and not infrequently misleading content can distract the casual user. This article will focus on strategies for making searches more productive and relevant to radiologic practice and describe tools to help you stay up to date efficiently. Finally, a brief collection of high-quality Web-based cardiovascular imaging educational resources will be illustrated.
Smarter searching
As one commentator noted, the Internet contains an 'embarrassment of radiological riches' but these are tempered by myriad distracting and often irrelevant sites which are a frequent source of frustration[4]. For example, the relatively new imaging modality of 'PET-CT' generates more than 3 million 'hits' in a Google search, however, the quality of these sites is extremely variable and a good deal of time may be wasted sifting through irrelevant material[5]. The key to successful Internet research is rapidly identifying the results that are relevant to your question while minimising the chance of irrelevant hits. Several smarter searching solutions are available to overcome this fundamental Web dilemma.
General search engines
Google (http://www.google.com) is widely accepted as the pre-eminent general search engine and this is recognised by its global domination in the search engine wars: in July 2009 it enjoyed more than 80% of all global search activity (http://marketshare.hitslink.com/). It is comprehensive, fast and up to date; most content is searchable within hours of Web publication. Like all the general search engines, the results are presented in order of relevance; as a general rule results are made more relevant to your question by adding more words to the search string. If you are looking for PET-CT teaching cases you are far more likely to get these if you change your search string from 'PET-CT' to 'PET-CT teaching'. Conversely, adding too many words to your search string may make it too specific, and may miss other relevant results.
Image-specific search engines
A number of search engines are dedicated to finding images and a few of these cater especially to radiologists. Google images (http://images.google.com/) offers a general image search engine with the same features and search advantages of the main Google search engine (Figure 1A).
The American Roentgen Ray Society (ARRS) has developed the Goldminer tool (http://goldminer.arrs.org/) which provides low resolution previews of images from the published radiology literature which can be filtered by modality, age and sex (Figure 1B). The tool will recognise abbreviations, synonyms, and diseases expressed either as concepts or keywords[6]. These are then matched to English-language Medical Subject Headings (MeSH) such that a search for 'kidney stones' will encompass images captioned as 'renal calculi'. Links provide direct access to the full-text articles and high-resolution images often with open access.
Customized radiology search engines
Creating your own customizable search engine
Radiology meta-link sites
Whilst these may represent the most 'low-tech' solution for searching for relevant radiology content, there can be no substitution for the human editorial control that these sites offer. Some present a simple but comprehensive list of relevant sites which meet stringent quality and currency standards (http://www.radiologyeducation.com), whilst others offer a brief description or even a subjective site rating. One of the most comprehensive and widely used sites that gives descriptions is Aunt Minnie (http://www.auntminnie.com) which also includes a wealth of other radiology resources and cases.
Using the Web to stay up to date
With the explosion of radiology information available on the Web, combined with an ever-expanding literature, the Internet offers a number of technologies that assist the radiologist in keeping abreast of the latest developments.
E-mailed table of contents (eTOCs) and customized alerts
Highwire Press allows the user to set up custom alerts based on literature searching via key words, author or specific journals. Users can also receive e-mailed table of contents (eTOC) or customised alerts when specific articles are cited in the literature.
Similarly, a number of sites offer a customised alerting system. Highwire Press, developed by Stanford Libraries in the United States, is one of best examples (http://highwire.stanford.edu/), and this can scour the medical literature (or the literature relevant to your practice) and provide custom alerts based on free text searching, key words or authors. In addition, the site provides a custom eTOC alert service across many different journals and a useful "cited-by" tracking service so you can see when your own publications are cited in the literature (Figure 2A).
