The growing role of mobile technology in radiology

If you ask Elliot Fishman, M.D., a professor of radiology, oncology, and surgery at Baltimore-based Johns Hopkins Medicine, mobile devices like tablets and smartphones have, in a very short time, had a huge impact on radiology.

Such tools have proven to be multi-functional, as radiologists are able to perform tasks ranging from mundane (like sending and receiving email) to critical (interpretation of imaging test results). And the devices seem to be performing all of these tasks quite well.

"I've looked at hundreds of Cardiac CTs and other images and I've never had a situation where I looked at one on an iPad, then came back the next day and looked at it on a monitor and said, 'Oh, my god, look at what I missed,'" Fishman told FierceMedicalImaging.

A learning tool

Education is a common--and critical--component of the iPad when it comes to radiology, according to Fishman. In his case, he does quite a bit of his journal reading on the tablet.

"The convenience of having it all in one place works quite nicely," Fishman said.

He pointed out, for example, that the American Journal of Roentgenology, gives subscribers the choice of print only, print and online, and online only subscriptions, and that a high percentage are choosing to get their subscriptions online. "I think what's happening is that people are using their mobile devices to keep the articles they want so they can read them when and where they want," Fishman said. "It's just a much more convenient way of doing things."

Further educational benefits of iPads were illustrated in a recent study out of Beth Israel Deaconess Medical Center in Boston, published in the Journal of the American College of Radiology.

For the study, residents were provided with iPad 2 tablets and subscriptions to e-Anatomy and STATdx. When asked to assess their use of the technology, 86 percent of the residents reported that they used the iPad on a daily basis, with most preferring to use it to read journal articles, and about half reporting that they used the tablet to read textbooks.

"[They] also are a good source of creating information, as well," Fishman (pictured left) said of mobile tools. Case in point, he said that there are hundreds of radiology education applications available for the iPad, several of which he has developed.

"And we are developing more of them--a couple every month," Fishman said, which, he added, range from hand and foot anatomy applications to one on CT contrast protocols.

Clinical functionality on the go

Mobile tools aren't just a good source for finding, storing and reading educational information, however. Fishman said he also uses the iPad to read tests remotely, and is more than satisfied with the quality of the images provided.

"It's [the image quality] basically the same," Fishman said about viewing images on his iPad compared to viewing them on an in-house monitor.

In a study published last summer in Emergency Radiology, Fishman and other Johns Hopkins researchers said the same; they found no difference between the use of an iPad and a PACS workstation with regard to diagnostic accuracy for detecting pulmonary embolism.

According to the study, readers--regardless of the display platform--interpreted 98 percent of the studies they read correctly.

The device "has the potential to expand radiologists' availability for consultation and expedite emergency patient management," Fishman and his colleagues concluded.

Another study, published in January in the Journal of the American College of Radiology, found no detectable effect when using an iPad 2 compared with a regular LCD monitor to diagnose tuberculosis.

"Mobile radiologic diagnosis holds the promise of expanding radiologists' availability for consultation and reducing dependence to specific fixed locations for review of medical images," wrote researchers from the University of Maryland School of Medicine in Baltimore.

Smartphones also useful

In Arizona, meanwhile, Bart Demaerschalk, M.D. (pictured right), and colleagues from the Mayo Clinic in Phoenix have shown that a mobile smartphone application can be used to evaluate medical images during a telestroke evaluation.

In telestroke care, the use of a telemedicine platform in a rural area, or an urban hospital lacking emergency neurological care, allows a stroke patient to be seen in real time by a neurology specialist. Oftentimes in such situations, though, physicians still are tied to a laptop or desktop computer, which means there could be delays in getting access to brain imaging studies. Smartphones eliminate that delay, Demaerschalk, alluding to his study--published last fall in the journal Stroke--told FierceMedicalImaging.

"Someone who is away from the hospital or home and carrying his smartphone will have much faster access to a patient than someone who with a laptop who has to set it up and find a connection," Demaerschalk said. "It's all about time and reducing neurological disability."

In their study, Demaerschalk and his colleagues evaluated 53 patients who presented at Yuma Regional Medical Center with acute stroke and underwent a CT brain scan.  The scans were interpreted by radiologists in Yuma, as well as telestroke doctors with smartphones.

While the researchers determined that the smartphones didn't perform perfectly--particularly when it came to evaluating subtle neurological features--there was a high level of agreement when it came to the critical aspects of CT scan interpretation, such as making treatment recommendations.

Fishman called such functionality "convenient and accurate" when it comes to reading studies, but also said it has its drawbacks.

"It's good because you're always available and if a person want's your opinion, you can give it remotely right away," Fishman said. "That's also the downside--you're always available, and that can be a challenge for some people."

While such portable devices may encroach on off-hours, Fishman said that ultimately, radiologists should recognize that they also offer an opportunity to create a better connection with referring physicians.

"We have this concern about radiology becoming a commodity," Fishman said. "But, something like the iPad allows you to be totally available and really demonstrate that radiology is not a commodity."

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