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3D and Workflow: Ipad Applications Imaging Pearls - Educational Tools | CT Scanning | CT Imaging | CT Scan Protocols - CTisus
Imaging Pearls ❯ 3D and Workflow ❯ iPad Applications

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  •  “The CT Contrast Protocols application for the iPad and iPhone is one of the first radiology applications in the Apple App Store to focus on radiology education and was designed to address the lack of practical information on contrast media for radiologists, technologists, nurses, and trainees.”
     CT Contrast Protocols Application for the iPad: New Resource for Technologists, Nurses, and Radiologists
    Raman SP, Raminpour S, Horton KM, Fishman EK
    RadioGraphics 2013; 33:913-921
  • “The developers of the application thought that providing the user with specific questions and answers could be more practically useful on a day-to-day basis than a larger amount of text or information.”
     CT Contrast Protocols Application for the iPad: New Resource for Technologists, Nurses, and Radiologists
    Raman SP, Raminpour S, Horton KM, Fishman EK
    RadioGraphics 2013; 33:913-921
  •  “ We believe that this application, in addition to its educational value, is a clear illustration of the unlimited possibilities that exist in the mobile sphere, particularly on the iPad and iPhone, for radiology educational resource .”
     CT Contrast Protocols Application for the iPad: New Resource for Technologists, Nurses, and Radiologists
    Raman SP, Raminpour S, Horton KM, Fishman EK
    RadioGraphics 2013; 33:913-921
  • “For both readers, there was no significant difference in agreement with the reference standard for per-vessel stenosis scores using either the 3D workstation or the iPad. In a multivariable logistic regression analysis including reader, workstation, and vessel as co-variates, there was no significant association between workstation type or reader and agreement with the reference standard (p > 0.05). Both readers identified 100 % of coronary anomalies using each technique.Reading of coronary CT angiography examinations on the iPad had no influence on stenosis assessment compared to the standard clinical workstation.”


    Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies 
Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, John Eng, Elliot K. Fishman
Emerg Radiol (2016) 23:255–261
  • “When agreement with the reference was assessed per vessel for the presence of significant CAD, overall agreement in- creased to 87 and 90 % for the iPad and clinical workstations, respectively (difference, p > 0.05). There was 100 % agreement between readers and the reference for identification of coronary anomalies and aneurysms for both the iPad and clinical workstation.”


    Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies 
Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, John Eng, Elliot K. Fishman
Emerg Radiol (2016) 23:255–261
  • “The multivariate analysis showed the use of the iPad had no significant impact on the accuracy of coronary CTA reads. In a multivariable logistic regression analysis including reader, workstation, and vessel as co-variates, there was no significant association between workstation type or reader and agreement with the reference scores for presence of significant CAD (p > 0.05).”


    Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies 
Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, John Eng, Elliot K. Fishman
Emerg Radiol (2016) 23:255–261
  • “Coronary CTA imaging requires considerable training and expertise. Mobile devices can be used to expand avail- ability of these expert readers by allowing them to perform evaluations anywhere with a reliable internet connection. If implemented in the clinical routine, it is important to consider how these results will be communicated to the covering physicians. In our practice, when a remote study is performed, the reading physician is provided the contact information of the ordering physician and discusses the case directly with the referring. A preliminary verbal report is then stored in our electronic medical record by the ED provider until the formal report can be dictated by the cardiac imager.”

    
Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies 
Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, John Eng, Elliot K. Fishman
Emerg Radiol (2016) 23:255–261
  • “Coronary CTA with using a tablet computer is feasible with results that are no different from reading of cardiac exams on standard clinical workstations. On multivariate analysis, we found no significant relationship between the type of reading modality and accuracy of interpretation. Remote reading with a tablet computer could be used to expand availability of coronary CTA in the ED.”


    Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies 
Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, John Eng, Elliot K. Fishman
Emerg Radiol (2016) 23:255–261
  • OBJECTIVE: To evaluate the effectiveness of the iPad (Apple Inc., Cupertino, CA) for two-dimensional (2D) reading of CT angiography (CTA) studies performed for suspected acute non-variceal gastrointestinal bleeding.
    CONCLUSION: Compared with a conventional PACS workstation, iPad-based preliminary 2D reading of CTA studies has comparable diagnostic accuracy for detection of acute gastrointestinal bleeding and can be significantly faster.
    ADVANCES IN KNOWLEDGE: The iPad could be used by on-call interventional radiologists for immediate decision on percutaneous embolization in patients with suspected acute gastrointestinal bleeding.
    iPad-based primary 2D reading of CT angiography examinations of patients with suspected acute gastrointestinal bleeding: preliminary experience.
    Faggioni L et al.
    Br J Radiol. 2015 Mar;88(1047)
  • PURPOSE: The purpose was to compare performance of diagnostic workstation monitors and the Apple iPad 2 (Cupertino, CA) in interpretation of emergency computed tomography (CT) brain studies.
    CONCLUSIONS: The iPad 2 is a reliable modality in the interpretation of CT brain studies in them emergency setting and for the detection of acute and chronic abnormalities, with comparable performance to standard diagnostic workstation monitors.
    Out of Hours Emergency Computed Tomography Brain Studies: Comparison of Standard 3 Megapixel Diagnostic Workstation Monitors With the iPad 2.
    Salati U et al.
    Can Assoc Radiol J. 2015 Nov;66(4):363-7
  • " For both readers, there was no significant difference in agreement with the reference standard for per-vessel stenosis scores using either the 3D workstation or the iPad. In a multivariable logistic regression analysis including reader, workstation, and vessel as co-variates, there was no significant association between workstation type or reader and agreement with the reference standard (p > 0.05). Both readers identified 100 % of coronary anomalies using each technique."
    Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies
    Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, John Eng, Elliot K. Fishman
    Emerg Radiol DOI 10.1007/s10140-016-1399-9
  • "However, in many institutions, coronary CTA access is limited to daytime and weekday hours, at least in part due to limits on availability of subspecialty trained physicians and the need for post-processing workstations. Remote reading of coronary CTA studies could expand access by providing a platform for after hour emergency department coverage on an as needed basis without requiring imagers to be in-house."
    Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies
    Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, John Eng, Elliot K. Fishman
    Emerg Radiol DOI 10.1007/s10140-016-1399-9
  • "Coronary CTA with using a tablet computer is feasible with results that are no different from reading of cardiac exams on standard clinical workstations. On multivariate analysis, we found no significant relationship between the type of reading modality and accuracy of interpretation. Remote reading with a tablet computer could be used to expand availability of coronary CTA in the ED."
    Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies
    Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, John Eng, Elliot K. Fishman
    Emerg Radiol DOI 10.1007/s10140-016-1399-9


  • Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies
    Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, John Eng, Elliot K. Fishman
    Emerg Radiol DOI 10.1007/s10140-016-1399-9
  • “To investigate whether abdominopelvic hemorrhage shown on computed tomography (CT) images can be diagnosed with the same accuracy on a tablet computer as on a dedicated reading display. One hundred patients with a clinical suspicion of abdominopelvic hemorrhage that underwent biphasic CT imaging were retrospectively read by two readers on a dedicated reading display (reference standard) and on a tablet computer (iPad Air). Reading was performed in a dedicated reading room with ambient light conditions.”


    Mobile Image Interpretation: Diagnostic Performance of CT Exams Displayed on a Tablet Computer in Detecting Abdominopelvic Hemorrhage        
Schlechtweg PM et al.
J Digit Imag (in press)
  • “Abdominopelvic hemorrhage shown on CT images can be diagnosed on a tablet computer with a high diagnostic accuracy allowing mobile on-call diagnoses. This may be helpful because an early and reliable diagnosis at any time is crucial for an adequate treatment strategy.”


    Mobile Image Interpretation: Diagnostic Performance of CT Exams Displayed on a Tablet Computer in Detecting Abdominopelvic Hemorrhage
Schlechtweg PM et al.
J Digit Imag (in press)
  • OBJECTIVE: To review the published evidence and to determine if radiological diagnostic accuracy is compromised when images are displayed on a tablet computer and thereby inform practice on using tablet computers for radiological interpretation by on-call radiologists.
    CONCLUSION: Our findings suggest that the diagnostic accuracy of radiological interpretation is not compromised by using a tablet computer. This result is only relevant to the Apple iPad and to the modalities of CT, MRI and plain radiography.
Radiological interpretation of images displayed on tablet computers: a systematic review.


    Caffery LJ1, Armfield NR, Smith AC.Br J Radiol. 2015 Jun;88(1050):20150191. doi: 10.1259/bjr.20150191. Epub 2015 Apr 17.
  • “11 studies met the inclusion criteria. 10 of these studies tested the Apple iPad(®) (Apple, Cupertino, CA). The included studies reported high sensitivity (84-98%), specificity (74-100%) and accuracy rates (98-100%) for radiological diagnosis. There was no statistically significant difference in accuracy between a tablet computer and a digital imaging and communication in medicine-calibrated control display. There was a near complete consensus from authors on the non-inferiority of diagnostic accuracy of images displayed on a tablet computer. All of the included studies were judged to be at risk of bias.”

    Radiological interpretation of images displayed on tablet computers: a systematic review.
Caffery LJ1, Armfield NR, Smith AC.Br J Radiol. 2015 Jun;88(1050):20150191. doi: 10.1259/bjr.20150191. Epub 2015 Apr 17.
  • ADVANCES IN KNOWLEDGE:
    The iPad may be appropriate for an on-call radiologist to use for radiological interpretation.

    Radiological interpretation of images displayed on tablet computers: a systematic review.
Caffery LJ1, Armfield NR, Smith AC.Br J Radiol. 2015 Jun;88(1050):20150191. doi: 10.1259/bjr.20150191. Epub 2015 Apr 17.
  • OBJECTIVE: To evaluate the effectiveness of the iPad (Apple Inc., Cupertino, CA) for two-dimensional (2D) reading of CT angiography (CTA) studies performed for suspected acute non-variceal gastrointestinal bleeding.

    CONCLUSION:Compared with a conventional PACS workstation, iPad-based preliminary 2D reading of CTA studies has comparable diagnostic accuracy for detection of acute gastrointestinal bleeding and can be significantly faster.

    ADVANCES IN KNOWLEDGE:The iPad could be used by on-call interventional radiologists for immediate decision on percutaneous embolization in patients with suspected acute gastrointestinal bleeding.
  • OBJECTIVE: To evaluate the effectiveness of the iPad (Apple Inc., Cupertino, CA) for two-dimensional (2D) reading of CT angiography (CTA) studies performed for suspected acute non-variceal gastrointestinal bleeding.

    CONCLUSION: Compared with a conventional PACS workstation, iPad-based preliminary 2D reading of CTA studies has comparable diagnostic accuracy for detection of acute gastrointestinal bleeding and can be significantly faster.

    ADVANCES IN KNOWLEDGE: The iPad could be used by on-call interventional radiologists for immediate decision on percutaneous embolization in patients with suspected acute gastrointestinal bleeding.
iPad-based primary 2D reading of CT angiography examinations of patients with suspected acute gastrointestinal bleeding: preliminary experience.