Really Simple Syndication (RSS)
An alternative to repeatedly returning to your favorite sites to look for new content is updates that can come directly to you using 'Rich Site Summary' or 'Really Simple Syndication' (RSS) technology. RSS allows Web sites to send a summary of their latest content, or a 'feed', directly to your computer or browser. The overwhelming majority of major news sites, Web logs (blogs) and major medical journals (including over 100 leading radiology journals) offer RSS feeds of their most up-to-date information. For example, most of the journals offer RSS feeds of their latest edition's table of contents, and some of the key journals offer focused feeds for regular features such as letters to the editor, book reviews and sub-specialty sections[7] (Figure 2B).
Schematic of Really Simple Syndication (RSS). Multiple sites, selected by the user, send 'feeds' of information to an aggregator, which are presented in an easy to read fashion
Web-based RSS aggregator (Google Reader) showing a custom RSS feed created from multiple RSS sources using Medworm.
To use RSS technology you require a standalone RSS aggregator which you install on your computer (Mozilla Thunderbird or FeedReader are good freely available examples). More recently, a number of Web-based RSS readers have emerged (http://www.google.com/reader (Figure 2C)) enabling you to take your custom feeds with you wherever you are. RSS technology can now integrate directly into your browser's toolbar (Microsoft Internet Explorer 8, Mozilla Firefox 2.0 and above), whereby clicking on the relevant RSS feed will offer a drop-down list of the most up-to-date content.
All is not lost if the journal or Web site you are interested in does not offer a custom feed tailored to your specialty interest. Medworm (http://www.medworm.com) scours 6000 medical RSS feeds from authoritative sources and re-sorts them via useful categories (Figure 2A). Alternatively, you can create your own custom feeds that are sent to your aggregator combining all the latest the medical Web has to offer with your own highly tailored search strategy[7] For those interested in learning more about how to use RSS feeds, a medically orientated Web site (http://rss4medics.com) offers comprehensive advice.
Selected cardiovascular imaging resources on the Web
Yale School of Medicine Centre for Advanced Instructional Media contains a large collection of teaching images covering anatomy, techniques and a wide variety of pathology
E-medicine contains in-depth, peer-reviewed and fullly referenced articles covering a broad breadth of topics including cardiac, interventional and chest radiology
| Producer | URL and site contents |
| Society of Thoracic Radiology (STR) | http://education.thoracicrad.org/online_edu.htm Approximately 60 lectures with audio covering cardiac and pulmonary imaging. The cardiac lectures (from the 2006 STR meeting) have a strong CT predominance with some introductory cardiac MR content. The pulmonary lectures are more recent and cover the full breadth of pulmonary radiology. |
| Yale School of Medicine Center for Advanced Instructional Media |
http://info.med.yale.edu/intmed/cardio/imaging/contents.html Approximately 100 illustrated teaching files covering normal anatomy and techniques (including echocardiography) and a wide variety of cardiac and pulmonary pathology (Figure 3A). |
| Johns Hopkins Institute | http://www.ctisus.org/rsna_2006/cardiac_cta/ Excellent lectures (via podcasts), case studies, teaching files and videos on many aspects of CT including specific resources on multi-detector cardiac CT angiography. |
| Learning Radiology | http://www.learningradiology.com/ A series of cardiac and pulmonary radiology lectures in Macromedia Flash, online Microsoft PowerPoint or Adobe PDF format with accompanying study notes and an image bank of high-quality cases. |
| E-medicine | http://emedicine.medscape.com/radiology Vast array of peer-reviewed articles covering the full spectrum of clinical medicine, including imaging. A wide variety of in-depth and fullly referenced articles covering the gamut of radiology including a good selection of cardiac, interventional and chest radiology articles (Figure 3B). |
| University of Virginia | http://www.med-ed.virginia.edu/courses/rad/ A number of high-quality tutorials on cardiac MR, introductory chest imaging and HRCT. |
| Medical College of Wisconsin | http://chorus.rad.mcw.edu/index/2.html A quick reference hypertext for physicians and medical students. The text was created using a collaborative peer review process. Chorus documents include images from the ARRS Goldminer project. |
| Society for Cardiovascular Magnetic Resonance |
http://www.scmr.org/caseoftheweek.html A collection of approximately 60 freely available high-quality cardiac MRI cases with history, radiological findings and a brief literature review (Figure 3C). |
| Table 1. A sampling of cardiovascular imaging resources on the Internet | |
A number of recent reviews[8-13] within the literature offer sub-specialty–based lists of the highest quality radiology resources on the Internet. The Table 1 lists carefully selected Web sites within the field of cardiovascular radiology which may be of specific interest to the readership of this journal. Many of the sites have a target audience of undergraduates, trainees or non-specialist radiologists, nevertheless they may also be of use to specialists, particularly for use in teaching.
