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Volume 20, Number 3 1993

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Computer-assisted Interactive Radiology Courseware

B. A. Selcer
Fom the Department of Anatomy and Radiology
College of Veterinary Medicine
The University of Georgia, Athens, GA 30602.


Introduction

Proficiency in diagnostic radiology is recognized as a complex skill involving the integration of knowledge of anatomy, pathophysiologic processes, patient specific information, and visual skills for radiographic pattern recognition. The traditional approach to teaching veterinary radiology has been through lecture sessions with 35 mm slides supplemented by teaching file cases and textbook assignments. Because radiology is an intensely visual discipline, active student effort is required in the learning process. Teaching radiology by lecture, while cost effective and manpower efficient for the instructor, is ultimately less efficient than more interactive methods, since it creates a passive learning situation for the student. Radiology teaching effectiveness is greatest when the teaching occurs in small groups interacting with an instructor (1, 2 ). Individual or small group study of teaching files would be the ideal method of radiology instruction if instructors could always be present while students worked at their own pace. Realistically, this method is not feasible due to demands on both student and faculty time. Computer-assisted instruction can bridge the gap between the ideal situation and the traditionally passive learning situation used to teach radiology.

Computer-assisted radiographic instruction has proven to be a valuable adjunct in teaching radiology at several universities and medical centers (1, 3-9). Studies based on test performance of medical students have shown that computer-based instruction is as effective as lecture instruction while requiring less student time. In the same studies, students subjectively rated the computer-assisted instruction superior to lecture instruction (1, 3, 4).

The goal of computer-assisted interactive radiology instruction is creation of customized, interactive, user friendly, courseware for student use. Created courseware should augment didactic information obtained in lecture courses, allow active student interaction, and allow students to work at their own pace to review material with the computer-assisted tutorial serving as a guide. This paper describes the development of an interactive computer-assisted courseware program used to supplement 3rd-year radiology instruction at The University of Georgia.

System Requirements and Courseware Specifics

Good interactive radiographic courseware design requires use of a system capable of high resolution image acquisition, storage, and display. At the student end, courseware should be designed to provide nonlinear tutorials in which multiple branching decisions are driven by student response. Immediate feedback as well as remedial exercises should be provided (1,9). Interactive radiology tutorials used in medical school instruction have found it advantageous to combine text and image on the same monitor (1). Financially, courseware design and student workstation cost are important considerations.

The Commodore-Amiga personal computer (Commodore Business Machines, West Chester, PA) was chosen to create interactive radiology tutorials. The Amiga computer system is graphically oriented and is readily adaptable to a multi-media interactive environment. A courseware program covering canine juvenile bone disease was designed to teach students the major radiographic signs and anatomic locations of lesions found in common cases of juvenile bone disease. The program was authored using AmigaVision (Commodore Electronics Limited and Insatt Corp., West Chester, PA) and runs on Amiga personal computers. The program is designed to run on either the A2000HD with color monitor or A3000HD with a multi-sync color monitor. Students are presented with screens on a single monitor which contain radiographic images as well as text. They interact with the computer through use of a mouse and an on-screen pointer. Invisible "hit boxes" have been placed on the screen which become active areas when the student uses the mouse and cursor in a "point and click" method. In this fashion, the student receives instruction throughout the program as well as feedback. For example, after reviewing a screen describing the appearance of a particular lesion with text and radiographic image, the student is asked to point out the actual lesion on the displayed radiographic image. The student uses the mouse to position the pointer over an area on the screen and receives feedback as to their accuracy. If incorrect, the student is prompted to "try again" or "review" the preceding instructional material. Various audio/visual formats are used as prompting/feedback screens; some incorporate humor, others give hints or additional review. If the student's response is correct, he or she is given positive reinforcement and continues in the tutorial.

Individual tutorials are stored on the microcomputer hard drive and are easily accessed by students. The juvenile bone disease tutorial which uses 30 individual high resolution screens combining graphics, animation, and sound requires approximately 1.7 megabytes of disk storage space. The juvenile bone disease courseware is a multimedia application combining interactive screens with invisible "hit boxes," animation, and sound. While the animation segments and audio capabilities of the program are not essential in the learning process, they are useful in creating a more interesting courseware end product.

Table 1. Financial Considerations in Amiga-based Multimedia Courseware Design.
(Dollar approximates, 1992)

HARDWARE
Low End System*
A2000HD personal computer
(includes: 3.5 FD, 1 M RAM, 50 M hard drive, mouse, keyboard, Amiga DOS, AmigaVision, serial and parallel ports)
$ 1300
1084S color monitor
(with RGB analog and composite video inputs/audio inputs and speakers)
$ 270
or
High End System*
A3000 - 16/50 personal computer
(includes 3.5 FD, 2 M RAM, 40 M hard drive, mouse, keyboard, Amiga DOS,
AmigaVision, serial and parallel ports, 15.75 and 31.5 khz video ports with built in
de-interlaced SCSI interface and math co-processor)
$ 1850
1950 multiscan color monitor
(with RGB analog and RGBI digital capacity)
$ 490
Software
Digitizing software (Digiview, Newtek, Topeka, KS)
$ 140
Paint program (Delux Paint III, Electronic Arts, San Matao, CA)
$ 100
* There are advantages and disadvantages each system has over the other. The high end A3000 system
offers flicker-free video images but lacks the composite video capability of the A2000.
Author's addendum: Current courseware design uses a 24 bit high resolution digitizer and paint program
(DCTV, Digital Creations, Rancho Cordova, CA) requiring the 1084S monitor.

