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Mobile (tele)radiology


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Presentation given at the European Congress of Radiology, ECR 2015 in Vienna, March 4th. About usage of mobile devices in radiology, current changes in radiology due to increasing use of mobile devices and growing wireless connectivity. About mobile radiology, m-Health & social media in radiology and medicine

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Mobile (tele)radiology

  1. 1. Mobile (tele)radiology Erik R. Ranschaert ECR 2015
  2. 2. Introduction • What is changing? • What are mobile devices? • What is mobility? • What is teleradiology? • What is the role of social media? • What is the impact on health care and radiology?
  3. 3. Internet (Tele)radiology Mobile devices Health Care SoMe
  4. 4. What is changing? • Availability & exchangeability of digital medical data • Online health-related services • Patient empowerment – management of health data – radiological images & reports • Personalized medicine – diagnostic testing… – …to select most appropriate therapy… – …based on patient’s genetic content • Bertalan Meskó, “20 Predictions in Medicine And Healthcare for 2014”-, Jan 3, 2014 • Frost & Sullivan White Paper, Slide presentation HealthStartup Europe ( • J Am Coll Radiology April 2012
  5. 5. Almost anything - including living things - will be connected to the Internet regardless of location or other physical restrictions
  6. 6. Health-related searches 5% of all searches are Health- related
  7. 7. Mobile devices and mobility • HC professionals are globally rapidly adapting to mobile technology. • Smartphones and tablets are regarded as “the most popular technological development for providers since the invention of the stethoscope”. Source: “The road to telehealth 2.0 is mobile”, Calgary Scientific, 2015 Boston Consulting Group & Telenor Group (2013). The Socio-Economic Impact of Mobile Health. Page 6.
  8. 8. What are mobile devices? • Smartphones are mainly for phone calls • Tablets are mainly for all other applications • Mini-tablets become smaller, smartphones become larger • Phablet combines tablet and phone features • Isn’t a laptop a mobile device? Smartphones TabletsPhablets
  9. 9. Size of mobile devices - Large phones (“phablet”) will grab 50% of the market in 2015 - Laptops are not threatened by tablets - Larger smartphones are “pushing out” tablets - Tablets need to evolve direction laptops: larger screen, multitasking 60% small 55% medium, 10 Oct. 2014, Phablet vs. mini-tablet: the big choice between two smallish devices Tablets aren’t killing laptops, but smartphones are killing tablets, Chris, 25 Oct. 2014
  10. 10. In 2015 iPad Air Pro with 12.2 inches? 2732 x 2048 and 265 pixels-per-inch (ppi)
  11. 11. Internet HealthRadiology Mobile devices Smartphones Phablets Tablets Laptops Mobile devices
  12. 12. What should radiologists use? • “Careful product selection and judicious use are necessary ...” • “It is the responsibility of the radiologist to securely and effectively utilize mobile technology in the best interests of patient care.”
  13. 13. 1 4 3 2 5
  14. 14. Display Size of mobile devices
  15. 15. Mobile viewing apps • USA: FDA approval • Europe (EU): CE mark – Apps for medical purposes need to be registered as medical device, following the Medical Device Directive (MDD) – Ensures safety and performance – DICOM viewing apps are in lowest MDD risk category (Class I of III) – Developers can self-declare conformity – Unfortunately very limited use of CE mark Rodrigues et al., Radiology smartphone applications; current provision and cautions, Insights Imaging. 2013 October; 4(5): 555–562.
