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FEASIBILITY OF THE USE OF INTERACTIVE DIGITAL WHITEBOARDS IN DIGITAL CYTOLOGY

Daniele Giansanti, Giuseppe D’Avenio, Mauro Grigioni Dipartimento di Tecnologie e Salute, Istituto Superiore di Sanità, Roma

Introduction

An electronic whiteboard is a large interactive display that connects to a Personal (PC) and shows images thrown by a projector. The mounted or freestanding whiteboard mirrors the PC screen, and you can control the PC by interacting with the board using a pen, fingers or a supported input device. While the first interactive whiteboards were used in offices for sharing and presenting ideas within business groups, they are now also found in schools, sports training rooms and TV studios. Interactive whiteboards connect to PCs via wired or wireless connection. Therefore, an electronic whiteboard can connect to a PC via USB, serial port cable, Bluetooth or Wi-Fi. Most of these whiteboards use infrared scanning with or without ultrasonic pens, resistive or electromagnetic pens for interactivity. The uses for interactive whiteboards by means of running loaded onto the connected PC (such as a web browser or other software used in the classroom) may include as a not exhaustive list: ‒ capture and save notes written on a whiteboard to the connected PC; ‒ capture notes written on a connected to the whiteboard ‒ control the PC from the whiteboard using click and drag, markup which annotates a program or presentation; ‒ use OCR (Optical Character Recognition) software to translate cursive writing on a graphics tablet into text; ‒ use an audience response system so that presenters can poll a classroom audience or conduct quizzes, capturing feedback onto the whiteboard ‒ draw with the aid of finger based tools (pan, zoom). ‒ activate multimedia files with the aid of finger based tools (pan, zoom). ‒ use of the Office programs with the aid of the finger based tools (pan, zoom). Examples of interactive digital whiteboards are: ‒ MimioBoard Interactive Whiteboard (Massachusetts Institute of Technology, USA); ‒ Hitachi FX-79E1 (Hitachi Co., Japan); ‒ eBeam Edge (Luidia Inc., USA). Electronics whiteboards are of different sizes and with varying sets of features. The right one to choose depends on your needs. For example, while all interactive whiteboards support pen and/or touch inputs, an electronic whiteboard for schools does not need to support smartphone connectivity or run business software like interactive whiteboards meant for offices.

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The main features of an interactive digital whiteboard are: ‒ Content interaction Interactivity is a key feature of electronic whiteboards. To keep your audience fully engaged, you need to be able to interact with the projected content on the smart board. Content interaction involves using your fingers, the included pen or supported input device to draw, highlight and click hyperlinks on the board. It also involves playing, pausing and extracting clips from multimedia contents. ‒ Software Electronic whiteboards run software. While there are models with general, all-purpose software for interacting with contents projected on these boards, you need a smart whiteboard running software specific for your needs. For example, an electronic whiteboard meant for grade schools should have software tailored for young students. Such software will provide access to educational content, just as a business electronic whiteboard should integrate with business collaborative tools such as Microsoft Lync. ‒ Saving, sharing and printing You should not have to take notes while using an electronic whiteboard. As you annotate and add more content to the board, you should be able to save each page at the press of a button. In addition to saving the content created on it, an electronic board should be able to share these saved pages with participants by sending them copies via email, wirelessly to connected mobile devices and as hard copies using a connected . ‒ Device support and interconnectivity In addition to the image projected onto its screen, an electronic whiteboard should also be able to pull content from connected peripheral devices such as flash drives, cameras and camcorders. Most interactive boards have USB ports for just this purpose. Furthermore, a smart whiteboard should be able to join a local network and go online either to provide access to more information or support remote participation. ‒ Position Electronic whiteboard can be vertical (more common) or horizontal (such as the large multi-touch table or large multi-touch tablet; e.g. Epson Xdesk interactive table.).

Interactive digital whiteboard in e-health

There are a lot of applications in e-health where the interactive digital whiteboard could be of aid; an interesting use is in the field of medical imaging, in particular: ‒ training in diagnostics. ‒ simulations; ‒ cooperative diagnosis; ‒ teleconsulting; ‒ image enhancement.

