Smartphones becoming clinical tools

A diagnostic laboratory, complete with an image reader and microscope, can fit into your back pocket. Smartphones -- rapidly being adopted by physicians for transferring medical information -- are turning into clinical tools.

Soon, if clinical application developers are successful, physicians will be able to run diagnostic blood tests and view and send radiology scans directly from their mobile phones. The potential market is huge: More than 60% of physicians use smartphones, and that number is expected to grow to more than 80% by 2012, according to Manhattan Research's 2009 Taking the Pulse survey, which provides an overview of the latest trends in physicians' use of technology.

"The diagnostics part is exciting, and it is, I would say, cutting edge," said Joseph C. Kvedar, MD, founder and director of the Center for Connected Health, the telemedicine division of Partners HealthCare in Boston.

This expanded smartphone use was displayed at the recent annual meeting of the Radiological Society of North America. Asim Choudhri, MD, a radiologist at Johns Hopkins University School of Medicine in Baltimore, presented findings from a study he conducted on using a mobile version of the medical image viewing software OsiriX and an iPhone to diagnose appendicitis.

One possible clinical use of a smartphone was demonstrated in a study by radiologist Asim Choudhri, MD. He studied appendicitis diagnoses using a mobile version of a medical image viewing software and found diagnosis was accurate in 124 out of 125 viewings of pelvic and abdominal x-rays.

The study found that in 125 total viewings of pelvic and abdominal x-rays (25 cases examined by five radiologists each), an accurate diagnosis was made 124 times. "That matches with established variations between readers on a full-sized [picture-archiving and communication system] work station," Dr. Choudhri said.

Joris Heuberger, who developed the mobile OsiriX system, said in an e-mail to American Medical News that he has no plans to market it as a diagnostic tool, as the process to gain FDA approval is long and expensive.

Dr. Choudhri anticipates that doctors, often quick to adopt applications they find useful, will use the system anyway. That's why he conducted the study.

Although tools like this do not replace traditional diagnostic tools, Dr. Choudhri said, they can help with diagnosis in areas without immediate access to a lab. They also could expedite consultations with an off-site physician.

Other researchers are conducting tests that not only would allow the exchange and sharing of data and images but also would adapt the phone itself to act as a microscope to create images.

Daniel Fletcher, PhD, associate professor of bioengineering at the University of California, Berkeley, led a group of student researchers who designed a microscope that works with a cell phone camera. The group published a study online in PloS One in July about using the technology in the field to diagnose malaria and tuberculosis.

The next step will be an effectiveness field test, which Fletcher plans to start in the summer of 2010.

Fletcher admits that the quality of microscopic images on cell phones will never be as accurate as with standard lab equipment. "It only has to be good enough," he said. The goal is to make sure the diagnostic accuracy is close to current standards, so that screenings can be conducted in remote areas where the closest lab could be several hours away. The technology also would allow patients to self-monitor some conditions.

Aydogan Ozcan, PhD, an assistant professor of electrical engineering at the University of California, Los Angeles, has developed a device that allows a camera-equipped cell phone to make a holographic image for cell-based analyses on any type of body fluid.

Ozcan spun his creation off into a company, Microskia, that is in the preliminary stages of commercializing the product. Microskia CEO Neven Karlovac, PhD, said the device likely will cost less than $20 and be easy to use. Plans are for the product to be ready for the market by late 2010.

While these products claim to accurately create, send and receive images, there are some limitations that need to be worked out before they go mainstream. For example, looking at a 2-inch cell phone screen is not optimal.

Dr. Choudhri said that in his research, the screen size affected some measurements' accuracy. Although very close, those measurements were not spot-on, he said, which they need to be in some clinical cases.

But if people using the tool are aware of this limitation, the cell phone can be used to assess the most urgent needs. Then exact measurements can be verified on a full-size screen as soon as possible, he said.

Cell phone networks also present limitations. "As of right now, data transfer over a cellular network is not fast enough for this to be a valuable tool," Dr. Choudhri said. But that will pick up as the networks improve.

Dr. Kvedar said the general public's use of smartphones also needs to improve before cellular solutions become mainstream. Although adoption is growing very rapidly, outside of physicians, more people use regular cell phones than use smartphones.

Much of this technology's promise comes from patient home monitoring. The next step would be to create a secure, private network on which to exchange data so that people actually would use it and trust it, Dr. Choudhri said.