Imaging Pearls ❯ 3D and Workflow ❯ Smartphones
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- Purpose: Software solutions such as mRay allow review of radiological images on handheld devices. We investigated if the quality is adequate for evaluating CT scans of patients with suspected stroke.
Results: All LVOs (large-vessel occlusion) , intracranial tumors and ICHs were detected on both mobile devices. There was no significant difference in the rating of CCT and CBF ASPECTS between all three devices, while the sensitivity for detecting a CBF/CBV-mismatch was above 80% on both devices. Both raters assessed the diagnostic quality to be sufficient on both mobile devices to base treatment decisions on.
Image review on mobile devices for suspected stroke patients: Evaluation of the mRay software solution
Alex Brehm et al.
PLOS ONE | https://doi.org/10.1371/journal.pone.0219051 June 28, 2019 - Methods:50 patients (Median age 80 years, 28 females) were retrospectively selected. All patients had undergone multidetector CT angiography ± perfusion and presented with clinical signs of acute stroke. Out of the 50 patients, 19 had large-vessel occlusion (LVO), 5 had intracra- nial hemorrhage (ICH), 10 had severe intracranial stenosis of at least one major vessel, 2 had intracranial tumor and 15 had no or an unrelated pathology. One experienced neurora- diologist and one resident scored the anonymized pictures separately on two handheld devices (iPhone 7 Plus, MED-TAB) equipped with mRay Software and on a PACS worksta- tion. Each case was reviewed on all three devices with a break in-between of at least 12 weeks. The scoring on the traditional workstation was compared with the two handheld devices, regarding detection of early ischemic signs, LVOs, CBV/CBF-mismatch, ICHs and severe stenosis. Both raters were asked to rate the diagnostic quality of both handheld devices regarding detection of LVOs, ICHs, early ischemic signs and overall.
Image review on mobile devices for suspected stroke patients: Evaluation of the mRay software solution
Alex Brehm et al.
PLOS ONE | https://doi.org/10.1371/journal.pone.0219051 June 28, 2019 - Conclusion: Our study shows that mobile devices can be safely used for image review of CT scans of suspected stroke patients and in case of an experienced rater treatment decisions can be based on such reviews. However for assuring, that additional findings are not missed reviewing the scans later on a traditional workstation should still be mandatory.
Image review on mobile devices for suspected stroke patients: Evaluation of the mRay software solution
Alex Brehm et al.
PLOS ONE | https://doi.org/10.1371/journal.pone.0219051 June 28, 2019 - “Email and SoMe (Social Media) can serve as effective tools for the dissemination of radiology educational content. SoMe offers the additional advantage of substantial visibility outside the home institution, enabling other important career benefits such as networking and personal and institutional branding. Archival of educational material is another advantage of electronic SoMe-based education, allowing many future learners to benefit from the effort of today’s online educators.”
Electronic and Social Media-based Radiology Learning Initiative: Development, Implementation, Viewership Trends, and Assessment at 1 Year
Koontz NA et al.
Acad Radiol 2018; 25:687-698 - “Both in terms of widely disseminating educational content and providing visibility for educational efforts, SoMe was a clear winner over email and traditional website means. This is supported by our data, which showed an overall viewer- ship growth trend on Twitter with regard to both case and answer Tweets, as well as a mild decrease in email viewership over the same time interval. With regard to SoMe, Twitter outperformed YouTube, which also showed an overall downward trend in viewership over the course of the first year of COTD implementation.”
Electronic and Social Media-based Radiology Learning Initiative: Development, Implementation, Viewership Trends, and Assessment at 1 Year
Koontz NA et al.
Acad Radiol 2018; 25:687-698
- "Dissatisfaction resulting from usability issues may cause physicians to resist using mobile apps for their education or training. The results of this study may be communicated to vendors to assist in the design of mobile education and training apps by highlighting the areas of difficulty radiologists are currently facing. These results could also inform the research and clinical community as evidence-based guidelines are created to help select mobile apps that will yield maximal educational and clinical benefits."
Exploring the Usability of Mobile Apps Supporting Radiologists' Training in Diagnostic Decision Making
Kim, Min Soon et al.
Journal of the American College of Radiology , Volume 13 , Issue 3 , 335 - 343 - "More than 85% of physicians in the United States use smart phones and 53% use tablets daily in their practice areas. There are four major app stores (iTunes, Google Play, Windows, and BlackBerry), but the majority of apps are offered through the iTunes and Google Play stores. In February 2015, the iTunes App Store contained approximately 32,000 medical mobile apps, whereas Google Play's app store had about 23,000 medical apps. Medical apps fall under many different categories, including reference apps, such as the Physician's Desk Reference app, medical calculators, and apps designed to access electronic health records or personal health information."
Exploring the Usability of Mobile Apps Supporting Radiologists' Training in Diagnostic Decision Making
Kim, Min Soon et al.
Journal of the American College of Radiology , Volume 13 , Issue 3 , 335 - 343
- PURPOSE: The present study aimed to compare the reliability of interpreting CT scans viewed by orthopedic surgeons in two ways for diagnosing, classifying, and treatment planning for thoracolumbar spine fractures: (1) captured as video clips from standard workstation-based picture archiving and communication system (PACS) and sent via a smartphone-based instant messaging application for viewing on a smartphone; and (2) viewed directly on a PACS.
