Thoracic Imaging 2003 - Society of Thoracic Radiology

TUESDAY
180
The Internet and the Practice of Radiology: A New
Educational Paradigm
Jud W Gurney, M.D., FACR
Objectives
Consider the Internet as an educational resource
Learn what online tools are currently available for education
and practice
The education of a radiologist begins during residency and
lasts during the professional’s lifetime. How much information
does a radiologist need to acquire to practice radiology? No one
knows but there are estimates that it requires more than 2 million
pieces of information to practice medicine.
Traditional sources of information include books, journals,
and lectures. These traditional sources of information have been
the mainstay of education since the development of the field of
radiology. However, Internet technologies have the potential to
markedly change how radiologists educate themselves.
The traditional sources of information have deficiencies.
Books are expensive and the publishing cycle limits the timeliness
of the information. Journals are unstructured making the
information accessible only through secondary indices. Finally,
lectures are extremely costly with travel and lodging. At the
point of care, where questions arise, none of these sources may
be either readily available or quickly accessed. In the current
health care environment, radiologists have less time to search
for information. Thus questions that arise when interpreting
films often go unanswered.
Nearly all physicians have used the Internet as a source of
information. In a 2001 survey, 90% have researched clinical
problems, 80% read journal articles, 60% communicated with
colleagues, 45% completed CME and 35% attended online conferences.
With this background, let’s examine what is currently
available online and what the future possibilities are.
The Internet is a new publishing medium, similar but different
than print publishing. Print publishing has had 500 years to
craft the current style of books and journals. Thus the current
Internet offerings are in an early stage of evolution as content
providers find out what works and what doesn’t (for example, it
took 200 years before publishers added page numbers to books).
Online reference tools can be roughly divided into 3 categories:
search tools, online libraries, and expert knowledge systems.
Search Tools
Search tools such as MEDLINE and Google ® are one of the
first tools physician’s turn to for information. The National
Library of Medicine’s MEDLINE is a database of more than 14
million citations dating from the 1960’s. MEDLINE is simple to
search but thorough access requires using the MeSH vocabulary
by which all articles are indexed. MEDLINE rarely answers the
clinical question, as the only accessible information beyond the
citations are abstracts. Thus MEDLINE serves as an intermediary
step to journal articles, which may or may not contain the
information needed to answer the question.
Generalized search tools like Google are also used to access
information. Search engines attempt to index all published web
pages on the Internet. Currently there are over 40 billion web
pages with a half-life of 44 days so that indexing is not a trivial
task. In addition, much information exists in databases that are
not accessible to the search engines. Information in the web is
unstructured and the results returned from a search query vary
considerably. The quality of the information provided by individual
web sites may also be of dubious quality. In contrast to
book publishing, the barrier to web publishing is minimal,
allowing anyone with a computer to become a publisher. Some
may downplay the web as a source of information because of
the lack of peer review and the content providers lack of credentials.
However, surveys of physicians consistently show that
availability is more important than credibility.
Online Libraries
The second category of online reference tool is the online
library. The online library attempts to recreate textbooks, articles,
and lectures online. Content is expensive to produce and
most sites have little content. Because it is easier for societies to
videotape lectures than write textbooks, lectures are more common
online than textbooks. For example, RSNA has captured
more than 250 lectures from their annual meeting online.
To be useful, online libraries need to be comprehensive, well
organized and easy to search. Besides lacking content, the information
architecture of existing sites is poor as is the technical
quality of the lectures (small images of poor quality). When the
dot com bubble burst, the activity of commercial sites which
were one of the primary driving forces for online libraries fizzled.
Sites such as AuntMinne and eMedicine have very little
content. For example, eMedicine currently has only 32 topics in
thoracic imaging.
Journals have effectively placed their print publications
online, however, the current subscription business model severly
hampers what will eventually become a powerful method of dissemination
and organizing information. To be more useful, journals
will have to abandon subscriptions. Then reference citations
will be hypertext links to the reference article allowing professionals
to rapidly find information of interest. Allowing physicians
to evaluate the author’s primary sources of information
will also enhance scholarship.
Online content will eventually displace reference texts. The
economics and ease of use favor the online text. For example,
one text that would make an excellent online textbook is Keats
and Anderson’s Atlas of Normal Roentgen Variants that may
Simulate Disease. Containing 5650 illustrations (and costing
$250) the book is primarily visual and is used exclusively at the
point of care where questions of normal and abnormal arise.
Having this resource online available at the workstation and
next to the teleradiology monitor would be a “killer” application
for radiologists.
Expert Systems
The last category of online reference tool is the expert
knowledge system. One of the unique aspects of the Internet is
that the user can interact with the information. Print publishing
is passive; there is no interaction with the printed page. For
example, the printed page can only publish formulas; the web
page can solve formulas. The most exciting and most difficult