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Karimian S, Rahimi B. A systematic review of effects of exchanging and sharing medical images systems in a sociotechnical context: Evaluation perspectives. INFORMATICS IN MEDICINE UNLOCKED 2023. [DOI: 10.1016/j.imu.2023.101212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
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Accuracy and Reliability of the Recommendation for IV Thrombolysis in Acute Ischemic Stroke Based on Interpretation of Head CT on a Smartphone or a Laptop. AJR Am J Roentgenol 2020; 214:877-884. [PMID: 32045304 DOI: 10.2214/ajr.19.21896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. The objective of this study was to assess the accuracy and reliability of IV thrombolysis recommendations made after interpretation of head CT images of patients with symptoms of acute stroke displayed on smartphone or laptop reading systems compared with those made after interpretation of images displayed on a medical workstation monitor. MATERIALS AND METHODS. This retrospective study was institutional review board-approved, and the requirement for informed consent was waived. We used a factorial design including 2256 interpretations (188 patients, four neuroradiologists, and three reading systems). To evaluate the reliability, we calculated the intraobserver and interobserver agreements using the intraclass correlation coefficient (ICC) and the following interpretation variables: hemorrhagic lesions, intraaxial neoplasm, stroke dating (acute, subacute, and chronic), hyperdense arteries, and infarct size assessment. Accuracy equivalence tests were performed for the IV thrombolysis recommendation; for this variable, sensitivity, specificity, and ROC curves were evaluated. RESULTS. Good or very good interobserver and intraobserver agreements were obtained after interpretation of each variable. The IV thrombolysis recommendation showed very good interobserver agreements (ICC ≥ 0.85) and very good intraobserver agreements (ICC ≥ 0.81). For the IV thrombolysis recommendation, the AUC values (0.83-0.84) and sensitivities (0.94-0.95) were equivalent among all the reading systems at a 5% equivalent threshold. CONCLUSION. Our study found that mobile devices are reliable and accurate to help stroke teams to decide whether to administer IV thrombolysis in patients with acute stroke.
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Salazar AJ, Useche N, Bermúdez S, Morillo A, Torres O, Granja M, Rueda N, Ropero B. Evaluation of the Accuracy Equivalence of Head CT Interpretations in Acute Stroke Patients Using a Smartphone, a Laptop, or a Medical Workstation. J Am Coll Radiol 2019; 16:1561-1571. [DOI: 10.1016/j.jacr.2019.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 11/26/2022]
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Salazar AJ, Useche N, Granja M, Bermúdez S, Morillo AJ, Torres O, Rueda N, Ropero B. Reliability and accuracy of individual Alberta Stroke Program Early CT Score regions using a medical and a smartphone reading system in a telestroke network. J Telemed Telecare 2019; 27:436-443. [PMID: 31635531 PMCID: PMC8366140 DOI: 10.1177/1357633x19881863] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction The aim of this study was to assess individual regions of the Alberta Stroke Program Early CT Score in noncontrast head computed tomography interpretations using a smartphone in a telestroke network, by comparison to a medical monitor. Methods The review board of our institution approved this retrospective study. A factorial design with 188 patients, four radiologists and two reading systems was used. Accuracy and reliability were evaluated. Results Very good interobserver agreements were observed on the total Alberta Stroke Program Early CT Score for both the medical and smartphone reading systems, with intraclass correlation coefficients of 0.91 and 0.84 respectively. Interobserver agreements were moderate to very good for the medical reading system (all intraclass correlation coefficients >0.74), whereas they were fair to very good for the smartphone (intraclass correlation coefficients ranged from 0.31–0.81). All intraobserver agreements were good (intraclass correlation coefficient >0.64), except for internal capsule (0.48) and M2 (0.55) regions. The areas under the receiver-operating curve ranged from 0.69–0.89 for the medical system, while for the smartphone ranged from 0.44–0.86. No statistical differences were observed between medical and smartphone reading systems for each region (all p > 0.05). Discussion If radiologists are better trained in the evaluation of the lesions in the insula, the internal capsule and the M2 regions, the total and the dichotomised Alberta Stroke Program Early CT Score will be more precise. Hence, ruling out contraindications to thrombolysis administration will be improved, allowing assessment of head computed tomography in a telestroke network using a smartphone to be a common practice.
