Radiology? There’s an App for that—The iPad & Imaging

While tablet computing had been around long before the launch of the iPad in spring 2010, its move into the mainstream has been nothing short of revolutionary. Tablets are everywhere, including medicine, and they hold particular promise for radiology.

As of 2012, just two years since the iPad burst onto the scene, physician tablet adoption for professional purposes had reached 62 percent, with Apple’s device being the dominant platform, according to healthcare market research firm Manhattan Research. Here’s how they are used in medical imaging:

Viral image sharing

The most obvious differences between an iPad and the iPhone smart phone that preceded it are screen size and resolution. At 9.7 inches diagonal, and up to 264 pixels per inch, for the first time radiologists can view and share the images and accompanying reports on a mobile device.

And PACS vendors have responded. The ability to access images through a mobile app is a standard feature in the PACS industry, and has made sharing information with referring physicians easier than ever.

“It’s been a great tool for our referring physicians because iPhone and iPad penetration in the physician space is very high … so everyone is kind of used to the app ecosystem and the utilization of products through apps,” says Satish Mathan, MD, incoming president of Raleigh Radiology in Raleigh, N.C.

Raleigh Radiology has been using a mobile image sharing app supported by its PACS vendor for about two years, and Mathan says it’s a much faster way to access images and makes it easier to take care of patients while on call. He says the practice felt offering the app would be a good way to differentiate itself in the market, as opposed to relying on more cumbersome browser-based mobile viewing systems. Their marketing team went to work, too. Flyers with instructions on how to install the app, connect with the server and search patients were created and sent to referring physicians.

Once physicians found out about the app, its spread was almost viral, says Mathan. One physician could tell another during an elevator ride, and the second person would download the app on the spot and instantly access the system using the same credentials they had for traditional portals.

Raleigh Radiology doesn’t track usage, but Mathan says use by outside physicians is strong, and during the few times server maintenance shut down access to the app, the practice fielded a number of calls asking when it will be back online. Anecdotally, Mathan reports that specialist use of the app is higher than primary care physician use.

Edging into interpretation

The iPad’s screen resolution is high for a mobile device, but it’s not ready to replace the standard clinical workstation in a reading room. That said, a few studies have compared the tablet with consumer-grade LCD monitors and found that, in a pinch, either works just as well as a secondary display for interpretation.

Mark McEntee, PhD, of the University of Sydney, Australia, and colleagues completed a study analyzing the results of eight U.S. board-certified radiologists attempting to identify intracranial bleeding, fractures and lung nodules on iPads, LCD monitors and high-resolution clinical monitors. The findings, presented at the 2012 International Society of Optical Engineering conference in San Diego, showed that while there were “noticeable differences” with the clinical monitors, both the iPad and LCD monitors fared the same.

Likewise, there was no detectable effect of using an iPad rather than a consumer-grade LCD for diagnosing tuberculosis, according to a study published in the January issue of the Journal of the American College of Radiology. Despite the consensus on interpretations between the displays, readers noted the iPad felt slower than the LCD monitor, according to Samir Abboud, MS, and colleagues from the University of Maryland School of Medicine in Baltimore.

"The limiting factor is a question of real estate. The typical tablet is smaller than a sheet of notebook paper, while a typical workstation can have two or three monitors with a 21-inch diagonal or greater," says Abboud.

"The mainstay of diagnostic radiology is, and should remain, the workstation," he adds. "However, interpretation of imaging studies is only half of the equation, communication to our clinical colleagues is equally important. While the tablets are not likely to change how studies are read, they do hold promise as communication and education tools."

An educational bounty

A poster presentation at the 2011 Society for Imaging Informatics in Medicine annual meeting in Washington, D.C., detailed the top 10 possible uses for an iPad in radiology education. According to Frederick Weiss, MD, of the University of Maryland in Baltimore, and colleagues, outside of the image sharing and communication tools of the iPad, other possible uses are:

  • The iPad is even smaller and more mobile than a laptop, making it a convenient platform for showcasing presentations. Keynote and Powerpoint presentations can be loaded onto an iPad, which can then be connected to an external display or projector (see sidebar).
  • Medical reference applications are available for the iPad, and textbooks could be read either through a PDF viewer or in iBook format.
  • A number of teaching file applications exist to aid radiology residents, including iRadiology, Radiology Assistant, Radiology 2.0, MIRC Viewer and Surgical Radiology.
  • Journal articles can be read anywhere using a tablet, and users may one day be able to interact with or manipulate 3D reconstructions from published articles, according to the presentation.
  • Remote desktop/connectivity through a VPN can provide access to applications not available as an iPad app.
  • Mobile cloud storage is available outside of whatever a practice’s PACS vendor offers through applications such as Dropbox. It should be noted, however, that Dropbox does not have HIPAA certifications, according to the company’s website, so use caution.
iPad in Court

Radiologic Associates of Gardiner, N.Y., was on the losing end of a $2.1 million malpractice lawsuit after the group was found to have failed to communicate findings of a spinal lesion on a CT scan, resulting in the patient, Mark Boyer, 56, permanently losing sensation in his legs. The plaintiff's lawyers stressed the importance of using an iPad to project CT and PET images in the courtroom.

"The iPad display of images made complex medical issues readily understandable for the jurors and directly contributed to their ability to correctly decide which of the defendants was responsible for Mr. Boyer's injuries," Margie Soehl of the Albany, N.Y.-based law firm Powers & Santola, told Health Imaging.

Soehl explained that there was no wi-fi in the court, but once the radiological studies were in evidence, they were saved locally on the iPad and displayed on a 50-inch plasma TV through the use of Apple TV and an Apple AirPort network.

"We have used iPads to display images in the courtroom before and will continue to use iPads to display medical images as well as documents," adds Soehl. "We believe that the use of iPads as well as other cutting edge technology will become a common practice in courtrooms."