    Faggioni L et al.
Br J Radiol. 2015 Mar;88(1047):20140477. doi: 10.1259/bjr.20140477.
  • CONCLUSION: Compared with a conventional PACS workstation, iPad-based preliminary 2D reading of CTA studies has comparable diagnostic accuracy for detection of acute gastrointestinal bleeding and can be significantly faster.

    ADVANCES IN KNOWLEDGE: The iPad could be used by on-call interventional radiologists for immediate decision on percutaneous embolization in patients with suspected acute gastrointestinal bleeding.

    iPad-based primary 2D reading of CT angiography examinations of patients with suspected acute gastrointestinal bleeding: preliminary experience.
Faggioni L et al.
Br J Radiol. 2015 Mar;88(1047):20140477. doi: 10.1259/bjr.20140477.
  • ADVANCES IN KNOWLEDGE: The iPad could be used by on-call interventional radiologists for immediate decision on percutaneous embolization in patients with suspected acute gastrointestinal bleeding.


    iPad-based primary 2D reading of CT angiography examinations of patients with suspected acute gastrointestinal bleeding: preliminary experience.
Faggioni L et al.
Br J Radiol. 2015 Mar;88(1047):20140477. doi: 10.1259/bjr.20140477.
  • iPad vs Conventional Workstaion
    - Acute GI bleeding
    - Pulmonary embolism
    - Coronary artery disease
    - Intracranial hemorrhage
    - Spinal trauma
    - Acute stroke
  • AIM: To evaluate the utility of a mobile device to detect and assess intracranial hemorrhage (ICH) on head computed tomographys (CT) performed in the emergency setting.
MATERIALS AND
    METHODS: 100 head CT scans were randomly selected from our emergency radiology database and anonymized for patient demographics and clinical history. The studies were independently interpreted by two experienced radiologists in a blinded manner, initially on a mobile device (iPad, Apple computers) and subsequently, at an interval of one week, on a regular desktop workstation. Evaluation was directed towards detection, localization and characterization of hemorrhage. The results were assessed for accuracy, sensitivity, specificity and positive predictive value. Statistical significance was ascertained using Fisher's exact test.
    RESULTS: 27 of the examinations were positive for ICH, of which 11 had multiple hemorrhages. Of these there were 17 subdural, 18 intraparenchymal, 8 subarachnoid, 4 intraventricular and 2 extradural hemorrhages. In 96 of the studies there was complete concurrence between the iPad and desktop interpretations for both radiologists. Of 49 hemorrhages, 48 were accurately detected on the iPad by one of the radiologists. In the remaining case, a tiny intraventricular hemorrhage was missed by both radiologists on the iPad as well as on the workstation, indicating that the miss was more likely related to the very small size of the hemorrhage than the viewer used.
    CONCLUSION: We conclude that in the emergency setting, a mobile device with appropriate web-based pictue archiving and communication system (PACS) is effective in the detection of intracranial hemorrhage present on head CT.
  • RESULTS: 27 of the examinations were positive for ICH, of which 11 had multiple hemorrhages. Of these there were 17 subdural, 18 intraparenchymal, 8 subarachnoid, 4 intraventricular and 2 extradural hemorrhages. In 96 of the studies there was complete concurrence between the iPad and desktop interpretations for both radiologists. Of 49 hemorrhages, 48 were accurately detected on the iPad by one of the radiologists. In the remaining case, a tiny intraventricular hemorrhage was missed by both radiologists on the iPad as well as on the workstation, indicating that the miss was more likely related to the very small size of the hemorrhage than the viewer used.

    CONCLUSION: We conclude that in the emergency setting, a mobile device with appropriate web-based pictue archiving and communication system (PACS) is effective in the detection of intracranial hemorrhage present on head CT.


    Utility of mobile devices in the computerized tomography evaluation of intracranial hemorrhage.
Panughpath SG, Kumar S, Kalyanpur
Indian J Radiol Imaging. 2013 Jan;23(1):4-7.
  • CONCLUSION: We conclude that in the emergency setting, a mobile device with appropriate web-based pictue archiving and communication system (PACS) is effective in the detection of intracranial hemorrhage present on head CT.


    Utility of mobile devices in the computerized tomography evaluation of intracranial hemorrhage.
Panughpath SG, Kumar S, Kalyanpur
Indian J Radiol Imaging. 2013 Jan;23(1):4-7.
  • “We aimed to assess the impact of iPad ownership on radiology resident education in terms of study habits and use of 
electronic and printed resources for learning and data reference in radiology.” 
The iPad in radiology resident education.


    Korbage AC, Bedi HS.
J Am Coll Radiol. 2012 Oct;9(10):759-60
  • “The iPad has generated excitement within the radiology community, particularly among resident educators, who are increasingly recognizing the unique needs of "millennial learners." This study showed that the majority of residents at the authors' institution have incorporated the iPad as an educational tool and use it as a learning aid. Incorporation of the iPad into clinical workflow has been less pronounced.”

    Resident iPad use: has it really changed the game?
Berkowitz SJ et al.
J Am Coll Radiol. 2014 Feb;11(2):180-4
  • “The Radiology Resident iPad Toolbox is a cost-effective, portable, educational instrument that has increased studying efficiency; improved access to study materials such as books, radiology cases, lectures, and web-based resources; and increased interactivity in educational conferences and lectures through the use of audience-response software, with questions geared toward the new ABR board format. This preconfigured tablet fully embraces the technology shift into mobile computing and represents a paradigm shift in educational strategy.”


