The Virtual Hospital

Electric Differential Multimedia Laboratory Bibliography

The Networked Multimedia Textbook: A Technique for the Global Distribution of Radiology Multimedia Information Across the Internet

Michael P. D'Alessandro,1,2
David L. Lacey,1
Jeffrey R. Galvin,1
William E. Erkonen,1
Donna M. Santer3

Peer Review Status: Externally Peer Reviewed


This work was supported by grants from The University of Iowa Department of Radiology and Apple Computer, Inc.

1Department of Radiology, Electric Differential Multimedia Laboratory, The University of Iowa College of Medicine, Iowa City, IA, 52242-1009.

2Present address: Department of Radiology, The Children's Hospital and Harvard Medical School, 300 Longwood Ave., Boston, MA 02115.

Address correspondence to:

M.P. D'Alessandro.
Dept of Radiology,UIHC
200 Hawkins Drive
Iowa City, IA 52242

The authors have no commercial interest in any product mentioned in the text.

Abstract
Objective.
The purpose of this project was to create an approach for global radiology multimedia publishing using the Internet that would address the two largest problems facing radiology multimedia publishers today: the high percentage of radiologists who are computer novices and the variety of available personal computers (Macintosh, Microsoft Windows / IBM-PC, X-Windows, Amiga) which are software incompatible.

Materials and Methods. We have developed a client/server approach to multimedia publishing, the networked multimedia textbook, which has a simple book-like user interface to facilitate its use by computer novices. Once created, a networked multimedia textbook can be viewed on all current popular personal computers (Macintosh, Microsoft Windows / IBM-PC, X-Windows, Amiga). The networked multimedia textbook is based on the Internet, World Wide Web, Mosaic and Wide Area Information Servers software technologies, and all are in the public domain.

Results. Currently, we have created six radiology networked multimedia textbooks.

Conclusion. This networked multimedia textbook approach for the global distribution of multimedia radiology information brings the benefits of multimedia publishing on the Internet to radiologists today.

Introduction
The Internet, the information superhighway of today, has tremendous potential as a means of publishing multimedia information in radiology. However, before this potential can be realized, two obstacles must be overcome. First, the user interface to this multimedia information must be intuitive and easy to use as most radiologists are computer novices. Second, this multimedia information must be able to be displayed on all current popular personal computers to allow all radiologists access which is difficult to do because each personal computer has its own hardware and software specifications, or standards, which are usually incompatible with each other.

Over the last 3 years we have been engaged in the creation of radiology multimedia textbooks on compact disc read-only memory (CD-ROM) for desktop computers which have partially addressed these issues [1,2]. We have defined a multimedia textbook to be a computer program that simulates the intuitive user interface of a printed textbook while having educational features far beyond those of printed materials, including the ability to play video clips and audio clips, display an almost unlimited number of high resolution color images, provide computer search capability, and be rapidly updated. We wished to extend our approach to multimedia textbook creation to the realm of networked computers. We call this new approach the Networked Multimedia Textbook. A networked multimedia textbook is a multimedia textbook that is stored on a server, or storage, computer and distributed across national and international computer networks, to personal, or client, computers in users homes or offices. The networked multimedia textbook has a simple user interface and may be accessed by all current popular personal computers and workstations including Macintosh, Microsoft Windows / IBM-PC, X-Windows, and Amiga.

Methods
The networked multimedia textbook approach is based on four discrete software technologies that are in the public domain: Internet, World Wide Web, Wide Area Information Servers, and Mosaic (see Appendix for detailed descriptions of these technologies and how they are used to implement the networked multimedia textbook).

Once the networked multimedia textbook is created, it is stored on a server, or storage, computer connected to the Internet, the information superhighway of the present. There, it is organized using an Internet database program called the World Wide Web and indexed using an Internet indexing program called Wide Area Information Servers. The networked multimedia textbook is transmitted to users personal computers and workstations, or clients, in their offices and homes via the Internet. It is viewed using Mosaic, an Internet program available for all popular personal computers and workstations (Macintosh, Microsoft Windows / IBM-PC, X-Windows, Amiga) which allows the viewing of information organized by the World Wide Web and indexed by Wide Area Information Servers.

The networked multimedia textbook user interface is patterned after that of a printed book, which makes navigation easy. The user begins by using Mosaic to select the World Wide Web server that contains the desired networked multimedia textbook. (Fig. 1). Once a networked multimedia textbook is selected, the table of contents appears, showing all of the chapters available (Fig. 2). After clicking on the chapter of interest, the user is shown the text of the entire chapter along with the links to associated media, which are indicated by underlined words and picture icons (Fig. 3). The user scrolls through the chapter by clicking on the scroll bar along the right side of the screen. By clicking on a link, media related to the text being read are displayed. Chapters within the networked multimedia textbook may consist of medical information, indices, dictionaries, study sheets, questions and answers, and so on. The user may take multimedia notes by using a word processing program that runs concurrently with Mosaic (Fig. 4). Users may also copy, paste, and save any portion of the networked multimedia textbook for their own future use and reference. Users are not allowed to modify the original networked multimedia textbook.

