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EDITORIAL Table of Contents   
Year : 2000  |  Volume : 10  |  Issue : 1  |  Page : 11-18
Millenium moments in radiology: From Wilhelm Roentgen to the world wide web


Dept of Radiodiagnosis, INHS Asvini Hospital, Mumbai, India

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Keywords: Internet, Radiology, Medicine, World-Wide Web, Email, Teleradiology

How to cite this article:
Indrajit I K. Millenium moments in radiology: From Wilhelm Roentgen to the world wide web. Indian J Radiol Imaging 2000;10:11-8

How to cite this URL:
Indrajit I K. Millenium moments in radiology: From Wilhelm Roentgen to the world wide web. Indian J Radiol Imaging [serial online] 2000 [cited 2019 Nov 13];10:11-8. Available from: http://www.ijri.org/text.asp?2000/10/1/11/30624
The Internet is a vast network of computers spanning the entire globe. Fabricated initially to suit the requirements of the military in United States of America, it has now broken all boundaries and has been seamlessly integrated into the personal computer, at home or in the office. From the history of radiology to electronic textbooks on MRI and from online radiology CME programs with case scenarios to locating articles and viewing radiology images, the Internet has become increasingly useful for radiologists. This review article describes the power of the Internet when applied in the context of radiology. Moreover an attempt has been made to briefly overview the sweep of radiology web sites on the Internet, to provide the reader a panorama of the powerful and magical world of Internet.

What is Internet?

The Internet was created in 1969, when the Advanced Research Projects Agency of the United States Department of Defense funded up an experimental a long-distance telecommunication network consisting of only four computers. In 1971, e-mail was invented by Ray Tomlinson. In the 1980s, ARPANET was superseded by NSFNET, a series of networks created by the National Science Foundation, which established the present-day structure of the Internet [1] . Over the last few years there has been an exponential explosion in the number of computers added to this network. It is estimated that Internet traffic doubles every 100 days with more than 100 million people worldwide now on-line. Telecommunications on the Internet are standardized by a set of communications protocols, the TCP/IP protocol suite, that describe routing of messages over the Internet, computer naming conventions and commonly used Internet services such as e-mail. The Internet is so vast that practically every aspect of human interest including medicine, communications, commerce, science, media, law, art etc is represented in some form or fashion.

To learn the Internet, there are many basic books available. However, for those who are desirous to learn about the net on the net itself, there are a host of sites that fulfill the need. These sites are featured as

  • Doctors guide to Internet at http://www.pslgroup.com/docguide.htm,
  • Learn the Net Animated Tutor http://www.learnthenet.com/english/animate/animate.htm,
  • Learn the net at http://www.learnthenet.com/english/../../../archives/20001001/index.html and
  • Hitchhikers web guide at http://www.hitchhikers.net/guide.phtml.


Related to the Internet, is a working knowledge of computers. A concise and informative online basic primer dealing with Computers in Medicine is specifically available from the BMJ group of publications:

  • ABC of Medical Computing http://www.bmjpg.com/data/abcmc.htm.


Another website dealing with basic information of computers is What is Computers, http://www.whatis.com.

Overview of Radiology on the Internet

The Internet has 800 million sites approximately at the moment, with a remarkable tendency to grow further. Of these, it has also been estimated that there are close to 100 million sites dealing primarily with medicine. It is therefore not surprising that radiology teaching has evolved from Vesalius to the electronic library [2] . Global networks, powerful personal computers and user friendly, graphically oriented software are creating a new infrastructure that promotes rapid, efficient access to information. Images, text, audio and video can be integrated into interactive multimedia presentations, providing a hierarchy of knowledge that can be traversed with the click of a mouse [3]. The extensive use of images in radiology makes education, worldwide consultation and scientific presentation via the Internet a major beneficiary of this technical development. This is possible, since both text information as well as medical images can be transported via the Internet [4].

Clearly, it would be impossible to browse and evaluate Clearly, it would be impossible to browse and evaluate all the million sites. A variety of techniques are used to access radiology information from the Internet. These include radiology search engines, general-purpose search engines, radiology meta-lists and commercial sites on the web. However, the best method of information retrieval from the web is not known. At the moment, the method in this madness to meaningfully search and derive information that one wants quickly relies on two strategies, namely search engines and radiology resource sites.

