Radiologists adapt iPods for clinical use -- for free

Since May 2004, hundreds of physicians worldwide have been using software written by two radiologists to store medical images on a device better known for storing and playing music.

AMNews interviewed Osman Ratib, MD, PhD, professor and vice chair of radiologic services at the University of California, Los Angeles, about the unconventional use of iPod, the hot-selling digital music player from Apple Computer, and the OsiriX software program that makes the medical application happen.

The software, which Dr. Antoine Rosset, a radiologist in Switzerland, wrote while on a research fellowship working with Dr. Ratib, is open-source software. It can be downloaded and used for free. The source code is available to any software programmer who wants to use it to develop additional applications.

Question: How did you come up with the idea to use the iPod?

Answer: For some reason the iPod became the thing that everybody talks about. The iPod is only a small feature of a pretty large open-source medical imaging software project. The idea is to provide or to develop an open platform, open-source software free in an academic way for the medical community to be able to manipulate and visualize 3D, 4D and complicated images. ... A [CT] scan that is done for a 3D-rendering of the heart, for example, is over 1,000 images, and they take space. It's in gigabytes. They don't fit in a CD and DVD. So I started using my iPod at work just because at first I didn't have enough capacity on my disks and laptop [for the images].

My colleague [Dr. Rosset], who is a software developer and physician, looked at me and said, "Why do you use that?"

I said, "I don't have enough space on my disk. I'm using my iPod because I have 40 gigabytes in my pocket and might as well use it [for images] because my music is taking only taking 1% of that."

Then he said, "Why don't we [write] software so that it will automatically look for images when the iPod is connected, the same way iTunes [Apple's online music program] does it when you connect your iPod and checks what music you have, and then shows you the list?"

Q: Why open-source software?

A: One scan today will provide -- I don't know, 500 to 600 images -- that we don't necessarily read one at a time. You may, but most of us now tend to use more sophisticated tools to do what we call "navigating the data." ... That today is available only with high-end software and workstations dedicated to medical imaging.

It's OK for academic medical centers or high-end imaging centers to buy those $100,000 to $200,000 workstations, but not the rest of the medical community. And even in an academic environment, we don't have enough of those platforms for research and development.

Q: Are you talking about just the radiological community?

A: No. The whole medical community. The whole point is that cardiologists, surgeons, internists need it. They don't have access to those machines, but they need them more and more.

I mean, we radiologists provide them with some kind of images. We print those on paper, we give them CDs, but they don't have access to a software platform that would allow them to [visualize and] manipulate the data in the way that they want to.

Q: What do users have to do to download and store images on an iPod?

A: You have to basically connect the iPod to a computer that is connected to the network of the medical institution [and download the images from its imaging systems].

Q: Does it work with Microsoft Windows?

A: The software runs only on Macs [Apple's PC system].

Q: Can doctors diagnose images on the iPod?

A: No. They would [do that] on the Mac where we have our OsiriX software. The iPod is just an accessory.

Q: Any HIPAA privacy implications?

A: Users [at UCLA] have to have the proper credential and authorization to get the images to start with, and in most cases they are obliged to [keep patient data anonymous] if they are using it for research. Our software allows you to extract and convert images to an anonymous version that will not have patient information on it.

Q: Can doctors store all their patient records in an iPod?

A: Anybody who has data -- whether it's text, graphics or other data -- can store [those data] in an iPod.

Q: Can they use OsiriX to do that?

A: Our software will not export those types of files, but you can do that manually [by dragging and dropping files into the iPod]. ... Actually, now that I think of it, I think that if you "save as" in any program like Word and Excel and your iPod is connected, you can probably save it to the iPod. I've never tried that, but I think it should work. I'm sure that's going to happen; it's a matter of time before people figure out that the iPod is just [an extra] storage device.

Q: Would you store all your patients' records on it?

A: I wouldn't do it. The iPod is convenient, but it's not the thing to be carrying all your patients' data on because it's not really designed for long-term storage. It's for taking a copy [of a file] with you on the road ... but to use it in a day-to-day environment? It's a device that you can drop and break. How do you back up an iPod? Then you have to have a redundant copy somewhere and so forth.

Q: What music do you have on your iPod?

A: I listen mostly to jazz.