Radiologists diagnose appendicitis remotely by using smart phone
1 December 2009
Radiologists can accurately diagnose acute appendicitis from a
remote location with the use of a handheld device or mobile phone
equipped with special software, according to a study presented at the
annual meeting of the Radiological Society of North America (RSNA) this
"The goal is to improve the speed and accuracy of medical diagnoses,
as well as to improve communications among different consulting
physicians," said the study's lead author, Asim F. Choudhri, M.D.,
fellow physician in the Division of Neuroradiology at Johns Hopkins
University in Baltimore. "When we can make these determinations earlier,
the appropriate surgical teams and equipment can be assembled before the
surgeon even has the chance to examine the patient."
Appendicitis, or inflammation and infection of the appendix, is a
medical emergency requiring surgical removal of the organ. Undiagnosed
or left untreated, the inflamed appendix will rupture, causing toxins to
spill into the abdominal cavity and potentially causing a
life-threatening infection. Appendicitis can occur at any age but is
most common in people between the ages of 10 and 30, according to the US
National Institutes of Health.
Typically, a patient arriving at the emergency room with suspected
appendicitis will undergo computed tomography (CT) and a physical
examination. If a radiologist is not immediately available to interpret
the CT images or if consultation with a specialist is needed, diagnosis
is delayed, increasing the risk of rupture. Transmitting the images over
a mobile device allows for instant consultation and diagnosis from a
remote location. It can also aid in surgical planning.
"This new technology can expedite diagnosis and, therefore,
treatment," Dr. Choudhri said.
the study performed at the University of Virginia in Charlottesville, CT
examinations of the abdomen and pelvis of 25 patients with pain in the
right lower abdomen were reviewed over an encrypted wireless network by
five radiologists using an iPhone G3 equipped with OsiriX Mobile medical
image viewing software. (Image on right shows an example of the Osirix
DICOM Viewer on Apple iPhone).
All of the patients had surgical confirmation or
follow-up evaluations to confirm whether or not they had appendicitis.
"The scans can be read in full resolution with very little panning,
and the software allows the reader to zoom and adjust the contrast and
brightness of the image," Dr. Choudhri said. "The radiologist is
evaluating actual raw image data, not snapshots."
Fifteen of the 25 patients were correctly identified as having acute
appendicitis on 74 (99 percent) of 75 interpretations, with one false
negative. There were no false positive readings. In eight of the 15
patients who had appendicitis, calcified deposits within the appendix
were correctly identified in 88 percent of the interpretations.
All 15 patients had signs of inflammation near the appendix that were
correctly identified in 96 percent of interpretations, and 10 of the 15
had fluid near the appendix, which was correctly identified in 94
percent of the interpretations. Three abscesses were correctly
identified by all five readers.
"The iPhone interpretations of the CT scans were as accurate as the
interpretations viewed on dedicated picture archiving and communication
system (PACS) workstations," Dr. Choudhri said.
Dr. Choudhri pointed out that patient privacy concerns would have to
be addressed before any handheld mobile device could be considered
practical for clinical use, but noted that this technique has great
potential for improving emergency room care.
"We hope that this will result in improved patient outcomes, as
evidenced by decreased rates of ruptured appendicitis, shorter hospital
stays and fewer complications," he said.