iPods aren’t just for grooving to tunes. In fact, even the healthcare industry is gettin’ jiggy with it.

Apple’s iPods—portable MP3 players with hard disk storage—are popular among people of all ages who enjoy listening to music at their convenience. The most powerful devices feature 60 gigabytes (GB) of storage, which enable consumers to download and store thousands of songs. Not only does this storage capability equally excite fans of both Bloc Party and Josh Groban, it also has the medical community sitting up and taking notice. Apparently, iPods are no longer just for listening to music.

Medical students are using iPods to store lectures so they can listen to them later. Physicians are using them to display and manipulate images, and the iChat capability can be used to instantly communicate with colleagues.

“Up to a few years ago, storage was very expensive for mobile devices,” says Gregory Quinn, PhD, leader of the Mobile Data Visualization group, San Diego Supercomputer Center, University of California San Diego (UCSD), who, along with C. Michael Wright, MD, FACC, LifeScore Clinic, La Jolla, Calif., is researching the potential of mobile device visualization. “The hardware coming down the pipeline, which contains graphics accelerators, is very impressive. Mobile devices are coming to market with micro-drives, primarily intended for MP3 storage, but potentially providing a repository for storing large amounts of data.”

Image Storage and Viewing
Two radiologists have developed OsiriX, free downloadable software, to store and share medical information on iPods. The more powerful iPods have more storage capability than some laptop computers, making them ideal for storing and transporting digital imaging and communications in medicine (DICOM) images. The addition of the iPod to medical applications has enabled physicians to enhance the picture archiving and communication system (PACS) with these new features.

Weighing only 5.5 ounces, 60 GB iPods are portable and easy to use. New models have a 2.5-inch color display, which is ideal for viewing images. Once the images are on the iPod, they can be carried to another computer—as long as it is a Macintosh. OsiriX software automatically recognizes and searches for any images that physicians have stored on their iPods. When images are detected, they will appear on a list of available image data, just as music files are displayed.

“I want to emphasize that the integration of the iPod is just a small feature of the OsiriX software that was highly acclaimed by the press, but is certainly not the main reason why physicians will adopt the program,” explains Osman Ratib, MD, PhD, professor and chief of nuclear medicine at the University Hospital of Geneva, one of the developers of OsiriX. “The iPod integration is a perfect example of how our software takes advantage of ‘disruptive’ technologies that come from the consumer market and can greatly benefit the professionals and the medical community in particular. It is part of other tools such as iChat, used for remote consultations and conferencing; .Mac, used for online data storage; and Bonjour, used for peer-to-peer sharing of images and data.

“We took advantage of all these new technologies that Apple has embedded in their system. The main revolution that OsiriX brings is the ability to display and manipulate complex medical images in 3-D, 4-D, and 5-D in a user-friendly, simple, and accessible way for physicians who are not necessarily computer experts. These features are only available so far on high-end, very expensive workstations that were available to specialists and academic centers. It is like in the video editing world when tools such as iMovie and iDVD suddenly allowed everybody to edit and create their own movies in a way that is similar to the complex video editing of professionals.”

The early PACS workstations were designed for simple visualization of static images and as a substitute for light boxes. Today, they have adapted to support more complex and larger imaging modalities, including 3-D visualization and reconstructions.

Despite these changes, PACS technology is limited due to various problems, including a lack of adequate means of communication and consultation among distant users; the need to transfer and communicate images constantly from one location to another, particularly in academic settings; Web-based PACS systems that are usually slow and have limited image manipulation capabilities; and emergency medicine that requires fast turnaround time and 24/7 availability from radiologists.1

Today’s medical practice relies heavily on images and image data for decision making and patient management, according to Ratib.

“The tools that allow physicians to communicate and access the images in a simple and cost effective way are lagging behind,” he says. “An increasing number of physicians today need to be able to manipulate and process complex medical images themselves. Also, there is a vital need for exchanging and communicating medical images between physicians and different specialties. This is the problem that OsiriX is trying to address and provide a solution for.”

According to Ratib, the OsiriX software was designed to conveniently integrate the iPod every time it is connected and allows for easy display and manipulation of the list of images in a similar way to the management of music files in iTunes, with the advantage of a convenient way to save and carry data sets when physicians need to transfer patient data from one location to another.

“It is certainly faster and more convenient than having to burn the data on a CD or DVD, or to have to transfer data through complex protected networks,” Ratib explains. “Furthermore, with the recent generations of iPod, it is also possible to set OsiriX to store the images in a format that can also be displayed on the screen of the iPod itself or on a larger screen or projector that the iPod could be connected to. This does certainly not have the quality required for diagnostic purposes, but is convenient for rapid review or presentation of some key images for discussion of a case or for teaching purposes.”

The iPod has many more potential uses with the recent adjunction of video streaming and the ability to download multimedia files and connect to podcasts. Ratib and his partner, Antoine Rosset, MD, have already demonstrated the ability to use OsiriX to create podcast movies and add comments and annotations for teaching and education purposes.

