TB or Not TB: interreader and intrareader variability in screening diagnosis on an iPad versus a traditional display

Usability of Mobile Solutions Intended for Diagnostic Images-A Systematic Review

Despite the growing popularity of mobile devices, they still have not found widespread use in medicine. This is due to the procedures in a given place, differences in the availability of mobile devices between individual institutions or lack of appropriate legal regulations and accreditation by relevant institutions. Numerous studies have been conducted and compared the usability of mobile solutions designed for diagnostic images evaluation on various mobile devices and applications with classic stationary descriptive stations. This study is an attempt to compare the usefulness of currently available mobile applications which are used in the medical industry, focusing on imaging diagnostics. As a consequence of the healthcare sector's diversity, it is also not possible to design a universal mobile application, which results in a multitude of software available on the market and makes it difficult to reliably compile and compare studies included in this systematic review. Despite these differences, it was possible to identify both positive and negative features of portable methods analyzing radiological images. The mobile application of the golden mean in hospital infrastructure should be widely available, with convenient and simple usage. Our future research will focus on development in the use of mobile devices and applications in the medical sector.

Symptom- and chest-radiography screening for active pulmonary tuberculosis in HIV-negative adults and adults with unknown HIV status

BACKGROUND

Systematic screening in high-burden settings is recommended as a strategy for early detection of pulmonary tuberculosis disease, reducing mortality, morbidity and transmission, and improving equity in access to care. Questioning for symptoms and chest radiography (CXR) have historically been the most widely available tools to screen for tuberculosis disease. Their accuracy is important for the design of tuberculosis screening programmes and determines, in combination with the accuracy of confirmatory diagnostic tests, the yield of a screening programme and the burden on individuals and the health service.

OBJECTIVES

To assess the sensitivity and specificity of questioning for the presence of one or more tuberculosis symptoms or symptom combinations, CXR, and combinations of these as screening tools for detecting bacteriologically confirmed pulmonary tuberculosis disease in HIV-negative adults and adults with unknown HIV status who are considered eligible for systematic screening for tuberculosis disease. Second, to investigate sources of heterogeneity, especially in relation to regional, epidemiological, and demographic characteristics of the study populations.

SEARCH METHODS

We searched the MEDLINE, Embase, LILACS, and HTA (Health Technology Assessment) databases using pre-specified search terms and consulted experts for unpublished reports, for the period 1992 to 2018. The search date was 10 December 2018. This search was repeated on 2 July 2021.

SELECTION CRITERIA

Studies were eligible if participants were screened for tuberculosis disease using symptom questions, or abnormalities on CXR, or both, and were offered confirmatory testing with a reference standard. We included studies if diagnostic two-by-two tables could be generated for one or more index tests, even if not all participants were subjected to a microbacteriological reference standard. We excluded studies evaluating self-reporting of symptoms.

DATA COLLECTION AND ANALYSIS

We categorized symptom and CXR index tests according to commonly used definitions. We assessed the methodological quality of included studies using the QUADAS-2 instrument. We examined the forest plots and receiver operating characteristic plots visually for heterogeneity. We estimated summary sensitivities and specificities (and 95% confidence intervals (CI)) for each index test using bivariate random-effects methods. We analyzed potential sources of heterogeneity in a hierarchical mixed-model.

