The rapid advances in mobile computing technology have the potential to change the way radiology and medicine as a whole are practiced. Several mobile computing advances have not yet found application to the practice of radiology, while others have already been applied to radiology but are not in widespread clinical use. This review addresses several areas where radiology and medicine in general may benefit from adoption of the latest mobile computing technologies and speculates on potential future applications.
The rapid changes in mobile computing hardware and software affect many aspects of our lives both personally and professionally. The rate at which technology has changed in recent years presents a particular challenge in medicine, where new ideas are typically accepted into clinical practice only after a comprehensive period of validation, to ensure that patients are helped and not harmed by the technology. These changes are particularly relevant to radiology, where our day-to-day workflow is intimately intertwined with the technological tools at our disposal. Several mobile computing advances have not yet found application to the practice of radiology, whereas others have already been applied to radiology but are not yet in widespread clinical use. Presented here are several areas where the advances in mobile computing have the potential to reshape the way we think of and practice not only radiology but medicine as a whole. Several trends in mobile technology are discussed, as well as their current and potential applications to radiology and medicine in general.
Mobile computing: past through the present
Mobile Computing: Its Evolution to the Present Day
Radiology makes significant use of the latest computers for each step in the pathway from image acquisition to reporting. Consequently, radiologists often unexpectedly find themselves leaders in the application of computers in medicine.
Frederick McKinley Jones invented the portable X-ray machine circa 1920 . Medicine had to wait until 1975 for the first commercially successful portable ultrasound unit, the ADR Model 2130 (Advanced Diagnostic Research), which could display only 16 shades of gray and used an oscilloscope for a display . Mobile computed tomography (CT) has been in existence for many years, and its applications have been evolving. In January 2012, Rhode Island Hospital was the first in the world to acquire a portable CT scanner specifically for use in operating rooms . “Mobile MRI [magnetic resonance imaging]” units on trailer trucks serve niche markets around the United States, but it will likely be some time before truly portable MR scanners can be wheeled around the hospital.
The pocket-sized calculator was not available until the 1970s. In the short time since then, we have seen the introduction of graphing calculators, Palm Pilots ® , laptops, BlackBerry ® devices, smartphones, touch screen smartphones, and tablet computers. Palm Pilots ® , with their fingertip pharmacopoeias, were replaced by smartphones, which offered the advantage of more versatile and colorful interfaces, intrinsic connectivity, and ubiquity. Tablet computers represent a hybrid of the smartphones and laptop computers and in many instances are preferred to traditional paperbound textbooks and journal articles. Mobile radiology image interpretation has only recently become approved, with the diagnostic radiology application for mobile devices receiving Food and Drug Administration clearance on February 4, 2011 .
Current Image Display Capabilities
The American College of Radiology (ACR)/American Association of Physicists in Medicine (AAPM)/Society for Imaging Informatics in Medicine (SIIM) Technical Standard for Electronic Practice of Medical Imaging provides useful benchmarks to guide the evaluation of currently available mobile platforms. Current smartphones and tablet computers have sufficient processor speed, storage capability, and working memory for viewing many diagnostic image data sets. Mobile computer display has seen significant advances in recent years. Table 1 , summarized from data available online , compares display characteristics of some of the more popular devices on the market currently with ACR recommendations and conventional diagnostic radiology monitors. Krupinski et al give a more thorough description of the properties of diagnostic imaging monitors.
Table 1
Mobile Computing Display Performance
Monitor Cost OS Resolution PLW Black Level CNR LAL CNR HAL Reflectivity Barco Coronis Fusion 10 MP $32,000 N/A 4096 × 2560 500–1250 950 iPad $499 iOS 2048 × 1536 421 0.48 877 55 7.7% Samsung Galaxy Tab 10.1″ $350 Android 1280 × 800 464 0.51 916 57 8.2% Microsoft Surface RT $499 Windows 8 1366 × 768 428 0.39 1097 74 5.8% ACR standards ∼350 1
Cost, approximate cost; OS, operating system; PLW, peak luminance for white (in cd/m 2 ); black level, given in cd/m 2 ; CNR LAL, contrast-to-noise ratio in low ambient light; CNR HAL, contrast-to-noise ratio in high ambient light; reflectivity, screen reflectivity; ACR dtandards, ACR standards for displays used for official interpretation of images other than mammography.
