Elizabeth A Krupinski

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Journals/Publications

• Krupinski, E., Erly, W. K., Tran, M., Dillon, R. C., & Krupinski, E. A. (0). Impact of hindsight bias on interpretation of nonenhanced computed tomographic head scans for acute stroke. Journal of computer assisted tomography, 34(2).
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  To determine whether knowledge of the presence or the absence of acute stroke from review of follow-up studies, including diffusion-weighted magnetic resonance imaging (DW-MRI) head scans, biases the retrospective review of a radiologist's detection of acute stroke on nonenhanced computed tomographic (CT) scans of the head.
• Krupinski, E., Kuhlman, M., Meyer, M., & Krupinski, E. A. (2012). Direct reporting of results to patients: the future of radiology?. Academic radiology, 19(6).
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  Radiologists have traditionally left relaying exam results to patients in the hands of clinicians. Recent editorials have reexamined radiologists' traditional position and questioned whether radiologists should continue to remain within the confines of the reading room or increase their contact with patients. The present study addressed this issue by surveying patients directly regarding their preferences.
• Krupinski, E., & Krupinski, E. A. (2011). The role of perception in imaging: past and future. Seminars in nuclear medicine, 41(6).
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  The accurate and efficient interpretation of medical images relies on a host of factors. Clearly the technologies and methods used to acquire, process, transmit, store, and display the image and associated data are critical, but they are only one-half of the equation. In the end, the final diagnostic interpretation and recommendations for further action lie with the clinician. Ideally we would like to believe that all decisions rendered by competent clinicians are correct, but the interpretation task is not always easy or black and white. Thus, decisions are not always absolutely conclusive, are often formulated with plausible alternatives, and errors in interpretation can and do occur regularly. The discipline of medical image perception seeks an improved understanding of the perceptual factors that underlie the creation and interpretation of medical images, with the belief that improved diagnostic performance with the use of imaging devices can be achieved by the development of systems that are optimized for the interpretation of visual diagnostic information. Perception research can identify specific reasons for missed diagnoses, thereby helping to train physicians and eliminate diagnostic errors, and clarifying situations in which errors are a consequence of fundamentally ambiguous information rather than poor reader performance. The goal of this article is to provide a short review of the history of the discipline of medical image perception, highlight key research areas, and provide a look toward the future regarding the role that medical image perception research will continue to fill as imaging technology in medicine advances and develops.
• Krupinski, E., Hunter, T. B., & Krupinski, E. A. (2011). Faculty attestation statements for resident-generated radiology reports. Journal of the American College of Radiology : JACR, 8(10).
• Krupinski, E., & Krupinski, E. A. (2010). Current perspectives in medical image perception. Attention, perception & psychophysics, 72(5).
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  Medical images constitute a core portion of the information a physician utilizes to render diagnostic and treatment decisions. At a fundamental level, this diagnostic process involves two basic processes: visually inspecting the image (visual perception) and rendering an interpretation (cognition). The likelihood of error in the interpretation of medical images is, unfortunately, not negligible. Errors do occur, and patients' lives are impacted, underscoring our need to understand how physicians interact with the information in an image during the interpretation process. With improved understanding, we can develop ways to further improve decision making and, thus, to improve patient care. The science of medical image perception is dedicated to understanding and improving the clinical interpretation process.
• Krupinski, E., & Krupinski, E. A. (2010). Optimizing the pathology workstation "cockpit": Challenges and solutions. Journal of pathology informatics, 1.
