The iPads large screen and interactive interface make it an ideal platform for medical imaging.

NeuroRad by RadLynx LLC is a clinical neuroradiology reference designed for a range of healthcare professionals involved in neurological imaging of the brain.

Written and designed by an American Board of Radiology certified Neuroradiologist, NeuroRad aims to improve understanding of neurological imaging and associated pathologies.

We have previously reviewed the NeuroRad Mini for the iPhone, and this is the iPad counterpart.

The main feature of this app is the interactive imaging atlases. This is split into a number of sections; Cross Sectional MRI Anatomy, Vascular territories, MR Angiography (both arterial and venous) and CT Angiography.

All three views (Saggital, Coronal and Axial) are accessible complete with labels. Navigation through the different parts is innovative and involves pinch-to-zoom multitouch gestures which scroll through the different anatomical slices. The images are high resolution and clearly labelled. Unfortunately, there was no way to turn off the labels in this section in order to test oneself.

The Vascular territory atlas covers both arterial and venous supply and is an excellent resource navigated in a similar fashion to the cross sectional atlas. A clear key illustrates the different areas of the brain supplied by each artery-key for any neurosurgeon. Labels are also included here to develop recognition of key structures

The MR Angiography section covers both the arterial and venous system. Each view has a multitude of labels which consolidates anatomical knowledge. There are also a range of views including ‘Tumble’ and ‘Spin’ which aim to improve 3-dimensional understanding.

The CT angiography also covers the three main views (Saggital, Axial and Coronal) and both arterial and venous systems. It is useful that these images are highlighted so that the path of the vessels can be visualised.

The other major section of NeuroRad for iPad is a detailed weblink and reference section. There are a decent range of weblinks covering a range of aspects related to neuroradiology from MRI images to clinical sites including journals and professional associations. This collection of weblinks (which open in Safari) is a good resource for residents and interns looking for further information.

The reference section contains some excellent information related to pathologies which may be seen on a scan. These are presented as a list of differential diagnoses which are extensive. There is very little pathophysiology explanation although references are provided for the interested resident who is looking for further reading.

Price:

• $9.99 (although currently on sale as new content is added and updated)

Likes:

• Detailed, labelled radiology atlas covering the three main views
• Excellent visualization of the vessels in the brain using both MR and CT Angiography
• Detailed differential diagnoses for a range of abnormalities seen on radiograms
• Collection of weblinks

Dislikes:

• No ability to share information/screenshots via email/social media
• No ability to turn the labels on/off in order to test oneself

Overall Rating:

• NeuroRad for iPad is a fantastic application for radiologist residents with an excellent neuroradiology atlas
• Has a range of uses for healthcare professionals ranging from student to resident
• An all-round excellent application for those interested in neurological imaging

iTunes link

by: Brian Chau, MS3

Being able to recognize key anatomical landmarks on radiological imagery is important for any medical student or clinician.

NeuroRad Mini is an app available through iTunes for users looking for a mobile reference and review guide to brain images.

NeuroRad Mini, from developer RadLynx, is a clinical MRI brain atlas for iOS devices. It features coronal, sagittal, and axial views of the brain. These are all labeled, allowing for easy viewing and review of important anatomical locations and relationships.

Designed by a senior member of the American Society of Neuroradiology, NeuroRad Mini is a more limited version of the iPad-only app, NeuroRad, also from RadLynx. NeuroRad Mini is designed to be a quick-reference guide to MRI views of the brain, while the iPad version offers more features, due to the limitations of the screen size and processing power of the iPod Touch and iPhone platforms.

I was impressed by how easy it was to navigate NeuroRad Mini on a small device such as the iPod Touch. Everything in the app loaded quickly, with little noticeable lag. Image scrolling through different cross-sectional views are fluid and accomplished by using the Multitouch contols. I could either swipe once to change to a single new view, or enable continuous image changes by dragging two fingers on screen. Just swiping to view the next image seemed to be the best way to view images through NeuroRad Mini.

