title: Enhanced visualization processing: effect on workflow.
abstract: OBJECTIVE
  Soft-copy viewing of digital radiographs allows for image processing to improve visualization of anatomy and lesions, but it can take more time than film-based viewing. Enhanced visualization processing (EVP) was developed to increase the latitude of an image without reducing the vital contrast, potentially reducing the need for the radiologist to manipulate images. This study examined the influence of processing radiographic images with EVP on workflow in a picture archiving and communications system (PACS).
  
  
  METHODS
  Portable computed radiographic chest images were obtained and processed either with EVP or without. A security camera with a videocassette recorder was positioned above the PACS workstation. Four radiologists reviewed the images during their normal work schedule. The current diagnostic image was used to determine if the case contained EVP or non-EVP images. The videotapes of the sessions were reviewed to determine diagnostic viewing times and how zoom and/or window and level manipulation was used.
  
  
  RESULTS
  Viewing time was significantly longer for the non-EVP than the EVP cases. The difference occurred with all readers. Window and level manipulation was used on 35% of the EVP and 41% of the non-EVP images. Zoom was used on 64% of the EVP and 69% of the non-EVP images. Average time spent using zoom and window and level manipulation was significantly shorter with the EVP than with the non-EVP images.
  
  
  CONCLUSIONS
  EVP of chest images displayed on PACS monitors significantly improved workflow as measured by viewing time. EVP decreased use of window and level manipulation and zooming and the amount of time each one was used.
authors.affiliation: Department of Radiology, University of Arizona, Tucson 85724, USA.
authors.forename: E A
authors.initials: EA
authors.lastname: Krupinski
authors.forename: M
authors.initials: M
authors.lastname: Radvany
authors.forename: A
authors.initials: A
authors.lastname: Levy
authors.forename: D
authors.initials: D
authors.lastname: Ballenger
authors.forename: J
authors.initials: J
authors.lastname: Tucker
authors.forename: A
authors.initials: A
authors.lastname: Chacko
authors.forename: R
authors.initials: R
authors.lastname: VanMetter
mesh_terms: D006801:Humans; D011856:Radiographic Image Enhancement; D013902:Radiography, Thoracic / Q000379:methods; D011873:Radiology Information Systems