Radiology Workflow Meets Mobile Devices
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 an iPad tablet, clinicians present multimedia pre-procedure instructions for a breath-hold and explain how a CT scan works, says Choy. "If the patient understands how he or she is supposed to participate, you can get better quality images, correct diagnoses, as well as no indeterminate scan results." Many procedures are complex to explain; however, the iPad allows physicians to offer a visual representation to patients, Choy says.
There are other imaging scenarios where iPads may have advantages. "Having iPad apps approved for diagnostic interpretation is a move forward," he continues.
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 of 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.
While iPad is not the only tablet, resolution and image processing are going to improve on all tablets, says Choy. "Then, we'll see many more use cases."
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. If an image can be acquired when a radiologist might not be available for immediate review, 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 [they] always have a phone. That's where you can save minutes, which can make a huge difference," Choy says.
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 operate and be supported as an enterprise device. [It needs to have] all the necessary security components and tie 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 now can remotely employ a video consultation with a patient.
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.
As part of that transformation, the radiology program is compiling a standardized collection of reference materials in electronic format accessible from iPads, "creating an electronic library that's mirrored across devices," says Miller.
The iPad lends itself to collaboration both because of its capability to render high-resolution images and because off-the-shelf apps enable facilitators to share images with residents for instruction via remote desktop functionality, Miller says. Web-enabled shared-session capabilities from a hospital PACS are just starting to come to market, adds Nagy.
However, "when it comes to a purely clinical role, it's not as powerful for radiologists," Nagy says. "It could be a good control panel for interfacing with high-resolution monitors, but the real power is going to be in hands of referring clinicians [as radiologists collaborate] with them."
The iPad can handle template reporting and the pictographic analysis that some radiologists prefer. "In radiology, I can see it being a helpful secondary information source and control surface. You want diagnostic screens to be nothing but images, but you want to have other sources that are synced to help manage all the information around it," Nagy says.
An iPad could be a diagnostic tool. It possesses the brightness, high-resolution and long-lasting batteries that are the 'killer triad' required to make it useful for physicians on rounds and in other areas. "And we've seen PACS vendors respond, migrating their platforms onto the iPad," he says.
Still, the platform is not the device, Nagy and Miller concur. Vendors are creating HTML5 platform-agnostic applications, not native apps for the iPad. "The platform is HTML5 and it's going to be [vital to the] transition to mobile apps, but the device is not as important as the concept of interoperability and mobile distribution," Miller explains.
Nevertheless, mobile devices are flexing their muscles in radiology, demonstrating their utility in patient education, clinician communication and more. And, if radiology follows in the path of other specialties, physicians are likely to uncover new roles for the devices. Stay tuned.
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 an iPad tablet, clinicians present multimedia pre-procedure instructions for a breath-hold and explain how a CT scan works, says Choy. "If the patient understands how he or she is supposed to participate, you can get better quality images, correct diagnoses, as well as no indeterminate scan results." Many procedures are complex to explain; however, the iPad allows physicians to offer a visual representation to patients, Choy says.
There are other imaging scenarios where iPads may have advantages. "Having iPad apps approved for diagnostic interpretation is a move forward," he continues.
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 of 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.
While iPad is not the only tablet, resolution and image processing are going to improve on all tablets, says Choy. "Then, we'll see many more use cases."
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. If an image can be acquired when a radiologist might not be available for immediate review, 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 [they] always have 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 in 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 operate and be supported as an enterprise device. [It needs to have] all the necessary security components and tie 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 now can remotely employ a video consultation with a patient.
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 are exploring use cases for mobile platforms as well. The department is providing iPads for all residents and will evaluate the devices for research and clinical applications, as well as collaboration and instruction, says Carl Miller, MD, chief resident in radiology. "We think [the iPad] has tremendous potential to transform clinical education in radiology," he says.As part of that transformation, the radiology program is compiling a standardized collection of reference materials in electronic format accessible from iPads, "creating an electronic library that's mirrored across devices," says Miller.
The iPad lends itself to collaboration both because of its capability to render high-resolution images and because off-the-shelf apps enable facilitators to share images with residents for instruction via remote desktop functionality, Miller says. Web-enabled shared-session capabilities from a hospital PACS are just starting to come to market, adds Nagy.
However, "when it comes to a purely clinical role, it's not as powerful for radiologists," Nagy says. "It could be a good control panel for interfacing with high-resolution monitors, but the real power is going to be in hands of referring clinicians [as radiologists collaborate] with them."
The iPad can handle template reporting and the pictographic analysis that some radiologists prefer. "In radiology, I can see it being a helpful secondary information source and control surface. You want diagnostic screens to be nothing but images, but you want to have other sources that are synced to help manage all the information around it," Nagy says.
An iPad could be a diagnostic tool. It possesses the brightness, high-resolution and long-lasting batteries that are the 'killer triad' required to make it useful for physicians on rounds and in other areas. "And we've seen PACS vendors respond, migrating their platforms onto the iPad," he says.
Still, the platform is not the device, Nagy and Miller concur. Vendors are creating HTML5 platform-agnostic applications, not native apps for the iPad. "The platform is HTML5 and it's going to be [vital to the] transition to mobile apps, but the device is not as important as the concept of interoperability and mobile distribution," Miller explains.
Nevertheless, mobile devices are flexing their muscles in radiology, demonstrating their utility in patient education, clinician communication and more. And, if radiology follows in the path of other specialties, physicians are likely to uncover new roles for the devices. Stay tuned.