NeuroRad Mini also allows the user to view labeled images of the various neuro cross-sections. This option is very useful, especially in a clinical educational setting. A simple upward swipe on the screen will turn off labels, while swiping down turns them on. The pointers to each brain region are easy to follow and visualize, even on the smaller screen of the iPod Touch. To zoom in, double-tapping the brain or tapping the magnifier glass will do the trick. I did notice that zoomed in images weren’t quite as detailed as many would like, but they are certainly still useful for learning and reference.

While some medical apps require an active Internet connection to pull images and information, NeuroRad Mini offers almost all of its content locally. This is a huge benefit, as not every user has access to a network data plan or wireless connection 24/7. Even the basic help and support pages on the app do not require active network access. Finally, for users desiring more information or assistance with NeuroRad Mini, the developer’s website offers a fairly comprehensive FAQ and user guide.

Price and technicals:

• NeuroRad Mini is available for $9.99, through iTunes
• This app requires iOS 4.3 or later and runs on the iPod Touch, iPhone and iPad
• There is also a larger version named NeuroRad available for the iPad exclusively.

Likes:

• Wonderful review of brain anatomy seen through MRI imagery
• Large selection of high-quality neuro MRI images
• Smooth navigation and superb layout
• Excellent clinical relevance
• Great customer support, both online and off

Dislikes:

• Users of older iOS devices will not be able to run NeuroRad Mini
• Limited to MRI imagery

Conclusion:

• NeuroRad Mini is a solid choice for a brain atlas utilizing MRI imagery
• It’s a must-have for any user interested in better understanding the anatomic layout of the brain in a clinical setting.

Links:

Developer
iTunes

Mobisante made its first big waves a little over a year ago with their ultrasound peripheral for smartphones as MobiUS began to accumulate awards all over the country.

After receiving FDA approval earlier this year, the device launched commercially with a reported cost of just under $8,000, comparable to other mobile ultrasound devices but with the additional benefit of wireless connectivity.

We caught up with Mobisante Chief Engineer Nikhil George at the mHealth Summit for a live demonstration of the latest version of the MobiUS device. There are now several different probes available with varying frequencies and also a pairing configuration available with a tablet.

In addition to the demo, we also got an update on their move to support Android devices.

We reported the possibility of Android integration a few weeks ago after reports that Android 4.0 (Ice Cream Sandwich) would enable USB 2.0 host support. As Sailesh Chutani, CEO of Mobisante, told us in an interview then,

“iMedicalApps: What do you think about Android 4.0 and it’s robust support for USB 2.0 hosting?

Sailesh Chutani: The new release of Android does support USB 2.0 host, which makes it suitable for connecting peripherals such as ours. Essentially, Android starts to become a real computing platform a la Windows, which is great for mHealth companies.

iMedicalApps: Are you planning on bringing your Ultrasound Peripheral to Android phones?

Sailesh Chutani: Yes”

Mr. George echoed the sentiment that Mr. Chutani shared with us though that this move will take a lot of work. As Mr. George put it, they broke pretty much every component of the Toshiba device on the road to developing MobiUS, and he expects to do the same with whichever Android device they start with from a wide range of expected and unexpected engineering challenges.

So in short, you will eventually be able to run a Mobisante ultrasound probe on an Android tablet or smartphone, but not in the immediate future.

We also learned that Mobisante is anticipating other diagnostic peripherals moving to smartphones and has built their software in such a way to allow for easier integration of future peripherals. They currently include a feature to take pictures using the smartphone’s camera, images which can be transferred in precisely the same way as the ultrasound images themselves.

While this may not sound like much, its important to remember that this feature not only includes some useful tools like labeling lesions with the diagnosis in question, but it would also be HIPAA compliant.

Check out our live demo below!

