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Teleradiology
Teleradiology is the transmission of radiological patient images from procedures such as x-rays, Computed tomography (CT), and MRI imaging, from one location to another for the purposes of sharing studies with other radiologists and physicians. Teleradiology allows radiologists to provide services without actually having to be at the location of the patient. This is particularly important when a sub-specialist such as an MRI radiologist, neuroradiologist, pediatric radiologist, or musculoskeletal radiologist is needed, since these professionals are generally only located in large metropolitan areas working during daytime hours. Teleradiology allows for specialists to be available at all times. Teleradiology utilizes standard network technologies such as the Internet, telephone lines, wide area networks, local area networks (LAN) and the latest advanced technologies such as medical cloud computing. Specialized software is used to transmit the images and enable the radiologist to effectively analyze potentially hundreds of images of a given study. Technologies such as advanced graphics processing, voice recognition, artificial intelligence, and image compression are often used in teleradiology. Through teleradiology and mobile DICOM viewers, images can be sent to another part of the hospital or to other locations around the world with equal effort. Teleradiology is a growth technology given that imaging procedures are growing approximately 15% annually against an increase of only 2% in the radiologist population. == Reports == Teleradiology services commonly provide either preliminary or final interpretations of medical imaging studies. Preliminary reads are frequently used in emergency settings to support immediate clinical decisions and may include direct communication of critical findings to the referring physician. Some providers report turnaround times of approximately 30 minutes for emergency cases, with faster processing for time-sensitive conditions such as stroke. Final reads are definitive and used in official patient records and billing. These reports typically include all relevant findings and may require access to prior imaging and clinical data. Teleradiology is also employed to provide off-hour or overflow coverage for healthcare institutions lacking continuous on-site radiology staffing. == Subspecialties == Some teleradiologists are fellowship trained and have a wide variety of subspecialty expertise including such difficult-to-find areas as neuroradiology, pediatric neuroradiology, thoracic imaging, musculoskeletal radiology, mammography, and nuclear cardiology. There are also various medical practitioners who are not radiologists that take on studies in radiology to become sub specialists in their respected fields, an example of this is dentistry where oral and maxillofacial radiology allows those in dentistry to specialize in the acquisition and interpretation of radiographic imaging studies performed for diagnosis of treatment guidance for conditions affecting the maxillofacial region. == Teleultrasound == Teleradiology infrastructure has also been adapted to support point-of-care ultrasound (POCUS) in remote and austere environments. In teleultrasound—also known as telementored ultrasound—a remote expert guides a non-specialist in real time during image acquisition. This technique has been successfully demonstrated in extreme settings, including aboard the International Space Station, on Mount Everest, and during helicopter flight. == Regulations == In the United States, Medicare and Medicaid laws require the teleradiologist to be on U.S. soil in order to qualify for reimbursement of the Final Read. In addition, advanced teleradiology systems must also be HIPAA compliant, which helps to ensure patients' privacy. HIPAA (Health Insurance Portability and Accountability Act of 1996) is a uniform, federal floor of privacy protections for consumers. It limits the ways that entities can use patients' personal information and protects the privacy of all medical information no matter what form it is in. Quality teleradiology must abide by important HIPAA rules to ensure patients' privacy is protected. Also State laws governing the licensing requirements and medical malpractice insurance coverage required for physicians vary from state to state. Ensuring compliance with these laws is a significant overhead expense for larger multi-state teleradiology groups. Medicare (Australia) has identical requirements to that of the United States, where the guidelines are provided by the Department of Health and Ageing, and government based payments fall under the Health Insurance Act. The regulations in Australia are also conducted at both federal and state levels, ensuring that strict guidelines are adhered to at all times, with regular yearly updates and amendments are introduced (usually around March and November of every year), ensuring that the legislation is kept up to date with changes in the industry. One of the most recent changes to Medicare and radiology / teleradiology in Australia was the introduction of the Diagnostic Imaging Accreditation Scheme (DIAS) on 1 July 2008. DIAS was introduced to further improve the quality of Diagnostic Imaging and to amend the Health Insurance Act. == Industry growth == Until the late 1990s teleradiology was primarily used by individual radiologists to interpret occasional emergency studies from offsite locations, often in the radiologists home. The connections were made through standard analog phone lines. Teleradiology expanded rapidly as the growth of the internet and broad band combined with new CT scanner technology to become an essential tool in trauma cases in emergency rooms throughout the country. The occasional 2–3 x-ray studies a week soon became 3–10 CT scans, or more, a night. Because ER physicians are not trained to read CT scans or MRIs, radiologists went from working 8–10 hours a day, five and half days a week to a schedule of 24 hours a day, 7 days a week coverage. This became a particularly acute challenge in smaller rural facilities that only had one solo radiologist with no other to share call. These circumstances spawned a post-dot.com boom of firms and groups that provided medical outsourcing, off-site teleradiology on-call services to hospitals and Radiology Groups around the country. As an example, a teleradiology firm might cover trauma at a hospital in Indiana with doctors based in Texas. Some firms even used overseas doctors in locations like Australia and India. Nighthawk, founded by Paul Berger, was the first to station U.S. licensed radiologists overseas (initially Australia and later Switzerland) to maximize the time zone difference to provide nightcall in U.S. hospitals. Currently, teleradiology firms are facing pricing pressures. Industry consolidation is likely as there are more than 500 of these firms, large and small, throughout the United States.
