Validating “Image box”-a new approach to multicentre radiology reviews using a web-based image review system: study protocol.

Penelope Laura Moyle, Masako Katako, Kevin Wheeler, Susan Gerty, Oliver Morrish, Matthew G Wallis, Diana M Eccles, Ruth Warren


Objectives: To validate the use of “Imagebox”- a web-based image review system for large scale multicentre trials.

Patients and Methods: As part of the multicentre trial ‘Prospective study of Outcomes in Sporadic versus Hereditary breast cancer (POSH) study’ mammograms were collected and digitised. Software was created allowing digitised mammograms to be viewed from any location with internet access. Two validation studies were performed. Firstly phantom studies using line-pairs (1–20 lpmm-1) to assess spatial resolution and the CDMAM 3.4 phantom were used to assess the visibility of gold discs for contrast detail .Secondly a comparison was made between the scoring of 77 patients’ original diagnostic analogue mammograms from 29 hospitals and the corresponding web images. Films and web images were scored by one experienced breast radiologist according to the BIRADS classification. At least 8 weeks elapsed between scoring images from the same patient.

Results: The original analogue spatial resolution was 20 lpmm-1 and web resolution of the same image reduced at 8.9 lpmm-1. Contrast detail assessment demonstrated analogue and web images with near concordance and the image quality factor, IQFinv for the web was reduced but within the 95% confidence interval of the original mammograms. BIRADS final assessment showed good agreement between the analogue and the identical web images (Kappa 0.82).

Conclusion: The overall reduction in spatial resolution did not adversely affect the quality of the diagnostic image on “Imagebox”. This may be due to its functionality, specifically the high magnification zoom which enhances diagnostic interpretation. Imagebox is a promising solution to address the logistical challenges for large breast imaging reviews and has further potential for education and self assessment.


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Journal of Biomedical Graphics and Computing    ISSN 1925-4008 (Print)   ISSN 1925-4016 (Online)

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