By Brian Wells, MSM, MPH

“Aspects of Anatomy: Thorax and Upper Limb” is a new visual study guide for anatomy with the lessons given by Dr. Peter Abrahams, a professor of clinical anatomy at Warwick University and at St. George’s University School of Medicine in Grenada.

Dr. Abrahams has examined and lectured doctors worldwide and has won prior awards for classroom and electronic teaching of anatomy. His extensive experience, as well as a love for anatomy, truly shows through in this application.

Excerpt of App from iTunes:

Cutting edge film tutorials teaching on the “real human body” by one of the most acknowledged international experts in the field of clincial anatomy. Filmed at the West Midlands Surgical Training Centre on plastinated prosections the 38 short films (3-8 minutes each) are hands-on demonstrations by Prof. Peter Abrahams an expert teacher on integrating human anatomy with the world of medicine.

This application is geared towards those learning anatomy for the first time or for those who need a quick brush-up on their basic anatomy but do not have a lot of time to sit and read a textbook. Dr. Abrahams provides excellent study points and does a very good job of highlighting major structures of which clinicians should be aware.

In addition to teaching anatomy, there are brief videos that discuss radiologic anatomy and cross section. These videos include an introduction to radiology, 2D radiology such as one would see in an axial CT, 3D radiology and even real-time 4D radiology of the heart.

Aside from only covering anatomy, this application also provides a few clinical condition/technique videos on breast cancer, carpal tunnel syndrome, Colles’ fracture and coronary angiography. Finally, this app also provides quiz functionality over the various areas covered by the videos, such as the thoracic wall, the lungs, the lung bronchial tree, the thoracic cavity lung, the heart and others.

Strengths:

• This app does an excellent job of reviewing major anatomical structures and integrating quiz-based learning with the lessons.
• All the videos are available offline which makes for easy viewing anywhere.
• While not as detailed as what can be found in full anatomical textbooks, Dr. Abrahams has carefully picked anatomic structures relevant to clinical anatomy.
• The end user will find value in watching the videos and going through the quizzes for reinforcement.

Weaknesses:

• It would be nice for the application to include more videos on radiologic anatomy and clinical conditions. However, given the number of videos, the quality of the video, the narration and quiz feature in the application, it would be hard to count this as a deal-breaking weakness.
• The most glaring weakness of this app:  Its not customized for the iPad’s screen — where its utility would significantly increase.

Overall:

• Overall, this is an excellent application for learning anatomy. While it will not completely replace the Rohen Atlas or Netter’s Anatomy, it makes for a wonderful addition to one’s study materials.
• The videos combined with the quiz feature in the application make learning anatomy easy and help reinforce the lessons covered.
• At only $7.99, I would consider this app a bargain, especially compared to textbooks which I have spent $30 and $40 dollars on.
• Dr. Abrahams’ skill as a teacher of clinical anatomy shows as his lessons are presented in a logical, easy to understand manner.
• I highly recommend this application to students of clinical anatomy.

YouTube video of the application: http://www.youtube.com/watch?v=PCp-9WfmhQA

iTunes Link: http://itunes.apple.com/us/app/aspects-of-anatomy/id422032949?mt=8

Price: $7.99

Disclaimer: Dr. Peter Abrahams is affiliated with St. George’s University School of Medicine. However, I have never met Dr. Abrahams nor have I ever attended one of his lectures. I have no financial interests in this application.

The ability to review patients’ imaging studies on smartphones is a natural progression for mobile physicians. Most hospital PACS (Picture archiving and communication system) now allow viewing not only on any hospital computer but often from home PCs. The ability to view the same images from your iPhone would be a great boon for many physicians and several contenders are already en route to market or have arrived. In addition the extremely dense pixel resolution of the iPhone 4 Retina Display makes it an obvious target for mobile radiology viewers.

In the past, this site has reviewed two applications already available on the iPhone, eFilm (review) and OsiriX (review). One problem that any mobile imaging viewer has to contend with is the vast amount of data (in Mb) of a DICOM image set and the processing power required to perform 2d and 3d transformations. For example, OsiriX stores all the data locally on the iPhone, using WiFi to transmit whole data sets to the phone or performing queries to the PACS server to request data sets to be sent to the phone.

