Adobe Success Story

Physicians today have revolutionary new ways to peer inside the human cardiovascular system to identify and treat heart disease. With imaging technologies such as computed tomography (CT) angiography, cardiovascular professionals can work with a complete 3D model of the entire coronary system; and with intravascular ultrasound, they can view detailed images of the interior walls of a patient's arteries to gauge the presence and distribution of heart disease.

Performing these advanced procedures requires training and certification based on American Heart Association and American College of Cardiology Foundation guidelines. However, it can be difficult for physicians to carve out time to become trained and certified. To add to the challenge, cardiovascular professionals may not have ready access to expensive equipment such as CT workstations, which typically cost more than $150,000. Now, with rich, interactive online tools created by Multiweb Communications using Adobe Dreamweaver, Flash, and Photoshop software, physicians can engage in a complete, mentored educational experience over the web. And to streamline the creation of online medical simulation and training even more, Multiweb will soon be using Adobe Creative Suite 3 Web Premium.

"For the busy physician, a web-based solution is a very viable way to learn. Having the embedded answers available immediately after analysis provides the positive feedback needed to accelerate learning," says Dr. John McB. Hodgson, cocreator and cardiology senior editor for the Multiweb projects.

Multiweb Creative Director Paul Carpenter notes that Adobe software is instrumental in enabling Multiweb to create interactive medical simulation and training that brings the experience of analyzing patient cases online. "This type of online training constitutes a real breakthrough for physicians because they can learn online, on their own schedule," says Carpenter.

Benefits

• Physicians can become certified in the latest cardiovascular diagnostic techniques
• Training can occur any time, without the need for expensive equipment
• Flash provides rich interaction and efficient image delivery
• Photoshop CS3 Extended will enable more efficient medical image processing

Project Details

Support for DICOM makes Multiweb's job easier
Multiweb has produced innovative healthcare education products for many big-name clients, including GE Medical Systems, Boston Scientific, Volcano Corporation, and Medtronic. In projects for these clients, Multiweb must work with images in Digital Imaging and Communications in Medicine (DICOM) format, the standard for exchanging digital information among medical imaging systems. That requirement is why it is vital that Photoshop CS3 Extended supports DICOM.

"All of the images we use in our simulation and training materials originate in DICOM format," explains Carpenter. "Previously we had to use proprietary workstations to convert thousands of still medical images into formats Photoshop could open and compile them into movie sequences. Now DICOM images can be brought directly into Photoshop CS3 Extended, saving countless hours that we would otherwise have to spend converting the images."

Rich tools for simulation and analysis
One of the most impressive simulation and training tools from Multiweb is TeachCTA, a project sponsored by GE Healthcare. To perform CT angiography and analyze the 3D images it produces, physicians are required to first review 50 cases in one-on-one mentoring with an expert and then review an additional 100 cases on their own. TeachCTA provides interactive online tools that simulate analysis of actual patient cases. Physicians can review up to 100 cases on their own time on TeachCTA.com—without the need for costly equipment. They can complete a variety of checklists and use interactive annotation tools to review and note calcium deposits, draw circles around lesions, and more. The system also provides real-time comparisons of the user's analysis with stored annotations and audio comments from an expert mentor.

A complex technical feat
Developing the TeachCTA project presented several challenges, from simple file logistics to difficult issues of how best to lead medical professionals through very complex materials. CT angiography is an intricate process, and it generates vast amounts of data. Patient cases typically consist of dozens or even hundreds of images, and each can be completely different: 3D, 2D, color, grayscale, still frames, movies, and more. Another major challenge was enabling users to make free-form annotations and classifications on any of the images or movies and display them interactively.

To produce TeachCTA, the Multiweb creative team processed thousands of medical images to be delivered through the Flash application. In some instances, the team combined medical images with vector artwork created in Adobe Illustrator software to help illustrate concepts. In parallel, Multiweb designed and produced the framework for the TeachCTA.com interactive website using Adobe Dreamweaver software. Multiweb currently adds new cases to TeachCTA on a monthly basis, using the Creative Suite applications.

To make the system work, Multiweb combined several interfaces developed with Flash, Sorenson video processing, and a server-based back-end. A reusable Flash "engine" uses XML to load all the imaging data, allowing one Flash (SWF) file to present any number of different patient cases. Flash handles all of the user interaction and passes the results to the back-end system, which generates reports on the user's performance on each case analysis.

The Flash interface also enables experts to input new cases and case interpretations. "Flash was vital because it allowed us to reduce the batch-processed medical image movies down to manageable file sizes for the web, all while maintaining high visual quality," says Carpenter. "Plus, the type of interactive, engaging simulation found in TeachCTA is virtually impossible to create without Flash."

Working smarter with Adobe Creative Suite 3
As Multiweb embarks on its next project, the team is looking forward to working with the newest versions of Adobe software—all part of the Adobe Creative Suite 3 Web Premium edition. Carpenter notes that ActionScript 3 in Adobe Flash CS3 will make scripting far more powerful and consistent, while support for the Spry Framework in Adobe Dreamweaver CS3 will help him and his team build interactive websites with greater speed and ease. Smart Objects in Photoshop CS3 Extended will make it easier to place and edit vector artwork without leaving Photoshop.

"With Adobe Creative Suite 3 Web Premium and Photoshop CS3 Extended in particular, Adobe is making notable advances in the ability to process and work with medical images," says Carpenter. "Especially with support for DICOM in Photoshop CS3 Extended, Adobe is helping medical professionals—and those of us who build the materials that educate them."

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