    The Radiology Resident iPad Toolbox: an educational and clinical tool for radiology residents.
Sharpe EE 3rd et al.
J Am Coll Radiol. 2013 Jul;10(7):527-32
  • “The goal was to create a portable device with comprehensive educational, clinical, and communication tools that would contain all necessary resources for an entire 4-year radiology residency. The device was distributed to a total of 34 radiology residents (8 first-year residents, 8 second-year residents, 9 third-year residents, and 9 fourth-year residents). This article describes the process used to develop and deploy the device, provides a distillation of useful applications and resources decided upon after extensive evaluation, and assesses the impact this device had on resident education.”


    The Radiology Resident iPad Toolbox: an educational and clinical tool for radiology residents.
Sharpe EE 3rd et al.
J Am Coll Radiol. 2013 Jul;10(7):527-32
  • RESULTS: Doctors reported that information sharing with patients is critical to the delivery of high-quality healthcare, but were not seen to use the iPad to share information with patients on ward rounds. Patients did not think the iPad had impacted on their engagement with doctors on rounds. Ward rounds were observed to follow set routines and patient interactions were brief.

    CONCLUSIONS: Although the iPad potentially creates new opportunities for information sharing and patient engagement, the ward round may not present the most appropriate context for this to be done.


    iPad use at the bedside: a tool for engaging patients in care processes during ward rounds?
 Baysari MT et al.
Intern Med J. 2014 Oct;44(10):986-90
  • AIMS: To assess if, and how, senior clinicians use an iPad to share information (e.g. patient test results) with patients during ward rounds and to explore patients' and doctors' experiences of information sharing events.
    CONCLUSIONS: Although the iPad potentially creates new opportunities for information sharing and patient engagement, the ward round may not present the most appropriate context for this to be done.

    iPad use at the bedside: a tool for engaging patients in care processes during ward rounds?
Baysari MT et al.
Intern Med J. 2014 Oct;44(10):986-90
  • OBJECTIVE: The study aimed to determine the acceptability of the iPad 3 as a display option for American Board of Radiology (ABR) examinations.
    SUBJECTS AND METHODS: A set of 20 cases for each of nine specialties examined by the ABR was prepared. Each comprised between one and seven images and case information and had been used in previous ABR Initial Certification examinations. Examining radiologists (n = 119) at the ABR oral Initial Certification examinations reviewed sets from one or more specialties on both a 2 MP LED monitor and on the iPad 3 and rated the visibility of the salient image features for each case. The Wilcoxon signed rank test was performed to compare ratings. In addition, a thematic analysis of participants' opinions was undertaken.

    RESULTS: When all specialties were pooled, the iPad 3 ratings were significantly higher than the monitor ratings (p = 0.0217). The breast, gastrointestinal, genitourinary, and nuclear medicine specialties also returned significantly higher ratings for the visibility of relevant image features for the iPad 3. Monitor ratings were significantly higher for the vascular and interventional specialty, although no images were rated unacceptably poor on the iPad in this specialty.
    CONCLUSION: The relevant image features were rated more visible on the iPad 3 than on the monitors overall. The iPad 3 was well accepted by a large majority of examiners and can be considered adequate for image display for examination in most or all specialties.


    Is the iPad suitable for image display at American Board of Radiology examinations?
Toomey RJ et al.
AJR Am J Roentgenol. 2014 Nov;203(5):1028-33. doi: 10.2214/AJR.13.12274.
  • OBJECTIVE: The study aimed to determine the acceptability of the iPad 3 as a display option for American Board of Radiology (ABR) examinations.
    RESULTS: When all specialties were pooled, the iPad 3 ratings were significantly higher than the monitor ratings (p = 0.0217). The breast, gastrointestinal, genitourinary, and nuclear medicine specialties also returned significantly higher ratings for the visibility of relevant image features for the iPad 3. Monitor ratings were significantly higher for the vascular and interventional specialty, although no images were rated unacceptably poor on the iPad in this specialty.

    CONCLUSION: The relevant image features were rated more visible on the iPad 3 than on the monitors overall. The iPad 3 was well accepted by a large majority of examiners and can be considered adequate for image display for examination in most or all specialties.


    Is the iPad suitable for image display at American Board of Radiology examinations?
Toomey RJ et al.
AJR Am J Roentgenol. 2014 Nov;203(5):1028-33. doi: 10.2214/AJR.13.12274.
  • RESULTS: When all specialties were pooled, the iPad 3 ratings were significantly higher than the monitor ratings (p = 0.0217). The breast, gastrointestinal, genitourinary, and nuclear medicine specialties also returned significantly higher ratings for the visibility of relevant image features for the iPad 3. Monitor ratings were significantly higher for the vascular and interventional specialty, although no images were rated unacceptably poor on the iPad in this specialty.

    CONCLUSION: The relevant image features were rated more visible on the iPad 3 than on the monitors overall. The iPad 3 was well accepted by a large majority of examiners and can be considered adequate for image display for examination in most or all specialties.


    Is the iPad suitable for image display at American Board of Radiology examinations?
Toomey RJ et al.
AJR Am J Roentgenol. 2014 Nov;203(5):1028-33. doi: 10.2214/AJR.13.12274.
  • CONCLUSION: The relevant image features were rated more visible on the iPad 3 than on the monitors overall. The iPad 3 was well accepted by a large majority of examiners and can be considered adequate for image display for examination in most or all specialties.


    Is the iPad suitable for image display at American Board of Radiology examinations?
Toomey RJ et al.
AJR Am J Roentgenol. 2014 Nov;203(5):1028-33. doi: 10.2214/AJR.13.12274.
  • “Our results demonstrate the feasibility of interpretation of CT- scans using mobile hand-held device with reasonable sensitivity and good specificity when compared to dedicated work-stations. With the cloud-based image sharing, studies became more acces- sible in space and time, and among multiple health care providers at a point of care. If properly and securely implemented, sharing imaging studies using the “cloud” in conjunction with reviewing studies on a hand-held device (if no dedicated work-station is immediately available) will allow for fast transfer of imaging studies, avoiding delayed diagnosis and treatment. In patients treated within clinical networks, this will facilitate appropriate triage.”


