From helping to demonstrate the meaningful use of electronic healthcare records (EHRs) to improving workflow in the MR imaging suite, ever-evolving mobile devices are well on their way to becoming embedded in the daily routine of many radiologists.
Along with tapping into mobile apps for their convenience and potential for collaboration, consultation and teaching, radiologists are using them to strengthen relationships with referring physicians who are adopting the technology in greater numbers and to improve relationships with patients who appreciate the acessibility mobile apps afford.
"Now I can do my job better because I am always available to answer questions on a CT study," said Elliot K. Fishman, M.D., director of diagnostic imaging and body CT at Johns Hopkins University Medical Center in Baltimore. Dr. Fishman was named RSNA Outstanding Educator in 2009 and is vice co-chair of the RSNA-American College of Radiology (ACR) Public Information Website Committee and serves on RSNA's Public Information Committee and Public Information Advisors Network. "Because you are always available, it really improves patient care."
As tablets continue to offer greater image clarity, resolution and functionality, mobile devices will move beyond a consultative role to a diagnostic one, experts say.
Introduced this spring, Apple's iPad 3 makes it easier for radiologists to review images, potentially moving medical imaging closer to using mobile devices for diagnostic purposes. Mobile MIM Software was one of the first apps for diagnostic radiology approved by the U.S. Food and Drug Administration (FDA), opening the way for other companies.
"Due to recent innovations in computer hardware and software, the iPad and other tablet devices have emerged as the newest forms of mobile computing with a role in image interpretation," Dr. Fishman said.
With a retina display of 2,048 by 1,536 pixels, iPad 3 features more than four times the number of pixels offered by iPad 2 and a million more than a high-definition television, said Mark Cain, chief technology officer at MIM Software.
"If you have an X-ray that is 4,000 by 4,000 pixels, you might not be able to see the whole image at once, but you can see large portions of it at a time and you don't have to pan over it as much," Cain said.
Full-volume rendering is also possible on the iPad 3 using the syngo® via WebViewer application created by Siemens Medical Solutions and used at Johns Hopkins. By loading a data set at full resolution, the application allows the user to interact in real time, essentially turning the iPad 3 into a mobile workstation, Dr. Fishman said.
"All the typical things you associate with the workstation we are able to do in real time on the iPad 3 without sacrificing quality," Dr. Fishman said. "In fact, the iPad 3 is faster."
Introduced at RSNA 2011, another app allows radiologists to track patient follow-up through their EHRs, potentially creating closer relationships with referring physicians.
Utilizing Softek's Illuminate PACS plug-in application with their Philips Healthcare software, users can tag the studies they want to follow and select a time window for the follow-up. The system automatically sends an alert when the follow-up study is performed and when the time window for follow-up expires. Alerts can also be created so radiologists know if a particular patient has returned for the recommended follow-up test.
"This is a whole new area," said app developer Safwan Halabi, M.D., of the Department of Radiology at the Henry Ford Health System in Detroit. "If I schedule a follow-up, this plug-in will alert me if that patient has or has not been seen at our healthcare system. This not only helps the primary care physician but also the continuity of patient care."
The app also makes it easier for radiologists to learn whether their initial interpretations were correct. For example, a radiologist who interprets a lesion on a chest X-ray as abnormal could ultimately learn it was benign. "If I do that 20 times and continue to get that negative feedback, it may help me avoid making that recommendation in the future, or vice-versa," Dr. Halabi said.
The app also helps guard against frivolous recommendations and add to the value of the radiology service, Dr. Halabi said.
While its use is so far confined to his institution, a Stanford University researcher has developed an app that improves workflow in the MR imaging suite.
Andrew Holbrook, Ph.D., developed the app using webOS software to operate on a modified mobile phone and a Hewlett-Packard (HP) TouchPad tablet, allowing users to control an MR imaging scanner. Dr. Holbrook removed most of the metal components so the user can operate the devices more safely in the MR imaging room.
"The big advantage is that the physician performing an intervention can also be the 'driver' of the imaging," said Dr. Holbrook, a research associate in the Department of Radiology at Stanford. "For example, every issue does not need to be communicated back to someone in the control room. With intuitive multi-touch gestures, radiologists can make changes themselves."
Although HP is no longer involved in the manufacturing of tablet PCs with webOS, the project has moved beyond the dependence on this operating system. Dr. Holbrook is now developing applications using modern, cross-platform web technologies that can run on a myriad of devices including PCs and tablets, regardless of vendor.
Challenges remain and radiologists aren't likely to abandon traditional workstations overnight, but experts say the industry is definitely moving in that direction.
In fact, in a study published in the March 2012 issue of Emergency Radiology, Dr. Fishman and other Johns Hopkins researchers found no difference between the use of an iPad and a PACS workstation in terms of diagnostic accuracy for detecting pulmonary embolism.
The device "has the potential to expand radiologists' availability for consultation and expedite emergency patient management," according to the authors.
"It's the best of both worlds—the application provides everything you need," Dr. Fishman added.
Along with the ultra-readable RSNA News tablet edition, RSNA offers other member-exclusive "must-have" apps free to iPhone, iPod touch and iPad users, including:
Access m.rsna.org from your smartphone or other mobile device to find select content in a mobile-optimized format:
For more information on RSNA mobile features, go to RSNA.org/Mobile_Options.aspx.
Coming soon, RSNA's newest app will offer patient safety content from RadiologyInfo.org for tablets and smartphones.
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