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  The 21(st) century has brought numerous changes to the clinical reading (i.e., image or virtual pathology slide interpretation) environment of pathologists and it will continue to change even more dramatically as information and communication technologies (ICTs) become more widespread in the integrated healthcare enterprise. The extent to which these changes impact the practicing pathologist differ as a function of the technology under consideration, but digital "virtual slides" and the viewing of images on computer monitors instead of glass slides through a microscope clearly represents a significant change in the way that pathologists extract information from these images and render diagnostic decisions. One of the major challenges facing pathologists in this new era is how to best optimize the pathology workstation, the reading environment and the new and varied types of information available in order to ensure efficient and accurate processing of this information. Although workstations can be stand-alone units with images imported via external storage devices, this scenario is becoming less common as pathology departments connect to information highways within their hospitals and to external sites. Picture Archiving and Communications systems are no longer confined to radiology departments but are serving the entire integrated healthcare enterprise, including pathology. In radiology, the workstation is often referred to as the "cockpit" with a "digital dashboard" and the reading room as the "control room." Although pathology has yet to "go digital" to the extent that radiology has, lessons derived from radiology reading "cockpits" can be quite valuable in setting up the digital pathology reading room. In this article, we describe the concept of the digital dashboard and provide some recent examples of informatics-based applications that have been shown to improve the workflow and quality in digital reading environments.
• Krupinski, E., & Krupinski, E. A. (2009). Medical grade vs off-the-shelf color displays: influence on observer performance and visual search. Journal of digital imaging, 22(4).
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  The goal of this study was to compare diagnostic accuracy of radiologists viewing clinical images on a top-of-the-line medical-grade vs a top-of-the-line commercial off-the-shelf (COTS) color display with the luminance values set to simulate a display that had been in use for 1 year. A set of 50 digital radiography chest images was selected for use in the study, half containing a solitary pulmonary nodule and half nodule-free. The images were displayed twice to each of six observers, once on each display. Eye position was recorded on a subset of the images. Overall, there was a statistically significant difference (F = 4.1496, p = 0.0471) between the medical-grade color display and the COTS color display in terms of receiver operating characteristic area under the curve values, with the medical-grade display yielding higher diagnostic accuracy. Total viewing time did not differ significantly, but eye position data revealed differences, suggesting better search and decision-making efficiency with the medical-grade display. Medical-grade color displays at 1 year old yield better diagnostic and search efficiency than COTS color displays and thus are recommended for primary reading if color displays are to be used.
• Krupinski, E., & Krupinski, E. A. (2009). Virtual slide telepathology workstation of the future: lessons learned from teleradiology. Human pathology, 40(8).
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  The clinical reading environment for the 21st century pathologist looks very different than it did even a few short years ago. Glass slides are quickly being replaced by digital "virtual slides," and the traditional light microscope is being replaced by the computer display. There are numerous questions that arise however when deciding exactly what this new digital display viewing environment will be like. Choosing a workstation for daily use in the interpretation of digital pathology images can be a very daunting task. Radiology went digital nearly 20 years ago and faced many of the same challenges so there are lessons to be learned from these experiences. One major lesson is that there is no "one size fits all" workstation so users must consider a variety of factors when choosing a workstation. In this article, we summarize some of the potentially critical elements in a pathology workstation and the characteristics one should be aware of and look for in the selection of one. Issues pertaining to both hardware and software aspects of medical workstations will be reviewed particularly as they may impact the interpretation process.
• Krupinski, E., & Krupinski, E. A. (2009). Virtual slide telepathology workstation-of-the-future: lessons learned from teleradiology. Seminars in diagnostic pathology, 26(4).
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  The clinical reading environment for the twenty-first century pathologist looks very different than it did even a few short years ago. Glass slides are quickly being replaced by digital "virtual slides" and the traditional light microscope is being replaced by the computer display. There are numerous questions that arise however when deciding exactly what this new digital display viewing environment be like. Choosing a workstation for daily use in the interpretation of digital pathology images can be a very daunting task. Radiology went digital nearly 20 years ago and faced many of the same challenges so there are lessons to be learned from these experiences. One major lesson is that there is no "one size fits all" workstation so users must consider a variety of factors when choosing a workstation. In this article, we summarize some of the potentially critical elements in a pathology workstation and the characteristics one should be aware of and look for in the selection of one. Issues pertaining to both hardware and software aspects of medical workstations will be reviewed particularly as they may impact the interpretation process.
• Krupinski, E., Rkein, A. M., Harrigal, C., Friedman, A. C., Persky, D., & Krupinski, E. A. (2009). Comparison of the accuracy of CT volume calculated by circumscription to prolate ellipsoid volume (bidimensional measurement multiplied by coronal long axis). Academic radiology, 16(2).
