Image documentation of endoscopic findings in ulcerative colitis: photographs or video clips?

Assessment of still and moving images in the diagnosis of gastric lesions using magnifying narrow-band imaging in a prospective multicenter trial

Objectives

Magnifying narrow-band imaging (M-NBI) is more accurate than white-light imaging for diagnosing small gastric cancers. However, it is uncertain whether moving M-NBI images have additional effects in the diagnosis of gastric cancers compared with still images.

Design

A prospective multicenter cohort study.

Methods

To identify the additional benefits of moving M-NBI images by comparing the diagnostic accuracy of still images only with that of both still and moving images. Still and moving M-NBI images of 40 gastric lesions were obtained by an expert endoscopist prior to this prospective multicenter cohort study. Thirty-four endoscopists from ten different Japanese institutions participated in the prospective multicenter cohort study. Each study participant was first tested using only still M-NBI images (still image test), then tested 1 month later using both still and moving M-NBI images (moving image test). The main outcome was a difference in the diagnostic accuracy of cancerous versus noncancerous lesions between the still image test and the moving image test.

Results

Thirty-four endoscopists were analysed. There were no significant difference of cancerous versus noncancerous lesions between still and moving image tests in the diagnostic accuracy (59.9% versus 61.5%), sensitivity (53.4% versus 55.9%), and specificity (67.0% versus 67.6%). And there were no significant difference in the diagnostic accuracy between still and moving image tests of demarcation line (65.4% versus 65.5%), microvascular pattern (56.7% versus 56.9%), and microsurface pattern (48.1% versus 50.9%). Diagnostic accuracy showed no significant difference between the still and moving image tests in the subgroups of endoscopic findings of the lesions.

Conclusions

The addition of moving M-NBI images to still M-NBI images does not improve the diagnostic accuracy for gastric lesions. It is reasonable to concentrate on taking sharp still M-NBI images during endoscopic observation and use them for diagnosis.

Trial registration

Umin.ac.jp UMIN-CTR000008048

Do patients want to see recordings of their surgery?

OBJECTIVE

In an effort to improve patients' understanding and perception of their surgery and communication between doctors and patients we have evaluated the use of a mobile digital video recorder in the case of women undergoing gynaecological surgery.

STUDY DESIGN

Patients scheduled for endoscopic or open surgery were asked if they would allow their surgery be recorded on a dedicated computer system. Those who agreed were offered the opportunity to have real-time edited highlights of their surgery recorded simultaneously on a miniature digital video recorder. They were shown the edited recording before discharge from hospital, and their reaction was assessed using a structured questionnaire.

RESULTS

51/54 (94.4%) women agreed to their surgery being recorded on the computer system, and 37/54 (68.5%) asked to see the edited highlights. The median duration of the computer and portable recordings for the 37 patients was 90 min (range 2-280) and 3.3 min (range 1-13.6) respectively. Thirty-four (91.9%) reported that the edited recording gave them a better understanding of their medical condition and surgery. Thirty (81.1%) would have liked a copy of the recording.

CONCLUSIONS

Portable video recorders are a convenient tool for recording surgical procedures. In our experience, about two-third of patients are interested in reviewing their surgery and find it provides useful information and a perceived better understanding of their condition. As these recording devices are small and fit into a pocket, their use could easily become a routine part of post-operative ward rounds. For the surgeon, such recordings have an educational value and provide the basis for a library of surgery as well as being useful when planning future management or for referral purposes.

The functionality and reliability of an Internet interface for assessments of endoscopic still images and video clips: distributed research in gastroenterology

BACKGROUND

Validation studies of medical images are required before the general use of new imaging techniques, and they necessitate a substantial number of observers. Multicenter studies are desirable but the logistic challenges are considerable.

OBJECTIVE

The aim of the present study was to develop and test the functionality and reliability of an Internet interface for distributed evaluation of endoscopic still images and video clips.

DESIGN

An Internet site for assessment of endoscopic still images and video clips was developed. To avoid limitations of the bandwidth, a solution was developed to launch and score high-quality video clips on digital video disks (DVDs) from the Internet interface.

SETTING

Fifty-five observers were enrolled in the randomized, prospective multicenter study of still images. The feasibility study of video clips included 7 observers.

PATIENTS

Four patients presenting with various degree of ulcerative colitis, ranging from normal to severe, were included.

MAIN OUTCOME MEASUREMENTS

We tested the reliability of the interface by dual-image assessment, as well as the feasibility of Internet assessment of endoscopic images. We physically distributed high-quality DVD video footage.

RESULTS

We recorded 2084 assessments of endoscopic still images and 35 assessments of video clips. The reliability of the Internet interface was confirmed by adequate repeatability and intraobserver agreement of the assessments. Video clips running from a DVD were also successfully shown on the Internet interface. Thus, high-quality video may be assessed independently of the Internet bandwidth.

CONCLUSIONS

The present Internet-based tool is functional, efficient, and reliable for high-volume assessment of endoscopic images and video clips.