Harold Kundel | University of Pennsylvania (original) (raw)

Papers by Harold Kundel

The contrast sensitivity of the retina is greatest in the center and decreases rapidly toward the... more The contrast sensitivity of the retina is greatest in the center and decreases rapidly toward the periphery. Therefore, the detection of low-contrast lung nodules depends upon the manner in which the image is sampled by retinal receptors as eye fixations jump across the image during scanning. The scanning performance of two radiologists was compared with two computed models, a systematic and a random scanner. Although radiologists do not seem to have random scanning patterns, their coverage of the image was matched more closely by the random model. This suggests that radiologists employ a scanning strategy that is designed to cover the image of the lungs in a minimum time using the smallest possible visual field. The visual field size that is most effective in detecting nodules during search has a radius of 3.5 degrees visual angle. Nodule detection may be limited by basic neurologic constraints on human scanning performance.

Statistical measures are described that are used in diagnostic imaging for expressing observer ag... more Statistical measures are described that are used in diagnostic imaging for expressing observer agreement in regard to categorical data. The measures are used to characterize the reliability of imaging methods and the reproducibility of disease classifications and, occasionally with great care, as the surrogate for accuracy. The review concentrates on the chance-corrected indices, kappa and weighted kappa. Examples from the imaging literature illustrate the method of calculation and the effects of both disease prevalence and the number of rating categories. Other measures of agreement that are used less frequently, including multiple-rater kappa, are referenced and described briefly.

To evaluate the changes in workflow, in the radiology department, after switching from a film-bas... more To evaluate the changes in workflow, in the radiology department, after switching from a film-based image management system to a picture archival and communication system.

Two hundred examinations were tracked through the neuroradiology reading room. The median time fr... more Two hundred examinations were tracked through the neuroradiology reading room. The median time from completing the exam to starting the interpretation was 1.6 hours for 76% and 18 hours for 24% of the cases. The delay occurred because exams done after 4:00 PM were held for the next day along with exams for which relevant prior studies were unavailable. The

In previous studies of workstation usage by physicians in the Medical Intensive Care Unit (MICU) ... more In previous studies of workstation usage by physicians in the Medical Intensive Care Unit (MICU) of the University of Pennsylvania Medical Center, we have compared which image manipulation functions were used when viewing digitized film and phosphor plate (CR) images. We had found some differences in the use of such features, particularly a decrease in the use of brightness and

To evaluate a conventional radiology image management system, by investigating information accura... more To evaluate a conventional radiology image management system, by investigating information accuracy, and information delivery. To discuss the customization of a picture archival and communication system (PACS), integrated radiology information system (RIS) and hospital information system (HIS) to a high volume emergency department (ED). Materials and Methods: Two data collection periods were completed. After the first data collection period, a

Radiology, 1996

To prospectively compare efficiency and outcome of a standard film-only system with those of a di... more To prospectively compare efficiency and outcome of a standard film-only system with those of a digital picture archiving and communication system (PACS). The film-only system, which used either analog film or computed radiography (CR) hard copy, was compared with a PACS, which used CR images displayed on a multiviewer in the radiology department and a workstation in the medical intensive care unit. A random sample of nonroutine, bedside chest radiographs was studied. Within 20 minutes of completion of radiography, 246 of 328 (75%) of the images were available at the workstations; it took 1.8 hours for 238 of 317 (75%) of the images to be displayed on the multiviewer. When the workstation was used, the staff did not access the image information earlier, but clinical actions were initiated more promptly in response to imaging findings. Consultation with radiologists decreased from 507 of 561 (90%) images with hard copies to 70 of 249 (28%) with the workstation. Use of a PACS improves ...