Radiology Search Techniques

The first strategy employs search engines. Search engines are comparable to yellow pages, delivering a list of sites pertaining to any radiology topic. Most of the search engines have a blank field where the topic is typed and utilize a search button, which needs to be clicked, displaying in a period of usually less than ten seconds, a list of sites. The current popular search engines include Yahoo, Alta Vista, Excite etc.

Search engines have evolved further with the introduction of metasearch engines. Metasearch engines function as "yellow pages of yellow pages "and query multiple search engines, echoing the oft repeated judgment " Why search when you can metasearch?". The popular metasearch engines include

  • All the Web at http://www.alltheweb.com/,
  • Google at http://www.google.com,
  • Dogpile at http://www.dogpile.com/,
  • Hotbot at http://www.hotbot.com/,
  • Metacrawler at http://www.metacrawler.com/ and
  • Savvysearch at http://www.savvysearch.com/.
  • For a list of search engines, Beaucoup is a site that has compiled a variety of 1600 search engines in various categories including metasearch engines: at http://www.beaucoup.com.


There is flip side too, while using search engines. To begin with, there are numerous search engines and therefore the selection is a personalized choice. Another inherent problem is that a typical search done on a search engine, eventually results in 20 to 30 % of useful material, with a bulk of the websites not catering specifically to the topic asked for. To overcome this problem the second strategy, namely the use of radiology directories is resorted to.

Radiology resources or Radiology directories deal with a huge catalogue of topics by categorizing them, usually by specialties. These large and comprehensive Radiology directories are extensively indexed as

  • Medak at http://www.medmark.org,
  • Medmatrix at http://www.medmatrix.com,
  • Martindale Virtual Centre at http://www-sci.lib.uci.edu/~martindale/MedicalRad.htm,
  • Loyola Univ at http://www.meddean.luc.edu/lumen/gme.htm,
  • UI Links at http://uilinks.8m.com/,
  • Siemens Links at http://www.sms.siemens.com/siemrad.htm,
  • REF India Links at http://www.refindia.net/infobase/teaching/../../../archives/20001001/index.htm,
  • Radiology Central at http://members.aol.com/garyrad/radcent.htm and
  • Hardin Meta Radio at http://www.lib.uiowa.edu/hardin/md/rad.html.


These directories host an extensive collection of hyperlinked websites under categories of various specialties or modalities.

Radiology and Internet: The Range of Sites

The Internet gives information on a wide range of radiology topics from "The History of Radiology" to "New Radiology Sites" that are added every week. History can be tracked at engaging sites such as

  • T he History of Radiology at http ://radiology.bidmc.harvard.edu/Headings/History/history.html,
  • Roentgen Centennial at http://users.aol.com/ricter/private/home/history.html,
  • Evolution of X-Ray tubes http://ftp1.rad.kumc.edu/teach/tubes/xraytube.htm? and
  • Radiology Philately Site at http://www.xray.hmc.psu.edu/rci/ss4/ss4_5.html.


At the other end of the spectrum are the new and updated sites that are added to the net, which can be perused at sites such as

  • What's New in Pediatric Radiology http://pediatricradiology.com/WhatsNew.html.


The Internet is a rapidly developing and useful tool for emergency physicians, too. There is a website for emergency radiology aptly tilted

  • First year Radiology call http://home.att.net/~kryssk/call.htm#Links.


In addition there are Emergency radiology image teaching files which can be downloaded freely from

  • Emergency Pediatric Cases Download at http://www2.hawaii.edu/medicine/pediatrics/pemxray/pemxray.html.


Truly, radiology information on the Net is not only measureless but endless too.

Radiology and Imaging Anatomy

There is a rich assortment of websites dealing with anatomy topics. Most of them offer illustrative contents that are catalogued by region or by modality. The principal anatomy sites are the

  • Whole body Visible Human Project at http://www.nlm.nih.gov/research/visible/visible_human.html and
  • DAVID at http://www.cid.ch/DAVID/Mainmenu.html.


