Acute aortic syndromes and traumatic aortic injury are often diagnosed on CT angiography, possibly requiring emergent intervention.
Advances in handheld computing have created the possibility of viewing full DICOM datasets from a remote location.
To evaluate the ability to diagnose and characterize acute aortic pathologies on CT angiograms of the thorax using an iPhone-based DICOM viewer.
Diagnosis of acute aortic pathology on CT angiograms of the thorax using a portable device DICOM viewer can be performed with good concordance to interpretations performed on PACS workstations in this preliminary investigation.
Commentary & Implication to mHealth
This study, although small, illustrates the diagnostic accuracy of radiological pathology when mobile devices are used. These results may potentially have improved given the hardware development available today that includes higher resolution screens. There are barriers to widespread use at the moment such as concern for patient privacy and integration with hospital PACS systems.
This study agrees with a number of other studies that show that mobile devices are a suitable adjunct to view imaging compared to standard hospital PACS systems. The discrepancies in the aortic dimensions between the handheld device measurements and those on a dedicated PACS station suggest that this is still an area of future development to work on.
- 15 CTA examinations of the thorax in patients with suspected acute aortic syndrome were identified. The study population included ten males and five females. The average age was 51.1±14.6 (range 24–75 years). Ten patients had a clinical indication of high-impact trauma. Five patients had a clinical suspicion for non-traumatic aortic dissection.
- Studies were transferred to a handheld device (iPhone 3G-display is 420 × 380 pixels at 163 ppi).
- Studies were evaluated by three radiologists blinded to the patient diagnosis and outcomes. The radiologists participating in this study had not previously reviewed the studies comprising the testing data set and were at least PGY-5.
- Assessments made on the handheld devices were compared to interpretations performed on a dedicated PACS workstation by two board certified radiologists with subspecialty training in vascular imaging.
- Each study was evaluated for the presence of aortic dissection, intramural hematoma, aortic pseudoaneurym/transection, and active extravasation. At the site of traumatic injury, measurements of maximal diameter of the pathology were obtained, and measurements of the aorta proximal and distal to the site of pathology were also made.
- Aortic pathology was correctly identified by all handheld device readers in nine out of nine cases, with the pathology correctly characterized as aortic transection/pseudoaneurysm (n=6), type A dissection (n=2), and type A intramural hematoma (n=1) by all reviewers.
- Six normal studies were appropriately identified as normal by all readers. There were no false-positive or false-negative interpretations
- In the nine patients with aortic pathology, the maximum diameter of the pathology was measured as 42.4±10.5 mm (range 32–64 mm) on the handheld device and 40.2±8.5 mm (range 28–56 mm) on a dedicated PACS workstation (p=NS). The descending thoracic aorta in areas not involved by acute pathology was measured as 24.5±4.2 mm (range 18–31 mm) on a PACS workstation, and 25.6±4.7 mm (range 19–33 mm) on the handheld device (p=0.03)
Article Name: Diagnosis and treatment planning of acute aortic emergencies using a handheld DICOM viewer
Authors: Asim F. Choudhri & Patrick T. Norton & Thomas M. Carr III & James R. Stone & Klaus D. Hagspiel & Michael D. Dake
Journal Published: Emerg Radiol
Date Published: Received: 20 November 2012 / Accepted: 10 March 2013 / Published online: 24 March 2013
Citation: Emerg Radiol (2013) 20:267–272 DOI 10.1007/s10140-013-1118-8