Healthy Together
Healthy Together is a health technology company that provides software for Health & Humans Services Departments. Healthy Together supports a “One Door” approach to eligibility, enrollment, and management for programs like Medicaid, Supplemental Nutrition Assistance Program, TANF and WIC, as well as behavioral health (988), disease surveillance, vital records, child welfare and more. The platform's use is to increase the reach and efficacy of program initiatives, improve health equity and reduce cost. Software is available in the United States of America with current deployments in Florida, Oklahoma. The United States Department of Veterans Affairs also utilizes Healthy Together's mobile platform. == Development == Healthy Together launched in March 2020 and builds software for public health and health and human services departments. The Florida Department of Health began using the platform in September 2020 to deliver real-time test results to residents. Over 50% of households in Florida have adopted the mobile application. On December 6, 2022, the Advanced Technology Academic Research Center (ATARC) awarded Healthy Together and the State of Florida's Department of Health with a Digital Experience Award at their 2022 GITEC Emerging Technology Award Ceremony in Washington, D.C. to recognize success of the project. The partnership was also highlighted on the Federal News Network's show Federal Drive. The platform is also used at universities in Oklahoma. In November 2022, the United States Department of Veterans Affairs and Healthy Together announced a collaboration to expand access to health records for Veterans. The platform provides 18 million Veterans with access to their health information through their smartphones and mobile devices. In December 2022, the integration was recognized as one of Healthcare IT News' Top 10 stories of 2022.
PropBank
PropBank is a corpus that is annotated with verbal propositions and their arguments—a "proposition bank". Although "PropBank" refers to a specific corpus produced by Martha Palmer et al., the term propbank is also coming to be used as a common noun referring to any corpus that has been annotated with propositions and their arguments. The PropBank project has played a role in research in natural language processing, and has been used in semantic role labelling. == Comparison == PropBank differs from FrameNet, the resource to which it is most frequently compared, in several ways. PropBank is a verb-oriented resource, while FrameNet is centered on the more abstract notion of frames, which generalizes descriptions across similar verbs (e.g. "describe" and "characterize") as well as nouns and other words (e.g. "description"). PropBank does not annotate events or states of affairs described using nouns. PropBank commits to annotating all verbs in a corpus, whereas the FrameNet project chooses sets of example sentences from a large corpus and only in a few cases has annotated longer continuous stretches of text. PropBank-style annotations often remain close to the syntactic level, while FrameNet-style annotations are sometimes more semantically motivated. From the start, PropBank was developed with the idea of serving as training data for machine learning-based semantic role labeling systems in mind. It requires that all arguments to a verb be syntactic constituents and different senses of a word are only distinguished if the differences bear on the arguments. Due to such differences, semantic role labeling with respect to PropBank is often a somewhat easier task than producing FrameNet-style annotations.