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  Tumor volume is one of the most important factors in evaluating the response to treatment of patients with cancer. The objective of this study was to compare computed tomographic (CT) volume calculation using a semiautomated circumscribing tracing tool (manual circumscription [MC]) to prolate ellipsoid volume calculation (PEVC; bidimensional measurement multiplied by coronal long axis) and determine which was more accurate and consistent.
• Krupinski, E., & Krupinski, E. A. (2008). American Telemedicine Association special interest groups: an update on goals and activities. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 14(10).
• Krupinski, E., & Krupinski, E. A. (2008). Telemedicine for home health and the new patient: when do we really need to go to the hospital?. Studies in health technology and informatics, 131.
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  This chapter will review the current state-of-the-art of home health services in the telemedicine environment. Two aspects in particular will be discussed that reflect where most of the efforts in home telehealth care are being directed. The first aspect is the more traditional implementation in which the healthcare practitioner "visits" the patient (typically chronically ill or at home recovering from a hospital visit) virtually at a distance using telemedicine technologies to assess their health status, obtain a select set of vital signs (e.g., blood pressure), and converse with them about how they feel and so on. The second application is the growing field of distance monitoring, especially as it pertains to prevention and health maintenance. In this application, the users may be patients with chronic conditions such as asthma or diabetes that require regular monitoring to achieve or maintain healthy functioning, but they are typically not in an acute phase. More and more often, however, the users of distance monitoring technologies are relatively healthy people looking to enhance their health awareness and healthy status by monitoring various vital signs to alert them of any potential changes in their health status that would require actual medical attention.
• Krupinski, E., & Krupinski, E. A. (2008). Telethinking with Elizabeth A. Krupinski, Ph.D.--interview by Vicki Glaser. Telemedicine journal and e-health : the official journal of the American Telemedicine Association, 14(2).
• Krupinski, E., & Krupinski, E. A. (2006). American Telemedicine Association's Fall Forum: Telemedicine Technology Summit and Venture Capital for Telemedicine. Journal of telemedicine and telecare, 12(5).
• Krupinski, E., & Krupinski, E. A. (2005). Visual search of mammographic images: influence of lesion subtlety. Academic radiology, 12(8).
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  The goal of this study is to determine whether mammographic lesion subtlety influences the detection accuracy and visual search parameters of radiologists.
• Krupinski, E., & Krupinski, E. A. (2004). Home health and telemedicine: where are we today?. Studies in health technology and informatics, 104.
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  This chapter will review the current state-of-the-art of home health services in the telemedicine environment. Special attention will be paid to some of the studies that our telemedicine program has conducted in the past few years. The chapter will conclude with some recommendations and a look to the future.
• Krupinski, E., & Krupinski, E. A. (2004). Telemedicine consultations: failed cases and floundering specialties. Journal of telemedicine and telecare, 10 Suppl 1.
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  The Arizona Telemedicine Program began as a multi-service provider, with teleconsultations in over 53 subspecialties. Although new sites often use numerous subspecialties at first, this is typically followed by a longer period when only a few subspecialties are used. A retrospective analysis of the referral rates from the sites showed wide variations, some exhibiting extreme fluctuations. There was a high correlation (0.84) between personnel turnover rates at each site (i.e. the number of personnel changing) and the degree to which the fluctuations were 'out of control'. Over six years, 402 teleconsultations were scheduled but did not occur. Of these, 82% were closed with no further contact, although 63% were managed eventually via telemedicine, all in telepsychiatry. The reasons for these appointments not taking place were that the patient did not show up (45%), the patient cancelled (32%), the telepsychiatrist cancelled (22%) or bad weather prevented travel (1%). Of the unsuccessful teleconsultations, 84% were realtime and 16% were store and forward. The average cost to the provider of a missed realtime teleconsultation was US$228 for a 1 h session.
• Krupinski, E., & Krupinski, E. A. (2003). Medical image perception issues for PACS deployment. Seminars in roentgenology, 38(3).