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Hey! Want to see my Kidney Stone?

December 16, 2008
by Joe Marion
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If you know me, you know that I believe in imaging technology and I am always interested in “practicing what I preach.” So, it should come as no surprise that several years ago when I was the unlucky recipient of a 6 mm kidney stone, I went to the to the Medical Records Department of the hospital after my ER visit, and requested a CD of my images! More on the significance of this later.

Having just spent a week making the annual trek to Chicago for the Radiological Society of North America (RSNA) meeting, I was intrigued with emerging technology for image viewing. Two vendors caught my interest in terms of interesting developments relative to image display. The first was Agfa Healthcare. As part of their Impax Data Center initiative, Agfa showed a “works-In-Progress” display that featured an innovative way to deliver image display. Instead of relying on the local viewer’s processing power and storage capacity, Agfa has come up with a way to manage image display and manipulation in a manner similar to Cytrix Systems’ application virtualization technology. The image manipulation horsepower is concentrated at the data center, leaving the client to simply display the end result, requiring no display application other than an image browser. The demonstration featured a link to a data center in New Jersey, and the near instantaneous display of a large sized CT data set!

The other technology was Merge Healthcare’s Cedara WebAccess, and Merge Mobile for the iPhone, an application that lets medical professionals and patients view digital medical images on their Apple iPhone or iPod Touch. Cedara WebAccess expands that capability to all Web-enabled devices, including PDAs that compete with the iPhone. McKesson Corporation has shown similar technology for the past two years as part of their advanced user interface research.

So, what is the significance of any image, anywhere, any time? Are these practical applications, or a novelty? Is the significance of such technology that it will open new markets in ways that we do not yet perceive? To me, this is the major question regarding these technologies.

In relation to the CD of my kidney stone, it really served no medical purpose to have it. I took it with me on a follow up visit to my general practitioner, and he had no way (or interest) in viewing it! He had received the report from the Urologist, and that was all he needed. So, outside of the novelty of saying I have my images, what purpose does it serve?

I am concerned about the impact of these forthcoming technologies. Does the average consumer care to have his/her images on their iPhone? Recently, there has been controversy in the news about the impropriety of certain self-portrait phone photos showing up on the Internet. Could the same be true for medical images? And, what is the liability of this happening? Carrying images of one’s child has always been popular – will this now mean that one can carry around Ultrasound images of their unborn child? As most images that would be significant are going to be for a positive diagnosis, does John Doe really want to be carrying around images of his brain tumor?

Is there a clinical benefit to the physician or medical staff to have non-diagnostic images delivered in this manner? Would any physician make a treatment decision based on having access to non-diagnostic images delivered to their phone? On the other hand, even though non-diagnostic, does the capability provide a good enough image to allow clinicians to decide if it warrants additional exploration, and is this a time saver to the physician?

Perhaps the Agfa demonstration is more relevant. If the technology could provide more rapid access to images from more locations, could it improve the productivity of physicians for such applications as Teleradiology? Does it usher in a new age of real-time referral and second opinions?

So, am I old-school, or am I missing something with regard to the significance of image display on a mobile device? Perhaps a survey of teenagers that live on their phones for both voice and Instant Messaging would be a good bellwether of the significance. I am interested in your perspective as a member of the healthcare community. What do you think? Will this usher in a new age of image accessibility? I welcome your perspective!



Good points by Joe and Jim! Jim's comments remind me of an effort I undertook many years ago that utilized Lotus Notes and a Lotus tool known as ScreenCam that enabled interactive image review. I called it "time independent, multi-media communications." It was a means of adding voice and cursor annotation to an image and making it available via the Notes server. It enabled a clinician to annotate an image and make it available to the referral. This pre-dated high speed internet, so it could be done today via an AVI file. Perhaps something like this would be more meaningful to physicians than a static image?! Still, it wouldn't do anything for the patient.

The reality is that most practitioners lack the expertise to read sophisticated scans with confidence and end up relying on the "official" reading. In my practice I made it a point to review interesting films with the radiologist during morning rounds (mainly for my own edification), but rarely felt comfortable reading films that patients brought with them on office visits. Decisions based on "non-diagnostic" quality images carries an added liability that few will shoulder. I did email enhanced photos of my kidney stone to many of my friends (I superimposed a classic photo of Hillary atop Everest) so I too am guilty of medical "over-share".

I agree with your perspective. I tested it against my experience. I have a specimen jar containing my gall stones (removed with my gall bladder, the old fashion way, in 1991.) To me, they represent the triumph over an excruciating and recurrent pain, often likened to childbirth pain. To everyone one else who sees this little jar, it's of absolutely no significance to them. Sharing an image of these stones would be pointless. Like you, I have a hard time thinking of counter examples.

This is really interesting i completely agree with the information. Thanks for guiding me through a lot of things. It was really a eye opener for a lot of people.