MAIN RESULTS

The electronic database search identified 9473 titles and abstracts. Through expert consultation, we identified 31 reports on national tuberculosis prevalence surveys as eligible (of which eight were already captured in the search of the electronic databases), and we identified 957 potentially relevant articles through reference checking. After removal of duplicates, we assessed 10,415 titles and abstracts, of which we identified 430 (4%) for full text review, whereafter we excluded 364 articles. In total, 66 articles provided data on 59 studies. We assessed the 2 July 2021 search results; seven studies were potentially eligible but would make no material difference to the review findings or grading of the evidence, and were not added in this edition of the review. We judged most studies at high risk of bias in one or more domains, most commonly because of incorporation bias and verification bias. We judged applicability concerns low in more than 80% of studies in all three domains. The three most common symptom index tests, cough for two or more weeks (41 studies), any cough (21 studies), and any tuberculosis symptom (29 studies), showed a summary sensitivity of 42.1% (95% CI 36.6% to 47.7%), 51.3% (95% CI 42.8% to 59.7%), and 70.6% (95% CI 61.7% to 78.2%, all very low-certainty evidence), and a specificity of 94.4% (95% CI 92.6% to 95.8%, high-certainty evidence), 87.6% (95% CI 81.6% to 91.8%, low-certainty evidence), and 65.1% (95% CI 53.3% to 75.4%, low-certainty evidence), respectively. The data on symptom index tests were more heterogenous than those for CXR. The studies on any tuberculosis symptom were the most heterogeneous, but had the lowest number of variables explaining this variation. Symptom index tests also showed regional variation. The summary sensitivity of any CXR abnormality (23 studies) was 94.7% (95% CI 92.2% to 96.4%, very low-certainty evidence) and 84.8% (95% CI 76.7% to 90.4%, low-certainty evidence) for CXR abnormalities suggestive of tuberculosis (19 studies), and specificity was 89.1% (95% CI 85.6% to 91.8%, low-certainty evidence) and 95.6% (95% CI 92.6% to 97.4%, high-certainty evidence), respectively. Sensitivity was more heterogenous than specificity, and could be explained by regional variation. The addition of cough for two or more weeks, whether to any (pulmonary) CXR abnormality or to CXR abnormalities suggestive of tuberculosis, resulted in a summary sensitivity and specificity of 99.2% (95% CI 96.8% to 99.8%) and 84.9% (95% CI 81.2% to 88.1%) (15 studies; certainty of evidence not assessed).

AUTHORS' CONCLUSIONS

The summary estimates of the symptom and CXR index tests may inform the choice of screening and diagnostic algorithms in any given setting or country where screening for tuberculosis is being implemented. The high sensitivity of CXR index tests, with or without symptom questions in parallel, suggests a high yield of persons with tuberculosis disease. However, additional considerations will determine the design of screening and diagnostic algorithms, such as the availability and accessibility of CXR facilities or the resources to fund them, and the need for more or fewer diagnostic tests to confirm the diagnosis (depending on screening test specificity), which also has resource implications. These review findings should be interpreted with caution due to methodological limitations in the included studies and regional variation in sensitivity and specificity. The sensitivity and specificity of an index test in a specific setting cannot be predicted with great precision due to heterogeneity. This should be borne in mind when planning for and implementing tuberculosis screening programmes.

Using a mobile device for margin assessment of specimen mammography in breast-conserving surgery

To compare the performance of margin assessment of specimen mammography (SM) in patients with breast-conserving surgery (BCS) on mobile devices and 5-megapixel (5M) thin film transistor liquid crystal display (TFT-LCD) monitors based on the safety margin for pathologic results.This retrospective study was approved by the institutional review board, and the requirement for informed consent was waived. A total of 105 consecutive breast cancer SM samples from 104 women who underwent BCS were included in the study. The SM were independently reviewed by two radiologists using mobile devices and by two additional radiologists using 5M TFT-LCD monitor. Each reader was asked to measure the shortest distance between the lesion and the lesion margin. The interpretation time was recorded. The sensitivity, specificity, and interobserver agreement were analyzed.In total, 19% (20/105) breast specimens had a positive surgical margin (<1 mm). The mean absolute difference from the pathologic margin was 0.60 ± 0.57 cm and 0.54 ± 0.47 cm using the 5 M TFT-LCD monitor and the mobile device, respectively (without any statistical significance, P = .273). The mean interpretation time was 49.5 and 47.6 s for the 5M TFT-LCD monitor and the mobile device, respectively (P = .012). The pooled sensitivity and specificity were 60% and 74% for 5M TFT-LCD monitor, and 60% and 69% for the mobile device (P = 1.00 and P = .190, respectively). The kappa coefficient indicated moderate agreement for both the displays.The diagnostic performance for margin assessment of SM in BCS patients on mobile devices and 5M TFT-LCD monitors are showed not statistically difference. The findings of the study provide evidence of the benefit of the mobile device for SM interpretation in patients who underwent BCS. However, a large sample size study is warranted before using a mobile device for margin evaluation on SM.The mobile device showed comparable diagnostic performance with 5M TFT-LCD monitor in the evaluation of SM margin in patients with BCS and could be used as a display tool for immediate assessment when a dedicated LCD monitor is unavailable.