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Affiliation(s)
- Antonio J Salazar
- Electrophysiology and Telemedicine Laboratory, University of Los Andes, Colombia
| | - Nicolás Useche
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia.,School of Medicine, Universidad El Bosque, Colombia
| | | | - Sonia Bermúdez
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia.,School of Medicine, Universidad El Bosque, Colombia
| | - Aníbal J Morillo
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia.,School of Medicine, Universidad El Bosque, Colombia
| | - Oscar Torres
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia
| | - Natalia Rueda
- Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia.,School of Medicine, Universidad El Bosque, Colombia
| | - Brenda Ropero
- Electrophysiology and Telemedicine Laboratory, University of Los Andes, Colombia.,Department of Diagnostic Imaging, University Hospital Fundación Santa Fe de Bogotá, Colombia
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Salazar AJ, Useche N, Granja MF, Morillo AJ, Bermúdez S, Sossa D, Ortiz CJ, Torres OJ, Ropero B. Mobile device for thrombolysis decisions for telestroke. Colomb Med (Cali) 2018; 49:254-260. [PMID: 30700917 PMCID: PMC6342084 DOI: 10.25100/cm.v49i4.3921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim: This study compares the reliability of brain CT interpretations performed using a diagnostic workstation and a mobile tablet computer in a telestroke context. Methods: A factorial design with 1,452 interpretations was used. Reliability was evaluated using the Fleiss’ kappa coefficient on the agreements of the interpretation results on the lesion classification, presence of imaging contraindications to the intravenous recombinant tissue-type plasminogen activator (t-PA) administration, and on the Alberta Stroke Program Early CT Score (ASPECTS). Results: The intra-observer agreements were as follows: good agreement on the overall lesion classification (κ= 0.63, p<0.001), very good agreement on hemorrhagic lesions (κ= 0.89, p<0.001), and moderate agreements on both without acute lesion classification and acute ischemic lesion classification (κ= 0.59 and κ= 0.58 respectively, p<0.001). There was good intra-observer agreement on the dichotomized-ASPECTS (κ= 0.65, p<0.001). Conclusions: The results of our study allow us to conclude that the reliability of the mobile solution for interpreting brain CT images of patients with acute stroke was assured, which would allow efficient and low-cost telestroke services.
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Affiliation(s)
- Antonio J Salazar
- Universidad de los Andes, Laboratorio de Telemedicina y Electrofisiología. Bogotá, Colombia
| | - Nicolás Useche
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
| | - Manuel F Granja
- Baptist Neurological Institute, Lyerly Neurosurgery, Jacksonville. FL, USA
| | - Aníbal J Morillo
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
| | - Sonia Bermúdez
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
| | - Didier Sossa
- Universidad El Bosque, Facultad de Medicina. Bogotá, Colombia
| | - Claudia J Ortiz
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
| | - Oscar J Torres
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
| | - Brenda Ropero
- Fundación Santa Fe de Bogotá, Hospital Universitario . Bogotá, Colombia
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Hattori H, Kuwayama Y, Inui Y, Murayama K, Hayakawa M, Ito S, Toyama H. Reliability of diagnosing acute ischemic cerebrovascular on magnetic resonance imaging disorders using iPads. Jpn J Radiol 2018; 36:726-735. [PMID: 30317411 DOI: 10.1007/s11604-018-0763-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Accepted: 08/04/2018] [Indexed: 11/25/2022]
Abstract
PURPOSE The use of tablet terminals has been explored in various medical settings; however, caution should be exercised when performing image diagnosis using this technology. The present study examined the characteristics of an iPad Air™ monitor and assessed radiographic image interpretations to verify the reliability of the telediagnosis of acute cerebral infarction based on magnetic resonance imaging (MRI) using a tablet terminal. MATERIALS AND METHODS The luminance of the iPad Air™ was measured using a UA-10 analyzer, and radiographic image interpretation experiments were performed in 100 patients who underwent MRI within 6 h of symptom onset. Ten physicians viewed the images on the iPad Air™ and a medical monitor, with an interval of 2 months between each interpretation. RESULTS When the iPad Air™ screen was pure white, the contour lines revealed nonuniform luminance distribution. In the reading experiment, the areas under the curve of the medical monitor and the iPad Air™ were 0.9311 and 0.9431, respectively. No significant difference was observed between the medical monitor and the iPad Air™ (p = 0.113). CONCLUSION The results of the observer performance studies for detecting acute ischemic cerebrovascular disorders on an iPad Air™ were found to be similar to those on a medical monitor.
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Affiliation(s)
- Hidekazu Hattori
- Department of Radiology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan.
| | - Yoshifumi Kuwayama
- Department of Medical Information Systems, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Yoshitaka Inui
- Department of Radiology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Kazuhiro Murayama
- Department of Radiology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
| | - Motoharu Hayakawa
- Department of Neurosurgery, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Shinji Ito
- Department of Neurology, Fujita Health University, School of Medicine, Toyoake, Aichi, Japan
| | - Hiroshi Toyama
- Department of Radiology, Fujita Health University, School of Medicine, 1-98, Dengakugakubo, Kutsukake, Toyoake, Aichi, 470-1192, Japan
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A Feasibility Study of Telementoring for Identifying the Appendix Using Smartphone-Based Telesonography. J Digit Imaging 2018; 30:148-155. [PMID: 27826671 DOI: 10.1007/s10278-016-9921-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
We investigated the feasibility of the clinical application of novice-practitioner-performed/offsite-mentor-guided ultrasonography for identifying the appendix. A randomized crossover study was conducted using a telesonography system that can transmit the ultrasound images displayed on the ultrasound monitor (ultrasound sequence video) and images showing the practitioner's operations (background video) to a smartphone without any interruption in motion over a Long-Term Evolution (LTE) network. Thirty novice practitioners were randomly assigned to two groups. The subjects in group A (n = 15) performed ultrasonography for the identification of the appendix under mentoring by an onsite expert, whereas those in group B (n = 15) performed the same procedure under mentoring by an offsite expert. Each subject performed the procedure on three simulated patients. After a 4-week interval, they performed the procedure again under the other type of mentoring. A total of 90 ultrasound examinations were performed in each scenario. The primary outcomes were the success rate for identifying the appendix and the time required to identify the appendix. The success rates for identifying the appendix were 91.1 % (82/90) in onsite-mentored ultrasonography and 87.8 % (79/90) in offsite-mentored ultrasonography; both rates were high, and there was no significant difference (p = 0.468) between them. The time required in the case of offsite mentoring (median, 242.9 s; interquartile range (IQR), 238.2) was longer than that for onsite mentoring (median, 291.4 s; IQR, 200.9); however, the difference was not significant (p = 0.051). It appears that offsite mentoring can allow novice onsite practitioners to perform ultrasonography as effectively as they can under onsite mentoring, even for examinations that require proficiency in rather complex practices, such as identifying the appendix.