Example of application: the Epson Xdesk

The Epson Xdesk is a horizontal interactive table; some call it a coffee table because you can put anything on the surface of the table, it works by projections, with the very latest technologies on that. This desk is also compatible with Bluetooth communication protocol and

13 Rapporti ISTISAN 16/46 as soon as you put your phone or camera on the surface of the table, the Xdesk will be able to see all your files and pictures on the desk. By natural interface pictures on the table can be managed freely and resized, zoomed in and out by finger movements as the iPod touch does, only on a fair larger scale. The Epson Xdesk has a 52-inch screen and a 1024x768 touch screen display. It represents the appropriate high technology solution for cooperative discussions, clinical audit and ultimately the future direction of cooperative virtual microscopy environment. Furthermore it could represent a tool suitable to recover the inheritance of some ICT (Information, Communication, Technology) solutions (such as Pap-Net) for large screening in cytology abandoned because in the first applications the technology was not ready, for computer assisted cervical/vaginal cytology diagnosis (3). The Epson Xdesk was used in a test including the following basic functions: ‒ design of a calibration procedure; ‒ installation of the software for the digital cytology remote consulting; ‒ assessment of the methodology. A calibration procedure has been designed to allow the system to optimize the feedback to the finger based operations. The procedure was based on a black grid with known dimensions designed in a white background. The feedback of the image is used by properly designed software to map the area of the large monitor with the effective area defined by the pc tools monitoring the area dedicated to the graphical applications (Figure 1).

Figure 1. Tool used for calibration of the Epson Xdesk

Figure 2 shows the web interface of the digital slide server (Spectrum). The client software Aperio Spectrum Web Viewer (Leica Biosystems Co, Germany) (1-4) is automatically downloaded in the browser. This software allows in internet a virtual navigation as a virtual microscope with the relevant functions (pan, zoom, etc.) in a remote digital slide of cytology. Figure 3 details the reaching of the web server where the digital slides are stored and the selections of a case.

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Figure 2. Web interface of the digital slide server (Spectrum) using Epson Xdesk

a b

c

Figure 3. Different Interfaces of the digital slide server (Spectrum) using Epson Xdesk: accessing by means of an account (a), selecting the directory where the digital slides are stored (b), selecting the case (c)

Figure 4 shows the digital slide (case) at the minimum level of zoom.

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Figure 4. Digital slide (case) at the minimum level of zoom within Aperio Spectrum Web Viewer using Epson Xdesk

Figure 5 details different levels of zoom and Figure 6 focuses on a problem of refresh caused by a reduction of the speed of the net.

Figure 5. Different levels of zoom within Aperio Spectrum Web Viewer using Epson Xdesk

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problem of refresh

Figure 6. Problem of refresh depending from the speed of the Net within Aperio Spectrum Web Viewer using Epson Xdesk

The assessment was successful and was performed by means of a specific study of Health Technology Assessment (HTA) proposed in the journal Telemedicine and e-Health (5).

References

1. Giansanti D, Grigioni M, D’Avenio G, Morelli S, Maccioni G, Bondi A, Giovagnoli MR. Virtual microscopy and digital cytology: state of the art. Ann Ist Super Sanita 2010, 46(2):115-22. 2. Giansanti D, Castrichella L, Giovagnoli MR. The design of a health technology assessment system in telepathology. Telemed J E Health 2008, 14(6):570-5. 3. Giansanti D, Castrichella L, Giovagnoli MR. New models of e-learning for healthcare professionals: a training course for biomedical laboratory technicians. J Telemed Telecare 2007, 13(7):374-6. 4. Giansanti D, Castrichella L, Giovagnoli MR. Telepathology training in a master of cytology degree course. J Telemed Telecare 2008;14(7):338-41. 5. Giansanti D. Pochini M. Giovagnoli MR. Integration of tablet technologies in the e-laboratory of cytology: a health technology assessment. Telemed J E Health 2014;20(10):909-15.

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