Now ResolutionMD (website) is presenting a different alternative. The DICOM processing and storage stays on the server and transformed image sets are sent to the phone for display and some processing like window and level manipulation. The app (iTunes link) is a free download but, of course, will not work until you hospital installs the server component. The demo (YouTube video) is quite impressive and a great indicator of how creative uses of smartphones will continue to push the envelopes of what was thought possible just a short while ago.

Last week we did a feature review of the iRadiology App, a recently released free radiology learning tool.  I thought it was a must have medical application for medical students and residents.  The application provides over 500 radiology cases explained in detail.  I had a quick Q&A with Dr. Lieberman to discuss the direction of this great learning tool and whether or not it will remain free. 

iMedical Apps: What was the inspiration of the app?

Dr. Lieberman: I have been a director of medical education for radiology at Harvard Medical School for 26 years and have dedicated my career to teaching, which has been very fulfilling. I have developed a number of different web-based learning programs, which can be accessed for no charge on my Lieberman’s eRadiology website at http://eradiology.bidmc.harvard.edu   This app is an extension of one of the programs I offer online.

iMedical Apps: How long did it take to develop iRadiology?

Dr. Lieberman: The app is based on Lieberman’s Classics Collection in Radiology, available at http://eradiology.bidmc.harvard.edu/Classics/ which has taken two years to develop and is continuously being expanded – we are adding an extensive cardiovascular section with CT and MRI multiplanar imaging this month.

iMedical Apps: Will the app stay free in the app store?

Dr. Lieberman: Our hope is to keep the app free in the app

store.

A special thanks to Dr. Lieberman for providing such a great resource for those learning how to read various imaging.  We look forward to seeing the additions to the application and I encourage everyone to use the online resources Dr. Lieberman mentioned as well.  I wish I had known about this earlier in my clinical years and it’s definitely a source I’ll use for residency. 

Link to the full review of the iRadiology medical app, available for the iPhone and iPod Touch.

A new radiology learning tool was just released in the App Store, the iRadiology App.  This app has a catalog of over 500 radiology cases designed to help medical students and residents improve their plain film,CT, and MRI reading skills.  The cases are derived from Dr. Gillian Lieberman, who is the currently Director of Harvard Medical Student training and Associate Director of the Residency Program at Beth Israel Medical Center.  This legitimizes the content of the application.  In this review we’ll discuss the application further and also show you how to turn on the “Zoom” feature built into the iPhone that will enable you to improve the utility of this medical app.

When you open up this application you are presented with the above screen.  With the search feature, you can search for various cases based on certain key words, such as cardiovascular, chest, or actual pathologies.  I didn’t find the Search function to be very helpful, but the topics section was great for navigating with the application.

Activating the “Zoom” feature on your iPhone:

Before writing about this application further, I’ll quickly show you how to turn on the native “Zoom” function of your iPhone.  While this app allows you to zoom into pictures,  you can’t zoom in as close as you’d like sometimes, but when you turn on the native “Zoom” function in your iPhone, you can get significantly closer, making these images even more useful.

Go to Settings, tap General, then Accessibility.  Once you tapped on Accessibility, tap Zoom, and slide the Zoom feature to the On position.  The instructions for how to use the extra Zoom feature are shown on the same page.  Make sure you know how to manipulate the “To change zoom” portion correctly.  Below is an example:

This feature will also be useful for other medical applications that require you to read detailed images.  Now back to iRadiology.  For the purpose of this review, I’ll select “Chest” from the Topics section, and then in the subcategory I’ll select Lungs.

Within the Lungs section there are further subcategories, showing the great diversity of cases this application possess.  I’ll select Sarcoidosis and go from there.

When you tap on Labels, you are presented with the above picture, revealing key areas of the image. 

