Friday, September 30, 2011

Calgary Approved

Way back last year, when I wrote an article for AdvanceWeb.com about iPad apps for radiology, I featured the ResolutionMD program from Calgary Scientific, one of the first apps to use server-side processing and rendering as opposed to being an on-board thick-client.

Calgary has just received approval from the FDA for ResMD to be used as a mobile, diagnostic application, diagnostic being the key word here. From Calgary's website:


Calgary Scientific Inc. has received clearance from the UnitedStates (US) Food and Drug Administration (FDA) to market its industry-leading medical imaging application, ResolutionMD™ Mobile, as a mobile diagnostic application, in the US. With this secure, highly scalable, server-based software solution, physicians located anywhere can rapidly access, view, and interact with patient images and reports stored within any healthcare facility, and render a clinical diagnosis using their mobile devices. Prior non-diagnostic versions of this product are currently distributed and licensed under Original Equipment Manufacturer (OEM) agreements with global leaders in medical imaging and information technology. In addition to the recent FDA clearance, ResolutionMD Mobile has also been licensed by Health Canada and bears the CE Mark for distribution in Europe.
Those global leaders include GE, whose iPhone/iPad app is simply a rebadged version of ResMD.

Calgary's approach is at least in theory more secure, as patient data is never really resident on the mobile device:
. . .The mobile app offers unparalleled performance, advanced capabilities and complete security, utilizes minimal bandwidth and offers strong performance even on 3/4G wireless, and ensures that no highly sensitive or confidential patient information is ever retained on the mobile device. The patient image data cannot be lost or stolen, as in the case of traditional mobile-device rendered software, which requires that data to be sent to the mobile device. . .
And there's more:
ResolutionMD Mobile incorporates many advanced capabilities including:
  • Interactive 2D, MIP/MPR and 3D advanced visualization
  • Anywhere, anytime access to andfully interactive use of MR and CT image
  • Supports HIPAA Compliance –User authentication and encrypted communications further protect confidential patient information
  • Concurrent support for Multiple Devices and Mobile Operating Platforms – The solution enables ResolutionMD Mobile capabilities on devices such as the Apple iPhone and iPad,as well as Android devices. Future versions of the server-based software solution will support an expanded list of mobile devices and operating systems, and supplementary applications to the FDA for clinical diagnostic imaging approval on those devices other than the iPhone and iPad will occur in then near future.
  • Ambient Light User Assessment –Provides sample images to the user to assess the viewing suitability of current lighting conditions.
ResolutionMD Mobile is currently available on Apple iPhone and iPad devices through the Apple App Store. A demonstration version (ResolutionMD Mobile Lite) is also available on the Apple App Store, providing access to anonymized patient images. The ResolutionMD Server is available from Calgary Scientific Inc., as well as from its family of global leading OEM partners in medical imaging and information technology.
Clearly, this system is in direct competition with Mobile MIM, which was FDA-approved for mobile use back in February as I outlined here. It's hard to say which approach will win out, and most likely both apps will find their way into the clinical armamentarium.  I personally give a very slight edge to thin-client, server-side processing, BUT we have to keep in mind that this approach is totally dependent on bandwidth, which the thick-client approach isn't, but how much of an impact that has on usability remeins to be seen.  I'm sure we'll see others in this venue in the near future.

1 comment :

Colin Holmes said...

Dear Dr Dalai - I'm a CSI employee and wanted to address a couple of your comments here, hopefully without turning this into too much of a marketing pitch.

"Clearly, this system is in direct competition with Mobile MIM."

Well, not really, as CSI is an OEM provider. You mention GE, but take a look at the other leading PACS vendors on the Apple app list for top ten radiology and imaging apps and compare with CSI's partner list. The capabilities of the two systems are materially different, too. CSI's offers advanced capability such as slab MPR and volume rendering viewed on the smart client. Due to the architecture, the same capability can be accessed on multiple smart client devices as well as from browsers or other custom integrations.

"...this approach is totally dependent on bandwidth, which the thick client approach isn't...." I think you may have missed the mark on the bandwidth view too. For instance, in the case you'd like to view a slab MPR of a 1000+ slice MDCT, first you'd have to transfer the whole thing to the client device for any approach that uses local rendering (thick client). For mobile clients, that may occur over wi-fi or even worse, over 3G cellular networks. So how long will it take to send 1000 slices over 3G before you can start your slab rendering? Clearly, bandwidth is an issue here. Then you may discover that the graphics capabilities on your smartphone are great for pasting up small web images but not so great for resampling gigabyte data sets. A remote rendering approach such as ResolutionMD Mobile, or the same tools rebranded for the major vendors, can send you renderings of your slab MPRs (and full volume renderings) immediately as the study is transferred directly from the PACS to the rendering engine, containing high end graphics hardware, which is housed in a network-adjacent fashion: ie studies move fast over the fat pipes in the PACS machine room.

A historical rebuttal of client-server versus thick client/workstation is: we can use the idle time of the network to preplace studies so the radiologist doesn't ever have to wait for the transfer. This is old fashioned thinking, really, and requires duplicated storage, messy DICOM routing rules and had its best days when there were dedicated workstations for each clinical function. It works less well with distributed radiologists who expect instant imagery regardless of where they sit down. It completely fails in the Mobile world where the limited bandwidth service, which is shared with voice and email transfers, combined with security issues suggest the mobile client is the last place you want to be caching patient imagery.