Diagnostic Reading on Mobile Devices
When, what, and why to read on mobile devices.
Processing speeds and display resolutions on tablets have increased to a level where many people are satisfied to use them for casual gaming or binge watching Netflix. But have we reached the point where radiologists can do diagnostic reading on mobile devices with confidence? The answer seems to be a resounding “yes”.
Often times, the best clinicians for a job aren’t where you need them – when you need them. The portability of tablets makes them ideal for mobile on-call diagnosis. Offsite specialists can advise on complex cases. In an emergency situation when every minute counts, on-call radiologists can give their diagnoses from their remote locations. A surgeon can do a quick review when called in for an emergency, giving him or her more time to think about the situation before arriving in the operating room. Mobile access also supports the coordinated care continuum, enabling ordering physicians, nurses, and others involved in care to be better informed.
Are diagnostic readings made on tablets as accurate as those made on a PACS workstation?
Several evidence-based studies have shown equivalent diagnostic accuracy of tablets compared with DICOM-calibrated PACS workstation displays. The studies include one by the British Journal of Radiology which reviewed 11 published studies evaluating high sensitivity, specificity, and accuracy rates of reading on “a tablet computer vs. a DICOM-calibrated control display.” (1)
In addition, the study found “there was a near complete consensus from authors on the non-inferiority of diagnostic accuracy of images displayed on a tablet computer.” The study concluded that “the diagnostic accuracy of radiological interpretation is not compromised by using a tablet computer.”*
Another study, from Singapore, showed that emergency conditions commonly encountered on CT and MRI can be diagnosed using tablet computers, with good agreement with dedicated PACS workstations. (2) The study, which was one of the earliest to perform a detailed comparison of results between experienced radiologists, resulted in total agreement on 240 of the 264 readings. These readings covered a gamut of conditions, including CT head and neck, abdomen and pelvis, angiograms, multi-regional trauma, and MRI brain and spine cases. (2)
The same technology advancements that make it possible to watch a movie on your tablet make it possible for radiologists to perform their magic from wherever they happen to be. Specifically, it’s the resolution, size, and lighting available today.
Excellent contrast ratio and luminesence on most tablets make them as good as PACS viewers. Resolution of2732 x 2048 pixels is not uncommon, compared to five years ago when most tablet displays didn’t have a resolution above 1024 x 768, according to Geek.com.
Also, processing and network speeds on tablets have accelerated to where they can receive images and execute volume rendering. A 2017 study concluded that “while the prototype application did not always achieve true real-time interaction, these results clearly demonstrated that visualizing 3D and 4D digital medical data is feasible with a properly constructed software framework.” (3)
Our universal viewer, CARESTREAM Vue Motion, includes a tool set with volumetric measuring capabilities to make reading possible on a tablet, or even a smartphone. Together, these advances make it possible for radiologists to read, report, and consult with referring clinicians with the same confidence that they would have completing an evaluation at their PACS workstations.
When and what to read on mobile devices
Are there limitations to what can and can’t be diagnosed on mobile? Are there best use cases? Many in the profession agree that mobile phones are not appropriate for diagnosis due to their smaller screen size.
In a presentation at ECR 2018, Dr. Nicola Strickland of Imperial College Healthcare NHS Trust, gave these use cases for mobile phones in radiology:
- Review images only, not for primary diagnosis
- Refresh memory about a patient condition
- Remote viewing by experienced radiologist to support junior rads in a hospital
As far as limitations for tablets, Carestream does not recommend them (or mobile phones) for comparing more than two studies. Additionally, we recommend the use of diagnostic workstations with top level quality for complex exams. Also, there are times when radiologists want the full set of applications and technologies available to them on their workstations, such as computer-aided detection and voice recognition.
In addition to the devices, consider the source of the images. Sharing patient images via unsecure messaging apps like WhatsApp is not a good practice. Images should be pulled only from a secure PACS – for security reasons and for image quality. Carestream Health is noted for delivering the first web-based viewer that can be accessed from tablets without installing additional software.
Additionally, make sure your PACS software is FDA approved for clinical review on a mobile device. Carestream was one of the first companies to receive FDA clearance for reading medical images on multiple mobile platforms.
Emergencies happen every minute. Your best specialists aren’t always on site. And junior radiologists are in need of consults. With the right mobile devices and FDA-approved software, it’s possible to provide everyone in the care continuum with rapid, secure, and legal access to make the best diagnoses possible.
What is your experience with diagnostic reading on mobile devices? Please comment below.
Santos Lopez is a business development manager for Carestream Health IT business in Iberia. He has been in healthcare IT for the last 18 years. He also served as a service manager in the healthcare industry for another 3 years, after working as a service engineer in the copy/print sector.
Read the blog on Mobile Devices and Messaging Apps in Radiology on the Rise.
- British Journal of Radiology, Radiological interpretation of images displayed on tablet computers: a systematic review, May 19, 2015
- Journal of Digital Imaging, Mobile Image Interpretation: Diagnostic Performance of CT Exams Displayed on a Tablet Computer in Detecting Abdominopelvic Hemorrhage, Oct. 5, 2015
- Journal of Digital Imaging, iPad-Based Patient Briefing for Radiological Examinations—a Clinical Trial, Apr. 1, 2014
* (The study states that this result is only relevant to the Apple iPad and to the modalities of CT, MRI and plain radiography.) (1)