REVIEW Annals of Nuclear Medicine Vol.11, No.1,7-13,1997 Internet in Nuclear Medicine Yutaka SUZUKI* and Masahiko NAKAMURA** Departments of *Radiology and **Biomedical Engineering, Tokai University Medical School, Japan INTRODUCTION Recently, the Internet has been widely used in nuclear medicine. Development of the Internet has brought a new communication tool for us. With this tool, we can easily and quickly exchange a large amount of information, regardless time and distance. The Internet is anticipated to have a great impact on clinical practice, education and research in nuclear medicine. In this paper, we, first, describe the outline and function of the Internet, and then introduce its applications in the various fields of nuclear medicine. OVERVIEW OF THE INTERNET1-3 The Internet is a world-wide network of computer networks that communicate with each other using the Transmission Control Protocol/Internet Protocol (TCP/IP). It has the following functions: electronic mail, electronic news, file transfer protocol, remote login, and hypertext transfer protocol (World-Wide Web). 1. Electronic Mail Electronic mail (e-mail) provides a private communication between individuals. The basic concepts behind e-mail parallel those of regular or snail mail. You send mail to people at their particular addresses. In turn, they write to you at your e-mail address. For example, "ysuzuki@is.icc.u-tokai.ac.jp" is the e-mail address of one of the authors. The e-mail address is generally composed by user name (ysuzuki), machine name (is) and domain name (icc.u-tokai.ac.jp). Mail messages are composed of two portions: the header and body. Based on an invited educational lecture at the 6th Asia and Oceania Congress of Nuclear Medicine and Biology, and the 36th Annual Scientific Meeting of the Japanese Society of Nuclear Medicine, Kyoto, October 1996. For reprint contact: Yutaka Suzuki, M.D., Department of Radiology, Tokai University Medical School, Bohseidai , Isehara 259-11, JAPAN. The header lists information about the sender of the message, the recipient, the posting date of the message, and a subject field. The body holds the text of the message itself, usually in ASCII format. The advantages of e-mail are that it provides very rapid communication; of the order of seconds to hour to reach the destination. It allows to send large volume of data such as source code. The confidence of the mail can not always be warranted, but is much better than those of other communication methods. Via e-mail we can also send a message to groups of individuals. In this case, the mail first sends to the computer, called "listserv," or "mailing lists" and then it is distributed to large number of individuals on the list. With this system individuals on the list can exchange opinions with each other on the particular topics. The advantages of mailing lists are that they provide for sharing of information to large groups of individuals and facilitate the online discussion of topics of interest. 2. Electronic News Electronic news is different from news on other media, in which news runs in one way direction from the media to individuals. In electronic news, information runs interactively among the individuals who are interested in that information. Electronic news is divided into newsgroups, which covers specific areas of interest. There are a large number of newsgroups in the world. The news groups are arranged in a hierarchical or tree fashion, with each root of the tree devoted to a major topic (Fig. 1). Like a tree, each of these roots has many branches, with each branch further defining subject area. There are many programs that can be used to read news and upload a news into the newsgroups. 3. File Transfer Protocol The file transfer protocol (FTP) makes it possible to move a file from one computer to another, even if each computer has a different operating system and file storage format. Files may be data, programs, and texts; anything that can be stored. Users are required to log in to each computer and to have permission to access the files you wish to retrieve or transfer. File transfer across the Internet is reliable because the machines involved can communicate directly, without relying on intermediate machines to make copies of the file along the way. With using FTP, large files can be transferred in short time. Several hosts provide the username anonymous for ftp retrieval of files from their system. This service called "anonymous FTP." The hosts that allow anonymous login do so by establishing a special anonymous login account, which works only with FTP, and can not be accessed for general use of that host. The anonymous account is a special one with access limited to the FTP archives offered by that host. In anonymous FTP, the login name for remote host will always be anonymous. The remote FTP program will often request the user's e-mail address as the password. 4. Remote Login In remote login, the Telnet protocol is used. This protocol allows an Internet user to log in to a remote host from his or her local host. Once connected and logged in to the remote host, a user can do any operation just as if he or she were logged in directly to the remote host. Every keystroke on the user's local computer is sent directly to the remote system. Telnet is a powerful tool in resource sharing. Telnet protocol some times require that you arrange for access in advance. Such arrangements usually include the assignment of an account name and password on the remote host. 5. World-Wide-Web World-Wide-Web (WWW) is constructed by the following three components; Uniform Resource Locator (URL), Hypertext Markup Language (HTML) and Hypertext Transfer Protocol (HTTP). 1) URL An URL is basically an expression of specifing the location of resources on the Internet. URLs can be used to describe just about any kind of connection on the Internet, including WWW, FTP, and e-mail, as shown in the following examples: http://mfs.med.u-tokai.ac. jp ftp://mfs.med.u-tokai.ac.jp/pub_jpns/workshop/ README 2) HTML HTML is language to describe hypertext or tag documents for electronic format and structural uses. The fundamental concept behind hypertext is that information can be stored and retrieved in a nonhierarchical structure. So instead of moving through directories of information, you can jump from one place to the next through a series of links created by some one. The hypermedia is the extended concept of the hypertext which includes images, movies and sounds. 