  16. 16. Web-based DICOM viewers • “Zero-footprint” • No downloading of patient info necessary • Independent of – device type – PACS-type • Safe for confidential data
  17. 17. Mobility • Radiologists are discovering new ways to create additional efficiencies with mobile tools • Key is to leverage mobility so that you’re able to benefit from it • Radiologists must embrace a purpose driven approach • “Look for the right devices for the right scenarios at the right places”
  18. 18. Example: Telestroke • 2012 study Mayo Clinic study • Smartphones connected to telestroke network in Utah and Arizona • “Hubs” of experts connected to “spoke clinics/hospitals” • Non-contrast CT identification of contra-indications for thrombolysis • Excellent correlation of CT findings by neurologists and radiologists • Accessing patient images on iPads is 6 x faster than using a high- resolution PACS viewer. • The iPad viewer provided comparable diagnostic confidence and ease of use. Bart M. Demaerschalk et al., Stroke 2012;43:3098-3101 Bart M. Demaerschalk et al., Stroke 2012;43:3095-3097
  19. 19. Bart M. Demaerschalk et al. Stroke. 2012;43:3098-3101 Copyright © American Heart Association, Inc. All rights reserved. Mobile infrastructure and algorithm
  20. 20. Terminology • Currently a wide range of terms is being used: – eHealth, mHealth – Telemedicine, telehealth – Teleradiology – Virtual imaging – Digital health – Wireless health – Connected health
  21. 21. Telemedicine and Teleradiology Keith J. Dreyer, Amit Mehta, James H. Thrall, Springer Science & Business Media, 2002
  22. 22. Applications of Teleradiology Keith J. Dreyer, David S. Hirschorn, James H. Thrall, Amit Mehta, Springer Science & Business Media, 2006 15. Social Media
  23. 23. Obsolete term? PACS, Keith J. Dreyer, David S. Hirschorn, James H. Thrall, Amit Mehta, Springer Science & Business Media, 2006
  24. 24. Current usage of teleradiology • Thousands of systems have been deployed in the US and Europe • Many (most?) are “lower end” systems, to provide emergency (on-call) coverage in radiology practices • Home workstation is usually a PC, laptop or tablet… • …for interpreting 512x512 images (CT, MRI, US) • Expectations are rising concerning the interpretation of medical images on mobile devices • Mobile devices used for radiology = mobile radiology Keith J. Dreyer, David S. Hirschorn, James H. Thrall, Amit Mehta, Springer Science & Business Media, 2006 IT Reference Guide for the Practicing Radiologist (ACR), 2013: Displays
  25. 25. Mobile (tele)radiology PC screen workstation is accessible on tablet after logging in with Citrix platform, (“receiver”) => virtual workstation is created, accessible on all kinds of mobile devices
  26. 26. Internet Health CareRadiology Mobile Telemedicine mHealth Teleradiology Mobile Radiology Terminology
  27. 27. Impact of mobility on radiology Academic Radiology, 20 (2013) 1495-1505. doi:10.1016/j.acra.2013.09.009
  28. 28. Changes for patients • Clinical logistics: – Online patient scheduling and check-in – Information on procedures – Satisfaction surveys • Communication of results – Patient portals: images and radiology reports – Images can be shared by patients with others Academic Radiology, 20 (2013) 1495-1505. doi:10.1016/j.acra.2013.09.009
  29. 29. Changes for radiologists • Improved radiology consultation – Radiologists-to-radiologist consult (on-call) – Greater social availability to clinicians – Bed-side rounding with clinical teams – Intra-operative guiding of operations (discussion of images) • Critical or urgent notifications – Providing timely, critical information complemented by a brief message, discussion, or video chat on a mobile device • Usage for management – Radiation measurement (linked to sensors/devices) Academic Radiology, 20 (2013) 1495-1505. doi:10.1016/j.acra.2013.09.009
  30. 30. Changes for clinicians • Computer-aided surgery: intra-operative usage of tablet computers – e.g. Augmented Reality applications by using 3D anatomical images based upon CT/MRI • Computerized Physician Order Entry… • …integrated with Clinical Decision Support • Personal Assistance Application (≈ Siri) Journal MTM 2:2:15􏰀19, 2013 doi:10.7309/jmtm.2.2.4
  31. 31. Future applications • Biotech entrepreneur Jonathan Rothberg with MIT physicists / engineers • “Capacitive Micro-machined Ultrasound Transducer” • Real-time 3D images • As cheap as stethoscope • AI integration for automating diagnosis Source: MIT Technology Review, Nov 2014
  32. 32. Artificial Intelligence
  33. 33. Scanner at home…?
