Objectives: What does the publicly available literature tell us about the attitudes of health care staff to the development of information technology in practice, including the factors which influence them and the factors which may be used to change these attitudes?



Methods:  Twelve databases were searched for literature published between 2000 and 2005 that identified research related to information technology (IT), health professionals and attitude. English language studies were included which described primary research relating to the attitudes of one or more health care staff groups towards IT. Letters, personal viewpoints, reflections and opinion pieces were not included.



Results:  Complex factors contribute to the formation of attitudes towards IT. Many of the issues identified were around the flexibility of the systems and whether they were ‘fit for purpose’, along with the confidence and experience of the IT users. The literature suggests that attitudes of practitioners are a significant factor in the acceptance and efficiency of use of IT in practice. The literature also suggested that education and training was a factor for encouraging the use of IT systems.



Conclusions:  A range of key issues, such as the need for flexibility and usability, appropriate education and training and the need for the software to be ‘fit for purpose’, showed that organizations need to plan carefully when proposing the introduction of IT-based systems into work practices. The studies reviewed did suggest that attitudes of health care professionals can be a significant factor in the acceptance and efficiency of use of IT in practice. Further qualitative and quantitative research is needed into the approaches that have most effect on the attitudes of health care staff towards IT.

The attitudes of health care staff to information technology: a comprehensive review of the research literature.

This paper provides a survey of medical applications that make use of Web3D technologies, covering the period from 1995 to 2005. We assess the impact that Web3D has made on medical education and training during this time and highlight current and future trends. The applications identified are categorized into: general education tools; tools for diagnosis; procedures training; and collaborative training. A summary of work that has been carried out to validate these tools is also included in the survey.

The impact of Web3D technologies on medical education and training

Virtual reality (VR) can be considered as the leading edge of a general evolution of present communication interfaces involving the television, computer, and telephone. The main characteristic of this evolution is the full immersion of the human sensorimotor channels into a vivid and global communication experience. Because telemedicine principally focuses on transmitting medical information, VR has the potential to enhance this function. Particularly, VR can be used in telemedicine as an advanced communication interface, which enables a more intuitive mode of interacting with information, and as a flexible environment that enhances the feeling of physical presence during the interaction. In this article, the state of the art in VR-based telemedicine applications is described. This technology is now used in remote or augmented surgery as well as surgical training, which are critically dependent on eye-hand coordination. Recently, however, different researchers have tried to use virtual environments in medical visualization and for assessment and rehabilitation in neuropsychology. This article also discusses technological, ergonomical, and human factor issues, and specific guidelines are presented for expanding the use of VR in telemedicine.

Virtual reality in telemedicine

Virtual reality in telemedicine.

Since the development of methods of electronic communication, clinicians have been using information and communication technologies for the exchange of health-related information. However, the emer...

From Telehealth to E-Health: Internet and Distributed Virtual Reality in Health Care

While computers have been able to work with true 3D models for a long time, the same does not apply to the users in common. Over the years, a number of 3D visualization techniques have been developed to enable a scientist or a student, to see not only a flat representation of an object, but also an approximation of its Z-axis. In addition to the traditional flat image representation of a 3D object, at least four established methodologies exist: Stereo pairs. Using image analysis tools or 3D software, a set of images can be made, each representing the left and the right eye view of an object. Placed next to each other and viewed through a separator, the three dimensionality of an object can be perceived. While this is usually done on still images, tests at Mednet have shown this to work with interactively animated models as well. However, this technique requires some training and experience. Pseudo3D, such as VRML or QuickTime VR, where the interactive manipulation of a 3D model lets the user achieve a sense of the model's true proportions. While this technique works reasonably well, it is not a "true" stereographic visualization technique. Red/Green separation, i.e. "the traditional 3D image" where a red and a green representation of a model is superimposed at an angle corresponding to the viewing angle of the eyes and by using a similar set of eyeglasses, a person can create a mental 3D image. The end result does produce a sense of 3D but the effect is difficult to maintain. Alternating left/right eye systems. These systems (typified by the StereoGraphics CrystalEyes system) let the computer display a "left eye" image followed by a "right eye" image while simultaneously triggering the eyepiece to alternatively make one eye "blind". When run at 60 Hz or higher, the brain will fuse the left/right images together and the user will effectively see a 3D object. Depending on configurations, the alternating systems run at between 50 and 60 Hz, thereby creating a flickering effect, which is strenuous for prolonged use. However, all of the above have one or more drawbacks such as high costs, poor quality and localized use. A fifth system, recently released by Barco Systems, modifies the CrystalEyes system by projecting two superimposed images, using polarized light, with the wave plane of the left image at right angle to that of the right image. By using polarized glasses, each eye will see the appropriate image and true stereographic vision is achieved. While the system requires very expensive hardware, it solves some of the more important problems mentioned above, such as the capacity to use higher frame rates and the ability to display images to a large audience. Mednet has instigated a research project which uses reconstructed models from the central nervous system (human brain and basal ganglia, cortex, dendrites and dendritic spines) and peripheral nervous system (nodes of Ranvier and axoplasmic areas). The aim is to modify the models to fit the different visualization techniques mentioned above and compare a group of users perceived degree of 3D for each technique.

