Mobile Devices Expand Radiologists Horizons

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mobile-cisco.jpg - Tablet
Radiologists share and discuss images with referring physicians using a mobile Cisco Cius tablet at Palomar Pomerado Health in San Diego.

Can mobile devices such as iPads and Androids untether radiologists from their stationary workflows? Maybe not right away, but evidence is building that these systems will improve efficiency and communication in radiology.

Patient education to optimize scanning is already going mobile in some radiology departments—especially in specialties where "you only have one shot, and you want to get it right, particularly with cardiac CT," says Garry Choy, MD, staff radiologist in emergency radiology and teleradiology at Massachusetts General Hospital (MGH), in Boston. Choy and colleagues are working on an educational app with simple pre-procedural instructions for cardiac imaging patients.

Using the iPad tablet, clinicians present multimedia pre-procedure instructions for the breath-hold and explain how a CT scan works, says Choy. "If the patient understands how he or she is supposed to participate, you get better quality images, correct diagnoses, as well as no indeterminate scan results." Many procedures are complex to explain; the iPad allows physicians to offer a visual representation to patients, Choy says.

There are other imaging scenarios where iPads may have advantages, he continues. "Having iPad apps approved for diagnostic interpretation is a move forward."

Earlier this year, the FDA approved the first diagnostic application for mobile devices, which allows physicians to view CT, MRI and PET images.

"The FDA has done a good job in seeing the value that the iPad has in the healthcare enterprise, but more study in real-life situations needs to be conducted," Choy says. "I still haven't seen anyone calibrate an iPad to the DICOM Part 14 Grayscale Display Function that optimizes a display for medical images," notes Paul G. Nagy, PhD, visiting associate professor in the department of radiology at Johns Hopkins University in Baltimore.

Furthermore, "The iPad is not the only tablet. Resolution is going to improve, processing is going to improve. We'll see many more use cases," explains Choy.

Tablets are not the only mobile platform, either. Choy and Supriya Gupta, MD, also from the department of radiology at MGH, conducted a study (in press) on the use of smartphones for interpretation of stroke. When a radiologist might not be available for immediate review, if an image can be acquired, it can be sent to a radiologist who can quickly decide whether a patient has had a stroke and direct him or her to the appropriate treatment center.

"The radiologist may not be in front of a PACS workstation, but always has a phone. That's where you can save minutes, which can make a huge difference," Choy says.

Beyond iPads

Palomar Pomerado Health (PPH) in San Diego rolled out 20 Cisco Cius tablets beginning late July as part of a mobility initiative. Using an internally built platform called MIAA (Medical Information Anytime Anywhere), on-the-go physicians have the power to leverage vital signs monitoring and EHR information. The platform was built one year ago while working with Cisco to test the pre-release version and provide feedback on the mobile device, says Orlando Portale, chief innovation officer at PPH.

The MIAA, built for use on an Android platform such as the Cius tablet, provides electronic health information including radiology reports and images, explains Portale. "The key differentiator is the ability to run and be supported as an enterprise device. [It needs to have] all the necessary security components and hooks into the hospital's network infrastructure so that a physician can bring it into the hospital, get the device authenticated and connect into the unified communications network."

The project has been a boon for collaboration and communication at PPH, according to Portale. Added functionalities like real-time video conferencing can assist physician-to-physician communication as they review a radiology report or image. Also, a referring physician can now remotely employ a video consultation with a patient as well.

From the radiology perspective, the ability to share images and reports for reviewing purposes is helpful for referring physicians so they are not flying blind on a particular patient on a mobile platform. If a patient is seen in the outpatient setting, a physician can pull up a comprehensive view of his or her EHR information on the tablet and view radiology images and the report, says Portale.

Expanding use cases

Residents in the department of radiology and radiological sciences at Johns Hopkins