Results
We have transferred six of our CD-ROM multimedia textbooks to the networked multimedia textbook format. They include networked multimedia textbooks on the imaging of diffuse lung disease, pulmonary embolus, pulmonary tumors, pulmonary anatomy, airway disease in children, and scintigraphy of the gastrointestinal tract. Our current networked multimedia textbooks are all in the public domain and may be freely read by anyone connected to the Internet.

Once a departmental or university multimedia publishing laboratory is in place, there is little extra cost in faculty time or money to create a networked multimedia textbook [1,2]. We have separated the creation of content, which is the faculty's responsibility, from the creation of the networked multimedia textbook, which is the responsibility of a skilled technician such as a graphic artist. Radiology content that already exists in the form of faculty lectures and scientific posters can be rapidly digitized into the format of a networked multimedia textbook by a graphic artist and is then proofed by the faculty and made available on-line for use.

Discussion
Recent articles in medical and radiologic publications have described how the information superhighways of the future will allow the electronic distribution of medical information [3, 4]. The networked multimedia textbook approach to distributing medical information outlines a technique for worldwide multimedia publishing that is possible today, using the Internet, the information superhighway of the present. Using the networked multimedia textbook approach, multimedia textbooks, teaching files, and journals are easily created and distributed to colleagues around the world.

The networked multimedia textbook has an intuitive, book-like user interface that makes its content accessible to computer novices. Medical multimedia authors must remember that the majority of their audience will be inexperienced with computers and must design accordingly. In addition, by using Mosaic, the networked multimedia textbook provides a uniform interface to the large amount of information contained in the World Wide Web.

A key problem facing multimedia today is the plethora of incompatible hardware standards confronting the multimedia author. Recent work, emphasizing a modular construction of multimedia applications, facilitates transferring of these applications among incompatible hardware platforms [2]. Nonetheless, this transferring process is tedious and time-consuming. The networked multimedia textbook approach to multimedia authoring helps overcome this problem by allowing authors to create a multimedia textbook composed of files that are in a standard multimedia file format by using a Hypertext Markup Language editor. These Hypertext Markup Language files can then be viewed using Mosaic on any personal computer or workstation connected to the Internet. Today, Mosaic is available for all major personal computers and workstations. Future changes in viewing hardware will require only the creation of a new version of Mosaic, and the networked multimedia textbooks themselves will not need to be revised. Therefore, the multimedia content and the viewing hardware are separate and are allowed to evolve independently.

In addition, the networked multimedia textbook allows convenient access to current information. Information should be maintained at a central source, where it can be quickly updated, and then published via computer networks. This approach poses a sharp contrast with either printed textbooks or multimedia textbooks distributed on CD-ROM. Both printed media and CD-ROM tend to be updated at yearly or greater intervals.

A potential problem faced by the networked multimedia textbook is that of overloading of Internet data transmission capacity because of the new need with the networked multimedia textbook for the Internet to transmit images, video, and audio as well as text. In the six months the networked multimedia textbooks have been in operation, we have never encountered Internet overloading. The reason for this is that the Internet is constantly growing in capacity right along with the amount of information it needs to carry and this situation should continue into the foreseeable future. As a point of reference, images from the networked multimedia textbook are displayed on the computer screen within 15-20 seconds of being requested. Video clips from the networked multimedia textbook, because of their larger size, require 60-180 seconds to appear after being requested. These access times, which are approximately two times longer than those of a CD-ROM drive, will decrease as Internet transmission speeds increase.

A current disadvantage of the networked multimedia textbook is that relatively few medical professionals are connected to the Internet. However, this situation will be corrected in the next few years as the telephone and cable companies begin to offer low-cost high-speed Internet access to private corporations and individuals. This will finally make it practical for the average radiologist to begin to receive multimedia radiology information over the Internet in their home or office. Therefore, the time to start authoring networked multimedia textbooks is now, so that as physicians come on-line, there will be medical content for them to read.

The best way to predict the future is to invent it. While many speak of what may be possible using the information superhighways of the future, we have outlined an approach to Internet multimedia publishing that is useful today.

Acknowledgments
The authors thank E.A. Franken, Jr., for providing the educational atmosphere and support to allow completion of this project.

For Further Information
If you are directly connected to the Internet and have a Macintosh, Microsoft Windows / IBM-PC, X-Windows or Amiga computer, you may view the networked multimedia textbooks using Mosaic. First, obtain Mosaic software for your personal computer or workstation by using File Transport Protocol (FTP) to connect to the computer ftp.ncsa.uiuc.edu and look in the directory /Mosaic. Once you have the Mosaic software running on your personal computer, set your Uniform Resource Locator (URL) to http://vh.radiology.uiowa.edu/ to connect to the Virtual Hospital, which contains the networked multimedia textbooks. In order to learn how to view the images, video clips and audio clips contained within the networked multimedia textbooks, consult the Mosaic on-line documentation.