Using mobile phone technology to treat alcohol use disorder: study protocol for a randomized controlled trial

Background

A primary concern within the healthcare system is to make treatment more accessible as well as attractive for the great majority of alcohol-dependent people who feel reluctant to participate in the treatment programs available. This paper presents the protocol for a randomized controlled trial (RCT) to test the efficacy of two different technical devices (mobile phone application and breathalyzer) on alcohol consumption.

Methods

The study is a three-armed RCT with follow-ups 3 and 6 months after randomization. In total, 375 adults (age 18+ years) diagnosed with alcohol use disorder (AUD) will be invited to participate in a 3-month intervention. The primary outcome is the number of days with heavy drinking, defined as four or more standard drinks (12 g alcohol/drink) and measured by the timeline follow back (TLFB) and Alcohol Use Disorder Identification Test (AUDIT) instruments at 3-month and 6-month follow-up. Secondary outcome measures include weekly alcohol consumption, measured by the TLFB, AUDIT, and phosphatidylethanol in blood values at 3-month and 6-month follow-up (number of days with blood alcohol concentration levels exceeding 60 mg/100 ml).

Discussion

Improving ways of collecting data on alcohol consumption, as well as the treatment system with regards to AUD, is of vital importance. Mobile phone technology, with associated applications, is widely recognized as a potentially powerful tool in the prevention and management of disease. This study will provide unique knowledge regarding the use of new technology as instruments for measuring alcohol consumption and, also, as a possible way to decrease it.

Trial registration

ISRCTN, ISRCTN14515753. Registered on 31 May 2018.

Electronic supplementary material

The online version of this article (10.1186/s13063-018-3137-y) contains supplementary material, which is available to authorized users.

Comparison of medical-grade and calibrated consumer-grade displays for diagnosis of subtle bone fissures

OBJECTIVE

To compare the diagnostic accuracy of medical-grade and calibrated consumer-grade digital displays for the detection of subtle bone fissures.

METHODS

Three experienced radiologists assessed 96 digital radiographs, 40 without and 56 with subtle bone fissures, for the presence or absence of fissures in various bones using one consumer-grade and two medical-grade displays calibrated according to the DICOM-Grayscale Standard Display Function. The reference standard was consensus reading. Subjective image quality was also assessed by the three readers. Statistical analysis was performed using receiver operating characteristic analysis and by calculating the sensitivity, specificity, and Youden's J for each combination of reader and display. Cohen's unweighted kappa was calculated to assess inter-rater agreement. Subjective image quality was compared using the Wilcoxon signed-rank test.

RESULTS

No significant differences were found for the assessment of subjective image quality. Diagnostic performance was similar across all readers and displays, with Youden's J ranging from 0.443 to 0.661. The differences were influenced more by the reader than by the display used for the assessment.

CONCLUSION

No significant differences were found between medical-grade and calibrated consumer-grade displays with regard to their diagnostic performance in assessing subtle bone fissures. Calibrated consumer-grade displays may be sufficient for most radiological examinations.

KEY POINTS

• Diagnostic performance of calibrated consumer-grade displays is comparable to medical-grade displays. • There is no significant difference with regard to subjective image quality. • Use of calibrated consumer-grade displays could cut display costs by 60-80%.

The reliability of tablet computers in depicting maxillofacial radiographic landmarks

Purpose

This study was performed to evaluate the reliability of the identification of anatomical landmarks in panoramic and lateral cephalometric radiographs on a standard medical grade picture archiving communication system (PACS) monitor and a tablet computer (iPad 5).