Radiology, 1988

This study examined the effect of a medical image management network on the behavior of physician... more This study examined the effect of a medical image management network on the behavior of physicians working in a medial intensive care unit (MICU). For 1 year, 8-week periods during which chest radiographs were digitized and made available to MICU physicians on a digital display console were alternated with 8-week periods during which only film images were available. Clinical efficacy during the periods was compared by measuring the time between completion of imaging examinations and initiation of specific clinical actions such as placement and positioning of tubes. Results indicate that the time required to take some clinical actions decreased with the immediate availability of images on the digital display console. Established procedures for obtaining radiologic information were altered by the digital imaging network. The time at which physicians viewed images changed, and consultations between MICU staff and radiologists decreased. These results indicate that behavior patterns are...

... a microcomputer workstation CF NODINE, HL KUNDEL, LC TOTO, and EA KRUPINSKI University ofPenn... more ... a microcomputer workstation CF NODINE, HL KUNDEL, LC TOTO, and EA KRUPINSKI University ofPennsylvania, Philadelphia, Pennsylvania ... 475 Copyright 1992 Psychonomic Society, Inc. Page 2. 476 NODINE, KUNDEL, TOTO, AND KRUPINSKI 2 0 ,---- ...

A very common task for a radiologist is to compare a previous examination with a current one. Wit... more A very common task for a radiologist is to compare a previous examination with a current one. With film, the typical method varies somewhat, but usually involves putting up comparable views on two adjacent lightboxes. The reader then looks back and forth between the two films to assess changes. For images that can be placed on adjacent lightboxes, this method

Medical Imaging 1998: PACS Design and Evaluation: Engineering and Clinical Issues, 1998

The purpose of this work was to develop a set of controls for image navigation and manipulation f... more The purpose of this work was to develop a set of controls for image navigation and manipulation for use at a workstation. The intended focus was to provide a set of controls that would be most useful for the task of reading plain radiographs, such as those from chest, abdominal, and ...

Medical Imaging 2000: PACS Design and Evaluation: Engineering and Clinical Issues, 2000

A study of timings of different events from the scheduling of an Emergency Department (ED) examin... more A study of timings of different events from the scheduling of an Emergency Department (ED) examination to the final reporting of it and review by the ED physician showed some expected and unexpected findings. Both computed radiography (CR) on film and CR using PACS were studied. The ...

Medical Imaging 2000: Image Perception and Performance, 2000

The use of feedback to the observer of the regions of the image that attract prolonged visual dwe... more The use of feedback to the observer of the regions of the image that attract prolonged visual dwell (> 1000 ms) has been shown to improve nodule detection performance in reading chest x-rays. The application of such a feedback mechanism in mammography seems appropriate, but it is often discouraged by the inherent difficulties of using an invasive eye-tracking system. In

Medical Imaging 2000: Image Perception and Performance, 2000

Women who undergo regular mammographic screening afford mammographers a unique opportunity to com... more Women who undergo regular mammographic screening afford mammographers a unique opportunity to compare current mammograms with prior exams. This comparison greatly assists mammographers in detecting early breast cancer. A question that commonly arises when a cancer is detected under regular periodic screening conditions is whether the caner is new, or was it missed on the prior exam? This is a difficult question to answer by retrospective analysis, because knowledge of the status of the current exam biases the interpretation of the prior exam. To eliminate this bias and provide some degree of objectivity in studying this question, we looked at whether experienced mammographers who had no prior knowledge of a set of test cases fixated on potential cancer-containing regions on mammograms from cases penultimate to cancer detection. The results show that experienced mammographers cannot recognize most malignant cancers selected by retrospective analysis.

Proceedings of the symposium on Eye tracking research & applications - ETRA '02, 2002

... cancers? Claudia Mello-Thoms Calvin F Nodine University of Pittsburgh University of Pennsylva... more ... cancers? Claudia Mello-Thoms Calvin F Nodine University of Pittsburgh University of Pennsylvania Department of Radiology Department of Radiology ... visual attention when reading mammograms and that yielded a decision by the radiologist, being this decision overt or covert. ...

