Mobility in Imaging: Is Diagnosis the Next Frontier?
Leonard BerlinAs mobile technology gains traction among primary care physicians to aid in faster, more effective patient consultation, can adoption of this technology among image-intensive specialties like radiology and cardiology be far behind? Not according to the results of a 2012 study by Jackson and Coker Research Associates, which found that, in order, the top five specialties using mobile technology in clinical practice are emergency department physicians, cardiologists, urologists, dermatologists, and radiologists. Their data correlate with the information, published in the June 2012 issue of JACR: The Journal of the American College of Radiology, that radiology residents are eager adopters of new technologies, with 74% using smart phones and 37% using tablets. Residents also reported that they used electronic resources to learn radiology as often as they used printed materials, and 81% agreed that they would spend more time learning the field if provided with tablets. Consultation vs. Diagnosis Leonard Berlin, MD, professor of radiology at Rush University Medical College, Skokie, Illinois, and author of the book Malpractice Issues in Radiology, notes that for the time being, the primary role of mobile technology for radiologists should be allowing consultation despite increasingly hectic clinician schedules. “Mobile technology is great when used informally among physicians and radiologists,” Berlin says. “For instance, if I am at the hospital and read a CT and report a tumor and send the referring physician an image to view on an iPad, that’s a great way for us to communicate.” Berlin stresses, however, that the tumor should be diagnosed on a full-sized monitor, not a significantly smaller tablet screen. “We have to be very careful with this technology now and in the immediate future,” he cautions. “I don’t think we can base a primary diagnosis on the resolution of an iPad, but that doesn’t mean we shouldn’t use an iPad to communicate that diagnosis after the fact.” He is hopeful, however, that in the near future we may see portable devices with the advanced screen resolution necessary to make diagnosis a possibility, at least for some images. In fact, the FDA has cleared at least one mobile application for diagnosis of certain images, but Berlin cautions clinicians against diving into this brave new world with both feet. Medicolegal Implications “The FDA approves a lot of things,” Berlin says, in reference to these applications, “but even with FDA approval, there isn’t a lot of data on the viability of using these devices for primary diagnosis. A lot of things look great, and then you find out that they don’t really work.” That could put a radiologist in a difficult position if he or she missed a finding as a result of using a smaller screen for interpretation and diagnosis, Berlin says. He adds that legal precedent suggests that the radiologist would not have much luck with the explanation that the application was FDA-cleared for primary diagnostic purposes. As an example, he shares a case from a few years ago in which a radiologist missed an aneurysm of the brain on an image he read at home, using equipment that had been set up in his home office for the purpose of remote interpretation. “The radiologist who missed it saw it the next day on the computer at the hospital, but he didn’t see it on the equipment he had for teleradiology,” Berlin explains. “He was found guilty. It’s not an excuse. If you are claiming, ‘I had poor equipment,’ then you shouldn’t have been using the equipment. The defense that the quality of the equipment resulted in misdiagnosis is weak.” For these reasons, Berlin recommends that radiologists limit their utilization of mobile technology to “informal communication between two physicians”—at least, for now. He is hopeful that in the not-too-distant future, the capabilities of mobile devices will be strong enough to open up new clinical applications for imagers. “The technology is headed in the direction [of diagnostic capability],” he says. “It is advancing at such a breakneck pace, it’s unbelievable.” Cat Vasko is editor of HealthIT Executive Forum.