Materials and Methods

A total of 1000 radiographs, including 500 panoramic and 500 lateral cephalometric radiographs, were retrieved from the de-identified dataset of the archive of the Section of Oral and Maxillofacial Radiology of the University Of Connecticut School Of Dental Medicine. Major radiographic anatomical landmarks were independently reviewed by two examiners on both displays. The examiners initially reviewed ten panoramic and ten lateral cephalometric radiographs using each imaging system, in order to verify interoperator agreement in landmark identification. The images were scored on a four-point scale reflecting the diagnostic image quality and exposure level of the images.

Results

Statistical analysis showed no significant difference between the two displays regarding the visibility and clarity of the landmarks in either the panoramic or cephalometric radiographs.

Conclusion

Tablet computers can reliably show anatomical landmarks in panoramic and lateral cephalometric radiographs.

A mapping analytic approach to trace development of multidisciplinary research field

Purpose

– This paper aims to provide clear domain knowledge and recent progresses on electronic healthcare (e-healthcare).

Design/methodology/approach

– In this paper, the authors use citation analysis to describe the trends of study on e-health with the help of CiteSpace II, a software for visualizing citation-based analysis. By analyzing the 2,752 publications and their citation data in ISI database, the authors proposed renewable figures and tables on ranking critical people, institutes, keywords and journals. Through the most influential articles given by CiteSpace, the authors can grasp the main direction in e-health researches. Furthermore, the authors analyzed the literature at e-health literacy as a case, to better understand the development of research viewpoints.

Findings

– Through the analysis, the authors found that e-health is a multi-disciplinary research field and the major research about it has changed. During the early stage, health information quality on the Internet dominates. Gradually, the role of information technology (IT) becomes more important. The authors also found that some researchers, recently, have proposed the effects of IT on e-health literacy which can then improve the ability to use health information on the Internet.

Research limitations/implications

– This paper has some research limitations, such as using an ISI database with most English publications. The future research may be conducted for collecting local publications data in China. It also has some implications. Based on the results, the authors claimed that IT may significantly improve people’s healthcare variance, e.g. e-health literacy. It is necessary to build new IT-based healthcare theories.

Practical implications

– This paper also has some practical implications. Practitioners and institute may easily come to know which are the hot topics, top institutes and tendencies in the e-healthcare field.

Social implications

– This paper may help practitioners to find common interests with other institutions and societies.

Originality/value

– This paper reported the status and trend of research in this field visually, and the result will help researchers to do more in-depth research in the future.

Radiological interpretation of images displayed on tablet computers: a systematic review

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.

iPad-based patient briefing for radiological examinations-a clinical trial

To analyze if an iPad-based patient briefing can serve as a digital alternative to conventional documentations prior to radiological examinations. One hundred one patients referred for routine MRI were randomized into two groups, who underwent iPad-based and classic written briefing in opposite order. For each briefing completion time, completeness and correctness were noted. Patient's knowledge about the content of either briefing modality was subsequently tested. The influence of patient-related factors on the performance of the electronic briefing (EB) was analyzed. Finally, the patient's subjective impression of the EB was assessed. The mean durations were 4.4 ± 2.2 min for EB and 1.7 ± 1.3 min for the classic briefing (p < 0.01). All iPad briefings were returned entirely filled out, whereas 11 % of the classic forms were returned with missing data. No significant differences in memorization of the briefing's information were objectified. There was a positive correlation between the duration of EB and age (r = 0.53; p < 0.01), whereas a negative correlation was found between computer skills and patient's age (r = -0.55; p < 0.01) or duration of EB (r = -0.62; p < 0.01). More than half of the study patients would prefer EB in the future; another 29 % had no preference at all. Patient briefing on iPads transfers the information for the patients equally well compared to the classic written approach. Although iPad briefing took patients longer to perform, the majority would prefer it to written consent briefings in the future. Nevertheless, measures have to be undertaken to improve the overall acceptance and performance.

