Capitalizing on a craze: Medicine on an MP3

The iPod has made its way into modern medicine in creative ways. Here are a few people who took advantage of a popular device and adapted it into a tool for practicing and teaching medicine.

By Pamela Lewis Dolan — Posted June 4, 2007

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Tiny, white earbuds became the symbol of a small cult following, mostly fueled by teens and twentysomethings, shortly after the first generation iPod hit the market in 2001.

But the iPod is now creating a niche in modern medicine, as the medical field learns that the iPod has value beyond just playing music or videos.

Medical iPod users now carry everything from the daily news to large digital files inside the pocket-sized machine that now has the capability to play videos. And as more of medicine becomes electronic, more doctors are finding the iPod to be a convenient alternative to carrying around a laptop or paper charts and x-ray films, and a much more convenient way to lecture and teach.

The following collection of stories illustrate some of the trailblazing ideas for the iPod in medicine.

Heart songs

Cardiologist Michael Barrett, MD, thought he was on the cutting edge two years ago when he handed his students at Temple University School of Medicine in Philadelphia a collection of CDs full of heart murmurs and told them to listen to them to improve their stethoscope skills. His students deflated his ego a notch or two by telling him that no one listens to CDs anymore.

Fortunately for Dr. Barrett, the concept he was trying to develop worked with an iPod, too.

The project was inspired from a study by Spanish researcher Mercedes Atienza, PhD, which looked at auditory perceptual learning and the idea that hearing the same sound repetitively increases the memory of that sound.

Dr. Barrett created sound files with four types of computer-generated heart murmurs -- mitral stenosis, aortic stenosis, mitral regurgitation and aortic regurgitation. He converted the files to an MP3 format that his students can download and listen to at their convenience. But before Dr. Barrett fully implemented the new listening exercise, he conducted his own research.

Dr. Barrett had suspected that detecting murmurs was not an intellectual skill, but rather a technical skill that could be learned by repetition. To test that theory, he paid a group of medical students to sit in a lab for several hours, listening to the MP3 files he dubbed "Heart Songs." Included along with the medical students was a student majoring in marketing.

According to a paper Dr. Barrett presented at March's American College of Cardiology conference, the medical students went from a 10% accuracy rate to more than 80%. The marketing major was also able to identify the murmurs with 80% accuracy. Impressive, considering the accuracy rate for most physicians is about 40%.

Further research found that it takes about 500 repetitions for the sounds to stick. "You have that point when the light bulb goes off in your head, and you hear that murmur and you know immediately what you are hearing," Dr. Barrett said.

Students using his "Heart Songs" exercise average 90% accuracy rates, compared with the 20% to 30% accuracy rates of most medical students and residents.

The best part of Dr. Barrett's experiment was learning the impact, he said. A survey of his students found 95% thought it was a great learning method, and 90% said they detected the sounds in patients after mastering the listening exercise.

The American College of Cardiology has made "Heart Songs" MP3s available for download on its resource site

Medical info to go

Grayson Wheatley, MD, was sitting on an airplane a couple of years ago, listening to his iPod and reading a medical journal, when a novel idea popped in his head. "Why can't we get medical information on the go?"

Dr. Wheatley, a cardiovascular surgeon at the Arizona Heart Institute and Hospital in Phoenix, had the idea of creating podcasts for patients to help them better understand complicated medical issues. This happened to be about the same time Apple had an idea of its own -- creating an iPod that can play videos.

Soon after Dr. Wheatley started creating a series of audio podcasts, he began creating a series of video podcasts, an idea that earned his hospital recognition from Apple as the first medical institute to offer video podcasting.

The podcasts were an idea the hospital was quick to embrace. There is now a five-member team at the Arizona Heart Institute that produces video segments, which include taped surgeries, lectures, and educational material on new treatments or procedures. The hospital also created the Cardiovascular Multimedia Information Network, which hosts an online library (link), where podcasts can be downloaded for free. The collection contains content for both patients and physicians.

Other medical institutions also have turned to podcasting to distribute information. Johns Hopkins in Baltimore was an early adopter.

Elizabeth Tracey, director of electronic media for Johns Hopkins Medicine, produces a weekly audio podcast with Rick Lange, MD, chief of clinical cardiology at Johns Hopkins. When she started exploring the idea, Tracey, who has a radio background, found that other available podcasts had one thing in common. "They were all unbelievably boring."

Instead of a format that gives the information in a newsy tone, Tracey and Dr. Lange offer opinions on news making headlines, the latest medical technology and trends. Tracey said the format helps bring clarity and relevance to listeners who are bombarded daily with information from numerous sources.

Medical journals, including the Journal of the American Medical Association, also have audio podcasts

Pocketful of memory

On a recent May night, radiologist Edward J. Zaragoza, MD, received a call from a fellow radiologist at the Santa Monica UCLA Medical Center who needed a second opinion on a tough case.

Dr. Zaragoza, associate clinical professor and radiology clinical director at the center, was able to view CT images of the patient and consult with his colleague within a matter of minutes, and without ever leaving his home. This scenario would have been much different a few years ago, before UCLA became one of more than 10,000 users of OsiriX software.

OsiriX was developed at UCLA by Dr. Osman Ratib, a radiologist from Geneva, who was on staff at UCLA in the early 2000s, and Dr. Antoine Rosset, who is also from Geneva and was doing a research fellowship at UCLA during Dr. Ratib's tenure there.