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Wireless Data Transfer
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New Mobile Devices and Their Potential Application to Medicine and Imaging
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Applications for referring physicians
Mobile Computing for Clinicians
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Computerized Physician Order Entry
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Clinical Decision Support
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Future Applications
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Physician: “I am concerned that my patient has a pulmonary embolism (PE). What is the best approach to objectively diagnosing this patient?”
PAA: “Based on the EMR, I see that the patient’s heart rate is >100 and that she has a previous objectively diagnosed PE per past medical history. Is PE the most likely diagnosis for this patient?”
Physician: “It is.”
PAA: “Has she been immobilized for at least 3 days, or has she had surgery in the previous 4 weeks?”
Physician: “She has not.”
PAA: “Does she currently have any hemoptysis?”
Physician: “She does.”
PAA: “And, finally, has she had any malignancy with treatment or palliative care within the last 6 months?”
Physician: “She has not.”
PAA: This patient has a Wells’ score of a least 7, placing her in the high-risk group for likelihood of PE. Is she pregnant?
Physician: “Yes, she is currently 8 weeks into her first pregnancy.”
PAA: Does the patient have leg swelling?
Physician: “Yes, unilateral on the right.”
PAA: According to the ACR-AC, the best approach to her imaging would be a lower extremity ultrasound with Doppler to search for potential sources of venous thromboembolism. Per the ACR-AC, an X-ray chest can also be beneficial to exclude other causes of acute chest pain, followed by a Tc-99m ventilation-perfusion scan with ventilation done only if necessary. If you would like, I can order a stat lower extremity ultrasound with Doppler. Would you like me to do so?
Physician: “Yes. Please also alert the radiologist to contact me as soon as the results are available.”
PAA: “Confirmed. I have ordered the imaging study, and have placed a high-priority call back alert for the interpreting radiologist.”
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Data acquisition and transmission
Historical Model for Radiology Image Acquisition and Transmission
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Digital Acquisition and Transmission of Radiographs
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Digital Acquisition and Transmission of Ultrasound
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Technologist: I am currently upstairs imaging Mr. X and have his images available for review.
Radiologist: It seems the patient is febrile and his doctors are worried about cholecystitis. Please let me see the images you have acquired.
Technologist: Most of the images are fine; however, there was bowel gas that limited some parts of the exam.
Radiologist: The gallbladder looks okay… Actually, is that a mass in the liver?
Technologist: I do not recall seeing one.
Radiologist: Let’s switch to real-time transmission to PACS. Now image the liver on midline. Good, now rotate the probe by 90°. Slow down… There!
Technologist: Wow, that’s subtle. Thank you for pointing it out. I will get some more images showing the largest dimensions and send them to PACS. Do you want anything else on this patient?
Radiologist: No, that should be fine. How do things look for the rest of the evening?
Technologist: Next I will be performing a renal ultrasound on a patient with a known stone and worsening abdominal pain. I will call you once I have images.
Radiologist: Thank you.
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Portable CT and MRI
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Remote Notification for Portable Examinations
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Bringing Radiology to the Patient
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The “multicorder” and beyond
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Radiologists
Mobile Teleradiology
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Radiology Consultation and Reference Materials Using Mobile Computing
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Critical Notifications and Mobile Computing
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Education
Introduction
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E-books and Journals
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Continuing Medical Education
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Resident Assessment
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Online Teaching Conferences
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Procedural Training
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Applications and implementation in patient care
The Increase in Mobile Technology Use by Nonphysicians
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Clinic Logistics
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Results Communication
EMRs
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Electronic access to images
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Patient Education and Compliance
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Barriers to Acceptance and Strategies for Success
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Familiarity with Mobile Technology
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Standardization of Information Format and Integration
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Information Security
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Demonstration of Economic Feasibility
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The Role of Research
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Fifty Years in the Future
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Conclusions
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