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For other articles and previous issues click here. February 27, 2006
Handheld PACS? iPod’s portable storage capabilities are only the beginning for pocket-size image management tools. If you spend any time in public, you’ll see people walking around hooked up to their iPods. Apple’s portable MP3 players with hard disk storage are wildly popular among people of all ages for listening to music. The most powerful iPods have 60-gigabyte hard drives that enable users to download and store thousands of songs. This storage capability excites leisure users, but iPods are carving out a niche in radiology. Physicians use them to transport, display, and manipulate images. And the iChat capability on iPods can be used to instantly communicate with others about the images. But it is the portable storage capacity that makes iPods so appealing to radiologists. “Up to a few years ago, storage was very expensive for mobile devices,” says Gregory Quinn, PhD, leader of the Mobile Data Visualization Group, San Diego Supercomputer Center, University of California, San Diego, who is researching the potential of mobile device visualization, along with C. Michael Wright, MD, FACC, LifeScore Clinic, La Jolla, Calif. “The hardware coming down the pipeline which contains graphics accelerators is very impressive. Mobile devices are coming to market with micro-drives, primarily intended for MP3 storage, but potentially providing a repository for storing large amounts of data.” Image
Storage and Viewing The iPod is convenient for radiologists, since it weighs 5.5 ounces and is easily portable. New models have a 2.5-inch color display for viewing images. Once the images are on the iPod, they can be carried to another Apple computer. OsiriX software automatically recognizes and searches for any images that physicians have stored on their iPods, and when images are detected, they will appear on a list of available image data, just as music files are displayed. “I want to emphasize that the integration of the iPod is just a small feature of the OsiriX software that was highly acclaimed by the press, but is certainly not the main reason why physicians will adopt the program,” explains Osman Ratib, MD, PhD, professor and chief of nuclear medicine at the University Hospital of Geneva and one of the developers of OsiriX. “The iPod integration is a perfect example of how our software takes advantage of ‘disruptive’ technologies that come from the consumer market and can greatly benefit the professionals and the medical community in particular. It is part of other tools such as iChat, used for remote consultations and conferencing; .Mac, used for online data storage; and Bonjour, used for peer-to-peer sharing of images and data. We took advantage of all these new technologies that Apple has embedded in their system. The main revolution that OsiriX brings is the ability to display and manipulate complex medical images in 3-D, 4-D, and 5-D in a user-friendly, simple, and accessible way for physicians who are not necessarily computer experts. These features are only available so far on high-end, very expensive workstations that were only available to specialists and academic centers. It is like in the video editing world when tools such as iMovie and iDVD suddenly allowed everybody to edit and create their own movies in a way that is similar to complex video editing of professionals.” Low-Cost
Portability “The tools that allow physicians to communicate and access the images in a simple and cost effective way are lagging behind,” Ratib says. “An increasing number of physicians today need to be able to manipulate and process complex medical images themselves. Also, there is a vital need for exchanging and communicating medical images between physicians and different specialties. This is the problem that OsiriX is trying to address and provide a solution for.” Open Source free software such as OsiriX provides tailored technical solutions, often designed and developed by the end users themselves. The success of OsiriX comes not only from the large community of users, but a community of developers worldwide are contributing to the project and the source code can be analyzed and edited by anyone who wants to contribute or modify the program, says Ratib. Graphics
Capability Security concerns are moot. According to Ratib, the software enables physicians to delete the patient’s personal information from an image file. The OsiriX software was designed to conveniently integrate the iPod every time it is connected and allows for easy display and manipulation of the list of images that are on the iPod in a similar way to the management of music files in iTunes, according to Ratib, the advantage being that it is a convenient way to save and carry data sets when physicians need to transfer patient data from one location to another. “It is certainly faster and more convenient that having to burn the data on a CD or DVD or to have to transfer data through complex protected networks. Furthermore, with the recent generations of iPods, it is also possible to set OsiriX to store the images in a format that can also be displayed on the screen of the iPod itself or on a larger screen or projector that the iPod could be connected to. This does certainly not have the quality required for diagnostic purpose, but is convenient for rapid review or presentation of some key images for discussion of a case or for teaching purposes,” explains Ratib. Early PACS workstations were designed for simple visualization of static images as a substitute for light boxes. They’ve evolved to support more complex and larger imaging modalities, including 3-D visualizations and reconstructions. Ratib sees portable systems like iPods as an emerging solution to some early PACS limitations, which include a lack of adequate means of communication and consultation among distant users. Portability also serves the growing need to transfer and communicate images constantly from one location to another, particularly in academic settings. The iPod has more potential uses with the recent adjunction of video streaming and ability to download multimedia files and connect to podcasts. Ratib and his partner, Antoine Rosset, MD, have already demonstrated the ability to use OsiriX to create podcast movies and add comments and annotations for teaching and educational purposes. Ratib and Rosset have lectured about integrating general consumer communication tools in the program, “Can PACS benefit from general consumer communication tools?” The adoption of OsiriX has exceeded the doctors’ “wildest expectations.” They received many awards in the past two years, including the 2005 Apple Design Award for Best Use of Open Source. Apples
& Oranges These devices are not being used for primary diagnosis but to provide a “reasonable image overview,” that a physician can review with a report, for example, or use to review patient information. “The resolution and depth of handheld devices are still low, but I suspect they will improve in the years to come,” says Piraino. Reuben Mezrich, MD, PhD, professor and chairman, department of radiology, University of Maryland School of Medicine, is in the process of implementing the MobileAccess Universal Wireless Network at the University of Maryland Medical Center. The project’s goal is to improve communication within the completely filmless hospital. He plans to experiment with numerous devices on the MobileAccess Wire-it-Once infrastructure, including video iPods, mobile phones, PDAs, laptops, and tablet PCs. His theory is that better communication will lead to increased productivity and better care. Mezrich explains that iPods are being utilized for educational purposes in medical schools. He cites fellow radiologist Jeffrey Galvin, MD, a radiologist at the University of Maryland School of Medicine, who has a long history of using Web-based learning and portable devices for students, residents, and clinicians. Galvin has put together teaching modules incorporating radiology and pathology images for audio podcasting (and now some video podcasting). “Radiology images are being used to illustrate a teaching point, not for diagnosis,” stresses Mezrich. “CT and MR images by their nature are not high-resolution images, so they are a good quality on the iPod. The quality of, say, chest x-rays and bone film does suffer when viewing them on an iPod, so you have to be more careful.” In five to 10 years, predicts Mezrich, the iPod will become a very strong teaching tool and may even replace textbooks. Mezrich notes that instant messaging and two-way, interactive, remote viewing on portable devices could help overcome the decrease in face-to-face consulting that PACS has caused and lead to more interaction between radiologists and other physicians. The
Future “Physicians will want to carry one item, and cell phones will have all the capabilities of the other portable devices. Cell phones will come with a huge storage capability and powerful graphics, and we will be leveraging that to end users like physicians and clinicians. Physicians will be able to do the same things that they have been doing with all three on their cell phone,” explains Quinn. Ratib sees the iPod as advancing rapidly over the coming five years, but still being an essential tool for physicians. “In five years, the iPod will not be the one we know today,” says Ratib. “There is a light speed development of portable technologies and physicians, being essentially nomads, are very eager to adopt any technology that will facilitate their work and make the huge amount of information that they need more accessible to them. I think there will be an increasing use of this type of technology by medical professionals where visual communication of images and videos are becoming an essential part of the information that is needed for patient care and patient management.” —
Laura Gater is a freelance healthcare writer based in Indiana.
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