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Browsing by Author "Rosenthal, David I."
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Item Improved human observer performance in digital reconstructed radiograph verification in head and neck cancer radiotherapy.(Springer, 2015-10) Sturgeon, Jared D.; Cox, John A.; Mayo, Lauren L.; Gunn, G. Brandon; Zhang, Lifei; Balter, Peter A.; Dong, Lei; Awan, Musaddiq; Kocak-Uzel, Esengul; Mohamed, Abdallah Sherif Radwan; Rosenthal, David I.; Fuller, Clifton David; Department of Radiation Oncology, IU School of MedicinePurpose: Digitally reconstructed radiographs (DRRs) are routinely used as an a priori reference for setup correction in radiotherapy. The spatial resolution of DRRs may be improved to reduce setup error in fractionated radiotherapy treatment protocols. The influence of finer CT slice thickness reconstruction (STR) and resultant increased resolution DRRs on physician setup accuracy was prospectively evaluated. Methods: Four head and neck patient CT-simulation images were acquired and used to create DRR cohorts by varying STRs at 0.5, 1, 2, 2.5, and 3 mm. DRRs were displaced relative to a fixed isocenter using 0–5 mm random shifts in the three cardinal axes. Physician observers reviewed DRRs of varying STRs and displacements and then aligned reference and test DRRs replicating daily KV imaging workflow. A total of 1,064 images were reviewed by four blinded physicians. Observer errors were analyzed using nonparametric statistics (Friedman’s test) to determine whether STR cohorts had detectably different displacement profiles. Post hoc bootstrap resampling was applied to evaluate potential generalizability. Results: The observer-based trial revealed a statistically significant difference between cohort means for observer displacement vector error (p = 0.02) and for Z-axis (p < 0.01). Bootstrap analysis suggests a 15% gain in isocenter translational setup error with reduction of STR from 3 mm to ≤2 mm, though interobserver variance was a larger feature than STR-associated measurement variance. Conclusions: Higher resolution DRRs generated using finer CT scan STR resulted in improved observer performance at shift detection and could decrease operator-dependent geometric error. Ideally, CT STRs ≤2 mm should be utilized for DRR generation in the head and break neck.Item Six habits of highly successful health information technology: powerful strategies for design and implementation(Oxford Academic, 2019-10) Ray, Jessica M.; Ratwani, Raj M.; Sinsky, Christine A.; Frankel, Richard M.; Friedberg, Mark W.; Powsner, Seth M.; Rosenthal, David I.; Wachter, Robert M.; Melnick, Edward R.; Regenstrief Institute, Indiana University School of MedicineHealthcare information technologies are now a routine component of patient–clinician interactions. Originally designed for operational functions including billing and regulatory compliance, these systems have had unintended consequences including increased exam room documentation, divided attention during the visit, and use of scribes to alleviate documentation burdens. In an age in which technology is ubiquitous in everyday life, we must re-envision healthcare technology to support both clinical operations and, above all, the patient–clinician relationship. We present 6 habits for designing user-centered health technologies: (1) put patient care first, (2) assemble a team with the right skills, (3) relentlessly ask WHY, (4) keep it simple, (5) be Darwinian, and (6) don’t lose the forest for the trees. These habits should open dialogues between developers, implementers, end users, and stakeholders, as well as outline a path for better, more usable technology that puts patients and their clinicians back at the center of care.