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ESR paper on the proper use of mobile devices in radiology. Insights Imaging 2018; 9:247-251. [PMID: 29569214 PMCID: PMC5893485 DOI: 10.1007/s13244-017-0589-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 12/14/2017] [Indexed: 11/29/2022] Open
Abstract
Abstract Mobile devices (smartphones, tablets, etc.) have become key methods of communication, data access and data sharing for the population in the past decade. The technological capabilities of these devices have expanded very rapidly; for example, their in-built cameras have largely replaced conventional cameras. Their processing power is often sufficient to handle the large data sets of radiology studies and to manipulate images and studies directly on hand-held devices. Thus, they can be used to transmit and view radiology studies, often in locations remote from the source of the imaging data. They are not recommended for primary interpretation of radiology studies, but they facilitate sharing of studies for second opinions, viewing of studies and reports by clinicians at the bedside, etc. Other potential applications include remote participation in educational activity (e.g. webinars) and consultation of online educational content, e-books, journals and reference sources. Social-networking applications can be used for exchanging professional information and teaching. Users of mobile device must be aware of the vulnerabilities and dangers of their use, in particular regarding the potential for inappropriate sharing of confidential patient information, and must take appropriate steps to protect confidential data. Key Points • Mobile devices have revolutionized communication in the past decade, and are now ubiquitous. • Mobile devices have sufficient processing power to manipulate and display large data sets of radiological images. • Mobile devices allow transmission & sharing of radiologic studies for purposes of second opinions, bedside review of images, teaching, etc. • Mobile devices are currently not recommended as tools for primary interpretation of radiologic studies. • The use of mobile devices for image and data transmission carries risks, especially regarding confidentiality, which must be considered.
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Kim C, Cha H, Kang BS, Choi HJ, Lim TH, Oh J. A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos. J Digit Imaging 2018; 29:347-56. [PMID: 26620200 DOI: 10.1007/s10278-015-9849-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Our aim was to prove the feasibility of the remote interpretation of real-time transmitted ultrasound videos of dynamic and static organs using a smartphone with control of the image quality given a limited internet connection speed. For this study, 100 cases of echocardiography videos (dynamic organ)-50 with an ejection fraction (EF) of ≥50 s and 50 with EF <50 %-and 100 cases of suspected pediatric appendicitis (static organ)-50 with signs of acute appendicitis and 50 with no findings of appendicitis-were consecutively selected. Twelve reviewers reviewed the original videos using the liquid crystal display (LCD) monitor of an ultrasound machine and using a smartphone, to which the images were transmitted from the ultrasound machine. The resolution of the transmitted echocardiography videos was reduced by approximately 20 % to increase the frame rate of transmission given the limited internet speed. The differences in diagnostic performance between the two devices when evaluating left ventricular (LV) systolic function by measuring the EF and when evaluating the presence of acute appendicitis were investigated using a five-point Likert scale. The average areas under the receiver operating characteristic curves for each reviewer's interpretations using the LCD monitor and smartphone were respectively 0.968 (0.949-0.986) and 0.963 (0.945-0.982) (P = 0.548) for echocardiography and 0.972 (0.954-0.989) and 0.966 (0.947-0.984) (P = 0.175) for abdominal ultrasonography. We confirmed the feasibility of remotely interpreting ultrasound images using smartphones, specifically for evaluating LV function and diagnosing pediatric acute appendicitis; the images were transferred from the ultrasound machine using image quality-controlled telesonography.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Hyunmin Cha
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea.
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchun-ro(st), Guri-si, GyeongGi-do, 471-701, Korea.
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea
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Venson JE, Bevilacqua F, Berni J, Onuki F, Maciel A. Diagnostic concordance between mobile interfaces and conventional workstations for emergency imaging assessment. Int J Med Inform 2018; 113:1-8. [PMID: 29602428 DOI: 10.1016/j.ijmedinf.2018.01.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Revised: 01/29/2018] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Mobile devices and software are now available with sufficient computing power, speed and complexity to allow for real-time interpretation of radiology exams. In this paper, we perform a multivariable user study that investigates concordance of image-based diagnoses provided using mobile devices on the one hand and conventional workstations on the other hand. METHODS We performed a between-subjects task-analysis using CT, MRI and radiography datasets. Moreover, we investigated the adequacy of the screen size, image quality, usability and the availability of the tools necessary for the analysis. Radiologists, members of several teams, participated in the experiment under real work conditions. A total of 64 studies with 93 main diagnoses were analyzed. RESULTS Our results showed that 56 cases were classified with complete concordance (87.69%), 5 cases with almost complete concordance (7.69%) and 1 case (1.56%) with partial concordance. Only 2 studies presented discordance between the reports (3.07%). The main reason to explain the cause of those disagreements was the lack of multiplanar reconstruction tool in the mobile viewer. Screen size and image quality had no direct impact on the mobile diagnosis process. CONCLUSION We concluded that for images from emergency modalities, a mobile interface provides accurate interpretation and swift response, which could benefit patients' healthcare.