Radiographic images were digitized off standard radiographic view boxes using a black and white video camera and digitizing software (Digiview, Newtek, Inc., Topeka, KS). Once images were captured, they were manipulated with the digitizing software and saved to either hard or floppy disks. A commercially available paint program (Deluxe Paint III, Electronic Arts, San Matao, CA) was used to manipulate the graphic images and add text. Screens so designed created a "what you see is what you get" (WYSIWYG) screen. In addition, various buttons (quit button, quiz button, main menu button, etc.) were designed. AmigaVision, an icon-based authoring system, was used to create the courseware flow in an interactive format of multiple decision branches. Additional text, hidden "hit boxes," screen fade transitions, sound, and animation were included in the flow. System specific costs are given in Table 1.

System Assessment

Studies performed at medical schools have indicated that computer-assisted instruction can be an important and practical method for radiologic education (1, 5 ). Students using programs at Ohio State University Hospitals (5) and The University of California, San Francisco (1) have responded favorably to computer-assisted radiology instruction, citing the interactivity of the courseware and the ability to work at their own pace as principal advantages. The canine juvenile bone disease tutorial has been used as an elective adjunct in the orthopedic section of the junior radiology course. A questionnaire distributed to the class following the orthopedic section of the course recorded the following comments with reference to the computer-assisted instruction. Slightly over one-half the class (57%) used the tutorial during the course. Of these, 60% found the tutorial more effective than studying the textbook. Approximately 80% found the tutorial to be an effective review after studying class notes. Ninety-eight percent of the students recommended making the program available to future classes as well as increasing the number of tutorials available.

Discussion

In the last several years, medical schools have recognized the benefits of computer-assisted instruction to augment teaching radiology. Several different computer operating systems have been used. In a survey of all U.S. radiology residency training programs (medical schools), the following percentages of computer system availability were found: 70% IBM , 38% IBM clones, 31% Apple, 10% Amiga, 5% Macintosh, and 2% Atari (10). Costs for program development and student workstations vary according to systems chosen. When the decision to produce a computer-assisted instructional program for radiology at the University of Georgia was first conceived (1990), financial support for the necessary image enhancement peripherals on IBM or Apple equipment was not available. Therefore, a cost-effective system capable of high-quality radiographic image reproduction was sought. The Commodore Amiga personal computer was chosen to develop the original prototypical program because of its image reproduction ability and cost. Computer and imaging technology continue to expand, and prices of personal computers have decreased. With decreasing price and improved technology, other computer systems may currently be able to duplicate the courseware described in this paper. This author, however, continues to believe that high quality interactive radiology tutorials can be cost effectively designed using the Amiga platform. Although the Amiga is not directly compatible with IBM or Apple/Macintosh computers, bridgeboards are available which allow Amiga PCπs to run their software alone or in conjunction with Amiga software.

  1. Benefits which may be derived from interactive radiographic computer-assisted instruction include the following:
  2. Provides instant "instructor" feedback and reinforcement.
  3. Allows students to work at their own pace.
  4. Creates active student involvement.
  5. Reinforces lecture material.
  6. Provides opportunity for greater case example diversity.

Summary

An interactive computer-assisted tutorial covering canine juvenile bone disease was designed as an adjunct to traditional radiologic teaching methods. Specific system requirements and program description are presented. Overall student acceptance of the courseware has been favorable.

References and Endnotes

1. Goldberg HI, Fell S, Myers HJ, Taylor RC: A computer-assisted, interactive radiology learning program. Invest Radiol 25:947-951, 1990.

2. Squire LF: On teaching radiology to medical students: challenges for the nineties. Am J Roentgenol 152:457-461, 1989.

3. Jacoby CG, Smith WL, Albanese MA: An evaluation of computer-assisted instruction in radiology. Am J Roentgenol 143:675-677, 1984.

4. Marion R, Niebuhr BR, Petrusa ER, Weinholtz D: Computer-based instruction in basic medical science education. J Medical Education 57:521-526, 1982.

5. McGhee RB, Bennett WF, Morris CS, Witanowski LS: Cost effective development of a computer- assisted instruction system. Am J Roentgenol 153:877-879, 1989.

6. Nashel DJ, Martin JJ: Images in rheumatology (IR): a multimedia program for medical education. J IBM Multimedia, 14-16, 1991.

7. Rubin A: Contributions of cognitive science and educational technology to training in radiology. Invest Radiol 24:729-732, 1989.

8. Sinka S, Sinka V, Kangarloo H, Huang HK: A PACS-based interactive teaching module for radiologic sciences. Am J Roentgenol 159:199-205, 1992.

9. Tessler FN: Computer applications in radiology education: A challenge for the 1990's. Am J Roentgenol 152:1169-1172, 1989.

10. Jones KM, Hunter TB, Boren WL: Computer use and education in radiology residency programs. Invest Radiol 25:596-598, 1990.

The author gratefully acknowledges the financial support of the Department of Anatomy and Radiology, College of Veterinary Medicine and The Office of Instructional Development, The University of Georgia; and Pew Charitable Trust, GSET Consortium.

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