Popular Gadgets Find Place on the Job in Radiology

The radiology community has long been one of inventors and technophiles, and it should come as no surprise that its members are jumping at every opportunity to make use of new popular gadgets as they pour into the mainstream. Several RSNA 2008 presentations reflect this phenomenon.

"A few days ago I let my 3-year-old daughter use the Nintendo Wii™ for the first time, and within a minute she was pointing and clicking," said RSNA 2008 presenter Brian Kalbfleisch, who plans to demonstrate the potential applications offered by the 'Wiimote's' intuitiveness.

"First there is depth—you can move objects on the z axis just by moving closer or farther away," said Kalbfleisch, RSNA's Web architect. "Second is tactile feedback. As you move over objects, you can rumble the Wiimote and also generate sounds."

Kalbfleisch said he envisions many uses in radiology. "Imagine being able to search data and have relevant results appear closer to you," he said. "As you move the Wiimote over images, it can rumble when you move over a problem area, such as cancer. You can rotate and zoom images just by moving your wrist."

In recent years mainstream gadgetry has offered new breakthroughs in image storage, manipulation and transmission. In particular, "smartphones" such as the Apple iPhone™ have readily found their way into radiologists' daily practice.

One unabashed gadgetry fan is the author of the Not Totally Rad Weblog. The diagnostic radiologist and university professor refers to himself as the Samurai Radiologist, a nod to John Belushi's samurai skits on "Saturday Night Live." The Samurai Radiologist, who asked that RSNA maintain his anonymity, received his medical degree in the late 1970s and now resides on the West Coast.

"It's probably the most revolutionary device I've used in the last 10 years," the Samurai Radiologist said of the iPhone. "I remember being at the RSNA annual meeting 15 or 20 years ago and chatting with a friend about the wacky possibility of a device that would let us say, 'Here, let me show you this cool case I have.' I guess this was the device we were thinking of."

Image Quality No Longer an Issue

As with the iPhone's predecessors—"pocket radiologist" and "pocket PACS" have thrived for many years on cheap wireless connections—there is concern about its small screen. Image quality, however, is less of an issue, said RSNA Radiology Informatics Committee member Adam E. Flanders, M.D. "We used to play a lot of tricks to get the images to wireless handheld devices, which would inevitably downgrade the image quality," said Dr. Flanders, a professor of radiology and rehabilitation medicine, co-director of the Division of Neuroradiology/ENT and director of radiology informatics research at Thomas Jefferson University Hospital in Philadelphia. "Now it's possible to get a full-fidelity image across the 'ether' and onto your device intact—it's just a miniaturized version of the real image."

Asked whether he would be confident making a diagnosis on a smartphone, Dr. Flanders noted, "I guess that would depend on whether or not it was going to be my final diagnosis or a consultation. If the abnormality is obvious, great; if I don't see an abnormality, I would feel more comfortable re-examining the image at the workstation."

An RSNA 2008 scientific paper session, "Are Second Opinions on Appendicular Skeletal Trauma Accurate on Smartphones?" will address such questions in a specific population. An education exhibit, "Simple Framework for Viewing PACS Images on Smartphones," also addresses questions.

For now, it seems radiologists still prefer the standard workstation. "I have a Blackberry® and I like to show people cine loops of CT angiograms, to demonstrate that you can actually visualize those conditions on the small screen," said Dr. Flanders.

Another valuable use of a Web-enabled smartphone is monitoring practice workflow and efficiency by using secure Web services as add-ons to information systems, added Dr. Flanders. "Every 5 or 10 minutes I can check to see what sorts of studies are stacking up and preempt someone paging me," he said.

Referring physicians may stand to benefit the most from visualization on smartphones, said some radiologists. "An image-enabled smartphone can be a useful tool for mobile clinicians who don't have immediate access to a dedicated enterprise workstation," said Dr. Flanders. "They can even share the images with their patients at the bedside."

Technologically minded radiologists said they are still waiting on a "killer application" for the iPhone. MIMvista, a medical imaging viewer, is the source of much anticipation, said the Samurai Radiologist. "The demo version comes with preloaded cases and you can zoom in, zoom out and window/level," he said. "If you want to do that with your own images, you have to buy a product they don't ship yet."

Noted Dr. Flanders: "There will probably be a rebirth of these things people have started to visit and play around with. They will be especially appealing for educating younger radiologists."