THE INTERNET FOR RADIOLOGY PRACTICE Amit Mehta, M.D. SPRINGER 3335_new afm 8/12/02 2:59 PM Page i The Internet for Radiology Practice 3335_new afm 8/12/02 2:59 PM Page ii 3335_new afm 8/12/02 2:59 PM Page iii THE INTERNET FOR RADIOLOGY PRACTICE With 33 Illustrations AMIT MEHTA, M.D. Massachusetts General Hospital Boston, Massachusetts USA Includes CD-ROM 3335_new afm 8/12/02 2:59 PM Page iv Amit Mehta, M.D. Massachusetts General Hospital Boston, MA 02114 USA [email protected] Library of Congress Cataloging-in-Publication Data Mehta, Amit. The Internet for radiology practice / Amit Mehta. p. cm. Includes bibliographical references and index. ISBN 0-387-95172-5 (pbk.:alk. paper) 1. Radiology, Medical—Computer network resources. 2. Internet. I. Title. R907 .M44 2003 025.06(cid:1)6160757—dc21 2001031423 ISBN 0-387-95172-5 Printed on acid-free paper. ©2003 Springer-Verlag New York, Inc. All rights reserved. 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Printed in the United States of America. 9 8 7 6 5 4 3 2 1 SPIN 10788820 www.springer-ny.com Springer-Verlag New York Berlin Heidelberg A member of BertelsmannSpringer Science(cid:2)Business Media GmbH 3335_new afm 8/12/02 2:59 PM Page v To my family—Mom, Dad, Chetan, and Sonal— for their unconditional support and love. To my mentors—Keith, Dave, Murray, and Jim— for their guidance. To my friends—Nik, Neal, and Angela— for their constant humor. 3335_new afm 8/12/02 2:59 PM Page vi This page intentionally left blank 3335_new afm 8/12/02 2:59 PM Page vii Series Preface The Internet is the ultimate amalgamation of the Information Age and the Com- munication Age. It is a technology that took 40 years to become an overnight sensation, moving from the province of computer geeks to household utility in short order, once it was discovered. We have gone from thinking a URL was a form of alien presence to viewing it as a natural footnote to bus advertising. Like the Internet itself, interest in computing, both local and distant, has grown exponentially. Now grandmothers send e-mails to their stockbrokers, meals are planned and the groceries purchased across the Web, and music videos can be previewed or concert tickets purchased—all with the help of the Internet. When our children come home from school, they are as likely to sign on to the Inter- net as they are to turn on the television. The Internet is a universal commodity, for those with access. The American Internet User Survey found that more than 41.5 million adults in the United States actively are using the Internet. Of these Web users, 51% use the Web on a daily basis. It seems everybody needs to be connected to the Web, just as everybody seems to need to make cell-phone calls while changing lanes in heavy traffic. The Internet is nothing less than a library card to the world. At the most basic level, the Internet is a high-speed web of worldwide computer- based information resources connected together. It is a network of computer net- works. One moment you can be browsing through the Library of Congress or looking at pictures from the National Library of Medicine, and the next moment conversing with a colleague in Indonesia. What about the Internet and medicine? Well, we physicians sell information. That is what we do in medicine. That is what we always have done. Today, the difference is that we do it in an age built on information. Information, medical and otherwise, is all around us. From pocket pagers that deliver stock quotes and sports scores to palm-top digital assistance that wirelessly connects to the Inter- net, information is achieving the status of oxygen—it is all around us and invis- ible. (Oxygen also is the name of a computing project at the Massachusetts In- stitute of Technology that is aimed at achieving this goal.) Today, information is managed, moved, and organized in ways never thought of in the past and will soon be managed in ways not yet conceived. In medicine, information is vital, but the exponential growth of knowledge available requires new approaches to its dissemination, access, and use. Central to this is the Internet. Information is now the province of anyone with a computer. This has led to “disintermedia- tion”: the ability of consumers to go directly to the source of information (or goods and services), bypassing the intermediate steps of providers. In medicine, vii 3335_new afm 8/12/02 2:59 PM Page viii viii Series Preface this means that physicians obtain and distribute information in new ways, pa- tients obtain and receive their information in new ways, and, together, patients and providers interact in new ways. Very little has remained the same, and yet fundamentally nothing is different—we still sell information. Medicine has fre- quently led the way with new technology: we used print materials when books were in their infancy; we embraced the telephone like few other professions; pagers, two-way radio, and teleconferencing (telemedicine) were all adopted by medicine early in their