Artificial Linguistic Internet Computer Entity
A.L.I.C.E. (Artificial Linguistic Internet Computer Entity), also referred to as Alicebot, or simply Alice, is a natural language processing chatbot—a program that engages in a conversation with a human by applying some heuristical pattern matching rules to the human's input. It was inspired by Joseph Weizenbaum's classical ELIZA program. It is one of the strongest programs of its type and has won the Loebner Prize, awarded to accomplished humanoid, talking robots, three times (in 2000, 2001, and 2004). The program is unable to pass the Turing test, as even the casual user will often expose its mechanistic aspects in short conversations. Alice was originally composed by Richard Wallace; it "came to life" on November 23, 1995. The program was rewritten in Java beginning in 1998. The current incarnation of the Java implementation is Program D. The program uses an XML Schema called AIML (Artificial Intelligence Markup Language) for specifying the heuristic conversation rules. Alice code has been reported to be available as open source. The AIML source is available from ALICE A.I. Foundation on Google Code and from the GitHub account of Richard Wallace. These AIML files can be run using an AIML interpreter like Program O or Program AB. == In popular culture == Spike Jonze has cited ALICE as the inspiration for his academy award-winning film Her, in which a human falls in love with a chatbot. In a New Yorker article titled “Can Humans Fall in Love with Bots?” Jonze said “that the idea originated from a program he tried about a decade ago called the ALICE bot, which engages in friendly conversation.” The Los Angeles Times reported:Though the film’s premise evokes comparisons to Siri, Jonze said he actually had the idea well before the Apple digital assistant came along, after using a program called Alicebot about ten years ago. As geek nostalgists will recall, that intriguing if at times crude software (it flunked the industry-standard Turing Test) would attempt to engage users in everyday chatter based on a database of prior conversations. Jonze liked it, and decided to apply a film genre to it. “I thought about that idea, and what if you had a real relationship with it?” Jonze told reporters. “And I used that as a way to write a relationship movie and a love story.”
Plotting algorithms for the Mandelbrot set
There are many programs and algorithms used to plot the Mandelbrot set and other fractals, some of which are described in fractal-generating software. These programs use a variety of algorithms to determine the color of individual pixels efficiently. == Escape time algorithm == The simplest algorithm for generating a representation of the Mandelbrot set is known as the "escape time" algorithm. A repeating calculation is performed for each x, y point in the plot area and based on the behavior of that calculation, a color is chosen for that pixel. === Unoptimized naïve escape time algorithm === In both the unoptimized and optimized escape time algorithms, the x and y locations of each point are used as starting values in a repeating, or iterating calculation (described in detail below). The result of each iteration is used as the starting values for the next. The values are checked during each iteration to see whether they have reached a critical "escape" condition, or "bailout". If that condition is reached, the calculation is stopped, the pixel is drawn, and the next x, y point is examined. For some starting values, escape occurs quickly, after only a small number of iterations. For starting values very close to but not in the set, it may take hundreds or thousands of iterations to escape. For values within the Mandelbrot set, escape will never occur. The programmer or user must choose how many iterations–or how much "depth"–they wish to examine. The higher the maximal number of iterations, the more detail and subtlety emerge in the final image, but the longer time it will take to calculate the fractal image. Escape conditions can be simple or complex. Because no complex number with a real or imaginary part greater than 2 can be part of the set, a common bailout is to escape when either coefficient exceeds 2. A more computationally complex method that detects escapes sooner, is to compute distance from the origin using the Pythagorean theorem, i.e., to determine the absolute value, or modulus, of the complex number. If this value exceeds 2, or equivalently, when the sum of the squares of the real and imaginary parts exceed 4, the point has reached escape. More computationally intensive rendering variations include the Buddhabrot method, which finds escaping points and plots their iterated coordinates. The color of each point represents how quickly the values reached the escape point. Often black is used to show values that fail to escape before the iteration limit, and gradually brighter colors are used for points that escape. This gives a visual