The adoption of OsiriX has exceeded the doctors’ “wildest expectations.” In the last two years, they have received several awards, including the 2005 Apple Design Award for Best Use of Open Source software.

Open Source free software is emerging as a new strategic solution that can provide tailored technical solutions for medical users that are being designed and developed by the users themselves. The great success of OsiriX comes not only from the large community of users, but also from the fact that a worldwide community of developers is contributing to the project and that the source code can be analyzed and edited by anyone who wants to contribute or modify the program, says Ratib.

Security concerns are moot. According to Ratib, the software enables physicians to delete the patient’s personal information from an image file.

Educational Uses
This year, the Duke University School of Medicine has been making the audio track for videos available through podcasting for iPods and other audio devices, according to Pat Thibodeau, MLS, MBA, the school’s associate dean for library services and archives who has heard that other medical schools are also doing this. Duke is also looking into using iPods for audio tutorials, library orientations, and oral histories of key Duke leaders and figures.

Medical students are also taking advantage of the iPod’s power by listening to conference lectures and course review material that is available for purchase.

“I’ve used iPods for instructional purposes since last summer with my nursing informatics students,” explains Linda Goodwin, PhD, RN, BC, Duke’s director of nursing informatics. “I deployed them and then had a student do a small pilot study last fall to test whether students preferred their online lectures via a) streaming audio [Flash] on the Web, b) podcast, or c) plain old printed slides with notes. The students mostly seemed to like the Flash versions better so that they had audio and images at the same time. With the podcasting, they only heard audio and used printed slides for note-taking. I have also mailed the iPod to remote guest faculty who used it to record audio for their lectures and then sent the iPod back to me so I could compile everything. This wasn’t always smooth, but it worked fairly well most of the time. I’ve tried it with audio memos to students, but they seem just as happy with text versions which are still easier to transmit.”

Goodwin’s class also used iPods for patient interviews. “We asked 30 individuals about their personal experiences of patient privacy in the healthcare system,” she says. “Responses were recorded on the iPod and downloaded without any identifiers. The recordings were of good quality. The only problem we encountered was that the interviewer had to be careful to allow a one- to two-second pause as the recording began; otherwise, it was cut off. We also had to remind people that they were not to use names of people or organizations—the interviewer was instructed to delete any recording that included anything that could identify a specific person or place. This was a feasibility analysis and not a formal study so we won’t use this data, but will be designing future studies that will utilize this technology to help study issues of patient privacy. The people interviewed found them unobtrusive and felt comfortable with recorded data that did not identify who they were.”

NCHICA Realizes Potential
The North Carolina Healthcare Information and Communications Alliance, Inc. (NCHICA) is a nonprofit consortium of more than 250 organizations dedicated to improving healthcare by accelerating the adoption of IT. Although it hasn’t explored the potential of iPods, NCHICA realizes the future role of mobile information and storage devices.

“NCHICA wants to forward adoption of new technologies,” says Martha B. Adams, MD, MA, associate clinical professor, general internal medicine and vice chair for clinical affairs-ambulatory at Duke. “The next educational event by NCHICA regards disease registries. Those, no doubt, will be enabled with mobile technology, whether laptop or PDA. I don’t know anyone forward enough for the iPod role yet, but we’re open to that.”

Adams believes computer science and multidisciplinary people will help promote the use of iPods to the next level for medical use. She would like to tout the winning attributes of iPods and similar mobile devices to those who are interested in entering the field of medicine so they will realize the applications of technology not only for education, but for clinical uses as well.

In addition, Adams is working on a project with students in the Duke Information Science and Information Studies program and the medicine house staff to see whether the iPod will make learning easier. The undertaking involves building a core curriculum in medicine that can be viewed online with slides, some of which are interactive.

The Future
Quinn predicts a convergence among PDAs, iPods, and cell phones within the next two to three years.

“Physicians will want to carry one item, and cell phones will have all the capabilities of the other portable devices. Cell phones will come with a huge storage capability and powerful graphics, and we will be leveraging that to end users like physicians and clinicians. Physicians will be able to do the same things that they have been doing with all three on their cell phone,” explains Quinn.

Ratib sees the iPod as advancing rapidly over the coming five years, but still being an essential tool for physicians.

“In five years, the iPod will not be the one we know today,” says Ratib. “There is a light-speed development of portable technologies, and physicians, being essentially nomads, are very eager to adopt any technology that will facilitate their work and make the huge amount of information that they need more accessible to them. I think there will be an increasing use of this type of technology by medical professionals where visual communication of images and videos are becoming an essential part of the information that is needed for patient care and patient management.”

— Laura Gater’s medical and business trade articles have been published in Medical Imaging, 24x7, Podiatry Management, Veterinary Forum, Corrections Forum, and other national and online publications.

Reference:
1. Proceedings of 19th International Congress of Computer Assisted Radiology and Surgery, Berlin, Germany

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