development. The need for information always has dri- ven this adoption, and it is no different for the Internet. This series of texts on the Internet in medicine and in medical subspecialty ar- eas is intended to assist in this natural evolution in two ways. First, it will help us understand the abilities of the Internet and know its tools so that we may cap- italize on what the Internet holds for ourselves as physicians and our patients. Second, the medical applications of the Internet have grown too rapidly and are too specialty specific to explore in depth in any single volume. Hence, the birth of specialty-specific volumes. When the first edition of The Internet for Physi- cians was published, it was mainly the technophile fringe that was surfing the Web. The first edition attempted to introduce the concept of information trans- fer and communication and point the way toward a tool of the future. The sec- ond edition attempted to assuage trepidation in the use of this emerging tool and suggest the whys and wherefores of being connected. The needs that drove those goals almost have completely disappeared. The third edition is more focused on the medical aspects of the Internet and its use and much less on the nuts and bolts of connecting and communicating through the Web. This evolution has opened the possibility of a special series dedicated to the Internet in various spe- cialties of medicine. Each of these specialty volumes deals with specialty- specific aspects of the Internet, going beyond the general scope of The Internet for Physicians. Each author has been chosen for his or her expertise in medical computing, and they are each a recognized leader in their field. Each volume builds on fundamentals introduced in The Internet for Physicians. While the vol- umes stand alone, they have all been created so that each fits within the same concept. As authors, we hope that this series will open new and exciting options for this new age of medical information. Surf’s up! Roger P. Smith, M.D. University of Missouri–Kansas City School of Medicine Kansas City, Missouri, USA Author of The Internet for Physicians 3335_new afm 8/12/02 2:59 PM Page ix Preface A revolution has occurred. The world has and continues to become linked elec- tronically from continent to continent and from coast to coast. The opportunity to communicate, exchange information, and promote new ideas has blossomed due to the development and distribution of the Internet. The Internet has allowed individuals from disparate geographic locations to share ideas, conduct transac- tions, and generate new paradigms for executing daily functions. Radiology, a specialty that centers around data in the forms of both images and reports, is well suited to harness the power of the Internet. The features and benefits an electronic network provides to radiologists both personally on a day- to-day basis and as a collaborative specialty are endless. As the digital depart- ment becomes a reality, an intimate knowledge of the Internet and its affiliated technologies will become a necessity. This book came about because of the overwhelming need to educate radiolo- gists and personnel affiliated with the radiology practice about the Internet. The ability to utilize the offerings currently available and to develop applications for this technology promises to make radiologists, technologists, and administrators more effective in their professions. It allows radiologists to better help referring physicians and ultimately their own patients. It allows technologies to improve the efficiency of producing images. It allows administrators to make the practice more cost-effective and streamlined, allowing more patients to benefit from the offered services. Initially, when the concept of this text was generated, the Internet revolution had just begun. Many people, including radiologists, were leaving their practices to join the “dot-com” revolution. Companies not only were finding new ways to do things using the Internet but also refining and restructuring many of the classic tasks for an electronic format. Over the course of writing the text, the Internet-affiliated technologies such as PACS, voice recognition, and Web-based distribution of images have become realities and fall under the rubric of Internet technologies; understanding these technologies is essential. Thus, the scope of the book grew to include what are deemed to be key and integral technologies for radiology practice in the coming decade. My hope is that this book will familiarize the reader with the technology be- hind the Internet and provide a basic understanding of what radiologists need to know to gain the most out of its potential offerings. The text is in no way meant to serve as a comprehensive review of the entire Internet or its adjunct tech- nologies, as individuals spend entire careers on these subjects; furthermore, there are comprehensive texts available on each of these subjects that will serve as an ix