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Access to the Internet / Learning Resources

J. Anthony Parker, MD PhD
Beth Israel Deaconess Medical Center
Joint Program in Nuclear Medicine
Boston, MA
Tony_Parker@BIDMC.Harvard.edu

There has been rapid expansion in the use of Internet, particularly the World Wide Web (WWW). Growth of the World Wide Web was spurred by the introduction of Mosaic, a Web browser from the National Center for Supercomputer Applications. Well known commercial Web browsers are Netscape Navigator from Netscape Communications Corporation and Internet Explorer from Microsoft. World Wide Web browsers allow the user to access multimedia documents (text, images, movies, and sounds) using a simple point-and-click graphical user interface. But if you are like many physicians, you may be asking "What do those words mean?"

The Internet

The Internet is a collection of interconnected computer networks throughout the world. They have all agreed to use a communications protocol called TCP/IP. The Internet is like the telephone network; its difficult to describe all the possible connections to the Internet. One way to define the Internet is that it is all the computers you can connect to from a computer which is already on the Internet. That definition may sound strange, but it is just like defining the telephone network as all the phones you can call from a single phone. Each computer has its own Internet address, which is analogous to a telephone number.

Built on top of Internet are a series of other protocols which allow electronic mail, remote login, file transfer, gopher, and finally the World Wide Web. The World Wide Web protocol permits use of most of the other functions of Internet, in a fashion which is understandable to the non computer specialist. This workshop will only deal with the World Wide Web.

Getting Connected

The first problem is getting connected to Internet. My opinion is that Internet is a basic infrastructure service which should be provided just like heat, light, electricity, and the telephone. You should expect that Internet is available on your desktop. Unfortunately, not everyone has come around to my opinion yet, so getting connected often requires some effort. In a hospital or other large facility, you should be able to call the Information Services (often called IS) group and have your computer connected.

At home or at Internet deficient facilities, you will need to connect to an Internet provider yourself. The on-line services are beginning to offer more and more of the Internet capabilities to their users, and there are other services which will connect you directly to the Internet. Your personal computer can be connected over a regular telephone line using a modem and either the Serial-Line Internet Protocol (SLIP) or the Point-to-Point Protocol (PPP). In order to make use of the multimedia capabilities, a 28,800 bit-per-second modem is desirable. If your local telephone exchange permits, an even faster connection can be made with ISDN, although ISDN has been slow penetrating to the end user. The cable companies, the telephone company, and even power utilities starting to provide internet connection using RF-modem. An RF-modem connects over an unused television channel at speeds of about 10 megabits-per-second. I have been connected to the internet via my local cable provider for over a year. Initially, we were beta testing the cable connection, but now connection is commercially available in my neighborhood.

You should not have to worry too much about these details. You should be able to purchase bundled hardware, software, and Internet provider access which is reasonably easily installed on your personal computer. The key issues are what services are provided and how fast is the connection. One decision you will need to make is whether to use an on-line service or a direct internet connection. The on-line services provide added value services and are often the easiest to set up, but usually are more expensive and have some limitations. You should demand Internet mail and a full function World Wide Web browser including network news and file transfer (ftp) capabilities. The fastest connection is a direct connection (e.g. ethernet) by Information Services at your hospital; an RF-modem from your cable company may be about the same speed; next best is ISDN; the slowest acceptable connection is a 28,800 bit-per-second modem over standard telephone lines.

The World Wide Web

The World Wide Web protocol is called HyperText Transfer Protocol (HTTP). It is a low overhead, client / server protocol. Your computer (or the computer you dial into) is the client; the computer you connect to is the server. Your computer connects, gets some information, and then disconnects. You can sit there looking at the information you received for as long as you want, and you are not keeping the server busy (you may be rolling up telephone and internet server charges). The major way that you get information from a server is by pointing-and-clicking on some hypertext (a highlighted piece of text). The document with the highlighted text has instruction on how to get the document to which the hypertext points. The user just points-and-clicks, and goes from document to document on servers located around the World.

