ECR 2015 - Mobile IT in Radiology - RC105

A. tablet computers: a technical overview

B. reading DICOM images on the tablet

C. mobile teleradiology: radiological features of the tablet-computer

Mobile devices already are around for quite some time, starting from the PDAs and mobile phones to current smartphones and tablets. These devices are gaining ground in medical application in a variety of applications.

This session covered te application of mobile devices in radiology. The recent devices can be used to view CT and MR and are increasingly integrated into the clinical work, even as a natural extension of the PACS workstation.

BYOD however, requires a high level of security when patient data is involved.

A more technical presentation by dr. Fernandez-Bayo showed that the current tablets are pretty close to the requirements normally placed on radiological reading displays when taking into account the diference in size and reading distance.

Recommendation when using a tablet for image review are a 10 inch diameter, 4:3 ratio and QXGA (3MP) displays. Also, it is recommended to use the highest brightness setting and disable the automatic brightness correction.

Tablets can not replace the workstation but could be used as a valuable extension to the workstation. They can display DICOM data with apps and web applications either from local storage or from a server. Increasing scientific prove is arising in numerous posters and publications that shows that clinical use of DICOM image review on tablets is feasible and reliable.

Social media is gaining interest. However, sharing images of patients is not allowed. Figure one is providing a social media platform for doctors that allows a validated and secure way of discussing cases. Social media is a requirement, not an option but security risks should be acknowledged.

ECR 2014 - RC305 - Mobile IT in radiology

In radiology, display usages is usually in portrait and sometimes in landscape orientation. The introduction of tablets has introduced the ability to mix the use of portrait and landscape use of a display. The tablet also provides many more features such as speech recognition that are normally provided by the PACS workstation. Tablets allow portability of images outside radiology, facilitates interaction wiith clinicians, facilitates interaction with patients.

In this session a good overview was given by J. Fernandez-Bayo about the technological developments showing a close to diagostic trend in the capabilities of tablets. After this, O. Ratib presented on the software side of tablets and the possible applications in Radiology. Good applications are already shown and validated although clinical question at a time. The big breakthrough now is the use in surgery where iPads are brought into the OR to have access to the images of a patient. Currently the images are downloaded to the iPad but the trend is towards cloud computing with on-line acces to data and high end visualization and post-processing.

In a final presentation, E. Randschaert presented on teleradiology. In a very interesting presentation he showed that mobile devices are not yet to be used for routine primary diagnosis, but they are moving in that way. The developments already allow a wide spread implementation and the tables are already used by  many physicians for different applications ranging from image viewing to teaching. 

ECR 2014 - session SS105 - Trends in reporting, image management and mobile computing

10 presentations on different topics were covered in this scientific session:

CAD

Evaluation of a Siemens software tool called FastSpine to perform analysis of the spine with automatic labeling and curved reconstruction. They showed a high percentage of correct automatic labeling of 93.5%. FastSpine took about a minute to perform on average with manual correction where needed. The CAD provided time saving in more complex cases and had a comparable performance.

Two presentations focused on RECIST implementation. One looked at the implementation of dedicated tools for RECIST analysis and showed a clear saving in reading time while maintaing reproducibility. A Japanese group presented a cloud-based Lesion Management Solution that is used to track patients in lung cancer screening workup.

MOBILE DEVICES

This session showed again that mobile devices are of great interest and interesting applications are identified and implemented. Four of the presentations covered this topic.

A by dr von Falk showed that an iPad could be used for diagosis of CT data although screen size and security are still hampering the implementation. Another issue with mobile devices is the diiffering reading environments that cannot be controlled and thus could influence the reading quality. Mobile devices should probably be implemented as additional possibility and not for primary use. 

The dkfz demonstrated the use of an iPad for offline analysis of radiology information at a distant location to be used during autopsy. 

A group from Pisa also evaluated the iPad on CT images and showed the iPad to be faster for evaluation with even higher sensitivity and specificity for the iPad.

An important point to keep in mind with all the evidence for using iPads in radiology is that it is all focused on a limited, well defined, clinical question and mostly limits to CT.

Another group from Germany introduced the iPad in anatomical courses. The developed AnatomyMap a dedicated software tool for interactive exploration of volume rendered data running on a remote server using a web based interface.

QUALITY CONTROL

A group from switzerland showed that after transfer from free text to structured reporting they needed quaity control of those structured reports. They analysed about 250 reports on over 30 criteria. They showed that one third was excellent, one third good and one third non-optimal. The two worst performing radiologists were those not (properly) using the structured reporting. 

USABILITY

A Dutch group presented their work on interface customization. Most PACS systems have an adaptable interface, but the radiologist do not optimally use this capability. The showed that using adaptive support suggestions based on usage could help to improve radiology workflow and workstation usage. 

RSNA 2013 - RC526 - Cool technologies for radiologists

From the second presentation in this session the most usefull tools were:

Glassboard for a dedicated group to share information. It's a private form of Facebook with groups on invitation only. All communication stays within the private group.