Conclusion
The Internet is in a constant state of flux, with new Web sites appearing whilst older ones are updated or removed. The ubiquity of broadband Internet access means that the judicious use of carefully selected Web-based resources has the potential to be extremely useful in radiology. To harness the maximum potential, it is important to be able to rapidly locate what you want using radiology-specific search engines. Personal efficiency and effectiveness can be optimised by configuring customised alerts to keep you apprised of the latest developments in your area of interest. It is hoped that this article has provided some food for thought and will encourage readers to explore the enormous potential, literally at your fingertips, which can be readily used to help streamline radiologic practice.
- A veritable feast of radiological riches is waiting to be discovered on the Web. Simple measures such as utilising radiologic-centric search engines vastly speed up the process of finding the exact information you require.
- It is comparatively easy to set up your own custom search engine, searching the Web sites you specify. This may give you the ultimate custom search experience.
- A small investment in time setting up customised alerts can reap major dividends in terms of personal effectiveness and efficiency when trying to keep up to date with specific areas of radiological interest.
- Radiology meta-link sites provide an attractive portal to many different radiological educational Web sites from a single point of reference, and the best quality ones have a strict policy on entry criteria for listed sites and dredge for newly emerging sites of interest.
- A variety of high-quality educational resources are freely available on the Web, covering aspects of cardiovascular imaging which may be of value in teaching, training and personal development.
References
- Maleck M, Fischer MR, Kammer B, et al. Do computers teach better? A media comparison study for case-based teaching in radiology. Radiographics 2001;21:1025-32.
- Healy DG, Fleming FJ, Gilhooley D, et al. Electronic learning can facilitate student performance in undergraduate surgical education: a prospective observational study. BMC Med Educ 2005;5:23.
- Scarsbrook AF, Graham RN, Perriss RW. Radiology education: a glimpse into the future. Clin Radiol 2006;61:640-8.
- Pomerantz SR. Net assets: personal technology for productivity in radiology. Radiology 2008;247:307-10.
- Scarsbrook AF, Graham RNJ, Perriss RW. The scope of educational resources for radiologists on the Internet. Clin Radiol 2005;60:523.
- Kahn CE. Multilingual retrieval of radiology images. RadioGraphics 2009; 29:23-9.
- Pomerantz SR. Net assets: RSS to the rescue. Radiology 2008;248:16-19.
- Perriss RW, Graham RN, Scarsbrook AF. Understanding the internet, website design and intranet development: a primer for radiologists. Clin Radiol 2006;61:377-89.
- Kalb B, Gay SB. Internet resources for education in radiology. Acad Radiol 2003;10 Suppl 1:S81-6.
- Graham RN, Perriss RW, Scarsbrook AF. Gastrointestinal and hepatobiliary radiology. Clin Radiol 2006;61:390-2.
- Graham RN, Perriss RW, Scarsbrook AF. Neuroradiology. Clin Radiol 2005;60:838-9.
- Scarsbrook AF, Graham RN, Perriss RW. Cardiothoracic radiology. Clin Radiol 2005;60:531-2.
- Bhatnagar P, Mankad K, Hoey E, Scarsbrook AF. Cardiac radiology. Clin Radiol 2008;63:370-2.
JB3764 07-2009