    Utility of hand-held devices in diagnosis and triage of cardiovascular emergencies. Observations during implementation of a PACS-based system in an acute aortic syndrome (AAS) network
        Ralph Matar   et al. 
 J Cardiovasc Comp Tomogr (in press)
  • Results: Readers' sensitivity and specificity using the hand-held device to diagnose acute chest pathology were calculated. Hand-held device evaluation was determined to have a sensitivity of 85.2% and a specificity of 98.6% by reader A and a sensitivity of 96.3% and specificity of 100% by reader B. Of 103 cases interpreted by both readers, the readers agreed about the diagnosis in 98 cases (95.1%).

    Conclusion: This study demonstrates that hand-held devices can be a potential useful tool to assist in diagnosis and triage of patients presenting with cardiovascular emergencies. Further studies are needed to assess the impact of screen size and resolution.

    Utility of hand-held devices in diagnosis and triage of cardiovascular emergencies. Observations during implementation of a PACS-based system in an acute aortic syndrome (AAS) network
 Ralph Matar et al. 
 J Cardiovasc Comp Tomogr (in press)
  • “This study demonstrates that hand-held devices can be a potential useful tool to assist in diagnosis and triage of patients presenting with cardiovascular emergencies. Further studies are needed to assess the impact of screen size and resolution.”


    Utility of hand-held devices in diagnosis and triage of cardiovascular emergencies. Observations during implementation of a PACS-based system in an acute aortic syndrome (AAS) network
 Ralph Matar et al. 
 J Cardiovasc Comp Tomogr (in press)
  • “Smartphones and tablets offer new opportunities for diagnostic imaging practitioners; these easy-to-use devices equipped with excellent display may be used for diagnostic reading, reference, learning, consultation, and for communication with patients.”
Smartphones, tablets and mobile applications for radiology 
 Székely A et al.
European Journal of Radiology 82 (2013) 829–836 
  • Future Direction: New Mobile Devices May Impact Usage
    - Apple Watch
    - FitBit systems
    - Google Watch
    - Small sensors
    - Other technologies
  • “For reader 1, there was no significant difference in agreement for per-vessel stenosis scores using either the clinical workstation or the iPad. For reader 2, only one of the seven vessel scores (the OMs) showed a significant agreement differences between the clinical workstation and the iPad (p=0.05), due to disagreement in 4 subjects with the iPad. In a multivariable logistic regression analysis including reader, workstation, and vessel as co-variates, there was no significant association between workstation type or reader and agreement with the reference standard (p>0.05). Both readers identified 100% of coronary anomalies using each techniques.”


    Remote reading of coronary CTA exams using a tablet computer: accuracy for stenosis assessment and identification of coronary anomalies
Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, 
Pamela T. Johnson, John Eng, Elliot K. Fishman
JCCT(Submitted)
  • “Coronary CTA with using a tablet computer is feasible and allows accurate remote reading of cardiac exams compared to standard clinical workstations. On multivariate analysis, we found no significant relationship between the type of reading modality and accuracy of interpretation. Remote reading with a tablet computer could be used to expand availability of coronary CTA in the ED.”

    Remote reading of coronary CTA exams using a tablet computer: accuracy for stenosis assessment and identification of coronary anomalies
Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, 
Pamela T. Johnson, John Eng, Elliot K. Fishman
JCCT(Submitted)
  • “Reading of coronary CTA examinations with the iPad had no significant influence on the accuracy of stenosis assessment compared to the standard clinical workstation.”


    Remote reading of coronary CTA exams using a tablet computer: accuracy for stenosis assessment and identification of coronary anomalies
Stefan L. Zimmerman, Cheng T. Lin, Linda C. Chu, 
Pamela T. Johnson, John Eng, Elliot K. Fishman
JCCT(Submitted)
  • “Current hardware and software capabilities support the increased use of mobile technologies for diagnostic imaging interpretation. While the exact role of mobile computing remains unclear, there are several potential applications.”

    Mobile Computing for Radiology
    Auffermann WF et al.
    Acad Radiol 2013;20:1495-1505
  • “It is unlikely that radiologists will use mobile devises as their standard platform for image interpretation. However, mobile computing may be useful for image interpretation by on-call radiologists who are not at a hardwired PACS, allowing for rapid evaluation of urgent imaging studies with minimal delay.”

    Mobile Computing for Radiology
    Auffermann WF et al.
    Acad Radiol 2013;20:1495-1505
  • “The iPad has generated excitement within the radiology community, particularly among resident educators, who are increasingly recognizing the unique needs of "millennial learners." This study showed that the majority of residents at the authors' institution have incorporated the iPad as an educational tool and use it as a learning aid. Incorporation of the iPad into clinical workflow has been less pronounced.”

    Resident iPad use: has it really changed the game?
    Berkowitz SJ et al.
    J Am Coll Radiol. 2014 Feb;11(2):180-4
  • “Excitement about the iPad as a tool for radiology education has been growing. In a recent nationwide survey, 81% of residents stated that they would spend more time studying radiology with a mobile tablet device . We present our initial experience with the iPad in a large academic radiology residency. The impact of the iPad on the daily clinical duties of radiology residents in our study was limited, but residents at our institution have adopted the iPad to view electronic journals and use radiology-specific applications. The full impact of this device on resident education will depend on the development of applications that harness the unique ability of this medium for training the next generation of radiologists.”