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Affiliation(s)
- José Eduardo Venson
- Instituto de Informática, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil.
| | - Fernando Bevilacqua
- Universidade Federal da Fronteira Sul, Chapecó, Brazil; University of Skövde, Sweden
| | - Jean Berni
- Animati Computação Aplicada à Saúde, Santa Maria, Brazil
| | | | - Anderson Maciel
- Instituto de Informática, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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Ruling Out Brain CT Contraindications prior to Intravenous Thrombolysis: Diagnostic Equivalence between a Primary Interpretation Workstation and a Mobile Tablet Computer. Int J Telemed Appl 2017; 2017:6869145. [PMID: 29250111 PMCID: PMC5700470 DOI: 10.1155/2017/6869145] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/17/2017] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to evaluate the equivalence of brain CT interpretations performed using a diagnostic workstation and a mobile tablet computer, in a telestroke service. Materials and Methods The ethics committee of our institution approved this retrospective study. A factorial design with 1452 interpretations was used. The assessed variables were the type of stroke classification, the presence of contraindications to the tPA administration, the presence of a hyperdense intracranial artery sign (HMCA), and the Alberta Stroke Program Early CT Score (ASPECTS) score. These variables were evaluated to determine the effect that the reading system had on their magnitudes. Results The achieved distribution of observed lesions using both the reading systems was not statistically different. The differences between the two reading systems to claim equivalence were 1.6% for hemorrhagic lesions, 4.5% for cases without lesion, and 5.2 for overall ischemic lesion. Equivalence was achieved at 2.1% for ASPECTS ≤ 6, 6.5% for the presence of imaging contraindication to the tPA administration, and 7.2% for the presence of HMCA. Conclusion The diagnostic performance for detecting acute stroke is likely equivalent whether a tablet computer or a diagnostic workstation is used or not.
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An HTML5-Based Pure Website Solution for Rapidly Viewing and Processing Large-Scale 3D Medical Volume Reconstruction on Mobile Internet. Int J Telemed Appl 2017. [PMID: 28638406 PMCID: PMC5468779 DOI: 10.1155/2017/4074137] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
This study aimed to propose a pure web-based solution to serve users to access large-scale 3D medical volume anywhere with good user experience and complete details. A novel solution of the Master-Slave interaction mode was proposed, which absorbed advantages of remote volume rendering and surface rendering. On server side, we designed a message-responding mechanism to listen to interactive requests from clients (Slave model) and to guide Master volume rendering. On client side, we used HTML5 to normalize user-interactive behaviors on Slave model and enhance the accuracy of behavior request and user-friendly experience. The results showed that more than four independent tasks (each with a data size of 249.4 MB) could be simultaneously carried out with a 100-KBps client bandwidth (extreme test); the first loading time was <12 s, and the response time of each behavior request for final high quality image remained at approximately 1 s, while the peak value of bandwidth was <50-KBps. Meanwhile, the FPS value for each client was ≥40. This solution could serve the users by rapidly accessing the application via one URL hyperlink without special software and hardware requirement in a diversified network environment and could be easily integrated into other telemedical systems seamlessly.
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Schlechtweg PM, Kammerer FJ, Seuss H, Uder M, Hammon M. Mobile Image Interpretation: Diagnostic Performance of CT Exams Displayed on a Tablet Computer in Detecting Abdominopelvic Hemorrhage. J Digit Imaging 2017; 29:183-8. [PMID: 26438423 DOI: 10.1007/s10278-015-9829-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
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. Image evaluation included signs of an active hemorrhage (extravasation of contrast media) and different signs indicating a condition after abdominopelvic hemorrhage (hematoma, intestinal clots, vessel stump, free abdominopelvic fluid with a mean Hounsfield unit value >20, and asymmetric muscle volume indicating intramuscular hemorrhage). Sensitivity, specificity, and positive and negative predictive values (PPV/NPV) were calculated for the tablet-based reading. Active abdominopelvic hemorrhage (n = 72) was diagnosed with the tablet computer with a sensitivity of 0.96, a specificity of 0.93, a PPV of 0.97, and an NPV of 0.90. The results for the detection of the signs indicating a condition after abdominopelvic hemorrhage range from 0.83 to 1.00 in the case of sensitivity, from 0.95 to 1.00 in the case of specificity, from 0.94 to 1.00 in the case of the PPV, and from 0.96 to 1.00 in the case of the NPV. 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.
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Affiliation(s)
- Philipp M Schlechtweg
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Ferdinand J Kammerer
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Hannes Seuss
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Michael Uder
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany
| | - Matthias Hammon
- Department of Radiology, University Hospital Erlangen, Maximiliansplatz 1, 91054, Erlangen, Germany.
