Intra and Inter-Observer Reliability of Mobile Tablet PACS Viewer System vs. Standard PACS Viewing Station-Diagnosis of Acute Central Nervous System Events

Abstract

Background and Purpose: The display resolution of the Apple iPad® is 1024 × 768 pixels, which is greater than that required for generating the typical CT or MRI images. The purpose of this study is to determine if specific CT and MR sequences can be interpreted accurately on mobile device/PACS software platforms when compared to a traditional stationary high resolution monitor/PACS radiological workstation. If so, this allows radiologists to provide comparable interpretation as if they were onsite at an imaging center or hospital. Materials and Methods: This study is an investigator initiated, single site, retrospective, nonrandomized, IRB approved study. Five radiologists were included in this study. Each independently interpreted specific CT and MR sequences on traditional high-resolution LCD monitors via eFilm® software as well as an iPad® mobile device using Osirix® software program. Repeat interpretations were performed, with 4 weeks minimum interval between interpretations of each patient. This investigation included: 50 patients with CTA perfusion imaging, 50 patients with MRI of the brain, and 50 patients with MRI of the spine, which were image study orders generated through emergency room requests. Subsequently, interpretive results of each radiologist for each patient were statistically compared to evaluate for intra-observer and inter-observer reliability. Results: The parameters set within the CTA perfusion brain studies demonstrated excellent intra-observer variability. All of the parameters within the MRI brain studies demonstrated excellent intra-observer variability with a Cohen's kappa value > 0.75. The Cohen's kappa values for the board certified neuroradiologist demonstrated excellent variability for all parameters; the resident radiologists had good variability, with a majority of kappa values near 0.75. Conclusions: The data and statistical analysis demonstrated that portable mobile devices such as the Apple iPad® can display adequate resolution of CT and MRI sequences to accurately diagnose acute central nervous system injuries and other non-acute pathology.

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

“…17 Many authors identified the likely application of a tablet computer was for remote on-call interpretation of emergency imaging and chose cases and pathology relevant to this situation. 1,2,[8][9][10]15,18,20 Hence, the included studies were judged to have a high applicability to the review question. The exceptions were the study by Abboud et al, 17 which tested the reliability of TB screening; the use of emergency department physicians as the study readers by Park et al; 8 and the accuracy of diagnosing urolithiasis from the abdominal radiographs 16 (which has in a large part been replaced by CT imaging 24 ).…”

“…1,2,8 Limitations in network coverage and speed, potential effect of ambient lighting on diagnosis were also noted. 8,15,20 The inability to access clinical systems for referral information and prior studies 1 and the increased time to perform a read compared with primary workstation 19 were other limitations of using tablet computers. The portability and fast boot time were seen as the major advantage of tablet computers.…”

“…The three diagnostic reliability studies 15,17,20 were assessed using the QAREL tool. All studies had at least one item judged to indicate a poor quality in the study.…”

Mobile markerless augmented reality and its application in forensic medicine

“…For stereo calibration (i.e., alignment of color and depth data), default implementations are provided in the Microsoft Kinect for Windows SDK 4 and OpenNI. 5 This allows, the depth data to be transformed directly into the color camera coordinate system and the device continuously captures color and depth data in a uniform coordinate system.…”

Efficient medical image access in diagnostic environments with limited resources

“…De Maio et al (2014) studied the accuracy of mobile diagnostics related to intra-articular knee pathology, concluding that an iPhone DICOM Viewer can be used and it is similar to that of a conventional radiology workstation. Bhatia et al (2013) also presented that mobile devices such as the Apple iPad can display adequate resolution of CT (computed tomography) and MRI (magnetic resonance imaging) sequences to accurately diagnose acute central nervous system injuries and other non-acute pathologies. John et al (2012) suggest that the emergency conditions commonly encountered in CT and MRI can be diagnosed using a portable device DICOM viewer with good concordance with the workstation evaluation.…”