Pdfpen scan+ allows taking a picture of a piece of text and it does OCR on it to use it on you device.

RSNA 2013 - RC526 - Cool technologies for radiologists

Tablet applications. 

- Pocket

Collecting bookmarks to websites into your pocket for later acces on any device.

- PDF readers

Examples are GoodReader, iAnnotate PDF, expert PDF. They allow reading and annotation of different files. However, they all are paid apps.

- Educational tools

Audience response apps are Poll everywhere (over 40 respondents requires a monthly payment), Poll runner ($10 per year), socrative (free and easy to use but a bit simple compared to others)

Baiboard collaborative whiteboard allowing multiple users that can join a board.

- technology tools

Editorially.com is a website to cooperate on writing a paper. It includes a full version tracking. This is a free tool.

Udutu online course authoring tool. Pre designed course templates can be used to design and share courses. Sharing either by webpage or by building a zip.

Udemy has a simpler GUI with less style which is also free to use.

Dropbox alternatives that can be used are Spideroak. Drawback is that it does not provide sharing. However, the data security level is higher than when using dropbox.

iPod during knee surgery

A novel application of the iPod was recently published. The iPod is used to display pre-operatively acquired images of the patient operated upon. These images are displayed on the iPod correctly by using tracking devices to detect the position and orientation of the iPod in the operating theatre. The surgeon can review images during surgery of specific locations on the iPod. An iPad can be placed in the operating theatre to allow other people involved in the procedure see the images the surgeon has on his/her iPod.

Read this article of USA Today on the use of an iPod during knee surgery.

RSNA 2012 - Poster stating the top 5 apps for radiological images on the iPad

According to a poster presented at RSNA, the top five apps to get onto your IPad for reviewing radiological images are:
1- Mobile MIM
2- ResolutionMD mobile
3- eFIlm mobile HD
4- OsirixHD
5- iClarity
Of these ResolutionMD Mobile and Mobile MIM have obtained FDA approval. All these viewers have basic viewing functionality and safe connection protocols.
The authors conclude that 'far from substituting radiologists workstations, the iPad can be a good and useful portable device for visualizing radiological images'

RSNA 2012 - Radiology Informatics Series: Mobile Computing Devices

This early morning a whole session on Mobile Computing Devices. Apperent from the attention mobile devices get both from the industry and the RSNA itself, this is a very important topic that will greatly influence the future of radiology.


Mobile lessons from other failures are:

1. Make sure your app works very well

2. Native apps win hands-on over web-apps


Both healthcare professionals and patients will be demanding the use of mobile devices. Although ipads and iphones are used prominently in industry and hospitals, the consumer market is dominated by Android because of the much larger market share in smartphones of Android.

To keep up to pace, healthcare institutions should pay attention to mHealth and start developing apps for both their employees and customers.

VSIN31-03 • Comparative Efficacy of Intra-operative Interfaces for Interventional Radiologists: The Microsoft Kinect Device, Hillcrest Labs Loop Pointer and the Apple iPad

Cherng Chao et al


Intra opative image review is challenging and standard setups using keyboard and mouse are not optimal. This group compared the used of Microsoft Kinect, hillcrest labs loopp pointer, apple iPad for image interaction all using mimcloud software. Time, measurement and easy of use was determined for a prototypical task measuring a liver lesion. The Kinect software used a button approach to switch tasks. 29 radiologists participated in this study. The iPad was the fastest in performing the task while the Kinect was the slowest. However, sterility requirements hampers the use of the loop and the iPad. All three devices were believed to be usefull in the future. Windowing and measuring proved to be the most challenging tasks. Users with video game experience and experience with a particular interaction method showed a better performance.


Main shortcoming of this study was that the users using the Loop and iPad did not use gloves.

VSIN31-04 • Modular Design of a Mobile Web-app Clinical Decision Support and Communication Tool for Radiologists and Ordering Clinicians in a Multi-Facility Academic Medical Center

Loyrirk Temiyakarn , MD et al


This group used iwebkit 5 to build a modular webapp that provided all kind of information beneficial to different healthcare providers such as guidelines, phone lists, protocols, etc.

VSIN31-05 • Enhancing Utilization of Mobile Imaging: Assessing Variation in Diagnostic Accuracy of iPad with the Nature of Radiological Findings on Chest Radiographs

Supriya Gupta et al


30 cases following tube placement at ICU were evaluated on iPad and (after one week) on a PACS workstation. The conclusion is that the iPad still has to be evaluated for image quality and to determine that it can be used for a certain task. Image quality heavily depends on the app. DICOM calibration of iPad screens is becoming a critical issue and methods have to be developed specifically for tablets.

FlipPad - rugged iPad case for medical use

The FlipPad™ is a new medical grade ruggedized case for the iPad 2 and the new iPad HD. Its is designed to pass tough standards on waterproofing and shock protection. In addition, the whole shape of the FlipPad is easy to clean with standard infection control sprays. The FlipPad™ will be available in with a LasarPen™ which is also waterproof and made of the same durable material.