How do you get started? The client program on your computer might have a convenient method of getting started. By clicking on a button, you might go to some home page which then points to other interesting locations, or a home page may come up automatically. Unfortunately, that home page may not be of most interest to you. Instead, it may be more useful for you to start at the RSNA or the SNM home page. In order to do that, you need to type in a reasonable long Uniform Resource Locator (URL), e.g. "http://www.rsna.org/" or "http://www.snm.org/". Once you arrive at a page you find interesting, then you can leave a bookmark at that page so that next time you can go back to that location without typing in the URL.

The advanced user can often guess the URL of major organizations. The last three letters are "edu" for educational organizations, "com" for commercial organizations, and "org" for societies and organizations. The first three letters of the major World Wide Web site for an organization are often "www". A good guess for the home page of a University is "http://www.name.edu/", where name is the common name or acronym for the University. Similarly, a good guess for the home page of a company is "http://www.name.com/", where name is the common name of the company.

How do you keep from getting lost? The short answer to this question is practice. The World Wide Web is a web; it is not organized. You can get lost easily. You can find something which is very interesting, and then not remember how to get back there. Since authors tend to link to related topics, you will find there are a lot of circular paths. There are some tricks. When you find something useful, leave a bookmark so you can get there again. The hyperlinks usually change color once you have been to a particular location; the color clue can keep you from going in circles. If your lucky, you can find a home page organized by someone with similar interests to your own. That page will often serve as a good starting point. The key feature, is that after you get used to surfing, it becomes much more natural.

How do you find resources? Indexing is one of the features of the Web which is in evolution. The short answer to the question is that there is not a single good way to find resources. There are, however, some tricks which help. Often if you have found a good starting point, that is the best place to look for related topics. There are some indexes and some "search engines" which can lead you to a large number of resources. "Yahoo" is a well known index which can be reached from Netscape"s home page. Yahoo has pointers to other well known search engines such as Alta Vista, which is a massive resource. I find Yahoo very useful for general topics - it has both a tree structured index and a word search. Alta Vista often overwhelms you with references on general topics, but when I want to find a very specific topic, Alta Vista is most likely to have a reference. I have listed some search engines in my own list of interesting URLs "http://www.med.harvard.edu/JPNM/InterestingURLs.html". To use a search engine, you often type one or more keywords into a form, and then the search engine returns a list of locations on the Internet which contain those words. Look at the instructions, since the syntax may not be obvious.

On-Line Resources

Assuming that you have managed to get connected, and that you have learned how to use a client program, the next question is what resources are available? There are lots and lots of computer related resources on Internet. A cynic might be tempted to say the reason that you should get connected to Internet is to get more programs to access Internet! But, there are beginning to be resources which are of interest to the Nuclear Medicine physician. In particular, there are now teaching materials which are available on Internet. The bulk of the workshop will deal with a demonstration of these teaching materials. A starting point is the Joint Program in Nuclear Medicine teaching file: "http://www.med.harvard.edu/JPNM/".

Hospital Information Systems

World Wide Web clients and servers with security features are now becoming available. These systems will be very useful for accessing confidential databases over Internet. I predict that eventually the World Wide Web will be the major method for accessing picture archiving and communications systems (PACS) and for accessing radiology and hospital information systems (RIS and HIS). For example, our Division of Nuclear Medicine is now entirely web-based (3). The World Wide Web will provide a uniform interface to a wide array of services for the physician including confidential patient information, continuing medical educational, and just plain surfing. However, donÕt hold your breath; it generally takes at least a decade for computer advances to make their way into medial products.

References

1. Parker JA, Wallis JW, Halama JR, Brown CV, Cradduck TD, Graham MM, Wu E, Wagenaar J, Mammone GL, Greenes RA, Holman BL: Collaboration using internet: Development of case-based teaching files. J Nucl Med 1996; 37:178-184. (available from: http://www.med.harvard.edu/JPNM/Publications/JNuclMed1996_37_178/).

2. Parker JA: Access to the internet / learning resources. Clinical Nuclear Medicine: 1996 http://www.med.harvard.edu/JPNM/Lectures/Internet/ClinNucMed96.html.

3. Barbaras L, Parker JA, Donohoe KJ, Kolodny GM: The all-digital department moves to the web. RSNAej July/Ausust, 1996,
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