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Typical user interaction in image processing is with command line entries, pull-down menus, or text menu selections from a list, and as such is not generally graphical in nature. Although applying these interactive methods to construct more sophisticated algorithms from a series of simple image processing steps may be clear to engineers and programmers, it may not be clear to clinicians. A solution to this problem is to implement a visual programming language using visual representations to express image processing algorithms. Visual representations promote a more natural and rapid understanding of image processing algorithms by providing more visual insight into what the algorithms do than the interactive methods mentioned above can provide. Individuals accustomed to dealing with images will be more likely to understand an algorithm that is represented visually. This is especially true of referring physicians, such as surgeons in an intensive care unit. With the increasing acceptance of picture archiving and communications system (PACS) workstations and the trend toward increasing clinical use of image processing, referring physicians will need to learn more sophisticated concepts than simply image access and display. If the procedures that they perform commonly, such as window width and window level adjustment and image enhancement using unsharp masking, are depicted visually in an interactive environment, it will be easier for them to learn and apply these concepts. The software described in this paper is a visual programming language for imaging processing which has been implemented on the NeXT computer using NeXTstep user interface development tools and other tools in an object-oriented environment. The concept is based upon the description of a visual language titled `Visualization of Vision Algorithms' (VIVA). Iconic representations of simple image processing steps are placed into a workbench screen and connected together into a dataflow path by the user. As the user creates and edits a dataflow path, more complex algorithms can be built on the screen. Once the algorithm is built, it can be executed, its results can be reviewed, and operator parameters can be interactively adjusted until an optimized output is produced. The optimized algorithm can then be saved and added to the system as a new operator. This system has been evaluated as a graphical teaching tool for window width and window level adjustment, image enhancement using unsharp masking, and other techniques.
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