Images … Coming Soon to a Handheld Near You

The medical image information system architecture has zoomed along in the last two decades with radiology evolving from viewing analog film on old-fashioned, wall-mounted lightboxes to reading digital images on industrial-strength PC workstations. Now medical imaging has reached the threshold of the next stage — viewing images on portable, handheld devices. So what's the upside on "downsizing"? Just take a peek!

Next-generation tablets, PDAs and Palms and image-enabled cell phones will be used to transmit and view images, predicts Edward Zaragosa, MD, associate professor of radiological sciences at University of California Los Angeles (UCLA). "Handheld viewing will allow physicians to finish the day in a timelier manner and ultimately deliver better care," Zaragosa says.

Handhelds certainly will not overtake desktops as the primary viewing apparatus, and screen size, resolution and battery life are valid concerns, says Zaragosa. But there are a number of niche applications where handhelds are just what the doctor ordered. What's more, technology is advancing rapidly, and new devices could overcome or minimize barriers presented by screen size and resolution. On the IT side, data streaming technology is expected to improve handheld image viewing.

For a few cutting-edge physicians, the era of handheld image viewing has arrived. Handheld users run the gamut from primary-care physicians to radiologists and clinical specialists. "In today's environment physicians are more mobile and need access to relevant data at the patient's bedside [and throughout and beyond the enterprise]," explains Dave Wilson, director of product management for Agfa Healthcare.

Applications at a glance

Handhelds fit the bill in a number of clinical scenarios, providing physicians with more immediate access to images and data, which, in turn, accelerates and improves patient care.

Zaragosa relies on OsiriX open source DICOM image viewing software to store unusual teaching cases to enable storage of images on an iPOD handheld computer. "The beauty of these systems is the storage capacity of 60 to 80 gigabytes. I can store screen resolution images [for quick viewing] or full resolution images to be uploaded to another system [such as a desktop computer]."

Cardiologists at Blunk Clinic in Bad Saarow, Germany, rely on IMCO Technologies IMCO-STAT software to view ultrasound, cath lab studies and echocardiograms acquired at Humaine Hospital. "The benefits are immediate access to images, which saves physicians' time. Decision-making is better coordinated, which can result in a shorter length of stay for the patient," says Werner Ullrich, PhD, country manager, Germany, for IMCO Technologies.

Angie Haas, MD, vice president and chief medical information officer for Susquehanna Health System in Williamsport, Pa., relies on a Motion Computing LS800 Tablet PC to view x-ray, CT and MRI studies anytime, anywhere. Haas launches into the images through Siemens Medical Solutions Soarian clinical information system. "It fosters better patient care," sums Haas. Another plus is improved turnaround time. For example, a radiology report may not be available when Haas sees her patient. She can view images on the handheld and make a preliminary diagnosis of pneumonia to accelerate care.

Providence Health System in Portland, Ore., has deployed tablet PCs in seven Oregon hospitals. Images stored on Philips Medical Systems iSite PACS can be viewed on the tablets, but acceptance is spotty, says Dick Gibson, MD, chief medical information officer. The primary barriers relate to tablet features and construction, not PACS software. Physicians working in limited geographic environments like the ER or ICU are more likely to embrace tablets because they can switch devices when the battery expires or access a keyboard fairly easily.

On the other hand, highly mobile, rounding physicians complain that today's tablets are too heavy and don't fit into a pocket, says Gibson. Plus more mobile clinicians cannot easily re-charge the battery or tap into a keyboard.

Despite some shortcomings, Gibson believes hospitals will overcome the barriers to more universal use of tablets as an image-viewing device. He says multiple docking stations for re-charges and keyboards will boost adoption and facilitate a successful implementation.

Size matters

There are significant differences among handhelds — particularly with screen size and resolution. Clinical needs drive the decision about the appropriate device, says Matt Long, general manager of healthcare informatics for Philips Medical Systems. If diagnostic integrity is important, the high-resolution display of a tablet is preferred. "It's not practical to view a 7,000 slice CT on a PDA with a 65 megabit memory," adds Wilson.

Lower-resolution portable handhelds suffice for information-only viewing, says Long. For example, CT studies are typically acquired in a 512 x 512 matrix. A PDA with 480 x 680 resolution enables non-diagnostic viewing with minimal zoom, says Wilson. While Gibson believes the 1024 x 768 resolution of larger tablets suffices for sharing images at the patient bedside, others make do with the lower resolution of smaller tablets. Haas says the 800 x 600 resolution of Motion Computing's LS 800 is adequate for sharing images with patients.

Conventional wisdom could undergo another shift as vendors are developing higher-resolution PDAs that can display a single CT at full-resolution, says IMCO Technologies President and CEO Mark Schwartz.

Handhelds of the future

Product development among PACS and handhelds vendors is moving at a rapid clip. "Data streaming off of PDAs will be a tremendous growth industry in the next two to three years," confirms Zaragosa.

"Data streaming technology allows for faster image paint time as compared to most other web-based image viewing solutions, and it could improve utilization of bandwidth on wireless networks because of the way the data are delivered to the viewing device. Finally, data streaming will increase flexibility of the devices that could be used to view images, i.e. PDA, phones, etc.," says Ed Majors, executive director of Imaging and PACS at Florida Hospital in Orlando. Fla. Physicians at Florida Hospital have expressed interest in Agfa Healthcare's IMPAX Mobile. The technology could be used to facilitate image sharing with patients and provide a reference image to illustrate virtual consultations.

Neurosurgeons at UCLA are developing tools to stream snapshot images to handheld devices. The development would allow surgeons to bypass the time-consuming traipse to radiology in some cases, which means improves workflow and faster patient care.

Data streaming isn't the only hot technology. Mark Morita, emerging user interaction marketing manager for GE Healthcare, provides a sneak peek at some more future solutions.

• Sony Reader, which is slated for release in June, could be the tablet of the future with a form factor that facilitates image viewing but can be carried in a jacket pocket. The next-generation solution is half the size of a tablet and less than a 1/2-inch thick.
   
• Pervasive headsets could grow beyond data viewing applications in the OR, says Morita. The systems paint visual representations of images onto the retina and could be used in the OR for non-diagnostic applications like needle guidance during biopsies. Similarly, interventional radiologists might use headsets in conjunction with GE Centricity PACS for an overall gestalt of images during needle biopsies or ablation.
   
• Graffiti PACS, a work-in-progress, could replace or limit the need for a mouse. The system leverages Palm's Graffiti data entry language and applies Graffiti characters to PACS. For example, instead of clicking the mouse to view the next image, the user could use a stylus to draw a forward arrow on the screen.

Conclusion

Handheld devices and wireless networks have become prevalent in the hospital market. As clinical users become more adept with handheld technology, the market for new applications including image viewing is expanding. PACS and handheld vendors have taken on the task, developing the software and hardware to facilitate image viewing on handheld devices. Physicians who've adopted the technology report both workflow and patient care benefits.