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McLaughlin PD, Moloney F, O'Neill SB, James K, Crush L, Flanagan O, Maher MM, Wyse G, Fanning N. CT of the head for acute stroke: Diagnostic performance of a tablet computer prior to intravenous thrombolysis. J Med Imaging Radiat Oncol 2017; 61:334-338. [PMID: 28156051 DOI: 10.1111/1754-9485.12585] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 12/08/2016] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The authors propose that tablet computers could benefit patients with acute stroke in the remote care setting, where time to and accuracy of CT interpretation greatly influences patient outcome. METHODS One hundred and fifty consecutive patients who presented to the Emergency Department of a tertiary referral neurosciences centre within a time window suitable for intravenous thrombolytic therapy were included. Images were wirelessly transmitted to a tablet computer (iPad 3rd Generation, model = A1430, Apple, Cupertino, CA) and were reviewed by radiologists with three levels of experience for signs of intracranial haemorrhage, large vessel occlusion and parenchymal infarction. Reference standard interpretation was performed by two neuroradiologists using a diagnostic monochrome display. RESULTS Consensus neuroradiologist review on the tablet display found and correctly classified all of the 23 cases of intracranial haemorrhage including 21 cases of parenchymal haematoma, two cases of petechial haemorrhage and one patient with an acute subdural haematoma. Less experienced readers missed cases of petechial and subdural haematomas. There was excellent agreement between the tablet and diagnostic monochrome display in cases with no infarct or extensive parenchymal infarction. CONCLUSIONS Tablet computers can be used to facilitate rapid preliminary CT interpretation in patients with acute stroke in the remote setting.
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Affiliation(s)
| | - Fiachra Moloney
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | | | - Karl James
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Lee Crush
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Oisin Flanagan
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Michael M Maher
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Gerald Wyse
- Department of Radiology, Cork University Hospital, Cork, Ireland
| | - Noel Fanning
- Department of Radiology, Cork University Hospital, Cork, Ireland
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Chen J, Lin Y, Shen B. Informatics for Precision Medicine and Healthcare. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 1005:1-20. [PMID: 28916926 DOI: 10.1007/978-981-10-5717-5_1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The past decade has witnessed great advances in biomedical informatics. Biomedical informatics is an emerging field of healthcare that aims to translate the laboratory observation into clinical practice. Smart healthcare has also developed rapidly with ubiquitous sensor and communication technologies. It is able to capture the online patient-centric phenotypic variables, thus providing a rich information base for translational biomedical informatics. Biomedical informatics and smart healthcare represent two interrelated disciplines. On one hand, biomedical informatics translates the bench discoveries into bedside, and, on the other hand, it is reciprocally informed by clinical data generated from smart healthcare. In this chapter, we will introduce the major strategies and challenges in the application of biomedical informatics technology in precision medicine and healthcare. We highlight how the informatics technology will promote the precision medicine and therefore promise the improvement of healthcare.
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Affiliation(s)
- Jiajia Chen
- School of Chemistry, Biology and Materials Engineering, Suzhou University of Science and Technology, No.1 Kerui road, Suzhou, Jiangsu, 215011, China
| | - Yuxin Lin
- Center for Systems Biology, Soochow University, No.1 Shizi Street, Suzhou, Jiangsu, 215006, China
| | - Bairong Shen
- Center for Systems Biology, Soochow University, No.1 Shizi Street, Suzhou, Jiangsu, 215006, China. .,Suzhou Institute of Biomedical Engineering and Technology, Chinese Academy of Sciences, Suzhou, Jiangsu, 215163, China. .,Medical College of Guizhou University, Guiyang, 550025, China.
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Bashshur RL, Krupinski EA, Thrall JH, Bashshur N. The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence. Telemed J E Health 2016; 22:868-898. [PMID: 27585301 PMCID: PMC5107673 DOI: 10.1089/tmj.2016.0149] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/10/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. METHODS A selective review of the credible literature during the past decade (2005-2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. FINDINGS The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.
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Affiliation(s)
| | | | - James H. Thrall
- Department of Radiology, Massachusetts General Hospital, Harvard, Boston, Massachusetts
| | - Noura Bashshur
- University of Michigan Health System, Ann Arbor, Michigan
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Kim C, Kang B, Choi HJ, Park JB. A Feasibility Study of Real-Time Remote CT Reading for Suspected Acute Appendicitis Using an iPhone. J Digit Imaging 2016; 28:399-406. [PMID: 25700617 DOI: 10.1007/s10278-015-9775-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
We aimed to evaluate the feasibility of an iPhone-based remote control system as a real-time remote computed tomography (CT) reading tool for suspected appendicitis using a third-generation (3G) network under suboptimal illumination. One hundred twenty abdominal CT scans were selected; 60 had no signs of appendicitis, whereas the remaining 60 had signs of appendicitis. The 16 raters reviewed the images using the liquid crystal display (LCD) monitor of a picture archiving and communication system (PACS) workstation, as well as using an iPhone connected to the PACS workstation via a remote control system. We graded the probability of the presence of acute appendicitis for each examination using a five-point Likert scale. The overall sensitivity and specificity for the diagnosis of suspected appendicitis using the iPhone and the LCD monitor were high, and they were not significantly different (sensitivity P = 1.00, specificity P = 0.14). The average areas under the receiver operating characteristic curves for all CT readings with the iPhone and LCD monitor were 0.978 (confidence interval 0.965-0.991) and 0.974 (0.960-0.988), respectively, and the two devices did not have significantly different diagnostic performances (P = 0.55). The inter-rater agreement for both devices was very good; the kappa value for the iPhone was 0.809 (0.793-0.826), and that for the LCD monitor was 0.817 (0.801-0.834). Each rater had moderate-to-very good intra-observer agreement between the two devices. We verified the feasibility of an iPhone-based remote control system as a real-time remote CT reading tool for identifying suspected appendicitis using a 3G network and suboptimal illumination.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Hanyang University Guri Hospital, 153 Gyeongchun-ro(st), Guri-si, Gyeonggi-do, 471-701, Republic of Korea
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Remote reading of coronary CTA exams using a tablet computer: utility for stenosis assessment and identification of coronary anomalies. Emerg Radiol 2016; 23:255-61. [PMID: 27085532 DOI: 10.1007/s10140-016-1399-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Accepted: 04/12/2016] [Indexed: 10/21/2022]
Abstract
The feasibility of remote reading of coronary CT examinations on tablet computers has not been evaluated. The purpose of this study is to evaluate the accuracy of coronary CT angiography reading using an iPad compared to standard 3D workstations. Fifty coronary CT angiography exams, including a spectrum of coronary artery disease and anatomic variants, were reviewed. Coronary CT angiography exams were interpreted by two readers independently on an iPad application (Siemens Webviewer) and a clinical 3D workstation at sessions 2 weeks apart. Studies were scored per vessel for severity of stenosis on a 0-3 scale (0 none, 1 <50 %, 2 ≥50-69 %, 3 ≥70 %). Coronary anomalies were recorded. A consensus read by two experienced cardiac imagers was used as the reference standard. Level of agreement with the reference for iPad and 3D workstations was compared. Multivariate logistic regression was used to analyze the relationship between agreement and display type and to adjust for inter-reader differences. 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.