3D visualization and stereographic techniques for medical research and education.

Academic and medical imaging are increasingly using computer based 3D reconstruction and/or visualization. Three-dimensional interactive models play a major role in areas such as preclinical medical education, clinical visualization and medical research. While 3D is comparably easy to do on a high end workstations, distribution and use of interactive 3D graphics necessitate the use of personal computers and the web. Several new techniques have been demonstrated providing interactive 3D via a web browser thereby allowing a limited version of VR to be experienced by a larger majority of students, medical practitioners and researchers. These techniques include QuickTimeVR2 (QTVR), VRML2, QuickDraw3D, OpenGL and Java3D. In order to test the usability of the different techniques, Mednet have initiated a number of projects designed to evaluate the potentials of 3D techniques for scientific reporting, clinical visualization and medical education. These include datasets created by manual tracing followed by triangulation, smoothing and 3D visualization, MRI or high-resolution laserscanning. Preliminary results indicate that both VRML and QTVR fulfills most of the requirements of web based, interactive 3D visualization, whereas QuickDraw3D is too limited. Presently, the JAVA 3D has not yet reached a level where in depth testing is possible. The use of high-resolution laserscanning is an important addition to 3D digitization.

Virtual reality on the web: the potentials of different methodologies and visualization techniques for scientific research and medical education.

UNLABELLED Recent advances in personal computer hardware and software have pushed the graphic capacity of these easier to use and, more importantly, cheaper computers to a level approximating the current standard of high end workstations. The interactivity and graphic complexity of a modern PC is rapidly approaching the current standard on Silicon Graphics (although with respect to texture mapping, the SGI is still ahead of the PCs). The modern medical student laboring under increasingly higher demands with respect to versatility, not only in basic science and traditional medical knowledge, is also faced with the requirement to learn and understand modern scientific visualization and analytical instruments. Furthermore, basic knowledge of information technology and computer literacy is expected of the next generation medical professionals. These demands forces medical schools to increasingly invest in computers and information technology for educational purposes. Due to common class sizes, these computers are most commonly Windows PCs or Apple Macintoshes. For distance education, telematics or studies at home, personal computer versions of the workstation graphics are a necessity. 3D-Brain 2.0 is an educational software package intended to run on basic personal computers and utilizing modern software technologies such as QuickTime VR 2.0 and VRML 2.0, to provide the students with insight into modern clinical and scientific visualization, focusing on the anatomy and functionality of the human brain. The aim of this paper to test the validity and usefulness of these new visualization techniques. METHODS 3D-Brain is based on human brains sliced in 1 mm sections (NB. NOT based on NLMs Visual Human). Each slice was photographed, digitized, optimized and aligned using proprietary software. The datasets were then created by manual tracing followed by triangulation, smoothing and 3D visualization using Silicon Graphics computers. For the QuickTime VR project, 684 images with a 10 degrees angle were generated for each scene and ported to an Apple Macintosh computer for further manipulation. VRML code was generated directly from the original dataset. All interactivity was programmed on a Macintosh and subsequently ported to the Windows95 PC platform. The minimum requirements to run the software are either a PowerPC based Macintosh computer or a Pentium based Windows 95 computer with 16 Mb, 16 bit display and a 4 speed CD-ROM. RESULTS AND DISCUSSION 3D-Brain 2.0 provides medical students at Goteborg University the means to complement traditional teaching using visualization techniques and three-dimensional models. These techniques also serve as an insight into the different clinical means of visualization the student will encounter throughout his/her continued education and professional career. For educational purposes, it has been established that among the tested new visualization techniques, CD-ROM based software utilizing QTVR is still the best methodology to use for pedagogical software. VRML shows promise in porting these software packages to the Web while Open Inventor is the preferred format for research purposes.

T Kling-Petersen

Papers

3D visualization and stereographic techniques for medical research and education.

Virtual reality on the web: the potentials of different methodologies and visualization techniques for scientific research and medical education.

3D-brain 2.0--narrowing the gap between personal computers and high end workstations.

Advanced 3D-visualization, including virtual reality, distributed by PCs, in brain research, clinical radiology and education.