In addition , there are sites, which offer specified characteristics of imaging anatomy such as

  • Normal Variants http://www.radiology.co.uk/xrayfile/xray/cases/frcr/frcr.htm,
  • Couinaud's liver segments http://everest.radiology.uiowa.edu/nlm/app/livertoc/liver/8seg.html
  • and Anatomy of the Pelvis and Perineum at http://www.vh.org/Providers/Textbooks/pelvis/pelvis.home.html.


Some of the premium sites include

  • FMRI Anatomy Images http://www.fmrib.ox.ac.uk/fmri_intro,
  • Thoracic Visceral Anatomy http://www9.biostr.washington.edu/cgi-bin/DA/imageform,
  • TMJ Tutorial http://www.rad.washington.edu/anatomy/modules/TMJ/TMJ.html,
  • Hippocampal Anatomy http://muskingum.edu/~biology/hippocp/anatomy/hipp.htm,
  • Cardiac MRI  Atlas More Details http://www.ctru.auckland.ac.nz/atlas/intro/cardiac.htm and
  • IOWA's Futuristic imaging Site http://everest.radiology.uiowa.edu/nlm/app/maintoc.html.


Most of these sites are accessible from hyperlinks at

  • Refindia Teaching files at http://www.refindia.net/infobase/teaching/anatomy.htm.


Radiology and Imaging Atlas on the Internet

Images form the sum and substance of Radiology practice. There is no greater illustrative example of this, than Wilhelm Roentgen obtaining a radiograph of his wife's wrist a century ago. Correspondingly, there a number of online radiology and imaging atlases that are freely available on the Net. These cover a wide range of topics including

  • CHD and X-Ray Atlas at http://www.tc.umn.edu/nlhome/m475/bjarn001/stuff/chd.html
  • Pediatric GI Radiology Atlas at http://www.vh.org/Providers/TeachingFiles/PAP/GIDiseases/GIDis../../../archives/20001001/index.htm
  • , Chest Atlas http://www.skiagram.com/gsroot.html,
  • CTisUS atlas on protocols and organ lesions at http://www.ctisus.org/tf/../../../archives/20001001/index.html or
  • thopedics Atlas at http://ch.nus.sg/cybermed/clinical/orthopaedics/atlas/ortho.html,
  • MRI Brain Atlas at http://www.med.harvard.edu/AANLIB/home.html,
  • Cardiac MRI Atlas at http://www.ctru.auckland.ac.nz/atlas/intro/cardiac.htm,
  • Whole body MRI Atlas at http://130.219.15.246/database/frameanat.html,
  • Musculoskeletal Atlas http://www.hslib.washington.edu/courses/hubio553/atlas/content.html and
  • Atlas of Uroradiology at http://cpmcnet.columbia.edu/dept/radiology/TUTORIAL/SCANS/../../../archives/20001001/index.html,


Radiology Modalities and Specialties on the Internet

In recent times, to cater to the needs of the variety of modalities in Radiology, a large number of websites have emerged. They cover a large list of topics within the modality. Some of the finest and absorbing sites categorized by modalities are given in [Table - 1]. Likewise, there are a host of websites which cater to a particular specialty, such as pediatrics orthopedics, neuroradiology, cardiac etc. As an illustrative example Pediatric Radiology is comprehensively mapped as

  • Pediatric Radiology at http://pediatricradiology.com-a catalog of pediatric radiology Web sites,
  • the MetaTextbook of Pediatric Radiology at http://www.vh.org/Providers/TeachingFiles/MetatextbookPedRad/MetaTBPedRad.html -a catalog of pediatric radiology teaching file cases on the Internet and
  • Pediapedia at http://www.vh.org/Providers/TeachingFiles/PAP/PAPHome.html -an imaging encyclopedia of pediatric disease [5].


The goal of hosting the websites has been to create and curate a pediatric radiology digital library that will make the Internet a useful reference tool for the radiologist at the point-of-care. Some of the finest sites categorized by specialties are given in [Table - 2].

