The medical image information system architecture has zoomed along in the last two decades with radiology evolving from viewing analog film on old-fashioned, wall-mounted lightboxes to reading digital images on industrial-strength PC workstations. Now medical imaging has reached the threshold of the next stage — viewing images on portable, handheld devices. So what's the upside on "downsizing"? Just take a peek!
Next-generation tablets, PDAs and Palms and image-enabled cell phones will be used to transmit and view images, predicts Edward Zaragosa, MD, associate professor of radiological sciences at University of California Los Angeles (UCLA). "Handheld viewing will allow physicians to finish the day in a timelier manner and ultimately deliver better care," Zaragosa says.
Handhelds certainly will not overtake desktops as the primary viewing apparatus, and screen size, resolution and battery life are valid concerns, says Zaragosa. But there are a number of niche applications where handhelds are just what the doctor ordered. What's more, technology is advancing rapidly, and new devices could overcome or minimize barriers presented by screen size and resolution. On the IT side, data streaming technology is expected to improve handheld image viewing.
For a few cutting-edge physicians, the era of handheld image viewing has arrived. Handheld users run the gamut from primary-care physicians to radiologists and clinical specialists. "In today's environment physicians are more mobile and need access to relevant data at the patient's bedside [and throughout and beyond the enterprise]," explains Dave Wilson, director of product management for Agfa Healthcare.
Applications at a glance
Handhelds fit the bill in a number of clinical scenarios, providing physicians with more immediate access to images and data, which, in turn, accelerates and improves patient care.
Zaragosa relies on OsiriX open source DICOM image viewing software to store unusual teaching cases to enable storage of images on an iPOD handheld computer. "The beauty of these systems is the storage capacity of 60 to 80 gigabytes. I can store screen resolution images [for quick viewing] or full resolution images to be uploaded to another system [such as a desktop computer]."
Cardiologists at Blunk Clinic in Bad Saarow, Germany, rely on IMCO Technologies IMCO-STAT software to view ultrasound, cath lab studies and echocardiograms acquired at Humaine Hospital. "The benefits are immediate access to images, which saves physicians' time. Decision-making is better coordinated, which can result in a shorter length of stay for the patient," says Werner Ullrich, PhD, country manager, Germany, for IMCO Technologies.
Angie Haas, MD, vice president and chief medical information officer for Susquehanna Health System in Williamsport, Pa., relies on a Motion Computing LS800 Tablet PC to view x-ray, CT and MRI studies anytime, anywhere. Haas launches into the images through Siemens Medical Solutions Soarian clinical information system. "It fosters better patient care," sums Haas. Another plus is improved turnaround time. For example, a radiology report may not be available when Haas sees her patient. She can view images on the handheld and make a preliminary diagnosis of pneumonia to accelerate care.
Providence Health System in Portland, Ore., has deployed tablet PCs in seven Oregon hospitals. Images stored on Philips Medical Systems iSite PACS can be viewed on the tablets, but acceptance is spotty, says Dick Gibson, MD, chief medical information officer. The primary barriers relate to tablet features and construction, not PACS software. Physicians working in limited geographic environments like the ER or ICU are more likely to embrace tablets because they can switch devices when the battery expires or access a keyboard fairly easily.
On the other hand, highly mobile, rounding physicians complain that today's tablets are too heavy and don't fit into a pocket, says Gibson. Plus more mobile clinicians cannot easily re-charge the battery or tap into a keyboard.
Despite some shortcomings, Gibson believes hospitals will overcome the barriers to more universal use of tablets as an image-viewing device. He says multiple docking stations for re-charges and keyboards will boost adoption and facilitate a successful implementation.
There are significant differences among handhelds — particularly with screen size and resolution. Clinical needs drive the decision about the appropriate