If you have a dial-up connection to the Internet and a personal computer with a communications program that can emulate a standard VT-100 terminal, you may view the text within the networked multimedia textbooks, but not the images, video clips and audio clips. Once connected to the Internet, issue the telnet command to connect to lemans.radiology.uiowa.edu and when prompted to login: type "lynx" and this will connect you to the Virtual Hospital, which contains the networked multimedia textbooks.

Appendix

1. Internet. The Internet is the worldwide information superhighway of today [5]. Initially created in 1969, its use was restricted for many years to government and university researchers. Currently, the Internet is in the process of undergoing a commercial transformation, making it the foundation of the information superhighways of tomorrow. Any corporation or individual may connect to it for a fee, and the fee depends on the speed of the connection. Slow-speed dial-up connections to the Internet which allow access to text information only on the Internet are currently available from commercial vendors such as America Online (America Online, Vienna, VA) and Delphi (NewsCorp, Cambridge, MA) for approximately $10-$20 / month. High-speed direct connections to the Internet which allow access to multimedia information on the Internet are becoming available this year from cable companies such as Continental Cable (Continental Cable, Cambridge, MA) for $100 / month, with the price expected to drop to $10-$20 / month over the next year. The Internet is growing rapidly, with data traffic doubling every few months. The key to the success of the Internet is its open hardware and software architecture, based on a communications protocol called Transmission Control Protocol/Internet Protocol (TCP/IP) [3].
2. World Wide Web. World Wide Web (WWW) (European Particle Physics Laboratory (CERN), Geneva, Switzerland) is an Internet hypermedia client/server data base software technology that facilitates the organization and acquisition of information stored on the Internet [5]. The World Wide Web server is a computer whose information is organized into a coherent network knowledge structure or "Web." A World Wide Web client is a personal computer running Mosaic (see below) that allows intuitive access to the Web through a point and click graphical user interface. World Wide Web servers communicate between themselves and with clients using a communications protocol known as the Hypertext Transfer Protocol (HTTP). Text files used by the World Wide Web are stored in the Hypertext Markup Language (HTML) file format. Hypertext Markup Language files are created using a standard text editor or word processor on any personal computer or workstation. In addition to containing text, Hypertext Markup Language files contain links to media available on other computers distributed throughout the World Wide Web. One can retrieve linked media that is stored on distant computers simply by clicking on a underlined linked word or picture icon. Each link describes a World Wide Web Uniform Resource Locator (URL), which is an Internet address pointing to where that piece of media is stored in the World Wide Web. Media in the World Wide Web may be stored in a variety of formats. Text is stored in the ASCII format, images in the Joint Photographic Experts Group (JPEG) and Graphics Interchange Format (GIF) formats, audio in the Sun .au format, and video in the QuickTime™ and Moving Picture Expert Group (MPEG) formats. By using only these media formats we ensure that our networked multimedia textbooks can be displayed with no hardware or software compatibility problems on the Macintosh, Microsoft Windows / IBM-PC, X-Windows and Amiga computers. World Wide Web is a published and documented standard that is free to use. World Wide Web server and client software is available in the public domain for all major personal computers and workstations. For these reasons, World Wide Web has become widely accepted.
3. Wide Area Information Servers (WAIS). Wide Area Information Servers is a client/server software technology that indexes text on the Internet. These text files are searchable via keyword and free text by Wide Area Information Servers's powerful search engine [5]. A Wide Area Information Servers server is a file server computer that contains and organizes Wide Area Information Servers indices. A Wide Area Information Servers client is a personal computer running Mosaic (see below) that allows intuitive access to "Wide Area Information Servers space."
4. Mosaic. Navigation through the Internet has traditionally been time consuming, difficult and confusing for computer novices as well as for experts. The development of Mosaic [National Center for Supercomputing Applications (NCSA), Champaign, IL] has begun to correct this situation. Mosaic is a program that serves as an easy to use point and click graphical user interface to the Internet. It allows Internet users to more easily navigate through the rich information resources contained on the Internet in the form of World Wide Web data bases and Wide Area Information Servers indices. Public domain Mosaic programs, which have identical graphical user interfaces, have been created for the Macintosh, Microsoft Windows / IBM-PC, X-Windows and Amiga computers.

The networked multimedia textbook is implemented in the following fashion by using these technologies. Each networked multimedia textbook is composed of a variable number of Hypertext Markup Language files; one file for each chapter in the networked multimedia textbook. Each Hypertext Markup Language file contains the text and all of the associated Uniform Resource Locators for that chapter and is created by using a Hypertext Markup Language editor on a Macintosh computer (Apple Computer, Cupertino, CA). Media is initially digitized into a Macintosh computer and is then processed and saved in the appropriate file format. The Hypertext Markup Language files and the related media files containing images, audio, and video are transferred over a local area network fro


Home | Help | Search | Outline | Disclaimer | Comments

librarian@vh.org

All contents copyright © 1992-1997 the Author(s) and the University of Iowa. All rights reserved.
Last Modified: March 04, 1997