Rodrigo Ayala, RT, imaging technologist in the Imaging Data Evaluation and Analytics Lab at Weill Cornell Medical College, views an abdominal CT on an iPad.

CHICAGO—Robust screen resolution for CT and MRI, solid encryption measures and new radiology vendor apps render the iPad (Apple) suitable for CT and MR image reading and "help combat the trend of decreasing radiologist-patient and -clinician interaction," according to Toshi Clark, MD, who will present the findings Dec. 1 at the annual meeting of the Radiological Society of North America (RSNA) in Chicago.

Clark, a radiology resident at Nassau University Medical Center in East Meadow, N.Y., and colleagues created an abstract model of the components that would be required to view a study and generate a diagnostic report on the iPad. The requirements included: display performance, network connectivity, DICOM visualization, report generation, RIS interface and data security.

In an interview with Health Imaging News, Clark, who studied computer science before attending medical school, said that "the resolution requirements of CT, MRI and ultrasound are handily met by the iPad's 1024 x 768 resolution." Meanwhile, Clark noted that "whether film-screen cassettes, computed radiography or digital radiography is used, the spatial- and contrast-resolution requirements of plain radiography and mammography far exceed the specifications of the iPad's display."

Speed also should be a non-issue. Clark and colleagues found that WiFi access speed would be roughly comparable to hospital Ethernet, while the software program OsiriX will enable advanced visualizations and secure DICOM queries on the iPad in its forthcoming release.

"Finally, data security/HIPPA compliance would be ensured by 128-bit SSL connections and passcode encryption of all data, features of iPhone OS 4.0," Clark and colleagues wrote.

With sufficient resolution, speed and security, PACS vendors would have the incentives to develop additional radiology viewing applications. For example, Merge Healthcare's eFilm Mobile enables access to worklists through a RIS/hospital information system interface.

Clark expressed his belief that "the iPad can help combat the trend of decreasing radiologist-patient and -clinician interaction ... and might allow radiologists to become more untethered from their reading rooms." He envisions outpatient imaging centers especially benefiting from the mobile device's capabilities, which might enable radiologists in these facilities to walk patients through imaging findings without any extended delays.

Untethered rad in action
One clinical implication of the iPad that could rather drastically impact emergency care, Clark proposes, is to use the iPad for image guidance and to perform central line insertion checklists during procedures outside of the operating room. According to Clark, intensive care "patients are often too unstable to be moved to areas of the hospital with PACS and other radiology imaging viewing devices, yet radiologists still need to perform procedures on them." One option would be to come into the ICU with an ultrasound machine and an iPad attached to the arm. This would be a clean and easy way to construct 3D images and perform procedures without PACS.

Clark and co-authors' findings suggest a number of other applications, including department making use of an "on-call iPad," much as departments use "hot pagers," to allow radiologists to read remotely without additional PACS workstations.

In addition to improving patients' access to their studies, iPad could boost efficiency. "Being able to view and interpret studies or complete procedure-related paperwork, regardless of the physical location, could increase efficiency and decrease the latency between study completion and the availability of the report on the electronic medical record," concluded Clark.