Title page Introduction Internet Teaching file Sharing Conclusion References
Table 1 Table 2 Table 3 Table 4 Figure 1 Figure 2

Sharing

Internet access facilitates sharing of information and resources among users. For example, the Computer and Instrumentation Council home page is designed to serve as an index to nuclear medicine resources available on the Internet (Figure 1). The hyperlinks available in a "point and click" interface allow ready access to information on DICOM and Interfile file format as well as to radiology and nuclear medicine teaching file collections; links to other topics such as image reconstruction are being added as authors become interested in "publishing" such information.

Multi-institutional Indexing

In the cases of teaching file collections, it would be useful to be able to search all of the available teaching files at the multiple institutions for specific types of cases. One approach might be to have each institution manually index the cases at each institution (Figure 2); this will rapidly become inefficient as the number of contributing institutions grows. A second approach might be to agree on an indexing scheme, and allow sites to simply swap index files periodically; this approach has been suggested in the most recent version of TF-Web (11).

A third and more general approach would be to have each site create a WAIS index of their case descriptions. WAIS, which stands for Wide Area Information Server, allows a server to maintain an index of the words used in the documents in its database. Free-form (natural language) queries can then be directed at the database; this results in document titles listed in descending order based on the match "score" between the document and the search query. Clicking on one of the titles then permits viewing of that document. A principal advantage of WAIS is that a WAIS search is inherently distributed, in that the search can access all available WAIS servers to fulfill the request. However, a controlled vocabulary has advantages when describing or indexing cases.

Granularity of Reuse

One issue that needs development is the level of granularity at which information from other sites may be addressed. For example, in an online document, the author could mention that there is a good case of Paget's disease available in the teaching case collection located at a particular site; alternately, the author could include a link to the case directly, or even a pointer to a particular image .

The appropriate level for external access is based on a number of factors, including link stability, author denotation, and copyright permission. Sites may (appropriately) retain the privilege of renaming or moving low-level documents from one computer to another; outside users attempting to access such a document directly would find that their link was no longer valid. In addition, low-level documents may not have a clear indicator as to the author or site at which the document is located. There is no single answer to this issue, though it can be generally stated that if the document or image does not indicate the author/ownership on it, only internal links should access that document directly.

A potential advantage of access at the lowest level is that it allows reuse of information in other formats. For example, if allowed, one could create a CME quiz or a guided medical student tutorial that employed images located in teaching files at other institutions. Prior to such repurposing of on-line information, one should check for any copyright statement at the contributing site and obtain permission, if needed.

Etiquette

In order to start the discussion of these issues, the Internet Focus Group of the Computer and Instrumentation Council of the Society of Nuclear Medicine has suggested an etiquette for sharing and cooperation in building Nuclear Medicine resources for the Internet (Table 4). The most active current collaborative effort is case-based teaching file development; therefore, many of the principles apply directly to that application. The goal of these principles is to encourage easy collaboration while allowing the contributions of each of the collaborators to be appropriately recognized.

Publication

The Internet is an ideal medium for posting material that is likely to be frequently updated or modified such as teaching files for Nuclear Medicine, and for a number of relatively short items of a timely nature. Such items include schedules of upcoming events, newsletters, and tables of contents of upcoming journals. The advantages of posting these items via the Internet are that they are accessible immediately, they can be corrected and updated easily, and the incremental cost is minimal.

A significant limitation of current hard copy journals is the lack of multimedia capabilities. Electronically published journals can provide movies and sounds that are integrated with the images and text (29-31). In addition electronic articles can take advantage of hypertext links to allow the reader to move to different parts of the article, or even to other documents, in a natural fashion. For example, a natural hypertext link would allow the reader to jump from the text discussing a figure or table directly to the figure and vice- versa.

A sense of permanence is usually associated with currently published material. Revisions are infrequent and are clearly identified as new editions. The ability to rapidly change and update electronically posted material, while an advantage in many instances, may be a disadvantage in other circumstances. At the present time, materials available on the Internet tend to change rapidly. A challenge for electronic publications is developing a mechanism for providing a sense of permanence. Perhaps libraries, which have a traditional archival function, will become important locations for published electronic materials. This could provide assurance that such publications are in their original form.

Another important practical issue is journal format. Paper-based journals are often read at a location where there is no Internet connection. Readers are used to the look and feel of hard copy journals and will need to develop a new style of reading to make effective use of electronic journals. This may include down-loading papers and reading them off-line, either by printing them or possibly even on a portable computer.

Quality Control

Quality control would seem to be a significant problem for Internet material since individuals can post or send anything over the Internet. This potential problem can be managed by developing electronic versions of current mechanisms of quality control. A journal article would require appropriate peer review before being published at the official site. Articles should have a heading that includes the authors' names and the extent of review that has occurred before the document was posted. Simple items such as a council newsletter will have minimal review, and the fact of minimal review will be apparent by reading the header information. Other documents, such as teaching file cases, will have submission date, review date, acceptance date, and method of review, including the name of the reviewing organization and possibly the names of the reviewers. In any case, it is important to have the appropriate header information so that the reader can judge the level of review (and thus the presumed quality) of an electronic document before reading it. This approach makes the author(s) responsible for quality control of their document. If there is no evidence of review, then the item will not be posted at the central site. If the authors choose to post it anyway at another site, then caveat lector, "Let the reader beware!".

Because of the extensive hypertext capabilities of Internet publication it is possible to incorporate links to other documents that may have undergone a different level of review from the original article. This capability has the potential to confuse the reader and makes it even more important that appropriate information about the quality control associated with an individual document be clearly apparent when the document is being viewed. Initial efforts will probably lack much of this information on quality control but, as electronic publication becomes more common, will become an essential part of any Internet document.

Physician's Desktop

The hyperlinking and multimedia capabilities of the World-Wide-Web provide an excellent interface for a case-based teaching file. Other educational resources, such as lecture notes, medical physics data, links to the medical literature, diagnostic algorithms, smart decision making programs, etc., can be provided. With proper security and confidentiality (27,28), access to patient information such as registration, laboratory results, electronic medical record, could be provided. Multimedia radiology reports including text, images, annotations, cines, and voice could provide a much richer communication to the referring physician (32).

A World-Wide-Web client program can access an array of services from any desktop computer connected to the Internet. In addition to medical applications, other more general services available on the network, from visiting the Vatican Museum Collection to obtaining the local weather are available. The World-Wide-Web provides a uniform protocol to link various hardware network servers to all of the common desktop computers.

Reprinted by permission of the Society of Nuclear Medicine from: Parker JA, et al.: Collaboration using Internet for development of case-based teaching files. Journal of Nuclear Medicine 1996; 37:178-184.

Title page Introduction Internet Teaching file Sharing Conclusion References
Table 1 Table 2 Table 3 Table 4 Figure 1 Figure 2