3) HTTP HTTP is the description how to transfer the documents described by HTML between a computer to a computer. An access to a WWW usually can be done on user's personal computer by using a software, termed a "browser." Netscape Navigator and Internet Explorer are the commonly used browsers. Running on the client's computer, the browsers retrieve HTML documents from the server and interpret markup commands embedded in the documents. The interpretation and execution of these markup commands result in the display of the documents. The user browses or navigates through hypermedia screens containing links to information located around the world. The user does not have to be concerned with the network address or geographical locations. With the browser, navigation is entirely accomplished through mouse clicks. Recently the functions of the browsers have been greatly expanded and e-mail, FTP, and electronic news can be handled on WWW by the browsers. INTERNET IN NUCLEAR MEDICINE4-13 The applications of the Internet in nuclear medicine, can be divided in two categories: one is use in nuclear medicine community and the other is use for communication with outside of the nuclear medicine community. In this section, these two applications will be described separately. 1. Use in Nuclear Medicine Community In nuclear medicine community, 5 different applications can be mentioned as shown in the Table 1. 1) Forums for discussion For establishing forums, mailing lists, WWW and newsgroups are now used. One of the most active listserv in nuclear medicine is "nucmed@largnet.uwo.ca" which has been established by Prof. Cradduck TD in the Department of Nuclear Medicine, University of West Ontario, London Ontario Canada. In this server, the topics about basic aspects of nuclear medicine are mainly discussed. A mailing list for individuals interested in PET nuclear medicine has been established and managed by Beth A Harkness, MS at the Department of Radiology, Bowman Gray School of Medicine, Winston Salem, North Calorina, USA. This mailing list covers broad aspects of the PET nuclear medicine such as basic technology and reimbursement policy. There is a very active bulletin board, called LUNIS (Loyola University Nuclear Medicine Information Service) in the division of Nuclear Medicine, Department of Radiology, Loyola University Medical School, Chicago Illinois, USA (Fig. 2). You can access to LUNIS via telnet or WWW (URL: http://wwwd.lunis.luc.edu: 80/lunis/), but you have to get permission in advance to participate in the discussion. There is no newsgroup dedicated solely to nuclear medicine, but you will find many interesting topics in the following newsgroups; sci.med.informatics, sci.med.physics, sci.med.radiology, and sci.med. telemedicine. 2) Teaching files There are many WWW sites uploading nuclear medicine teaching files. Some sites are sampled in the Table 2. Figure 3 shows the English version of our home page at the Department of Biomedical Engineering, Tokai University Medical School. We have uploaded 25 cases in which nuclear medicine is useful for the diagnosis and elucidating the pathophysiology. Our teaching files are constructed of 3 components; brief clinical history and data, images, and diagnosis and comments (Fig. 4). The WWW-based teaching files have several advantages over the film-based ones: 1, Network access permits use at multiple sites, both within an institution and cross multiple institutions. 2, The space for keeping teaching files can be saved. 3, Loss of teaching file cases due misfiling of films is prevented, and rearrangement of files is easily carried out. 4, Because of the small size of nuclear medicine images and ready access to the imaging data in digital form, nuclear medicine is particularly well suited for creating a digital teaching file. 5, Incorporation of best cases from multiple institutions enhances the quality of teaching files. Development of teaching file material is time-consuming. By being able to link to materials developed at other institutions, the final product is multiplied number of collaborators. Each institution can invest a moderate effort but the endproduct can be very impressive. 3) Data base of nuclear medicine When you want to get the information related to the basic science of nuclear medicine, nuclear medicine procedures and softwares, you can find the specific information on the many WWW sites. Some such sites are tabulated in the Table 3. For example, if you access to the Texas Health Science Center, there are many useful review manuals covering the entire field of nuclear medicine (Fig. 5). 4) Home pages of the academic organizations Now many academic organizations in nuclear medicine and related fields have their own home pages (Table 4). These home pages contribute to enhancement of communications between the organization and its members, and among the members. Each home page is expected to be useful for promotion of nuclear medicine toward the outside of the nuclear medicine community. 5) Home pages of the companies related to nuclear medicine In the Table 5, a couple of the homepages of the companies related to nuclear medicine are listed. These home pages give us useful information about the products of each company. 2. Use for Communication with Outsides of Nuclear Medicine Community Using the Internet, we can send a messages to the professionals in medicine as well as to lay person. WWW is a very powerful method for this purpose. As for the professionals in medicine, we can teach them the indications, contraindications, advantages and disadvantages of each study, and have a discussion about the specific case with them. Uploading the study protocol will be convenient to all professionals in medicine. Introduction of new method and new developed indications of the old methods to the doctors in other specialties are our important duties. WWW is suitable for all of these purposes. The big problem in nuclear medicine is that we nuclear physicians play a great role in clinical practice, but lay person does not know anything about nuclear medicine, our role in medicine and its benefit to them. We always have to continue sending clear messages to them. In the home pages of the Society of Nuclear Medicine, there are messages to lay person. Here people can learn many things about nuclear medicine from its history to characteristics. They can get information about radiation dose of each examination in nuclear medicine compared with the other modalities. The home page of Mallinckrodt has also useful documents for lay person. They can get general information about nuclear medicine and also how to do each examination. They can get knowledge of nuclear medicine procedures in comparison with other method. CONCLUSION The internet has various functions which are very useful for the clinicians and scientists in nuclear medicine. 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