Investigative Radiology - INVEST RADIOL, 1986

The contrast sensitivity of the retina is greatest in the center and decreases rapidly toward the... more The contrast sensitivity of the retina is greatest in the center and decreases rapidly toward the periphery. Therefore, the detection of low-contrast lung nodules depends upon the manner in which the image is sampled by retinal receptors as eye fixations jump across the image during scanning. The scanning performance of two radiologists was compared with two computed models, a systematic and a random scanner. Although radiologists do not seem to have random scanning patterns, their coverage of the image was matched more closely by the random model. This suggests that radiologists employ a scanning strategy that is designed to cover the image of the lungs in a minimum time using the smallest possible visual field. The visual field size that is most effective in detecting nodules during search has a radius of 3.5 degrees visual angle. Nodule detection may be limited by basic neurologic constraints on human scanning performance.

Statistical measures are described that are used in diagnostic imaging for expressing observer ag... more Statistical measures are described that are used in diagnostic imaging for expressing observer agreement in regard to categorical data. The measures are used to characterize the reliability of imaging methods and the reproducibility of disease classifications and, occasionally with great care, as the surrogate for accuracy. The review concentrates on the chance-corrected indices, kappa and weighted kappa. Examples from the imaging literature illustrate the method of calculation and the effects of both disease prevalence and the number of rating categories. Other measures of agreement that are used less frequently, including multiple-rater kappa, are referenced and described briefly.

To evaluate the changes in workflow, in the radiology department, after switching from a film-bas... more To evaluate the changes in workflow, in the radiology department, after switching from a film-based image management system to a picture archival and communication system.

Two hundred examinations were tracked through the neuroradiology reading room. The median time fr... more Two hundred examinations were tracked through the neuroradiology reading room. The median time from completing the exam to starting the interpretation was 1.6 hours for 76% and 18 hours for 24% of the cases. The delay occurred because exams done after 4:00 PM were held for the next day along with exams for which relevant prior studies were unavailable. The

In previous studies of workstation usage by physicians in the Medical Intensive Care Unit (MICU) ... more In previous studies of workstation usage by physicians in the Medical Intensive Care Unit (MICU) of the University of Pennsylvania Medical Center, we have compared which image manipulation functions were used when viewing digitized film and phosphor plate (CR) images. We had found some differences in the use of such features, particularly a decrease in the use of brightness and

To evaluate a conventional radiology image management system, by investigating information accura... more To evaluate a conventional radiology image management system, by investigating information accuracy, and information delivery. To discuss the customization of a picture archival and communication system (PACS), integrated radiology information system (RIS) and hospital information system (HIS) to a high volume emergency department (ED). Materials and Methods: Two data collection periods were completed. After the first data collection period, a

Radiology, 1996

To prospectively compare efficiency and outcome of a standard film-only system with those of a di... more To prospectively compare efficiency and outcome of a standard film-only system with those of a digital picture archiving and communication system (PACS). The film-only system, which used either analog film or computed radiography (CR) hard copy, was compared with a PACS, which used CR images displayed on a multiviewer in the radiology department and a workstation in the medical intensive care unit. A random sample of nonroutine, bedside chest radiographs was studied. Within 20 minutes of completion of radiography, 246 of 328 (75%) of the images were available at the workstations; it took 1.8 hours for 238 of 317 (75%) of the images to be displayed on the multiviewer. When the workstation was used, the staff did not access the image information earlier, but clinical actions were initiated more promptly in response to imaging findings. Consultation with radiologists decreased from 507 of 561 (90%) images with hard copies to 70 of 249 (28%) with the workstation. Use of a PACS improves ...

