Mobile computing technologies allied with advances in data transmission and software applications can improve physician-patient communication by increasing the frequency of interactions, providing visual aids (medical images and multimedia files), and contributing to the patient educational process.

Like other medical specialties, radiology has to comply with multiple requirements proposed by regulatory organizations. The Joint Commission on Accreditation of Healthcare Organizations (JACHO) is a well known, and highly respected, commission. Because miscommunication with patients has been identified as being responsible for lapses in the quality of patient care, JACHO created a special section to address this issue. As part of the Patient Safety Goals for 2007, JACHO states that patients should actively involve themselves in their own care.[1]

Some authors believe that radiologists do not communicate with patients as much as they should.[2] To further complicate this culture of lack of communication, even when interaction does occur, it is often difficult to evaluate whether communication happened appropriately or was understood as intended by both parties. As George Bernard Shaw said: “The single biggest problem in communication is the illusion that it has taken place.” Miscommunication between physician and patient not only can negatively impact the quality of care, but also can be responsible for malpractice claims.[2] Medical Imaging IT and Quality and Safety programs have been focusing on these issues to try to solve them adequately. Instead of viewing technology as a problem, which is believed by some to increase the distance between physicians and patients, new programs are using IT tools to improve quality and safety.[3,4] The concept that “a picture is worth a thousand words” is very well known and utilized in healthcare, but it has been used primarily to improve physician-physician communications rather than to augmenting the physician-patient relationship. Research shows that the ability of patients to recall facts presented in an informed consent varies, depending on the format in which it is provided. It was recognized that visual aids improve the ability to recall these facts.[5] Although visual aids have been successfully implemented in pre-procedure and post-procedure education, they are usually general in nature and do not demonstrate the difficulties or severity inherent to specific cases. It is thought that if patients can visualize the problem that is specific to their case, it would be easier to understand the outcome of procedures, to engage patients to be part of their own care, to increase treatment compliance, and to improve patient satisfaction with the care process. In this context, one of the biggest barriers to implementing an infrastructure to facilitate communication resides on the technological side. This study will address the informatics challenges for methods of transmission of radiological images and videos to mobile devices.

The use of handheld devices in radiology has already been evaluated in previous studies. Their reduced capability in dealing with complex imaging data has been consistently cited as one of the disadvantages of this technology in this area of medicine.[6,7] In order to solve this problem researchers have been using data compression algorithms and image conversion techniques to display the image on less powerful hardware. In addition, with the advent of thin-client architectures, an important improvement in the area of network communication was achieved. This structure allows less powerful devices to communicate with more robust machines over a network using a remote display protocol.[8]

Mobile devices such as iPods (Apple Inc., Cupertino, CA) have been used in the radiological environment with some success.[9] Although this tool allows an interactive visualization of pre-built 3D states using QuickTime Virtual Reality (QTVR) technology, the big limitation of reviewing and displaying images on these devices is the reduced screen size. A handheld named iPhone (Apple Inc., Cupertino, CA) was released in the market. It works as a phone, iPod, and a web browser, and it has a high resolution display of 480x320 pixels. It has already been reported that this device can display medical images using a specific web application.[10] Although the iPhone seems to work with proprietary software, its use with other web applications in the specialized and restrictive medical environment still has to be tested.

In general, Personal Digital Assistants (PDAs) have been very well accepted by the medical community. It has been reported that their use in Radiology can be beneficial in emergency departments for capturing, delivering and tracking urgent exam results.[11,12] Their use for image manipulation has been more limited, but reports show that it can be feasible if the appropriate infrastructure is created for it.[6,10] Open-source applications that can deal with DICOM images have been developed and implemented in multiple institutions. Applications such as MIRC and Osirix can easily convert DICOM into more generally accessible formats, including JPEGs and MOV files. These applications allow for the possibility of demonstrating the final result of the radiological interpretation process with less computational effort. In addition to displaying the content in a web-ready format, JPEG images converted in MIRC, for example, can be easily resized to any given format previously configured in order to be adjusted to mobile devices. Radiologists are currently facing an increased need to communicate more frequently and reliably with their patients in a mode understood by all. Due to recent advances in technology, researchers and industries are now breaking the barriers that were once in place to make this happen using medical imaging IT tools.

With this research, current technologies to display medical images in mobile devices using open-source or commercially available tools will be evaluated. By comparing each infrastructure (simple to more complex environments) and evaluating off-the-shelf mobile technology, resulting supporting information could be provided to other institutions planning to build similar solutions. In addition, if successfully built and developed, an opportunity may be created to further increase the physician-patient communication and decrease potential gaps that may exist in this interaction.

The workflow in two clinical sections (interventional radiology and interventional cardiology) will be evaluated in terms of the applications that are routinely used during clinical procedures and image interpretation. Physician-patient communication interactions will be measured. Pre-implementation physician and patient survey instruments will be administered during this phase. To understand which infrastructure best suits the requirements of healthcare institutions, four different architectures, using various methods of data transmission, will be studied: (a) Thin client web-browser in a handheld; (b) Web-based thin-client DICOM viewers in handhelds; (c) Using the Medical Imaging Resource Center (MIRC) in a handheld device; and (d) Osirix as an asynchronous content distributor for handhelds.

Three handheld devices will be evaluated for comparison using the following criteria: size, security, display, and processor speed/performance. Time spent to display a case will be measured from time of acquisition of image to time to display in the handheld. Automaticity, ease-of-use, and scalability will be evaluated. The quality of presentation, including videos with different frame rates and multi-frame DICOM objects, will be tested in each infrastructure. The ability of mobile devices to function appropriately in the hospital, using security standards of data transmission, will be assessed.

The optimal device and corresponding infrastructure will be implemented in a test environment. Evaluation in the clinical environment will include survey mechanisms, and usage and performance metrics. The cost to implement and maintain these technologies in the clinical environment will be assessed, as will ease-of-use, reliability, stability, convenience, and overall acceptance.

Work to be done during the coming year based on SIIM research grant award started on July 1st, 2008.

Work to be done during the coming year based on SIIM research grant award started on July 1st, 2008.