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O'Connell TW, Patlas MN. Mobile devices and their prospective future role in emergency radiology. Br J Radiol 2016; 89:20150820. [PMID: 26689095 DOI: 10.1259/bjr.20150820] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Mobile devices, wireless networks and software have significantly evolved since the late 1990s and are now available with sufficient computing power, speed and complexity to allow real-time interpretation of radiology studies. Emergency radiology (ER)'s time-sensitive nature would seem to be an excellent match for study interpretation using mobile devices, allowing the radiologist to read studies anywhere, at any time. While suitable for use by the radiologist outside of the hospital, or clinicians and surgeons at the bedside or in the operating room, these devices do have limitations, and regulatory approval for in-hospital diagnostic use is limited. In the ER setting, we suggest that the best use of mobile devices is to be available to consult directly with patients about their imaging findings and to the clinical team during rounds and at handover. This will bring the radiologist to the clinician and patient, helping us to better understand the patient's presentation, educate both the physician and patient and increase the visibility and value of the radiologist as a member of the clinical care team.
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Affiliation(s)
- Timothy W O'Connell
- 1 Department of Radiology, Vancouver General Hospital, Vancouver, BC, Canada
| | - Michael N Patlas
- 2 Department of Radiology, McMaster University, Hamilton, ON, Canada
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Effect of display type and room illuminance in chest radiographs. Eur Radiol 2015; 26:3171-9. [PMID: 26662032 DOI: 10.1007/s00330-015-4150-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 11/19/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
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Out of Hours Emergency Computed Tomography Brain Studies: Comparison of Standard 3 Megapixel Diagnostic Workstation Monitors with the iPad 2. Can Assoc Radiol J 2015; 66:363-7. [DOI: 10.1016/j.carj.2015.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Revised: 03/17/2015] [Accepted: 03/26/2015] [Indexed: 11/20/2022] Open
Abstract
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. Methods Two experienced radiologists interpreted 100 random emergency CT brain studies on both on-site diagnostic workstation monitors and the iPad 2 via remote access. The radiologists were blinded to patient clinical details and to each other's interpretation and the study list was randomized between interpretations on different modalities. Interobserver agreement between radiologists and intraobserver agreement between modalities was determined and Cohen kappa coefficients calculated for each. Performance with regards to urgent and nonurgent abnormalities was assessed separately. Results There was substantial intraobserver agreement of both radiologists between the modalities with overall calculated kappa values of 0.959 and 0.940 in detecting acute abnormalities and perfect agreement with regards to hemorrhage. Intraobserver agreement kappa values were 0.939 and 0.860 for nonurgent abnormalities. Interobserver agreement between the 2 radiologists for both diagnostic monitors and the iPad 2 was also substantial ranging from 0.821-0.860. 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.
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Kim C, Kang BS, Choi HJ, Lim TH, Oh J, Chee Y. Clinical application of real-time tele-ultrasonography in diagnosing pediatric acute appendicitis in the ED. Am J Emerg Med 2015; 33:1354-9. [PMID: 26306436 DOI: 10.1016/j.ajem.2015.07.048] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/22/2015] [Accepted: 07/22/2015] [Indexed: 10/23/2022] Open
Abstract
PURPOSE We investigated the effectiveness of tele-mentored ultrasonography between emergency medicine (EM) residents and remote experts in diagnosing acute appendicitis. METHODS This prospective observational study was performed in an academic emergency department. Beginning in June 2014, the EM residents performed the initial ultrasonography for suspected pediatric acute appendicitis; then, the remote experts observed/mentored the residents' practice using the tele-ultrasonography system; and finally, an onsite expert verified the diagnosis. The diagnostic confidence of each examiner (resident, remote expert, and onsite expert) was rated on a 5-point Likert scale. The appendix identification rate and the diagnostic values; sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) for each type of examination were calculated. RESULTS A total of 115 pediatric cases with suspected acute appendicitis, including 36 with pathology-confirmed acute appendicitis, between June 2014 and February 2015 were enrolled in this study. In 9 of the 115 (7.8%) cases, a non-appendicitis diagnosis was determined in the absence of the successful identification of a normal appendix upon resident examination. Of these, seven appendices were identified upon expert tele-ultrasonography. The diagnostic values for expert tele-ultrasonography were higher (sensitivity: 1.000, specificity: 0.975, PPV: 0.947, NPV: 1.000) than those for resident-performed ultrasonography (sensitivity: 0.917, specificity: 0.899, PPV: 0.805, NPV: 0.959) and similar to those for onsite expert-performed ultrasonography (sensitivity: 1.000, specificity: 0.987, PPV: 0.973, NPV: 1.000). CONCLUSION Tele-ultrasonography with tele-mentoring between EM residents and experienced mentors was effectively applied in diagnosing pediatric acute appendicitis in an emergency clinical setting.