Is the iPad suitable for image display at American Board of Radiology examinations?

OBJECTIVE

The study aimed to determine the acceptability of the iPad 3 as a display option for American Board of Radiology (ABR) examinations.

SUBJECTS AND METHODS

A set of 20 cases for each of nine specialties examined by the ABR was prepared. Each comprised between one and seven images and case information and had been used in previous ABR Initial Certification examinations. Examining radiologists (n = 119) at the ABR oral Initial Certification examinations reviewed sets from one or more specialties on both a 2 MP LED monitor and on the iPad 3 and rated the visibility of the salient image features for each case. The Wilcoxon signed rank test was performed to compare ratings. In addition, a thematic analysis of participants' opinions was undertaken.

RESULTS

When all specialties were pooled, the iPad 3 ratings were significantly higher than the monitor ratings (p = 0.0217). The breast, gastrointestinal, genitourinary, and nuclear medicine specialties also returned significantly higher ratings for the visibility of relevant image features for the iPad 3. Monitor ratings were significantly higher for the vascular and interventional specialty, although no images were rated unacceptably poor on the iPad in this specialty.

CONCLUSION

The relevant image features were rated more visible on the iPad 3 than on the monitors overall. The iPad 3 was well accepted by a large majority of examiners and can be considered adequate for image display for examination in most or all specialties.

iPads in Breast Imaging - A Phantom Study

Introduction: Modern tablet PCs as the iPad are becoming more and more integrated into medicine. The aim of this study was to evaluate the display quality of iPads regarding digital mammography. Materials and Methods: Three experienced readers compared the display quality of the iPad 2 and 3 with a dedicated 10 megapixel (MP) mammography liquid crystal display (LCD) screen in consensus using the standardized Contrast Detail Mammography (CDMAM) phantom. Phantom fields without agreement between the readers were classified as "uncertain", correct 2 : 1 decisions were classified as "uncertain/readable". In a second step display quality of the three reading devices was judged subjectively in a side by side comparison. Results: The 10 MP screen was superior to both iPads in 4 (phantom-)fields and inferior in 2 fields. Comparing the iPads, version 3 was superior in 4 fields and version 2 was superior in 1 field. However these differences were not significant. Total number of "uncertain" fields did not show significant differences. The number of "uncertain" fields was 15 with the 10 MP screen, 16 with the iPad 2 and 17 with the iPad 3 (p > 0.05), the number of "uncertain/readable" fields was 4, 7 and 8, respectively. Subjective image quality of the iPad 3 and the 10 MP screen was rated superior to the iPad 2. Conclusion: The evaluated iPads, especially in version 3, seem to be adequate to display mammograms in a diagnostic quality and thus could be useful e.g. for patient consultation, clinical demonstration or educational and teaching purposes. However primary mammogram reading should still be performed on dedicated large sized reading screens.

Telemedicine Workplace Environments: Designing for Success

When designing a facility for telemedicine, there are several things to consider from a human factors point of view, as well as from a practicality point of view. Although the future practice of telemedicine is likely to be more of a mobile-based practice and centered more in the home than it is now, it is still very important to consider ways to optimize the design of clinic-based telemedicine facilities. This is true on both ends of a consultation—where the patient is and where the consultant is. On the patient side, the first thing to realize is that most telemedicine clinics are not going to be newly designed and built. In all likelihood they will be existing rooms converted to telemedicine clinic rooms. Quite often the former room will not even have been used for clinical purposes, but may have simply been a storage area cleared out for telemedicine use. Therefore, design is often a challenge but there are a few basic principles that can be followed to create a workable clinical space. This paper will review some of the basic human factors principles to take into account when designing a working telemedicine environment.