  34. 34. Internet HealthRadiology Mobile Telemedicine mHealth Teleradiology Mobile radiology Smartphones Phablets Tablets Laptops Social media
  35. 35. What’s the role of social media?
  36. 36. Social media and medical image • Young physicians are embracing the digital revolution • They want to share complex or interesting cases with other HC professionals • They use mobile devices and social media to transmit medical images to other doctors • Patients’ privacy is not protected on most SoMe, no secure platforms • Personal data cannot be removed (patient’s face, tattoo, name) • No archiving of interesting teaching cases possible
  37. 37. Instagram for Doctors • Founded by Joshua Landy, Canadian IC doctor • iOS and Android • For sharing images of tough medical cases
  38. 38. Officially approved • Free App • Started in UK, Ireland, US, Canada, Australia, New Zealand • Growing European presence, recently the Netherlands • Approved by health authorities in each country • HC professionals sign up and need to go through process to validate their medical license • Automated protection tools removing sensitive patient details • Human privacy moderation team
  39. 39. Figure 1 patient privacy • Patients' faces are automatically obscured by the app • Users must manually block identifying marks like tattoos. • Each photo is reviewed by moderators before it is added to the database
  40. 40. Video chat example
  41. 41. Should radiologists engage? • Are we easy to reach? Always nearby? Never too busy? Always easy to communicate with? • Should we engage in SoMe as radiologists, or can we stay away from them? • Should residents/clinicians prefer Figure 1 to solve cases and ask questions about radiology among each other … • …instead of communicating directly with radiologists?
  42. 42. Social networking no longer optional • We HAVE to engage – To assist residents & colleagues with interpreting difficult cases – To communicate with clinicians more often and more efficiently – To interact online, even with patients – To improve clinical care and advance scientific research • “Become more social again” Source: Erik Ridley, Auntminnie Oct. 8, 2014 - Academic Radiology, William Auffermann et al. – (Acad Radiol, September 25, 2014)
  43. 43. Security risk of mobile devices • Mobile devices = vulnerable to loss/theft • Patient information can be downloaded without encryption • Images can be shared through public platforms or cloud technology, not designed for storing protected patient information (PHI) McEntee et al: 5 April 2012; Proc. of SPIE Vol. 8318 DOI: 10.1117/12.913754
  44. 44. Privacy
  45. 45.
  46. 46. Hospital hacking • 600% increase in attacks in 2014 • Medical records often contain both identification information and financial information. • Connection of smartphones, tablets, and various medical devices to health-care facility networks could introduce new vulnerabilities Source: Mike Orcutt, MIT Technology Review, Dec 23, 2014
  47. 47. Protection • “In the next half of this decade, as much attention must be paid to deep medical learning to pre-empt illness as to data security to protect the privacy of individuals.” Eric J Topol et al., Digital medical tools and sensors, JAMA, 2015 vol. 313 (4) pp. 353-354.
  48. 48. Information of patients • Health Care professionals should – ensure that their patients understand what the information that’s being collected is being used for, how it may be disclosed, and that they agree to these. – understand their own institution’s policies about collecting, sharing, and storing information on mobile devices.
  49. 49. Summary • Radiologists need to consider a mobile strategy – not only to view images for diagnosis on a consultative basis, – but also to enrich the referring clinicians’ experience and – to improves the patient’s health care process • It’s the responsibility of the radiologist to securely and effectively utilize mobile technology in the best interests of patient care. • Guidelines are needed with the intention to facilitate this process and to protect the patient’s privacy & security.
  50. 50. Radiology-starship “Enterprise” The Wall Street Journal, Jan 26, 2015 View from “the bridge”, controlling all patient information Mobile imaging performed by “soldiers” with the Star Trek-style Tricorder