If you have the Zoom feature turned on, as explained at the beginning, you can zoom in ridiculously close and get a better picture of these films.  I wasn’t able to include the pictures where I used the “Zoom” feature because the iPhone doesn’t take screen shots of these pictures.

When you tap on Findings, you are presented with further information about the radiology case at hand, in this case, sarcoidosis.  I found this section to include a great deal of high yield information that is often asked on the USMLE step 1 and step 2 exams.

What I liked:

• Great wealth of knowledge, over 500 radiology cases
• Labels section does a great job of showing the pathology of interest
• Great diversity in the cases present
• Legitimate source for the pictures and cases provided in the application
• Great explanations of the radiology pathology presented in the application
• It’s FREE

What I didn’t like so much:

• Zoom feature, using the traditional pinch motion, could be more robust, although the iPhone’s new native “Zoom” feature can be used
• Supports landscape mode, but the Findings section can only be viewed in vertical screen.

What I’d like to see in future updates:

• Quiz Mode
• Bookmarking of favorite cases to review
• Built in link to Wikipedia for more information about the radiologic case at hand

Conclusion:

We’ve reviewed other radiology related applications before, such as iAnatomy, and the Joslin Chest Atlas.  iAnatomy did a great job of providing cross sectional CT images for anatomy learning, but did not provide pictures of various disease pathologies.  Joslin’s Chest Atlas provided some great plain chest film images, but the amount of content is limited with less than 100 images.  The beauty with iRadiology is in the huge amount of content provided, with over 500 radiology cases, and these cases are high yield as well.  The majority of these cases are ones I’ve seen in the hospital or have learned about.  Oh by the way, this app included plain film x-rays, CT scans, AND MRIs.

This application has the full package and I’d definitely recommend it to medical students, residents, or any other health care providers who want to improve their radiology reading skills.  With the price tag of “free” this app is a no brainer to download.

[itunes]

[website]

This app is 137 mb, so make sure you’re connected to a dedicated WiFi connection when downloading.

Also, special thanks to one of our readers in Taiwan for alerting us of this application.  Remember, many of our post ideas come from you, our readers.

In a recent study presented at the annual meeting of the Radiological Society of North America (RSNA) researchers showed how the DICOM viewer, OsiriX, can effectively help diagnose acute appendicitis.

This doesn’t come as much of a surprise to us.  We reviewed OsiriX a few months ago and were definitely fans of this DICOM viewer then.

My only issue is with the lack of information provided in the study.  You can view the abstract of the study but the full study is currently not yet published.  Yes, the findings are interesting, but lets hold back some of the excitement until we get more information.  I’ve seen multiple medical and non medical outlets reporting on this story, but I don’t think they are looking at how the study itself was performed in detail.  The main points mentioned in the abstract were the following:

25 Abdomen and Pelvis CT studies performed on patients with right lower quadrant pain were identified. All patients had either surgical confirmation of the diagnosis of acute appendicitis or followup clinical evaluation confirming no acute appendicitis. Each study was viewed by five blinded radiologists on a handheld device (iPhone) using a DICOM viewer (OsiriX). Studies were evaluated for the ability to find the appendix, the maximum appendiceal diameter, presence of an appendicolith, periappendicial stranding and fluid, abscess formation, and a binary assessment of the diagnosis of acute appendicitis. Studies were compared to a faculty-read of the study as performed on a dedicated PACS workstation.

-Choudhri, et. al (Link to Abstract)

15 cases of acute appendicitis were correctly identified on 74 of 75 interpretations (99%), with one false negative. No false positive readings were seen in this study. 8 appendicoliths were correctly identified on 35 of 40 interpretations (88%). 3 abscesses were correctly identified by all five readers. There was greater than 90% agreement on the presence of peri-appendiceal stranding and free fluid. The iPhone measurement of appendiceal diameter averaged 0.9 ± 0.7 mm larger than the value obtained on a PACS workstation (p=0.04).

