Prime Time for iPadOr Not?
Launched in April, the iPad continues to make waves across the world. Technophiles, teenagers and grandmas alike love the iPad, which has been touted as the tool to mobilize business users. Apple has sold about 8 million, with many physicians among those who have been bitten by the iPad bug.

In a February survey by Epocrates, 20 percent of U.S. physicians planned to buy an iPad. A larger group, however, remained somewhat cautious; 38 percent of physicians expressed interest in the iPad, but wanted more information to solidify their purchase decision.

At first glance, radiology seems to be a logical target for the iPad. Radiologists are, after all, a notoriously techno-savvy, gadget-happy group. And the iPad’s form factor is appealing. At 1.5 pounds with 10 hours of battery life, it’s a powerhouse in a featherweight package.  

Some physicians are utilizing Citrix to run healthcare apps supporting  HIPAA requirements by not storing data on the device and by using secure remote connections, while others are using a WYSE Cloud app that uses the iPad as a portal. A more secure iPad version (iOS 4.2) is expected to be available in a couple of months.

The 1024 x 768 resolution suffices for CT image browsing. Prime-time television ads even plug medical imaging apps (albeit, somewhat misleadingly, as its resolution does not suffice for primary diagnostic x-ray review).

So Health Imaging & IT, along with radiologists everywhere, are asking: Is the iPad ready for prime time? Early data suggest a cautious approach with patient education and consultation apps more viable than diagnostic image review.

The research realm

“There are several ways iPad can impact our work in radiology,” says Kamran Shah, a radiology resident and informatics fellow at the University of Maryland in College Park, who is presenting at RSNA 2010 on the subject. While the iPad’s small display and technology couldn’t suffice as a diagnostic workstation, he notes, it could provide a portable viewing application for clinical staff. “As a portable viewing device, iPad could have value if you envision a thin client powered on the iPad that could interface with an existing PACS and allow a surgery resident to review a CT of the abdomen before surgery.”

“I don’t see myself using the iPad for primary diagnosis; I still see myself sitting at a workstation with a proper monitor and in a proper environment, but there are roles for the iPad in radiology,” says Krishna Juluru, assistant professor, department of radiology, co-director of the Imaging Data and Evaluation and Analytics Lab at Weill Cornell Medical College in New York City. Juluru and colleagues have experimented with thin client tools on the iPad for visualization of axial images and 3D visualization of radiographic datasets where the 3D post-processing is done on a central server and images are streamed over to iPad.

According to Juluru, iPad’s success in radiology will hinge on the utilization of the multitouch screen for image manipulation. “With a keyboard and mouse, there are a lot of buttons available for a radiologist to manipulate the images. With the preliminary tools with which we were working, there weren’t enough options on the multitouch screen to allow us to manipulate the datasets in a way we felt comfortable with.” However, the technology continues to improve and radiologists are becoming more creative in their approach to the multitouch screen, he says.

Inside an early adopter

As researchers explore applications and utility, early adopters are tiptoeing into the market. Take for example Advanced Radiology Consultants in Trumbull, Conn. The practice uses iPads on a limited basis to assist consultation, collaboration and education. Neuroradiologist Gerald J. Muro, MD, has leveraged the iPad for consultation since July.

“If a referring physician wants to review a case and I’m not in the office, I have access to those images over the internet,” says Muro. “The iPad increases communication and connectivity, so there are fewer delays, and we’re more easily accessible by radiologists and referring physicians.”

As Muro waits for vendors to step up with iPad apps, he anticipates apps that could be used to show patients their images on the iPad, which could increase patient engagement and satisfaction.

The iPad for radiology is a work in progress. Early adopters and researchers are still determining its utility. Although it’s unlikely to replace traditional workstations, the iPad could provide a handy complement to the radiologist’s toolkit.

iPad meets medical education

This fall, Stanford University in Palo Alto, Calif., equipped 98 incoming medical students with iPads. The main goal is to improve the student learning experience by giving them flexible access to content whether it is a virtual cadaver in the dissection lab, annotated lecture slides and videos in the classroom or journal articles for evidence-based practice in clinic.

The medical school has not yet determined the practical impacts of the project, but pioneers point to its potential.

“Hopefully, we’ll begin to see new kinds of content delivery that take advantage of the iPad’s capabilities emerging. You could imagine [iPad use] in an educational setting where curriculum are more interactive, more graphically-based and more video intensive,” says Michael Halaas, chief technology officer at Stanford’s School of Medicine. “Given that medicine is a technology-intense field, having students learn how to learn with technology and learn how to adapt to new technology is a skill in and of it itself.”

Stanford is collecting statistics on the use of iPads and laptops so it can better understand how students use the devices, Halaas says.

Some medical apps, but not many

The number of iPad applications dubbed “medical” is growing daily with a total of 483 medical iPad applications as of early this fall. However, “medical” may be a loose term in the app world.  

A few apps focus on clinical evaluation of specific conditions, others provide patient education tools and a final group offers generic health information.

Radiology apps are far fewer. The iTunes Store markets a mere 11 apps compared with 59 iPhone radiology applications. A few radiology iPad apps include:
  • iClarity: A medical image viewing app that enables viewing images stored on ClarityPACS, or using iClarity Gateway, to receive and view images from an existing PACS.
  • HD Radiology: A reference guidea.
  • modalityBODY: Interactive anatomy and Medical Imaging for iPad: For professional reference, training and patient education.
Radiology vendors have made available iPhone applications for clinical use. Although some iPhone medical applications can be ported to the iPad, image resolution issues can arise in transition if applications are not specifically developed for the iPad, says Advanced Radiology Consultant’s (Trumbull, Conn.) Director of IT Chris Craft.

Is it game time?

While some physicians and vendors are geared to leap into the iPad world, others aren’t so sure.

For starters, the FDA has rained on the parade. MIMvista, a software developer, pulled its Mobile MIM iPhone application from the U.S. iTunes App Store after the FDA classified the application as a class III medical device requiring pre-market approval. Given the regulatory uncertainty, vendors are expected to issue disclaimers about image viewing on iPads.

Even if the iPad gets a pass from the FDA, detractors wonder whether or not it can withstand the medical environment. Compared to tablet devices designed for healthcare, the iPad is fragile and lacks an integrated camera and barcode scanning capabilities. Some other issues to consider are:
  • iPad is not equipped with sealed ports, making it susceptible to damage from disinfectants and hospital fluids;
  • Security and HIPAA-compliance are precarious without fingerprint access and password-authentication and encryption; and
  • iPad might not be a clinician’s only device and it might prove difficult to concurrently support laptops, iPads and desktops.