Saturday, October 1, 2011

Tips From a Road Warrior (16): WiFi in the Sky?

Some airline carriers are starting to offer WIFI in the sky, allowing one to check email, and/or browse the Internet. Certain sites and/or applications are apparently blocked, for example, you cannot use SKYPE or any other Internet carrier to make calls from the sky (yet). So, I was very excited when I boarded a flight from the East Coast to find that they were promoting the service with a free introductory offer. However, this turned out to be a very frustrating experience as pretty much everyone on the plane had the same idea. Even though this was a small plane (a MD-80), the WiFi capacity was obviously way too limited. The router kept dropping web connections and on several occasions the login was rejected due to too many users. 

WiFi is also taking off in healthcare institutions. Wireless portable x-ray systems are becoming very popular, as it allows you to query a worklist at the unit, preview the image taken and send it wirelessly to its destination, which can be the PACS, a QA station, or directly to a radiologist. This has helped "instant radiology" become a reality. There undoubtedly will be a big push from physicians to allow entering orders over the wireless network as well. 

As you may recall CPEO (centralized physician order entry) is a requirement for Meaningful Use implementation for Electronic Health Records. Ordering medications and diagnostic procedures from the bedside using a wireless tablet or smart phone should be feasible. Also, the ability to show results on the tablet is becoming reality as the first tablets for this use were recently approved by the FDA. 

This all shows great potential, however, before you get too excited, you might want to take it slowly. For example, I recently saw a portable unit in a corridor in a hospital and upon asking why it was not being used, they told me that they had so many issues with the wireless connection that they basically did not use this particular manufacturer anymore. As you may know, hospitals have many physical barriers to wireless signals, steel firewalls, and lead-lined walls surrounding x-ray rooms interfere with electromagnetic signals, including wireless signals. 

The lesson learned here is that, while wireless networking is definitely worth the investment, you need to make sure that you test the devices thoroughly prior to introducing them. Make the purchase and final payment of new wireless devices dependent on proper functioning in your environment. Last but not least, if you use standard web transmission technology, make sure the information is encrypted as others can easily listen in. If you take these precautions, WiFi will definitely enhance your healthcare practice. In the meantime, I hope they fix the bugs in the airplane WiFi so I can check my email in the sky, instead of having to catch up after my trips. 

Eliot Siegel Q&A

This is a transcript of the Q and A session of the September vDHIMS eposium presentation by Eliot Siegel about advanced visualization workstations. If you are interested, you can listen to the full one-hour presentation, simply register at and enjoy. 

Q: There is a difference in the quantitative output of several advanced visualization workstations among the different vendors, do you see a potential standardization and/or certification by a company such as ECRI?

A: That is a great question and it is of tremendous concern to several people including myself with regard to quality control as we seem to look for the esthetics of how the images look but when we are making quantitative measurements either manually or by using the software, the measurements vary considerably. 

I propose to do a couple of things, and we have been talking with some vendors about them. The first thing would be to have standard scans of phantom data, for example creating a phantom for lung nodules or carotid stenosis. Another option is to work with NIST, which has created standard objects that have been measured very precisely that we can scan. Yet another option is to create a mathematical model, so we would not have to use the scanner to create a data set, and there are interesting data sets that are well known and which can be submitted to the vendors. 

The problem is that it is hard to reproduce the human anatomy with phantoms, therefore one might use a de-identified data set, with patient approval, and share those and use them to create a semi-standard. It would be great if one could go to RSNA or another meeting and go to a vendor and look at a standard data set for carotid imaging or cardiac etc. So I think it is a great idea and, as a customer and a person who is interested in quality improvement, I would very much like to pursue that. 

Q: Do you keep the thin axial CT slices and what would you recommend for a typical hospital? 

A: I work in multiple clinical settings and at the University of Maryland, we keep them for only three to six months unless it is designated as a research study or need to be kept for other purposes. At the VA, we keep all of our thin slice data indefinitely. My recommendation would be for everyone to keep the thin slices indefinitely. However, I think that if you look across the country, only a minority of institutions keeps the thin slices. 

When we talk with the legal folks about what data to retain, the answer that they give us is that you should retain data that you used for making your original clinical diagnosis. I and other people are doing image interpretation from the thin slices and therefore logically the conclusion would seem to be that if we use the data for making the day-to-day diagnosis, we ought to be keeping that information because my decision was partly predicated upon what I would see in an oblique image or a reconstructed image that was synthesized from the original data. I don't really have a record of what I saw unless I am able to save the thin slices. Therefore my philosophy is to save it, especially with the cost of storage declining. One compromise for institutions who are having cost issues would be to compress thin sections in a number of different ways. You could store the thick sections uncompressed and then use, for example, a JPEG compression for the thin sections. Therefore my philosophy is that in the near future everybody will start saving the thin sections.