Multiple Radiology Specialties Links

There are radiology sites that conveniently catalogue the best of each specialty and link them directly from a single page. These can be viewed as "one-stop" page, making a difficult task easy. These popular sites are comprehensively compiled at

  • Morimoto Radiology Teaching File http://www.shimane-med.ac.jp/IMAGE/Radiology.HTML,
  • Multiple Teaching Files http://www.med.univ-rennes1.fr/cerf/iconocerf/index_an.html,
  • Refindia Teaching Files at http://www.refindia.net/infobase/teaching/../../../archives/20001001/index.htm and
  • Radiology Education on the Net http://brighamrad.harvard.edu/education.html.


Electronic Radiology and Imaging Books on the Internet

A further significant feature on the Net is the access to radiology textbooks online which are freely available. Some of the most popular e-Radiology books include

  • Wheelers' Textbook of Orthopedics at http://www.medmedia.com/med.htm,
  • Hypertext on Radiology http://chorus.rad.mcw.edu/, Electronic AJR Online Pictorial Essays http://www.arrs.org/eajr/pictorials,
  • MRI Referral Indications http://www.gcnet.com/maven/aurora/mri/toc.html,
  • MRI Virtual Textbook http://www.medic-online.net/mr/../../../archives/20001001/index.html and
  • NMR Textbook at http://www.cis.rit.edu/htbooks/nmr/inside.htm.


These sites comprehensively cover a broad area of radiology akin to textbooks, except that they is freely available online. The new millenium is likely to witness the emergence of many e-textbooks catering to the needs of various sub-specialties and modalities of radiology.

Searching Radiology literature and Articles on the Internet

The widespread use of computers and the Internet have made searching Radiology literature easier and more accessible to most radiology practitioners. Radiology articles can be conveniently accessed and derived from Medline. Medline is the National Library of Medicine's premier bibliographic database covering the field of medicine available free on the Internet through many agencies including PubMed [6]. This retrieval system allows users of all skill levels to obtain important radiology information. Interestingly, the Medline is a comprehensive, cross-referenced database of citations to the radiology literature covering 1966 to the present. A shortcoming however is that the full articles may not be available freely. Medline is accessed through the portal

  • Pubmed http:/ /www.ncbi.nlm.nih.gov/PubMed.


What's more there are sites which compare the various web agencies that offer Medline, namely

  • Medmatrix Medline Comparator at http://www.medmatrix.org/info/medlinetable.asp


and a site recently introduced as

  • Dr Felix's Free Medline Page at http://www.docnet.org.uk/drfelix.


Another popular site utilized for searching the net is

  • Internet Grateful Med at http://igm.nlm.nih.gov/ [7].


Radiology Journals on the Internet

Radiology journals undoubtedly form the backbone of scientific learning and effective practice in Imaging. There are sites that have been compiled across the globe which display a list of Radiology journals. The various Radiology journals are grouped exhaustively at popular sites such as

  • Sciencekomm Radiology Journals at http://www.sciencekomm.at/journals/medicine/radiol.html,
  • Medweb Radiology Journals at http://www.medwebplus.com/subject/Radiology/Periodicals.html,
  • E journals in Radiology at http://library.med.nyu.edu/library/internet/ejournal/subjects/radiolog.html,
  • Publist Radiology Journals at http://www.publist.com/indexes/MED080000_01.html,
  • Radiology Journals at http://www.radiology.com/resources/journals.asp,
  • Mednets Radiology Journals at http://www.internets.com/mednets/xrayjournals.htm and
  • Intravision Radiology Journals Links at http://www.intravsn.com/assocs.shtml.


There are sites now available which focuses on articles derived from radiology journals based in India, too. These are available at

  • Indian Journals Medline database http://www.qmedin.com/medsites/medlinejournals.htm.


Popular Radiology journals

There are certain Radiology journals, which comprehensively cater to a wide group of professionals merging the barriers between various modalities. As an illustrative example, a small select group of the popular radiology journals freely available on the Internet includes

  • Radiology accessible at Radiology Archive http://radiology.rsnajnls.org/contents-by-date.0.shtml and
  • Radiographics at Radiographics Archive http:radiographics.rsnajnls. org/contents-by-date.0.shtml.
  • The Indian Journal of Radiology and Imaging is available online at http://www.ijri.org/.


Radiology Standards and Appropriateness Criteria

Radiology standards are a set of guidelines set up by a team of leading radiologists around the world. The standards describe the basic steps that should be correctly applied to procedures and techniques in radiology and Imaging. The standards can be downloaded at

  • ACR Standards Download http://www.acr.org/departments/stand_accred/standards/dl_list.html.


