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The introduction of Microsoft's new Surface tablet and Fujitsu's Q702, among others, has some questioning whether the latest tablets, laptops and smartphones are appropriate for medical imaging management. But at least one healthcare vendor wonders whether those questions are misdirected.
"The fact is that most doctors are reading (images) on monitors that are far worse than an iPad," says Steve Deaton, vice president of sales for Viztek, a Garner, N.C.-based developer of PACS and RIS solutions. He points out that many of the newest devices are designed so that one can play intricate video games and watch movies and TV shows with ease – so the quality of the image is paramount.
That point was borne out in a recent issue of Academic Radiology, which found no difference in diagnostic accuracy between the iPad and a DICOM-calibrated, secondary-class LCD monitor when viewing spinal emergency cases on an MRI.
Deaton's point is simple: Some doctors may indeed be rushing out to buy the latest tablet device, but a majority are struggling to keep their expenses under control, and they're making do in the office with older, outdated equipment that might not be best suited for viewing images.
The dilemma is an ages-old one. Today's devices are often better than the standards in place, so the real problem isn't with new technology, but with physicians who are using old technology that might not be up to standards any more. Faced with declining reimbursements and shifting costs, they're getting by with what they've had for some time. And that might not be good enough for the parent whose child has a mysterious growth that needs closer examination or the person with a badly broken leg that needs to be set correctly.
To be fair, Deaton says physicians are smart enough to know the limitations.
"The mobile device doesn't let you diagnose more effectively than a workstation," he says. "And they (physicians) know that. Any study that gets read on a mobile device is going to be read the next day on a diagnostic workstation."
That was the point made in a story featured last year on healthcare IT newsletter AuntMinnie, which posited that tablets equipped with clinical apps for medical image review won't replace diagnostic workstations any time soon because providers still want and need "real estate" – basically, a place to sit down and look long and hard at an image on a larger, more detailed monitor.
"You won't find a radiologist who wants to read a chest x-ray off an Apple iPad. It's not what it's meant for," said David Hirschorn, director of radiology informatics at Staten Island University Hospital, in the Oct. 24, 2011 article. "We generally want real visual real estate giving us a lot of space to investigate."
The concern over image viewing on mobile tools hasn't escaped the U.S. Food and Drug Administration, which is working on guidelines for mobile medical apps. Among the concerns expressed by FDA officials is that while some images – high-contrast, low-resolution images like CT, MRI, nuclear medicine and PET scans – can be viewed on mobile devices with accuracy, other exams, like radiology, require more intricacy than a mobile device can accommodate.
"When the (FDA) stated that mobile tablets had new technological characteristics that raised new types of safety and effectiveness questions, the FDA was not simply knee-jerking," Hirschorn said in the AuntMinnie article. "Agency officials were rightfully concerned about whether radiologists could make accurate diagnoses."
Deaton says the proliferation of mobile devices can lead to concerns about their over-use. The physician who relies on his or her tablet or smartphone too much for diagnoses might not be taking seriously the importance of using a workstation. Looking at an image while at home, at the ballgame, in a restaurant or on the golf course isn't the same as sitting down at a desk at work.
"Some people use mobile devices casually. You don’t want that flippant attitude to come into play," he says.
Likewise, technology that's intended for World of Warcraft or the latest episode of True Blood may be fine for an "on the go" analysis, but it can't replace viewing solutions designed specifically for healthcare.
"Technology is so abundantly available in the U.S. It's so in your face," Deaton adds. "But the whole understanding of what makes one monitor better than another (in imaging situations) isn't always there."
The old adage of trusting one's own eyes doesn't always hold true in medicine. Viewing platforms need to be calibrated to account for the vagaries of vision. The human eye doesn't always detect slight changes in light, and is more sensitive to the dark end of the spectrum. That could make a crucial difference in image analysis.
The moral of the story? Let doctors use the latest in smartphones and tablets for initial image review because they're good enough to do the job. But make sure the technology back in the office comes into play – and make sure it's at least as good as what you have in your hand.
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