The idea for OsiriX occurred to the doctors after Dr. Ratib started using his iPod to transport large radiological files from one computer to another. The software recognizes the iPod and expedites the downloads of images much like iTunes recognizes an iPod when it is plugged in. But the iPod feature is only a small part of the program.

OsiriX, which is compatible only with Apple computers, allows physicians to view and navigate the data just as effectively as workstations costing upwards of $150,000, according to Joe Borelli, MD, chair of the American College of Radiology MRI Accreditation Committee, and a regular OsiriX user.

"It's an amazing era that we live in now, because the technology is so ridiculously easy and so robust," said Dr. Zaragoza, who is also president and medical director of MRI of Belfair in Bluffton, S.C.

Dr. Borelli has become such a fan of OsiriX that he now uses every available opportunity to evangelize. "If you give me five minutes with a radiologist, they will be using OsiriX," he said.

His enthusiasm earned him the starring -- although unpaid -- role in a OsiriX Web seminar produced by Apple, and available through the company's Web site.

The software is continually changing, as users make suggestions to Dr. Rosset. It is available as an open-source download through Apple. A version of the software, which received FDA approval earlier this year, is also available through Aycan Medical Systems, a technology company that develops software for radiologists.

Convenient relaxation

Music has long been used as a way to relax patients experiencing stress or trauma. Providing patients with music became a whole lot easier with the rise of digital music files.

Fred Schwartz, MD, an anesthesiologist and a musician, started bringing tape decks into pre-op rooms at Piedmont Hospital in Atlanta back in 1979. It was a great way to get presurgical patients relaxed and feeling comfortable, he said.

Over the years, the hospital's music program evolved from a tape deck to a rolling cart with a built-in car stereo; then a 10-channel CD collection accessed by headphones; then a digitized format using the hospital's television wiring; and now MP3 files stored on servers. The hospital's music program is included in most every part of the hospital where patients can use a little help relaxing, including labor and delivery, gastrointestinal labs, the intensive care unit and pre-op.

Because so much of what happens at a hospital is out of the patient's control, having a choice in music is a form of empowerment that can really benefit the patient, Dr. Schwartz said. Piedmont, patients aren't the only ones who listen to tunes. Most of Piedmont's operating rooms have iPod docking stations.

Lawrence Ross, MD, a urologist at the University of Illinois Medical Center in Chicago, also knows the benefits of music as a de-stressor.

"Patients who are extremely nervous or who might be fidgety on the table, if they have the chance to listen to their own music, it calms them," he said. Sometimes his iPod-wearing patients get so relaxed, they fall asleep and have to be awakened when the procedure is complete.

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iPod facts

  • Percentage of correct murmur detection for 149 general internists before doing iPod listening exercise: 60%
  • Correct murmur detection for 149 general internists after 90-minute listening exercise: 80.5%
  • Average accuracy rate for cardiologists correctly identifying murmurs: 80.5%
  • Average accuracy rate for cardiology fellows: 25%-30%
  • Average accuracy rate for general population of medical students and residents: 20%-30%
  • Size of typical MRI or CT scan: 100-200 MB
  • Approximate storage capacity of 60 GB iPod: 300 to 600 exams
  • Weight of 60 GB iPod: 5.5 ounces
  • iPods sold since November 2001: 100 million
  • Podcasts using "medical" as a search term on iTunes: 110

Sources: Apple Inc., Michael Barrett, MD

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Examining the iPod

A typical MRI or CT scan occupies roughly 100-200 megabytes. Thus, a 60 gigabyte iPod could hold between 300 and 600 exams. A typical CT scan is about 0.5 GB. A typical 64-slice CT scan is between 1 GB and 2.5 GB.

iPod nano iPod
Height 3.5 inches 4.1 inches
Width 1.6 inches 2.4 inches
Depth 0.26 inches 0.55 inches
Weight 1.41 ounces 5.5 ounces
Memory 2 GB, 4 GB or 8 GB 30 GB or 80 GB

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A Piedmont Hospital sampler

Ten music channels are available for Piedmont Hospital patients, four from satellite. The most popular genres include soothing soundtracks, light piano, classical, new age and contemporary rock.

Of the song files stored on the hospital's server, titles include:

Vocal popular
"Unforgettable With Love," Natalie Cole
"This Funny World," Mary Cleere Haran
"Here's to Life," Shirley Horne
"The Art of Excellence," Tony Bennett
"Songs of Earth & Sky," Bill Douglas

New age
"Numinous," George Skaroulis
"Sunset Tint," Keiichi Oku
"Dream Images," Shardad
"Neverland," Suzanne Ciani
"Ocean Dreams," Dean Evenson

Light piano
"Grand Piano," George Shearing
"Waiting for Spring," David Benoit
"Black and White," Danny Wright
"Encore," Danny Wright

"Six Cello Sonatas," Vivaldi
"Evocation of the Spirit," Shaw/ASO
"Three Clarinet Concertos"
"Clarinet and Oboe Concertos," Mozart

"Nearness of You/The Ballad Book," Michael Brecker
"Affinity," Bill Evans
"Pure Desmond," Paul Desmond
"Letter to Evan," David Benoit
"Love and Other Obsessions," Spyro Gyra

Soothing soundtracks
"Out of Africa," John Barry
"Somewhere in Time," John Barry
"Tribute to Henri Mancini"
"The Prince of Tides," James Newton Howard
"Black and White 7," Danny Wright

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