On the other hand, radiology appropriateness criteria and practice guidelines seek to promote the cost-effective use of radiology procedures and interventions. This area has been attracting significant attention in recent times wherein a clinical problem has the potential to be evaluated aimlessly and erratically by a battery of radiology investigations. The appropriateness criteria answers objectively the crucial question of "which investigation for which clinical presentation", a situation that regularly comes up in imaging practice. The criteria offer objective guidelines in selecting and choosing the modalities correctly before employing them. The appropriateness criteria are download able from

  • Appropriateness at http://www.acr.org/departments/appropriateness_criteria/text.html. [8]


CME on the Internet: Radiology and Imaging

Continuing medical education (CME) is meant to bridge the gap between new scientific observations and clinical practice [9] [10]. However, traditional CMEs have not been effective at altering the behaviors of physicians. One reason for this failure of traditional CME programs may be their inflexibility. In traditional CMEs, the clinician does not choose the topic, the pace of the program or the place of learning and the CME material cannot be easily delivered to the point of care where the clinician needs the information. Computers and computer networks have the potential to accomplish these goals. CMEs have begun to appear on the Internet; however, there have been few evaluations of their usefulness, acceptance and effectiveness. Several obstacles to their wide use remain, including training in using the Internet for physicians, reluctance of physicians to participate in on-line commerce and the current unavailability of CMEs to be delivered in small-grained quantities to the point of care. As these issues are being addressed, on-line CMEs can be experienced from the following sites such as

  • CME Radiology at http://www.cmecourses.com/,
  • Radiographics Download CME at http://www.rsna.org/REG/publications/rg/cmeobj.html,
  • Washington Online CME at http://uwcme.org/courses/courseindx.html and
  • Stanford Online CME at http://radiologycme.stanford.edu/online/.


Radiology and Quizzes on the Internet

Quizzes and tests in Imaging are one of the popular methods of teaching and assessment in Radiology. They have the not only the unique ability to offer facts on common and uncommon imaging appearances, but they also train the eye in picking up lesions, besides creating an element of suspense and arousing interest in the minds of students. Some of the enticing quizzes in Radiology include

  • AJR Case of the week at http://www.arrs.org/eajr/caseofweek,
  • Neurorad Quiz at http:fibonacci.rad.washington.edu/neuroRR/nthome.htm#Contents,
  • Refindia Quiz at http://www.refindia.net/quiz/archives.htm.


A large set of links to Radiology quizzes around the world can be accessed from

  • Radiology Quiz links at http://www.ijri.org/teaching/cases_quizzes.htm.


Teleradiology and Internet

The new buzzword sweeping across the globe is telemedicine, amongst which the application of Teleradiology is a clear forerunner. Teleradiology is a means of electronically transmitting radiographic patient images and consultative text from one location to another by the click of a mouse. Furthermore audio and video can be integrated and augmented to the above data. A basic teleradiology system consists of three major components: 1. an image sending station, 2. a transmission network and 3. a receiving/image review station. Patient images are electronically encoded in a digital format at the sending station, sent on the transmission network and received, viewed and possibly stored at the review station. In general, typical times for sending cases over reasonably clean phone lines with lossy compression would be 15 to 30 seconds per MR or CT slice (20 CT images would take 5 to 10 minutes) and in ISDN (2-64K data channels), these times would be 5 to 10 seconds per MR or CT slice (20 CT images would take 2 to 4 minutes) [11].

Radiology on the Internet: Indian Scenario

Websites dealing with the various issues of radiology and Imaging in India are emerging fast. The Radiology Education Foundation, formed in 1998-99, has the remarkable distinction of creating net awareness amongst radiologists in India. The site offers quizzes, teaching files, information on radiologists and trade, details of conferences, access to radiology journals and so on. The industry leaders and radiology related trade organizations in India, form an important partner in the delivery of imaging services throughout India. Details of their products can be accessed from

  • Imaging Trade Companies Database at http://www.refindia.net/infobase/companies/india.htm.


