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Medical Image Quality on iPhone Sufficient for Doctors to Make Accurate Appendicitis Diagnoses: Presented at RSNA

By Ed Susman

CHICAGO -- November 30, 2009 -- The image quality that can be seen on a commercially available handheld device is sufficient to determine if a person is suffering appendicitis or a less urgent problem, according to a study presented here at the Radiological Society of North America (RSNA) 95th Annual Meeting. When doctors reviewed computer-assisted tomography (CT) scans on their iPhones, just 1 error was recorded out of 125 tests, researchers reported.

At an RSNA-sponsored press briefing, Asim Choudhri, MD, a fellow in neuroradiology at Johns Hopkins University, Baltimore, Maryland, said, "This new technology can expedite diagnosis and, therefore, treatment. We knew that recent advances in handheld device technology allowed viewing of medical imaging. But it is unproven whether viewing on a small screen allows a reader to reliably and reproducibly obtain information."

Dr. Choudhri and colleagues reviewed medical records of 25 patients suspected of having appendicitis and sent them via iPhone to 5 residents and asked the residents to make a diagnosis on what they could see on their phones.

The researchers compared the results from the resident readers with those obtained by 2 gastrointestinal specialists who reviewed the images at a hospital workstation with normal sized imaging. The 2 specialists identified all those with appendicitis and all those without appendicitis. Their findings were considered the "gold standard" for comparisons in the study. The results were also double-checked with surgical and medical outcomes.

Only 1 reader failed to make the right diagnosis. In every other case, the readers determined that 15 of the patients were suffering appendicitis and that 10 of the patients did not have appendicitis and did not require treatment, Dr. Choudhri said in his oral presentation on November 30, 2009.

He said an 80-image scan can be received in 1 to 5 minutes on an iPhone depending on the type of connection -- 3G or WiFi -- that is available for downloading the series. He envisioned that confirmative or suggestive diagnoses could be made by a remote reader in cases where on-site hospital staff may seek emergent consultations or second opinions.

He noted that about 5% of patients who now present with appendicitis-like symptoms go to surgery for normal anatomy. The use of CT technology has reduced the unnecessary surgery from 20% of cases with abdominal pain to 5%. In his study, 1 of the 10 patients who did not have appendicitis underwent surgery.

Dr. Choudhri used OsiriX mobile software for the iPhone, which allows for transmission of medical imaging data through the iTunes Application. He said he has no financial involvement with the company. There was no external funding for the study.

The use of OsiriX for diagnosis of appendicitis is not approved by the US Food and Drug Administration. Dr. Choudhri said he would not recommend that final diagnosis of a patient be considered using the iPhone technology -- rather the device should be used to guide further diagnostic modalities.

[Presentation title: Handheld Device Review of Abdominal CT for the Evaluation of Acute Appendicitis. Abstract SSE09-03]

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