representation of how many cycles were required before reaching the escape condition. To render such an image, the region of the complex plane we are considering is subdivided into a certain number of pixels. To color any such pixel, let c {\displaystyle c} be the midpoint of that pixel. We now iterate the critical point 0 under P c {\displaystyle P_{c}} , checking at each step whether the orbit point has modulus larger than 2. When this is the case, we know that c {\displaystyle c} does not belong to the Mandelbrot set, and we color our pixel according to the number of iterations used to find out. Otherwise, we keep iterating up to a fixed number of steps, after which we decide that our parameter is "probably" in the Mandelbrot set, or at least very close to it, and color the pixel black. In pseudocode, this algorithm would look as follows. The algorithm does not use complex numbers and manually simulates complex-number operations using two real numbers, for those who do not have a complex data type. The program may be simplified if the programming language includes complex-data-type operations. for each pixel (Px, Py) on the screen do x0 := scaled x coordinate of pixel (scaled to lie in the Mandelbrot X scale (-2.00, 0.47)) y0 := scaled y coordinate of pixel (scaled to lie in the Mandelbrot Y scale (-1.12, 1.12)) x := 0.0 y := 0.0 iteration := 0 max_iteration := 1000 while (xx + yy ≤ 22 AND iteration < max_iteration) do xtemp := xx - yy + x0 y := 2xy + y0 x := xtemp iteration := iteration + 1 color := palette[iteration] plot(Px, Py, color) Here, relating the pseudocode to c {\displaystyle c} , z {\displaystyle z} and P c {\displaystyle P_{c}} : z = x + i y {\displaystyle z=x+iy\ } z 2 = x 2 + 2 i x y {\displaystyle z^{2}=x^{2}+2ixy} - y 2 {\displaystyle y^{2}\ } c = x 0 + i y 0 {\displaystyle c=x_{0}+iy_{0}\ } and so, as can be seen in the pseudocode in the computation of x and y: x = R e ( z 2 + c ) = x 2 − y 2 + x 0 {\displaystyle x=\mathop {\mathrm {Re} } (z^{2}+c)=x^{2}-y^{2}+x_{0}} and y = I m ( z 2 + c ) = 2 x y + y 0 . {\displaystyle y=\mathop {\mathrm {Im} } (z^{2}+c)=2xy+y_{0}.\ } To get colorful images of the set, the assignment of a color to each value of the number of executed iterations can be made using one of a variety of functions (linear, exponential, etc.). One practical way, without slowing down calculations, is to use the number of executed iterations as an entry to a palette initialized at startup. If the color table has, for instance, 500 entries, then the color selection is n mod 500, where n is the number of iterations. === Optimized escape time algorithms === The code in the previous section uses an unoptimized inner while loop for clarity. In the unoptimized version, one must perform five multiplications per iteration. To reduce the number of multiplications the following code for the inner while loop may be used instead: x2:= 0 y2:= 0 w:= 0 while (x2 + y2 ≤ 4 and iteration < max_iteration) do x:= x2 - y2 + x0 y:= w - x2 - y2 + y0 x2:= x x y2:= y y w:= (x + y) (x + y) iteration:= iteration + 1 The above code works via some algebraic simplification of the complex multiplication: ( i y + x ) 2 = − y 2 + 2 i y x + x 2 = x 2 − y 2 + 2 i y x {\displaystyle {\begin{aligned}(iy+x)^{2}&=-y^{2}+2iyx+x^{2}\\&=x^{2}-y^{2}+2iyx\end{aligned}}} Using the above identity, the number of multiplications can be reduced to three instead of five. The above inner while loop can be further optimized by expanding w to w = x 2 + 2 x y + y 2 {\displaystyle w=x^{2}+2xy+y^{2}} Substituting w into y = w − x 2 − y 2 + y 0 {\displaystyle y=w-x^{2}-y^{2}+y_{0}} yields y = 2 x y + y 0 {\displaystyle y=2xy+y_{0}} and hence calculating w is no longer needed. The further optimized pseudocode for the above is: x:= 0 y:= 0 x2:= 0 y2:= 0 while (x2 + y2 ≤ 4 and iteration < max_iteration) do x2:= x x y2:= y y y:= 2 x y + y0 x:= x2 - y2 + x0 iteration:= iteration + 1 Note that in the above pseudocode, 2 x y {\displaystyle 2xy} seems to increase the number of multiplications by 1, but since 2 is the multiplier the code can be optimized via ( x + x ) y {\displaystyle (x+x)y} . == Coloring algorithms == In addition to plotting the set, a variety of algorithms have been developed to efficiently color the set in an aesthetically pleasing way show structures of the data (scientific visualisation) === Histogram coloring === A more complex coloring method involves using a histogram which pairs each pixel with said pixel's maximum iteration count before escape/bailout. This method will equally distribute colors to the same overall area, and, importantly, is independent of the maximum number of iterations chosen. This algorithm has four passes. The first pass involves calculating the iteration counts associated with each pixel (but without any pixels being plotted). These are stored in an array IterationCounts[x][y], where x and y are the x and y coordinates of said pixel on the screen respectively. The first