Radiology, 1988

This study examined the effect of a medical image management network on the behavior of physician... more This study examined the effect of a medical image management network on the behavior of physicians working in a medial intensive care unit (MICU). For 1 year, 8-week periods during which chest radiographs were digitized and made available to MICU physicians on a digital display console were alternated with 8-week periods during which only film images were available. Clinical efficacy during the periods was compared by measuring the time between completion of imaging examinations and initiation of specific clinical actions such as placement and positioning of tubes. Results indicate that the time required to take some clinical actions decreased with the immediate availability of images on the digital display console. Established procedures for obtaining radiologic information were altered by the digital imaging network. The time at which physicians viewed images changed, and consultations between MICU staff and radiologists decreased. These results indicate that behavior patterns are...

... a microcomputer workstation CF NODINE, HL KUNDEL, LC TOTO, and EA KRUPINSKI University ofPenn... more ... a microcomputer workstation CF NODINE, HL KUNDEL, LC TOTO, and EA KRUPINSKI University ofPennsylvania, Philadelphia, Pennsylvania ... 475 Copyright 1992 Psychonomic Society, Inc. Page 2. 476 NODINE, KUNDEL, TOTO, AND KRUPINSKI 2 0 ,---- ...

A very common task for a radiologist is to compare a previous examination with a current one. Wit... more A very common task for a radiologist is to compare a previous examination with a current one. With film, the typical method varies somewhat, but usually involves putting up comparable views on two adjacent lightboxes. The reader then looks back and forth between the two films to assess changes. For images that can be placed on adjacent lightboxes, this method

Medical Imaging 1998: PACS Design and Evaluation: Engineering and Clinical Issues, 1998

The purpose of this work was to develop a set of controls for image navigation and manipulation f... more The purpose of this work was to develop a set of controls for image navigation and manipulation for use at a workstation. The intended focus was to provide a set of controls that would be most useful for the task of reading plain radiographs, such as those from chest, abdominal, and ...

Medical Imaging 2000: PACS Design and Evaluation: Engineering and Clinical Issues, 2000

A study of timings of different events from the scheduling of an Emergency Department (ED) examin... more A study of timings of different events from the scheduling of an Emergency Department (ED) examination to the final reporting of it and review by the ED physician showed some expected and unexpected findings. Both computed radiography (CR) on film and CR using PACS were studied. The ...

Medical Imaging 2000: Image Perception and Performance, 2000

The use of feedback to the observer of the regions of the image that attract prolonged visual dwe... more The use of feedback to the observer of the regions of the image that attract prolonged visual dwell (> 1000 ms) has been shown to improve nodule detection performance in reading chest x-rays. The application of such a feedback mechanism in mammography seems appropriate, but it is often discouraged by the inherent difficulties of using an invasive eye-tracking system. In

Medical Imaging 2000: Image Perception and Performance, 2000

Women who undergo regular mammographic screening afford mammographers a unique opportunity to com... more Women who undergo regular mammographic screening afford mammographers a unique opportunity to compare current mammograms with prior exams. This comparison greatly assists mammographers in detecting early breast cancer. A question that commonly arises when a cancer is detected under regular periodic screening conditions is whether the caner is new, or was it missed on the prior exam? This is a difficult question to answer by retrospective analysis, because knowledge of the status of the current exam biases the interpretation of the prior exam. To eliminate this bias and provide some degree of objectivity in studying this question, we looked at whether experienced mammographers who had no prior knowledge of a set of test cases fixated on potential cancer-containing regions on mammograms from cases penultimate to cancer detection. The results show that experienced mammographers cannot recognize most malignant cancers selected by retrospective analysis.

Proceedings of the symposium on Eye tracking research & applications - ETRA '02, 2002

... cancers? Claudia Mello-Thoms Calvin F Nodine University of Pittsburgh University of Pennsylva... more ... cancers? Claudia Mello-Thoms Calvin F Nodine University of Pittsburgh University of Pennsylvania Department of Radiology Department of Radiology ... visual attention when reading mammograms and that yielded a decision by the radiologist, being this decision overt or covert. ...

Investigative Radiology - INVEST RADIOL, 1986