Human Factors and Human-Computer Considerations in Teleradiology and Telepathology

Radiology and pathology are unique among other clinical specialties that incorporate telemedicine technologies into clinical practice, as, for the most part in traditional practice, there are few or no direct patient encounters. The majority of teleradiology and telepathology involves viewing images, which is exactly what occurs without the "tele" component. The images used are generally quite large, require dedicated displays and software for viewing, and present challenges to the clinician who must navigate through the presented data to render a diagnostic decision or interpretation. This digital viewing environment is very different from the more traditional reading environment (i.e., film and microscopy), necessitating a new look at how to optimize reading environments and address human factors issues. This paper will review some of the key components that need to be optimized for effective and efficient practice of teleradiology and telepathology using traditional workstations as well as some of the newer mobile viewing applications.

Diagnostic accuracy of digitized chest X-rays using consumer-grade color displays for low-cost teleradiology services: a multireader-multicase comparison

INTRODUCTION

In teleradiology services and in hospitals, the extensive use of visualization displays requires affordable devices. The purpose of this study was to compare three differently priced displays (a medical-grade grayscale display and two consumer-grade color displays) for image visualization of digitized chest X-rays.

MATERIALS AND METHODS

The evaluated conditions were interstitial opacities, pneumothorax, and nodules using computed tomography as the gold standard. The comparison was accomplished in terms of receiver operating characteristic (ROC) curves, the diagnostic power measured as the area under ROC curves, accuracy in conditions classification, and main factors affecting accuracy, in a factorial study with 76 cases and six radiologists.

RESULTS

The ROC curves for all of the displays and pathologies had similar shapes and no differences in diagnostic power. The proportion of cases correctly classified for each display was greater than 71.9%. The correctness proportions of the three displays were different (p<0.05) only for interstitial opacities. The evaluation of the main factors affecting these proportions revealed that the display factor was not significant for either nodule size or pneumothorax size (p>0.05).

CONCLUSIONS

Although the image quality variables showed differences in the radiologists' perceptions of the image quality of the three displays, significant differences in the accuracy did not occur. The main effect on the variability of the proportions of correctly classified cases did not come from the display factor. This study confirms previous findings that medical-grade displays could be replaced by consumer-grade color displays with the same image quality.

Mobile medical and health apps: state of the art, concerns, regulatory control and certification

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.

Resident iPad use: has it really changed the game?

PURPOSE

The purpose of this study was to assess residents' usage patterns and opinions of the iPad as a tool for radiology education and clinical practice at an academic medical center.

METHODS

All 38 radiology residents in our radiology program (postgraduate years 2 to 5) were provided with iPad 2 tablets and subscriptions to e-Anatomy and STATdx. After 6 months of device use, residents were surveyed to assess their opinions regarding the technology as a tool for education and clinical practice.

RESULTS

A total of 36 residents (95%) completed the survey. Eighty-six percent reported daily iPad use. Radiology-specific applications, particularly e-Anatomy, were used weekly or daily by 88% of respondents. Most preferred to read journal articles on the iPad (70%), but the number of respondents preferring to read textbooks on the iPad (48.5%) compared with the traditional bound form (48.5%) was evenly divided. Residents were also divided on the clinical utility of the iPad. Most had not used the iPad to view radiologic examinations (75%). Fewer than half (47%) used their iPads during readout. Finally, only 12% had used the iPad to edit dictated reports.

CONCLUSIONS

The iPad has generated excitement within the radiology community, particularly among resident educators, who are increasingly recognizing the unique needs of "millennial learners." This study showed that the majority of residents at the authors' institution have incorporated the iPad as an educational tool and use it as a learning aid. Incorporation of the iPad into clinical workflow has been less pronounced.

Radiology and the mobile device: Radiology in motion

The use of mobile devices is revolutionizing the way we communicate, interact, are entertained, and organize our lives. With healthcare in general and radiology in particular becoming increasingly digital, the use of such devices in radiologic practice is inevitable. This article reviews the current status of the use of mobile devices in the clinical practice of radiology, namely in emergency teleradiology. Technical parameters such as luminance and resolution are discussed. The article also discusses the benefits of such mobility vis-à-vis the current limitations of the technologies available.