    Resident iPad use: has it really changed the game?
    Berkowitz SJ et al.
    J Am Coll Radiol. 2014 Feb;11(2):180-4
  • OBJECTIVE. The study aimed to determine the acceptability of the iPad 3 as a display option for American Board of Radiology (ABR) examinations.
    CONCLUSION: “The relevant image features were rated more visible on the iPad 3 than on the monitors overall. The iPad 3 was well accepted by a large majority of examiners and can be considered adequate for image display for examination in most or all specialties.”
    Is the iPad Suitable for Image Display at American Board of Radiology Examinations?
    Toomey RJ et al.
    AJR Am J Roentgenol. 2014 Nov;203(5):1028-33
  • “The relevant image features were rated more visible on the iPad 3 than on the monitors overall. The iPad 3 was well accepted by a large majority of examiners and can be considered adequate for image display for examination in most or all specialties.”
    Is the iPad Suitable for Image Display at American Board of Radiology Examinations?
    Toomey RJ et al.
    AJR Am J Roentgenol. 2014 Nov;203(5):1028-33
  • “ When all specialties were pooled, the iPad 3 ratings were significantly higher than the monitor ratings (p = 0.0217). The breast, gastrointestinal, genitourinary, and nuclear medicine specialties also returned significantly higher ratings for the visibility of relevant image features for the iPad 3. ”
    Is the iPad Suitable for Image Display at American Board of Radiology Examinations?
    Toomey RJ et al.
    AJR Am J Roentgenol. 2014 Nov;203(5):1028-33
  • “Monitor ratings were significantly higher for the vascular and interventional specialty, although no images were rated unacceptably poor on the iPad in this specialty.”
    Is the iPad Suitable for Image Display at American Board of Radiology Examinations?
    Toomey RJ et al.
    AJR Am J Roentgenol. 2014 Nov;203(5):1028-33
  • “ The iPad, iPhone, and other portable devices offer a unique opportunity for radiology education, allowing presentation of information in a simple, concise, and mobile fashion to large groups of learners. The CT Contrast Protocols application for the iPad and iPhone is one of the first radiology applications in the Apple App Store to focus on radiology education and was designed to address the lack of practical information on contrast media for radiologists, technologists, nurses, and trainees. The application was developed in response to questions about contrast media use from clinicians, technologists, and nurses; its content is based on questions from these members of the authors' department and hospital, as well as users of the CTisus.com Web site.”
    Informatics in Radiology: CT Contrast Protocols Application for the iPad: New Resource for Technologists, Nurses, and Radiologists
    Raman SP, Raminpour S, Horton KM, Fishman EK
    Radiographics. 2013 May;33(3):913-21
  • “ The iPad, iPhone, and other portable devices offer a unique opportunity for radiology education, allowing presentation of information in a simple, concise, and mobile fashion to large groups of learners. The CT Contrast Protocols application for the iPad and iPhone is one of the first radiology applications in the Apple App Store to focus on radiology education and was designed to address the lack of practical information on contrast media for radiologists, technologists, nurses, and trainees.”
    Informatics in Radiology: CT Contrast Protocols Application for the iPad: New Resource for Technologists, Nurses, and Radiologists
    Raman SP, Raminpour S, Horton KM, Fishman EK
    Radiographics. 2013 May;33(3):913-21
  • “The application was developed in response to questions about contrast media use from clinicians, technologists, and nurses; its content is based on questions from these members of the authors' department and hospital, as well as users of the CTisus.com Web site. The application uses a simple interface that requires no training and can be easily navigated by those who have only recently begun using an iPad or iPhone. It provides simple, easily understood answers to many common questions about contrast media use, all arranged under several subject headings. The application is constantly evolving and represents an aggregate of the knowledge found in the literature, the American College of Radiology's consensus guidelines, and the institutional practices of the computed tomography division of Johns Hopkins Hospital.”
    Informatics in Radiology: CT Contrast Protocols Application for the iPad: New Resource for Technologists, Nurses, and Radiologists
    Raman SP, Raminpour S, Horton KM, Fishman EK
    Radiographics. 2013 May;33(3):913-21
  • OBJECTIVE. The purpose of the study was to compare observer performance in the detection of cerebral infarction on a brain CT using medical-grade liquid crystal display (LCD) monitors calibrated with the gray-scale standard display function and with - 2.2 and using an iPad with a simulated screen setting.
    Comparison of Liquid Crystal Display Monitors Calibrated With Gray-Scale Standard Display Function and With - 2.2 and iPad: Observer Performance in Detection of Cerebral Infarction on Brain CT.
    Yoshimura K et al.
    AJR 2013 June;200(6):1304-9
  • “The difference among the three monitors was very small. There was no significant difference between gray-scale standard display function LCD and - 2.2 LCD. However, the Az value was statistically significantly smaller for the iPad than the - 2.2 LCD (p < 0.05).”
    Comparison of Liquid Crystal Display Monitors Calibrated With Gray-Scale Standard Display Function and With - 2.2 and iPad: Observer Performance in Detection of Cerebral Infarction on Brain CT.
    Yoshimura K et al.
    AJR 2013 June;200(6):1304-9
  • “CONCLUSION. Observer performance for detecting cerebral infarction on the LCD with - 2.2 calibration was found to be similar to the LCD with gray-scale standard display function calibration. Although observer performance using the iPad was poorer than that using the other LCDs, the difference was small. Therefore, the iPad could not substitute for other LCD monitors. However, owing to the promising potential advantages of tablet PCs, such as portability, further examination is needed into the clinical use of tablet PCs.”
    Comparison of Liquid Crystal Display Monitors Calibrated With Gray-Scale Standard Display Function and With - 2.2 and iPad: Observer Performance in Detection of Cerebral Infarction on Brain CT.
    Yoshimura K et al.
    AJR 2013 June;200(6):1304-9
  • “CONCLUSION. Observer performance for detecting cerebral infarction on the LCD with - 2.2 calibration was found to be similar to the LCD with gray-scale standard display function calibration. Although observer performance using the iPad was poorer than that using the other LCDs, the difference was small. Therefore, the iPad could not substitute for other LCD monitors. However, owing to the promising potential advantages of tablet PCs, such as portability, further examination is needed into the clinical use of tablet PCs.”
    Comparison of Liquid Crystal Display Monitors Calibrated With Gray-Scale Standard Display Function and With - 2.2 and iPad: Observer Performance in Detection of Cerebral Infarction on Brain CT.
    Yoshimura K et al.
    AJR 2013 June;200(6):1304-9
  • June 2013: iPad and Radiology Pubmed Search
  • “CT interpretation on an iPad enabled accurate identification of pulmonary embolism, equivalent to display on the PACS. This mobile device has the potential to expand radiologists' availability for consultation and expedite emergency patient management.”
    The iPad as a mobile devise for CT display and interpretation: diagnostic accuracy for identification of pulmonary embolism
    Johnson PT, Zimmerman SL, Heath D, Eng J, Horton KM, Scott WW, Fishman EK
    Emerg Radiol 2012 Mar 27
  • “ Recent software developments enable interactive, real-time axial, 2D and 3D CT display on an iPad by cloud computing from a server for remote rendering.”
    The iPad as a mobile devise for CT display and interpretation: diagnostic accuracy for identification of pulmonary embolism
    Johnson PT, Zimmerman SL, Heath D, Eng J, Horton KM, Scott WW, Fishman EK
    Emerg Radiol 2012 Mar 27
  • Emerg Radiol. 2012 Apr;19(2):127-33. Epub 2011 Dec 16.