METHODS: CT scans were captured by use of an iPhone 6 smartphone from a computer screen displaying PACS. Then by use of the WhatsApp instant messaging application, video clips of the scans were sent to the personal smartphones of five spine surgeons. These evaluators were asked to diagnose, classify, and determine the course of treatment for each case. Evaluation of the cases was repeated 4 weeks later, this time using the standard method of workstation-based PACS. Intraobserver agreement was interpreted based on the value of Cohen's kappa statistic. - CONCLUSIONS: Video clips of CT scans can be readily captured by a smartphone from a workstation-based PACS and then transmitted by use of the WhatsApp instant messaging application. Diagnosing, classifying, and proposing treatment of fractures of the thoracic and lumbar spine can be made with equal reliability by evaluating video clips of CT scans transmitted to a smartphone or by the standard method of viewing the CT scan on a workstation-based PACS. Evaluating video clips of CT scans transmitted to a smartphone is a readily accessible, simple, and inexpensive method. We believe that it can be reliably used for consultations between the emergency physicians or orthopedic or neurosurgical residents with offsite, on-call specialists. It might also enable rural orcommunity emergency department physicians to communicate more efficiently and effectively with surgeons in tertiary referral centers.
- CONCLUSIONS: Diagnosing, classifying, and proposing treatment of fractures of the thoracic and lumbar spine can be made with equal reliability by evaluating video clips of CT scans transmitted to a smartphone or by the standard method of viewing the CT scan on a workstation-based PACS. Evaluating video clips of CT scans transmitted to a smartphone is a readily accessible, simple, and inexpensive method. We believe that it can be reliably used for consultations between the emergency physicians or orthopedic or neurosurgical residents with offsite, on-call specialists. It might also enable rural orcommunity emergency department physicians to communicate more efficiently and effectively with surgeons in tertiary referral centers.
Reliability of smartphone-based teleradiology for evaluating thoracolumbar spine fractures
Stahl I et al. Spine J. 2016 Aug 16. pii: S1529-9430(16)30882-8.
- “Our results showed similarly high levels of agreement for CAD scores between our test readers and reference readers, independent of whether an iPhone or standard workstation was used. Intraobserver intertechnology agreement was higher for each test reader than their corresponding interobserver agreement with the reference reader.”
Evaluation of coronary artery disease and coronary anomalies with a handheld mobile device Cheng Ting Lin, Stefan Loy Zimmerman, Linda Chu, John Eng, Elliot K Fishman AJR (in review) - “Coronary CTA examinations can be interpreted on a smartphone with diagnostic accuracy comparable to a standard workstation. DICOM-viewing app on the iPhone may facilitate urgent coronary CTA review when a workstation is not available.”
Evaluation of coronary artery disease and coronary anomalies with a handheld mobile device Cheng Ting Lin, Stefan Loy Zimmerman, Linda Chu, John Eng, Elliot K Fishman AJR (in review)
- “ Server side rendering and processing allows manipulation of images to be done where the information is stored. The image currently being viewed on the devise is the only one that is stored at that point in time. Because there is minimal information on the devise at any given time, the method of viewing radiology images is the most secure.”
Cybersecurity in Radiology: Access of Public Hot Spots and Public Wi-Fi and Prevention of Cybercrimes and HIPAA Violations
Gerard P et al.
AJR 2013; 201:1186-1189 - “ Server side rendering and processing allows manipulation of images to be done where the information is stored. The image currently being viewed on the devise is the only one that is stored at that point in time.”
Cybersecurity in Radiology: Access of Public Hot Spots and Public Wi-Fi and Prevention of Cybercrimes and HIPAA Violations
Gerard P et al.
AJR 2013; 201:1186-1189
- “ With the given study sample, the diagnostic performance of the offsite smartphone readings did not differ significantly from that of the in-house preliminary reports. However, the smartphone readings provided higher diagnostic confidence than the preliminary reports.”
Off-Site Smartphone Reading of CT Images for Patients With Inconclusive Diagnoses of Appendicitis From On-Call Radiologists
Seong NJ et al.
AJR 2014;203:3-9 - “ Our results suggest that a mobile consultation is potentially a useful adjunct to an on-call radiologist’s preliminary report when the on-call radiologist’s diagnosis of appendicitis is not conclusive.”
Off-Site Smartphone Reading of CT Images for Patients With Inconclusive Diagnoses of Appendicitis From On-Call Radiologists
Seong NJ et al.
AJR 2014;203:3-9 - “In conclusion, with the given study sample, the diagnostic performance of the offsite smartphone readings did not differ significantly from that of the in-house preliminary reports. However, the smartphone readings provided higher diagnostic confidence than the preliminary reports.”
Off-Site Smartphone Reading of CT Images for Patients With Inconclusive Diagnoses of Appendicitis From On-Call Radiologists
Seong NJ et al.
AJR 2014;203:3-9 - “The mobile consultation system (Infinitt mobile viewer 1.2, Infinitt Healthcare) consisted of a mobile PACS server and a smartphone (iPhone 4, Apple) running a client viewing program.”
Off-Site Smartphone Reading of CT Images for Patients With Inconclusive Diagnoses of Appendicitis From On-Call Radiologists
Seong NJ et al.
AJR 2014;203:3-9