Other sites useful for Radiologists

In addition to the sites described above, there are few Internet sites that cover the spectrum of topics that influence our "day to day" Radiology practice. Some of the these sites that are available on the Internet are

  • Aunt Minnie at http://www.auntminnie.com/,
  • What's New Today Medicine at http://medwebplus.com/whatsnew/today.html,
  • Clay Helbers Statistics Links at http://www.execpc.com/~helberg/statistics.html,
  • Electronic Statistics Tutor at http://www.statsoft.com/textbook/stathome.html and
  • Medical Quotations at http://www.doctorspage.net/quotes.asp.


The Flipside

Today, the worldwide Internet offers a variety of radiological information that can be accessed via modem by every PC user. The rapid pace of information exchange is making the world of radiology smaller and more intimate. Unfortunately on the flip side, there are radiologists around the world and many patients with health problems as well, least likely to have access to such technologies. Barriers to access include cost, geographic location, illiteracy, disability and factors related to the capacity of people to use these technologies appropriately and effectively. Time expenditure is also considered as an important problem while using the Internet [12].

The Future

The practice of radiology will be more integrated with the Internet in the twenty-first century. Conventional slide shows will migrate in large numbers to the WWW for convenient downloading for doctors and patients. Multimedia capabilities of the WWW that expand the depth of information transmission will enable education emanating from remote sites with narration and video depiction of procedures. These sophisticated tools will have real online applications with the prolific growth of teleradiology. Basic tenets of effective health care delivery services in the future will revolve around authentic health information to radiology personnel and patients augmented by high-speed communication of voice/text/images across the globe.

Conclusion

The Internet is a vast network of computers spanning the entire globe. At the turn of the century, there is an explosion of information with a swift outburst of radiology and imaging related websites. As far as one can see, it would be impracticable to browse and evaluate completely all the radiology and imaging related sites. Consequently, a variety of techniques are used presently to access radiology information in a focussed form on the Internet. These embody general-purpose search engines, radiology search engines, radiology meta-lists and commercial sites on the Web. As the new millenium beckons, it is discernible that the Internet, e-mail, the world wide web and the information superhighway are here to stay and radiology education, teaching and research, as well as imaging practice, will be affected in multitudinous distinct ways by these advances.

 
   References Top

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2.Vasas L: From Vesalius to the electronic library. Orv Hetil 1999; 25;140:1695-8.  Back to cited text no. 2    
3.McEnery KW: The Internet, World-Wide Web and Mosaic: an overview. Am J Roentgenol 1995; 164:469-73.  Back to cited text no. 3    
4. Wunderbaldinger P, Schima W, Turetschek K, et al in World Wide Web and Internet: applications for radiologists. Eur Radiol 1999; 9:1170-82.  Back to cited text no. 4    
5.D'Alessandro MP: Creating and curating a pediatric radiology digital library to make the internet a useful reference tool for the radiologist. Pediatr Radiol 1998; 28:890-5.  Back to cited text no. 5    
6.Putnam NC: Searching MEDLINE free on the Internet using the National Library of Medicine's PubMed. Clin Excell Nurse Pract 1998; 2:314-6.  Back to cited text no. 6    
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8.Tjahjono D, Kahn CE Jr: Promoting the online use of radiology appropriateness criteria. Radiographics 1999; 19:1673-81.  Back to cited text no. 8    
9.Peterson MW, Galvin JR, Dayton C, D'Alessandro MP: Realizing the promise: delivering pulmonary continuing medical education over the Internet. Chest 1999; 115:1429-36.  Back to cited text no. 9    
10.Krebs TL, Berg WA, Roys SR, Ratakonda S, Pomerantz SM, Siegel EL: MammoWeb continuing medical education (CME): a web-based breast imaging CME program. J Digit Imaging 1999;12:124-6.  Back to cited text no. 10    
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Correspondence Address:
I K Indrajit
Dept of Radiodiagnosis, INHS Asvini Hospital, Navy Nagar, Colaba, Mumbai 400 005
India
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Source of Support: None, Conflict of Interest: None


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1 Medicine and the Internet: A survey of the information highway
Indrajit, I.K., Nangpal, S., Roy, N.
National Medical Journal of India. 2000; 13(4): 193-201
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