    Emergency CT brain: preliminary interpretation with a tablet device: image quality and diagnostic performance of the Apple iPad.

    Mc Laughlin P, Neill SO, Fanning N, Mc Garrigle AM, Connor OJ, Wyse G, Maher MM.

    Source

    Department of Radiology, Cork University Hospital, Wilton, Cork, Ireland.

    Abstract

    Tablet devices have recently been used in radiological image interpretation because they have a display resolution comparable to desktop LCD monitors. We identified a need to examine tablet display performance prior to their use in preliminary interpretation of radiological images. We compared the spatial and contrast resolution of a commercially available tablet display with a diagnostic grade 2 megapixel monochrome LCD using a contrast detail phantom. We also recorded reporting discrepancies, using the ACR RADPEER system, between preliminary interpretation of 100 emergency CT brain examinations on the tablet display and formal review on a diagnostic LCD. The iPad display performed inferiorly to the diagnostic monochrome display without the ability to zoom. When the software zoom function was enabled on the tablet device, comparable contrast detail phantom scores of 163 vs 165 points were achieved. No reporting discrepancies were encountered during the interpretation of 43 normal examinations and five cases of acute intracranial hemorrhage. There were seven RADPEER2 (understandable) misses when using the iPad display and 12 with the diagnostic LCD. Use of software zoom in the tablet device improved its contrast detail phantom score. The tablet allowed satisfactory identification of acute CT brain findings, but additional research will be required to examine the cause of "understandable" reporting discrepancies that occur when using tablet devices.

  • Three-dimensional imaging navigation during a lung segmentectomy using an iPad

    Takashi Eguchia,b,*, Keiichiro Takasunaa, Atsushi Kitazawac, Youhei Fukuzawac, Yasuo Sakauec, Kazuo Yoshidab and Makoto Matsubarac

    +Author Affiliations

    aDepartment of Thoracic Surgery, Ina Central Hospital, Ina, Japan
    bDepartment of Thoracic Surgery, Shinshu University School of Medicine, Matsumoto, Japan
    cDepartment of Radiology, Ina Central Hospital, Ina, Japan
    * Corresponding author. Department of Thoracic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto, Japan. Tel: +81-263-372657; fax: +81-263-372721; e-mail: tks1976@shinshu-u.ac.jp (T. Eguchi).

    Received July 11, 2011.
    Revision received August 23, 2011.
    Accepted August 29, 2011.

    Abstract

    OBJECTIVES The requirement for anatomical lung segmentectomies has increased in recent years but this surgical procedure is relatively difficult. We herein present the benefits of using three-dimensional (3D) imaging navigation during a lung segmentectomy via the intra-operative use of an iPad.

    METHODS Fourteen patients who had undergone an anatomic segmentectomy for a primary lung cancer or a metastatic lung tumour between 1 October 2010 and 30 April 2011 were included in this study. Contrast-enhanced scanning was performed twice on each patient, and 3D images were constructed using a workstation. These images were then transferred to an iPad and analysed during the operation using DICOM image viewer software.

    RESULTS The study group included 3 men (21%) and 11 women (79%) ranging in age from 57 to 83 (mean 69 ± 7.8 years). The operative procedure involved a resection in one case each of the right S1, the right S2, the right S2 + S6a, the right S3, the right S6, the left S8 and the left S8 + 9. The left S1 + 2 and the left basal segment were resected in two cases. The left upper division was resected in three cases. All segmentectomies were successful and no major post-operative complications developed in any patient during or after their procedures. No positive margins were detected pathologically.

    CONCLUSIONS A 3D computed tomography navigation using an iPad enhances the ability to perform a safe and secure segmentectomy.