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Affiliation(s)
- Changsun Kim
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Bo Seung Kang
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea.
| | - Hyuk Joong Choi
- Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Tae Ho Lim
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Jaehoon Oh
- Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Republic of Korea
| | - Youngjoon Chee
- School of Electrical Engineering, Ulsan University, Republic of Korea
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Kammerer FJ, Hammon M, Schlechtweg PM, Uder M, Schwab SA. A web based cross-platform application for teleconsultation in radiology. J Telemed Telecare 2015; 21:355-63. [PMID: 25962651 DOI: 10.1177/1357633x15575237] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Accepted: 02/02/2015] [Indexed: 11/17/2022]
Abstract
The growing complexity of radiologic examinations and interventional procedures requires frequent exchange of knowledge. Consequently a simple way to share and discuss patient images between radiology experts and with colleagues from other medical disciplines is needed. Aims of this work were the development and initial performance evaluation of a fast and user friendly, platform independent teleconsultation system for medical imaging. A local back end system receives DICOM images and generates anonymized JPEG files that are uploaded to an internet webserver. The front end running on that webserver comprises an image viewer with a specially developed pointer element for indicating findings to collaborative partners. The front end that uses only standard web technologies works on a variety of different platforms, mobile devices and desktop computers. Images can be accessed by simply calling up a special internet address in a web browser that may be exchanged between users (e.g. via email). A speed evaluation of the system showed good results: For example the preparation and upload of a standard head CT took less than 21 seconds. The data volume of the same series and the viewer application could be transferred to a mobile phone in less than 42 seconds via a UMTS network or in less than 3 seconds via a HSPA network. The presented system with its minimal hard- and software requirements, its simplicity and platform independence might be a promising tool in the increasingly important area of teleconsultation.
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Affiliation(s)
| | - Matthias Hammon
- Department of Radiology, University hospital Erlangen, Germany
| | | | - Michael Uder
- Department of Radiology, University hospital Erlangen, Germany
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Caffery LJ, Armfield NR, Smith AC. Radiological interpretation of images displayed on tablet computers: a systematic review. Br J Radiol 2015; 88:20150191. [PMID: 25882691 DOI: 10.1259/bjr.20150191] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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. METHODS We searched the PubMed and EMBASE databases for studies on the diagnostic accuracy or diagnostic reliability of images interpreted on tablet computers. Studies were screened for inclusion based on pre-determined inclusion and exclusion criteria. Studies were assessed for quality and risk of bias using Quality Appraisal of Diagnostic Reliability Studies or the revised Quality Assessment of Diagnostic Accuracy Studies tool. Treatment of studies was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). RESULTS 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. 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. ADVANCES IN KNOWLEDGE The iPad may be appropriate for an on-call radiologist to use for radiological interpretation.
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Affiliation(s)
- L J Caffery
- Centre for Online Health, The University of Queensland, Brisbane, QLD, Australia
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Faggioni L, Neri E, Bargellini I, Scalise P, Calcagni F, Mantarro A, D'Ippolito G, Bartolozzi C. iPad-based primary 2D reading of CT angiography examinations of patients with suspected acute gastrointestinal bleeding: preliminary experience. Br J Radiol 2015; 88:20140477. [PMID: 25652643 DOI: 10.1259/bjr.20140477] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
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. METHODS 24 CTA examinations of patients with suspected acute gastrointestinal bleeding confirmed (19/24, 79.2%) or ruled out (5/24, 20.8%) by digital subtraction angiography (DSA) were retrospectively reviewed by three independent readers on a commercial picture archiving communication system (PACS) workstation and on an iPad with Retina Display® 64 GB (Apple Inc.). The time needed to complete reading of every CTA examination was recorded, as well as the rate of detection of arterial bleeding and identification of suspected bleeding arteries on both devices. RESULTS Overall, the area under the receiver operating characteristic curve, sensitivity, specificity, positive- and negative-predictive values for bleeding detection were not significantly different while using the iPad and workstation (0.774 vs 0.847, 0.947 vs 0.895, 0.6 vs 0.8, 0.9 vs 0.944 and 0.750 vs 0.667, respectively; p > 0.05). In DSA-positive cases, the iPad and workstation allowed correct identification of the bleeding source in 17/19 cases (89.5%) and 15/19 cases (78.9%), respectively (p > 0.05). Finally, the time needed to complete reading of every CTA study was significantly shorter using the iPad (169 ± 74 vs 222 ± 70 s, respectively; p < 0.01). 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.
