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Smartphone App Enables Accurate Stroke Diagnosis

Study validates that doctors can read radiology images on small iPhone screens just as well as they can on large workstation monitors.

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Doctors can make a stroke diagnosis using an iPhone application with the same accuracy as a one made using a medical computer workstation, a study from the University of Calgary's Faculty of Medicine revealed.

The research, which was published in the May 6 Journal of Medical Internet Research, has significant implications for iPhone use among physicians treating stroke patients, and is another example of how mobile health applications are enabling doctors to make medical diagnoses based on images viewed on their mobile devices.

Neuro-radiologists in the study looked at 120 recent consecutive non-contrast computed tomography (NCCT) brain scans and 70 computed tomography angiogram (CTA) head scans that were obtained from the Calgary Stroke Program database.

The scans were read by two neuro-radiologists, on a medical diagnostic workstation and on an iPhone, and the results showed that there was a 94% to 100% rate of accuracy for diagnosing acute stroke compared with a medical workstation that has a much larger screen.

The study was done using Calgary Scientific's ResolutionMD Mobile, an application that uses iPhone and Android smartphones. The software's advanced 2-D and 3-D visualization of medical images was originally developed by Ross Mitchell and his research team at the Hotchkiss Brain Institute (HBI), then further enhanced and commercialized by Calgary Scientific, a company that Mitchell cofounded.

In an interview, Mitchell noted that during the early stages of the software's development, many doctors felt the iPhone was not the best device for reading medical images.

"Before we built the iPhone app we talked to radiologists who said 'we'll never be able to diagnose anything on a screen that small,'" Mitchell said. "Overall there were a few cases were the neuro-radiologists in the study were down to 94% accuracy, but most of the time they were 98% or 99% in agreement with the diagnosis on the workstation. Most importantly, the physicians did not believe that any of the discrepancies would have actually altered patient care or outcome."

Mayank Goyal, director of research in the department of radiology at the University of Calgary, and one of the neuro-radiologists who analyzed the data, noted that the research reveals that by using the iPhone app to access the images, physicians are able to speed up the time it takes to diagnose a stroke and start treatment.

"There are definitely benefits for doctors to have the ability to analyze and diagnose these images from virtually anywhere. We were pleasantly surprised at our ability to detect subtle findings on the CT scan, which are often very critical in patient management, using this software," Goyal said in a statement. "Another strength of this platform was its ability to handle massive imaging datasets of over 700 images seamlessly over the iPhone."

In April 2010, the application was approved by Health Canada, which allows Canadian doctors to use the software on their mobile devices to make a primary diagnosis.

According to officials at Calgary Scientific, ResolutionMD is different from other medical image applications because a server does all the computing work and streams images to display on a smartphone in real-time.

"Typically what happens in a telehealth setting is the images at the distant site are moved to a central repository and then if you want to do advanced visualization you have to move the images from the central repository to a workstation and the expert radiologist has to go to that workstation to make the diagnosis. That creates workflow issues," Mitchell said.

The technology can also be used over great distances. By placing a server in a remote community, distant medical experts, such as stroke neurologists and radiologists, can have immediate access to patient scans anywhere. The images can be viewed on an iPhone, iPad, Android smartphone, or Web browser.

Currently, Calgary Scientific has an application pending with the Food and Drug Administration's 510 (k) clearance program as the company seeks to make the software available to physicians in the United States.

Nominate your favorite mobile health or telehealth application as part of our Mobile Application Smackdown competition.

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