  • Acad Radiol. 2012 Apr 14. [Epub ahead of print]

    Flexible Image Evaluation: iPad versus Secondary-class Monitors for Review of MR Spinal Emergency Cases, A Comparative Study.

    McNulty JP, Ryan JT, Evanoff MG, Rainford LA.

    Source

    Diagnostic Imaging, School of Medicine and Medical Science, Health Science Centre, University College Dublin, Belfield, Dublin 4, Ireland.

    Abstract

    RATIONALE AND OBJECTIVES:

    Studies have highlighted the potential of handheld viewing devices for rapid diagnosis and increased smartphone usage among physicians and radiologists is known as is the clinical applicability of hand-held devices for computed tomography (CT) spinal injury cases. Magnetic resonance (MR), however, is the accepted gold standard for spinal imaging, providing visualization of both ligament and spinal cord pathology. This study investigated the diagnostic accuracy of the iPad, the most probable alternative display device outside the radiology environment and financially viable alternative, when reviewing emergency spinal MR images, in comparison with secondary-class LCD devices in the case of the interpretation of CT and MR imaging examinations.

    MATERIALS AND METHODS:

    In total 31 MR cases including both positives (n = 13) containing one of four possible presentations: spinal cord compression, cauda equine syndrome, spinal cord hemorrhage, or spinal cord edema and controls (n = 18) were reviewed. Ziltron iPad software facilitated the display of cases and the receiver operating characteristic (ROC) analysis. Thirteen American Board of Radiology board-certified radiologists reviewed all cases on both displays. Standardized viewing conditions were maintained.

    RESULTS:

    Dorfman-Berbaum-Metz multireader-multicase (DBM MRMC) analysis was performed including random readers/random cases, fixed readers/random cases and random readers/fixed cases. No differences of statistical significance (P ≤ .05) could be found in terms of area under the curve, sensitivity and specificity between the iPad and secondary-class display.

    CONCLUSION:

    The iPad performed with equal diagnostic accuracy when compared with the secondary-class LCD device after DBM MRMC analysis, demonstrating the iPad as an option to aid initial review of MR spinal emergency cases.

    Copyright © 2012 AUR. Published by Elsevier Inc. All rights reserved.

  • J Digit Imaging. 2012 May 5. [Epub ahead of print]

    The iPad Tablet Computer for Mobile On-Call Radiology Diagnosis? Auditing Discrepancy in CT and MRI Reporting.

    Source

    Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore, sindhu_john@yahoo.com.

    Abstract

    Tablet computers such as the iPad, which have a large format, improved graphic display resolution and a touch screen interface, may have an advantage compared to existing mobile devices such as smartphones and laptops for viewing radiological images. We assessed their potential for emergency radiology teleconsultation by reviewing multi-image CT and MRI studies on iPad tablet computers compared to Picture Archival and Communication Systems (PACS) workstations. Annonymised DICOM images of 79 CT and nine MRI studies comprising a range of common on-call conditions, reported on full-featured diagnostic PACS workstation by one Reporting Radiologist, were transferred from PACS to three iPad tablet computers running OsiriX HD v 2.02 DICOM software and viewed independently by three reviewing radiologists. Structured documentation was made of major findings (primary diagnosis or other clinically important findings), minor findings (incidental findings), and user feedback. Two hundred and sixty four readings (88 studies read by three reviewing radiologists) were compared, with 3.4 % (nine of 264) major discrepancies and 5.6 % (15 of 264) minor discrepancies. All reviewing radiologists reported favorable user experience but noted issues with software stability and limitations of image manipulation tools. Our results suggest that emergency conditions commonly encountered on CT and MRI can be diagnosed using tablet computers with good agreement with dedicated PACS workstations. Shortcomings in software and application design should be addressed if the potential of tablet computers for mobile teleradiology is to be fully realized.

  • Emerg Radiol. 2012 Mar 27. [Epub ahead of print]

    The iPad as a mobile device for CT display and interpretation: diagnostic accuracy for identification of pulmonary embolism.

    Source

    The Russell H. Morgan Department of Radiology and Radiologic Science, Johns Hopkins School of Medicine, 601 N. Caroline Street, Room 3140D, Baltimore, MD, 21287, USA, pjohnso5@jhmi.edu.

    Abstract

    Recent software developments enable interactive, real-time axial, 2D and 3D CT display on an iPad by cloud computing from a server for remote rendering. The purpose of this study was to compare radiologists' interpretative performance on the iPad to interpretation on the conventional picture archive and communication system (PACS). Fifty de-identified contrast-enhanced CT exams performed for suspected pulmonary embolism were compiled as an educational tool to prepare our residents for night call. Two junior radiology attendings blindly interpreted the cases twice, one reader used the PACS first, and the other interpreted on the iPad first. After an interval of at least 2 weeks, the cases were reinterpreted in different order using the other display technique. Sensitivity, specificity, and accuracy for identification of pulmonary embolism were compared for each interpretation method. Pulmonary embolism was present in 25 patients, ranging from main pulmonary artery to subsegmental thrombi. Both readers interpreted 98 % of cases correctly regardless of display platform. There was no significant difference in sensitivity (98 vs 100 %, p = 1.0), specificity (98 vs 96 %, p = 1.0), or accuracy (98 vs 98 %, p = 1.0) for interpretation with the iPad vs the PACS, respectively. CT interpretation on an iPad enabled accurate identification of pulmonary embolism, equivalent to display on the PACS. This mobile device has the potential to expand radiologists' availability for consultation and expedite emergency patient management.

© 1999-2018 Elliot K. Fishman, MD, FACR. All rights reserved.