step of the second pass is to create an array NumIterationsPerPixel[n], where the array size n is the maximum iteration count. Next, one must iterate over the array of pixel-iteration count pairs IterationCounts[x][y], and retrieve each pixel's saved iteration count, i, via e.g. i = IterationCounts[x][y]. After each pixel's iteration count i is retrieved, it is necessary to index the NumIterationsPerPixel array at i and increment the indexed value (which is initially zero) -- e.g. NumIterationsPerPixel[i] = NumIterationsPerPixel[i] + 1. for (x = 0; x < width; x++) do for (y = 0; y < height; y++) do i:= IterationCounts[x][y] NumIterationsPerPixel[i]++ The third pass iterates through the NumIterationsPerPixel array and adds up all the stored values, saving them in total. The array index represents the number of pixels that reached that iteration count before bailout. total: = 0 for (i = 0; i < max_iterations; i++) do total += NumIterationsPerPixel[i] After this, the fourth pass begins and all the values in the IterationCounts array are indexed, and, for each iteration count i, associated with each pixel, the count is added to a global sum of all the iteration counts from 1 to i in the NumIterationsPerPixel array . This value is then normalized by dividing the sum by the total value computed earlier. hue[][]:= 0.0 for (x = 0; x < width; x++) do for (y = 0; y < height; y++) do iteration:= Iteration
Content determination
Content determination is the subtask of natural language generation (NLG) that involves deciding on the information to be communicated in a generated text. It is closely related to the task of document structuring. == Example == Consider an NLG system which summarises information about sick babies. Suppose this system has four pieces of information it can communicate The baby is being given morphine via an IV drop The baby's heart rate shows bradycardia's (temporary drops) The baby's temperature is normal The baby is crying Which of these bits of information should be included in the generated texts? == Issues == There are three general issues which almost always impact the content determination task, and can be illustrated with the above example. Perhaps the most fundamental issue is the communicative goal of the text, i.e. its purpose and reader. In the above example, for instance, a doctor who wants to make a decision about medical treatment would probably be most interested in the heart rate bradycardias, while a parent who wanted to know how her child was doing would probably be more interested in the fact that the baby was being given morphine and was crying. The second issue is the size and level of detail of the generated text. For instance, a short summary which was sent to a doctor as a 160 character SMS text message might only mention the heart rate bradycardias, while a longer summary which was printed out as a multipage document might also mention the fact that the baby is on a morphine IV. The final issue is how unusual and unexpected the information is. For example, neither doctors nor parents would place a high priority on being told that the baby's temperature was normal, if they expected this to be the case. Regardless, content determination is very important to users, indeed in many cases the quality of content determination is the most important factor (from the user's perspective) in determining the overall quality of the generated text. == Techniques == There are three basic approaches to document structuring: schemas (content templates), statistical approaches, and explicit reasoning. Schemas are templates which explicitly specify the content of a generated text (as well as document structuring information). Typically, they are constructed by manually analysing a corpus of human-written texts in the target genre, and extracting a content template from these texts. Schemas work well in practice in domains where content is somewhat standardised, but work less well in domains where content is more fluid (such as the medical example above). Statistical techniques use statistical corpus analysis techniques to automatically determine the content of the generated texts. Such work is in its infancy, and has mostly been applied to contexts where the communicative goal, reader, size, and level of detail are fixed. For example, generation of newswire summaries of sporting events. Explicit reasoning approaches have probably attracted the most attention from researchers. The basic idea is to use AI reasoning techniques (such as knowledge-based rules, planning, pattern detection, case-based reasoning, etc.) to examine the information available to be communicated (including how unusual/unexpected it is), the communicative goal and reader, and the characteristics of the generated text (including target size), and decide on the optimal content for the generated text. A very wide range of techniques has been explored, but there is no consensus as to which is most effective.