-Choudhri, et. al (Link to Abstract)

These are just some of the few questions I have for this study and I’m hoping they will be addressed once the full study is published:

1. How were the residents blinded?
2. I’d like to know more about the selection criteria for the 25 CT studies included.  What was the researchers definition of “right lower quadrant” pain.  If the threshold for right lower quadrant pain was high, then making a diagnosis of acute appendicitis via imaging might be significantly easier due to a higher burden of disease.
3. I’d also like to see the results when 25 random Abdomen and Pelvic CTs are included that do not meet the inclusion criteria of right lower quadrant pain. There might be some false positives that come out of this arm.

Hopefully some of these answers will be answered once the full study is published.

One problem that has plagued physicians in specialties where imaging is important is how to describe a patient’s imaging findings to a colleague. Certainly, the radiologist’s report is helpful but sometimes it’s not enough. Particularly for surgeons and interventional radiologists, imaging findings are like a road map to a procedure. If you’ve ever given driving directions to an out of towner, you’ve seen the look of confusion overcoming their face as you desperately pile on landmarks hoping they don’t get lost. But, if you are a physician, how do you communicate the subtleties of abnormal anatomy without pictures?  This review will discuss how this application helps put a legitimate image viewer in the palm of your hand via the iPhone Operating System.

The Osirix iPhone app can actually help. This well-written application brings a small and easy to use DICOM viewer to the iPhone. DICOM is the standard file format used for almost all forms of radiology imaging, including CT, MRI and nuclear medicine.The Osirix iPhone app ($19.99) is a good companion to the OsiriX desktop application (http://www.osirix-viewer.com/). For those not familiar with this remarkable piece of software, it’s a free & open-source DICOM viewer developed specifically for Mac OS X by a group of radiologists. The desktop application is now over 5 years old and is a mature, feature filled imaging workstation. It’s a rope of rescue from the minimalist and poorly designed viewers included on imaging CD ROMs brought in by the majority of patients these days.

The Osirix iPhone app can download images from the OsiriX desktop application over a wireless network. If you have access to your institution’s PACS server, it can even interface directly to the PACS using the DICOM Query & Retrieve (“Q&R”) protocol. Once the images are on the iPhone, you can scroll through them, change the windowing (soft tissue, bone, lung, etc.), make measurements, and even quantify Hounsefield (radiodensity) units!

What I liked about this app:

• ability to zoom, pan and change windowing as well as make measurements
• once image files are on the phone, good performance
• the iPhone Osirix viewer is immediately recognized by the desktop app, if on the same wireless network
• the help instructions are well-written and available from the top level tab-bar

What I didn’t like:

• the price tag might dissuade a few people from trying the application
• performing a query & retrieve over the internet from the OsiriX desktop application is very slow, making it almost mandatory to transfer images over a local wireless network
• if the DICOM server is behind a router (which is usually the case in a small office), the patient study list will be visible but the images cannot be accessed. While this is probably a limitation of the DICOM Q&R protocol, it is especially unfortunate now that we have powerful mobile DICOM viewers available.

What I’d like to see in future updates:

• using a single button for pan vs. zoom vs. window is a bit confusing, the three functions should be separated
• a subset of the amazing 2d (and 3d?) image reconstruction features available on the desktop application
• if feasible, a work-around to the DICOM Q&R protocol, giving the ability to access images behind a router (analogous to the “Back to my Mac” feature of OS X)

Conclusion:

The OsiriX iphone app is a very useful medical application that shows the flexibility and power of the iPhone platform. The app was even highlighted in one of Apple’s television commercials. More importantly though, when speaking to another physician, we can actually look at patient’s images now, instead of drawing lines and circles on the nearest piece of paper.

[itunes]

[website]

Dr. Wodajo is our newest contributor to the iMedical Apps team and we feel privileged to have him on board. He provides a surgeons perspective, along with an extensive clinical background.