Purpose:To augment traditional visual data perception of complex multiparametric imaging data sets by adding auditory feedback to improve the delineation of regions of interest (ROIs) in tumor assessment in dynamic contrastenhanced (DCE) MRI. Materials and Methods:In addition to conventional display methodologies, we have created an application window which interfaces with audio output using dynamically loadable sound modules, providing goodness of fit (GF) information through auditory feedback. We have assessed effectiveness of conveying sound information with three independent readers on eight DCE-MR breast image data sets. The assessment was based on either conventional visual only mode or combined visual plus auditory mode. For statistical comparison between two sensory approaches, interobserver repeatability was measured with three different criteria.Results: Adding auditory feedback improves repeatability significantly (P Ͻ 0.01), and the enhanced sensory approach had higher repeatability than visual only mode in visually complex breast tumor cases. However, in easy and moderate cases, visual only mode was more reproducible than the combined mode with very high significance (P Ͻ 0.001). Conclusion:Adding auditory information to visual based image analysis for identifying tumor ROIs provides higher interobserver repeatability for analyzing complex multidimensional/multiparametric medical image data sets with visually difficult lesions to delineate. TODAY'S ADVANCED IMAGING scanner systems generate multiparametric and multimodality (computed tomography [CT], MR, positron emission tomography [PET], ultrasound [US]) information in a short amount of time.It is important to simultaneously access and to coherently communicate with all these different types of image information for better lesion characterization and for more accurate and reliable diagnostic image analysis in many clinical applications. As the complexity and combination of different types of acquired imaging data increase, conveying this information to a human observer in a meaningful way for diagnostic purpose becomes a bottleneck.The traditional method of analyzing medical images solely relies on the visual perception system, using grayscale values and color overlays to represent composite imaging data or showing different types of image data in a side by side display regarding which the observer must be trained to mentally align corresponding positions in the image data sets. Furthermore, the visual representation of complex medical images is often limited by screen size, two-dimensional (2D) display of three-dimensional (3D) spatial information, image resolution, and the capacity of the human visual system. Therefore, it is not easy to quickly access valuable information due to the complexity of multiparametric imaging data sets and the limits of visual perception system.Dynamic contrast-enhanced MRI (DCE-MRI) is widely used as a powerful noninvasive clinical tool for the diagnosis of tumors and for therapy monitoring of a variety of treatment...

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The majority of previous studies on North Korean Refugees (NKRs) focused on the linguistic heterogeneity of pronunciation and vocabulary use. Only a handful of studies examined differences between South Koreans' (SKs) and NKRs' language use and they concluded that NKRs prefer direct refusal speech acts rather than indirect ones. However, we hypothesized that NKRs' preference on direct refusal speech acts would vary depending on the types of inducing speech acts; speech acts that induces refusal expressions. 47 SKs and 43 NKRs answered three questions after watching video clips of short conversation in refusal situations. The results were statistically analyzed with independent sample t-tests and multi response analyses, revealing that NKRs preference on direct refusal speech acts varied depending on the types of inducing speech act. In addition, multi response analyses indicated that the NKRs and SKs evaluated the same rejecter's personality differently and that this difference may result in miscommunication. Lastly, NKRs' evaluations on the refusal speech acts did not change over time, as NKRs who stayed less than a year in South Korea and those who stayed more than five years did not show significant difference in their evaluation. This result suggests that explicit education on this may be required. Additionally, it is worth to note that current research confirms that SKs and NKRs react differently toward expressions used only in North Korea, and, therefore, not only the refusal strategy, but also the refusal expression itself are both important for successful communication. Additionally, the results showed that refusing with nonavoidable and non-personal reasons were perceived more positively than personal reasons. These findings suggest that for successful communication to happen between two groups with different linguistic backgrounds, pragmatic awareness in language use is helpful.

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