RSNA News - April 2005

Handheld Technology for Radiology on the Brink of Big Expansion

We're at the cusp right now where a lot of the applications that we may use on a daily basis as radiologists will be able to reside on a handheld device or a device slightly larger than a handheld.
—Adam E. Flanders, M.D.

Personal digital assistants (PDAs) and other handheld devices are soon expected to become even more valuable to radiologists. Recent advances in PDA technology, including high-resolution screens, increased storage capacity and wireless networking, are leading to the development of more sophisticated radiology-specific applications.

William W. Boonn, M.D.

Hospital of the University of Pennsylvania

"I think we're at a turning point where the applications are just starting to catch up with the technology that's available," said William W. Boonn, M.D., a radiology resident at the Hospital of the University of Pennsylvania in Philadelphia and also the founder of the Web sites MedicalPocketPC.com and MedicalTabletPC.com.

Dr. Boonn and Adam E. Flanders, M.D., a neuroradiologist from the Department of Radiology at Thomas Jefferson University Hospital in Philadelphia, conducted a survey of RSNA members to gauge the use of PDAs in radiology and compare it with other medical specialties. Their article appears in the March-April issue of RadioGraphics.

Of the 528 RSNA members who participated in the survey, 238 (45.1 percent) reported owning a PDA or using a PDA on a daily basis. The most common use was for the address book and calendar functions.

"The surprising thing was that less than a quarter of the respondents use these devices for radiology-specific applications—that's lower than the percentage for other physicians, such as internal medicine physicians, who use their PDAs for medicine-specific applications," Dr. Boonn reported.

Survey Demographics Of 1,658 randomly selected active and training RSNA members within North America, 528 (32.4 percent) completed the survey. 417 Men (79.0%) 104 Women (19.7%) 181 Academic Practice (34.3%) 319 Private Practice (60.4%) 91 Trainees (17.2%) 413 Attending or Board-certified Radiologists (78.2%)

He suggested two reasons for the finding. "One, I think clinicians are often more on the go and may not have access to a PC. Therefore, it's much more convenient for them to be able to access information on a portable handheld," he explained. "That's in contrast to the radiologist who often works in front of a full PACS workstation and desktop computer."

The second reason involves the technology itself. "For a while, PDAs really were not powerful enough to handle a lot of the tasks that were required by radiologists," he said. "For example, viewing radiology images requires a fairly high-resolution screen. Only the more recent PDAs have had the capability of displaying these higher resolution images."

The storage requirement for images is also much higher than for text data or applications like drug databases. "Previously, PDAs did not have the memory capability to store sufficient images to be really useful," Dr. Boonn said. "But at this point, the newer, more powerful PDAs can carry up to a gigabyte or more of memory. Therefore, the applications that are designed for the radiologist can be much more useful."

The survey also showed that residents and fellows were more likely to own PDAs than were attending physicians. The residents and fellows were also more likely to have radiology software installed on their PDAs.

"I think younger trainees are much more comfortable with the devices. And, in a lot of ways, they have a greater need for radiology-based applications than radiologists who are already in practice," said Dr. Boonn.

Use of PDAs

238 (45.1%) on a daily basis Address book and calendar (98.3%) Drug references (31.2%) Radiology applications (24.6%) General medical references (21.7%) E -mail/internet access (13.6%)

290 (54.9%) did not use a PDA Never really found a need for one (83.3%) Poor screen readability (19.7%) Too awkward to use (16.7%) Not enough applications (13.3%) Not enough radiology software available (12.9%)

Radiology Applications on the Horizon?

The researchers also found a relative lack of PDA software designed for radiology, compared with other medical specialties.

Adam E. Flanders, M.D.

Thomas Jefferson University Hospital

Dr. Flanders suggests two applications that could be useful for radiologists. "I think it would be really compelling for radiologists to be able to dictate into their PDA directly into a speech recognition engine," he said. "Sometimes radiologists are in a procedure room or the operating room and have to dictate a report. It would be easier if they could just dictate into a device they have in their pocket and the report could be immediately uploaded into the radiology information system for the clinician or whomever needs to view the report."

Dr. Flanders also suggested being able to monitor a radiology practice via a PDA. "Today's radiology practices are often decentralized and typically own multiple imaging centers," he explained. "Even with soft copy reading, many radiologists find that they are splitting time between two or more sites each day. Using a Web-enabled cell phone/PDA, radiologists can potentially have instant access to information from anywhere about their practice that normally would have required a few phone calls and more time."

He said valuable practice metrics could include:

• Up-to-date information about the patient schedule to identify delays or backlogs
• Monitoring workflow for volume of undictated studies or unsigned reports
• Access to the protocol engine at a modality to make up-to-the-minute changes in study design

Dr. Boonn said several radiology applications are being developed for the PDA that take advantage of wireless networking. "These include the ability to protocol studies or to monitor the workflow parameters on the network," he said, pointing to a number of posters and demonstrations of novel projects involving PDAs in radiology that he saw at RSNA 2004 in the Mobile Computing Pavilion and in the infoRAD area.

Is there any other technology that might compete with or even eclipse the PDA for use among radiologists? Drs. Boonn and Flanders agree it is the Tablet PC.

"The Tablet PC is a full-featured Windows XP system that allows you to run desktop applications on a fairly portable device," Dr. Boonn said. "Almost any application that you can run on your desktop computer, such as your Web-based PACS, RIS or speech recognition program can be run on a Tablet PC. The advantage of these devices is the ability to use a stylus for pen-based input. The screen resolution on the Tablet PC is also much higher and, as a result, may replace the PDA for some people. The downside is that these devices are more expensive and are not as mobile as PDAs."

Although their study showed that the number of radiology applications and radiology-specific use are both fairly low at this time, Drs. Boonn and Flanders said that will soon change.

"With the advent of more powerful PDAs, the growth in development of software applications and the fact that more and more trainees are coming into practice comfortable using PDAs, I think the future is pretty bright for the exciting use of PDAs in radiology," Dr. Boonn emphasized.

"We're at the cusp right now where a lot of the applications that we may use on a daily basis as radiologists will be able to reside on a handheld device or a device slightly larger than a handheld," Dr. Flanders added. "Get ready. There are a lot of exciting things to look for in the next few years."

To view the RadioGraphics article, go to rsna.org/radiographics and click on the journal cover for the current issue articles.