Check out their website at http://www.flippad.co.uk

Virtual projection keyboard

Interesting new product to add a keyboard to a tablet or smartphone.
Keychain device with projected keyboard.
See http://www.brookstone.com/laser-projection-virtual-keyboard

Virtual Surgery on iPad

Virtual surgery is a free iPad app to go through a surgical total knee replacement procedure. The app is fully narrated and interactive and also includes multiple choice questions to test the knowledge of the 'player'. This is really put on the market as being a serious game and is really well designed. Apps like these really show the ability of the iPad as an educational device.

Tablets Make Good Educational Tool for Radiology Residents

The iPad and other tablets are gaining ground in Healthcare, not only in practical use but also in education. Use of tablet devices, such as iPads, by radiology residents would enhance their education, allowing them to keep up with evolving technology, said researchers in a study published in the June issue of the Journal of the American College of Radiology.
A short article on this can be found at the website of Diagnostic Imaging.
The full paper can be found at the site of the JACR.

Report: Docs are adopting tablets more than you think

Physicians’ device and digital media adoption are evolving much faster than anticipated, especially when it comes to tablets, according to a May report from healthcare market research firm Manhattan Research.
Report: Docs are adopting tablets more than you think

iPad as good in interpretation of pulmonary embolism as PACS workstation

The iPad is gaining ground in medical imaging. In a recent (online) publication in the journal Emergency Radiology entitled "The iPad as a mobile device for CT display and interpretation: diagnostic accuracy for identification of pulmonary embolism", the authors demonstrated the use of iPad interpretation of CT scans in patients suspected with Pulmonary Embolism. They conclude that:

CT interpretation on an iPad enabled accurate identification of pulmonary embolism, equivalent to display on the PACS. This mobile device has the potential to expand radiologists’ availability for consultation and expedite emergency patient management.

RADbook available for free for the iPad

RADbook 2012 is now available for free for the iPad. The RADbook app provides a 168 page overview of what is available on the radiology market today subdivided into 11 categories. These categories are: IT, CT, MRI, Interventional, Mammo, R/F, Nuclear, Displays/Printers, Ultrasound, Injectors, and Testing Devices.

It provides a listing of the available devices/systems with a direct link to the website of the vendor. A valuable tool for anyone looking to buy new equipment.

Study: iPads boost residents' efficiency

Providing personal mobile computers to medical residents increases their efficiency, reduces delays in patient care and enhances continuity of care, according to a research letter in the March 12 issue of the Archives of Internal Medicine. Read more about this in the HealthImaging coverage: Study: iPads boost residents' efficiency

Are free Apps a security hazard for patient privacy?

"You might want to think twice the next time you download a free app to your smartphone. That app could be riddled with malware able to steal information stored on your phone, according to IEEE Fellow Jeffrey Voas. It pays to be extra cautious now, Voas says, because mobile hacking is on the rise, with free apps possibly the most popular tool for gaining access." 

This is the first sentence of a news item at the IEEE 'the Institute' website. If this is actually true the increased use of apps in the medical arena could potentially lead to a privacy risk for patients. An increasing amount of apps are (freely) available that allow to record patient information and data to facilitate the work of the physician and have the information available on their mobile device. However, as shown in the research mentioned above, this could potentially lead to access to that data by others than the physician. The researchers only scanned Android apps,  where the risk may be higher than with Apple because of the fact that every app going into the Apple appstore is checked. In 280000 Android apps scanned they found some kind of malware in about 1 percent of the apps. The actual percentage could be higher because not all malware can be easily detected.

Top 10 uses of iPad in Radiology - SIIM

A SIIM poster by Frederick Weiss discussed the top 10 uses of the iPad in radiology during the SIIM conference in 2011. This poster is now available in text at the SIIM website.

There is also a detailed version available here. However, in my case it took a long time to load the 7.5MB pdf  from their site, so be patient.

Pocket Physio app launched for knee surgery patients

UK Specialist Hospitals (UKSH), an independent healthcare provider to the NHS, has launched a physiotherapy app – Pocket Physio – for patients undergoing major hip and knee surgery. It is available in the AppStore.

Pocket Physio is the first physiotherapy app designed by an orthopaedic provider specifically to help improve patients’ recoveries.

UKSH has also made it freely available in the UK to anyone interested in finding out more about the physiotherapy involved in hip and knee surgery.

Hosital IT Europe

Free IPad magazine on HIT

HITExchange magazine is now available for free through the Apple iTunes store. It deliveres an HIT interactive magazine that really starts to use the capabilities of digital magazines to the iPad for free.
HIT Exchange magazine connects healthcare executives who set strategy for their organizations and the IT professionals charged with implementing this strategy throughout their facilities. Each issue covers the most salient IT issues, innovations, and trends from both business and technical perspectives throughout their facilities-reaching more than 72,000 HIT decision makers nationwide.