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Affiliation(s)
- L Faggioni
- 1 Department of Diagnostic and Interventional Radiology, University of Pisa, Pisa, Italy
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Murakami T, Tajika Y, Ueno H, Awata S, Hirasawa S, Sugimoto M, Kominato Y, Tsushima Y, Endo K, Yorifuji H. An integrated teaching method of gross anatomy and computed tomography radiology. ANATOMICAL SCIENCES EDUCATION 2014; 7:438-449. [PMID: 24443310 DOI: 10.1002/ase.1430] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 09/04/2013] [Accepted: 11/13/2013] [Indexed: 06/03/2023]
Abstract
It is essential for medical students to learn and comprehend human anatomy in three dimensions (3D). With this in mind, a new system was designed in order to integrate anatomical dissections with diagnostic computed tomography (CT) radiology. Cadavers were scanned by CT scanners, and students then consulted the postmortem CT images during cadaver dissection to gain a better understanding of 3D human anatomy and diagnostic radiology. Students used handheld digital imaging and communications in medicine viewers at the bench-side (OsiriX on iPod touch or iPad), which enabled "pixel-to-tissue" direct comparisons of CT images and cadavers. Students had lectures and workshops on diagnostic radiology, and they completed study assignments where they discussed findings in the anatomy laboratory compared with CT radiology findings. This teaching method for gross and radiological anatomy was used beginning in 2009, and it yielded strongly positive student perspectives and significant improvements in radiology skills in later clinical courses.
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Affiliation(s)
- Tohru Murakami
- Department of Anatomy, Gunma University Graduate School of Medicine, Maebashi, Japan
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Mobile medical and health apps: state of the art, concerns, regulatory control and certification. Online J Public Health Inform 2014; 5:229. [PMID: 24683442 PMCID: PMC3959919 DOI: 10.5210/ojphi.v5i3.4814] [Citation(s) in RCA: 229] [Impact Index Per Article: 22.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
This paper examines the state of the art in mobile clinical and health-related apps. A 2012
estimate puts the number of health-related apps at no fewer than 40,000, as healthcare professionals
and consumers continue to express concerns about the quality of many apps, calling for some form of
app regulatory control or certification to be put in place. We describe the range of apps on offer
as of 2013, and then present a brief survey of evaluation studies of medical and health-related apps
that have been conducted to date, covering a range of clinical disciplines and topics. Our survey
includes studies that highlighted risks, negative issues and worrying deficiencies in existing apps.
We discuss the concept of ‘apps as a medical device’ and the relevant regulatory
controls that apply in USA and Europe, offering examples of apps that have been formally approved
using these mechanisms. We describe the online Health Apps Library run by the National Health
Service in England and the calls for a vetted medical and health app store. We discuss the
ingredients for successful apps beyond the rather narrow definition of ‘apps as a medical
device’. These ingredients cover app content quality, usability, the need to match apps to
consumers’ general and health literacy levels, device connectivity standards (for apps that
connect to glucometers, blood pressure monitors, etc.), as well as app security and user privacy.
‘Happtique Health App Certification Program’ (HACP), a voluntary app certification
scheme, successfully captures most of these desiderata, but is solely focused on apps targeting the
US market. HACP, while very welcome, is in ways reminiscent of the early days of the Web, when many
“similar” quality benchmarking tools and codes of conduct for information publishers
were proposed to appraise and rate online medical and health information. It is probably impossible
to rate and police every app on offer today, much like in those early days of the Web, when people
quickly realised the same regarding informational Web pages. The best first line of defence was, is,
and will always be to educate consumers regarding the potentially harmful content of (some)
apps.
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Image quality characteristics of handheld display devices for medical imaging. PLoS One 2013; 8:e79243. [PMID: 24236113 PMCID: PMC3827384 DOI: 10.1371/journal.pone.0079243] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2013] [Accepted: 09/07/2013] [Indexed: 11/24/2022] Open
Abstract
Handheld devices such as mobile phones and tablet computers have become widespread with thousands of available software applications. Recently, handhelds are being proposed as part of medical imaging solutions, especially in emergency medicine, where immediate consultation is required. However, handheld devices differ significantly from medical workstation displays in terms of display characteristics. Moreover, the characteristics vary significantly among device types. We investigate the image quality characteristics of various handheld devices with respect to luminance response, spatial resolution, spatial noise, and reflectance. We show that the luminance characteristics of the handheld displays are different from those of workstation displays complying with grayscale standard target response suggesting that luminance calibration might be needed. Our results also demonstrate that the spatial characteristics of handhelds can surpass those of medical workstation displays particularly for recent generation devices. While a 5 mega-pixel monochrome workstation display has horizontal and vertical modulation transfer factors of 0.52 and 0.47 at the Nyquist frequency, the handheld displays released after 2011 can have values higher than 0.63 at the respective Nyquist frequencies. The noise power spectra for workstation displays are higher than 1.2×10−5 mm2 at 1 mm−1, while handheld displays have values lower than 3.7×10−6 mm2. Reflectance measurements on some of the handheld displays are consistent with measurements for workstation displays with, in some cases, low specular and diffuse reflectance coefficients. The variability of the characterization results among devices due to the different technological features indicates that image quality varies greatly among handheld display devices.
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