Patient Notes on a PDA

^†Gregory B Quinn, Ph.D. and ^‡C. Michael Wright, M.D., F.A.C.C.

University of California, San Diego

^†San Diego Supercomputer Center and ^‡Division of Cardiovascular Disease, College of Medicine

 

BACKGROUND

The portability/mobility of casualty diagnostic and medical health data has importance in many potential real-world scenarios, both in civilian and military contexts. Perhaps the most compelling usage scenario for patient data mobility will likely involve the wireless transmission of medical data to mobile devices such as PDAs and cell phones to enable medical workers in the field to instantaneously gain access to, view and prognosticate on complex medical visualizations. One potentially important area of development is in mobile access to complex patient data, such as computer tomography (CT) derived data, Figure 1. Electron beam tomography (EBT) and X-Ray tomography provides the clinician with accurate cross-section images clearly delineating several body tissue types. This enables its use in diagnosing trauma, infectious diseases, cancers, cardiovascular disease and musculoskeletal disorders. An important use of the cross-sectional images is in the automated generation of organ models, such as the heart and colon.

 

 

a                                                                          b

Fig 1

Electron Beam Tomography (EBT) and X Ray computer tomography (CT) scanning of the human body enables the rapid generation of 3D organ models from a series of 2D “slices”. Fig 1a shows a patient undergoing an EBT scan of the upper thorax. Fig 1b shows the generation of a 3D thorax volume model derived from scan data, displayed on a dedicated workstation.

 

Access to this kind of advanced patient medical data greatly enhances the ability of a physician to correctly diagnose and treat the patient. We have developed a prototype application to view such data on an advanced handheld device, thereby greatly assisting clinicians on-the-move and working in harsh environments.

 

DEVELOPMENT

The utility of this vision of patient data access will in large part rest on the quality of medical imaging and the ease with which it can be accessed by the mobile device, either from portable storage or wireless connection. In order to enable this vision, several criteria need to be satisfied:

 

1.      Commercially available mobile hardware needs to be sufficiently capable. This is certainly now the case, with mobile devices coming to market with high resolution transreflective QVGA and VGA displays, inclusion of graphics accelerators/co-processors, large amounts of storage or memory card slots to support additional storage, wireless and/or cellular connectivity and support for 3D development APIs such as OpenGL ES and Mobile Direct3D

2.      The underlying mobile operating system needs to support advanced device hardware. Windows CE 5.0 and Windows Mobile 5.0 have new API’s to support advanced hardware features such as accelerated graphics through Media/DirectDraw API’s, OpenGL|ES and Mobile Direct3D.

3.      Application software needs to take full advantage of these software and hardware features. Our software has started to do this (see below).

4.      Data formats need to be optimized for display and wireless download

 

PATIENT NOTES PROTOTYPE

Our preliminary development work to display radiological data and 3D organ models on a 2D/3D graphics-accelerated mobile device has been promising, Fig 2. Using the Windows Mobile 5.0 platform, we were able to utilize 2D and 3D graphics acceleration in the Dell Axim x51v PDA device to display organ model meshes, highly interactive patient chart data, video simulations and video annotations of dicom images. Video annotations of cross-sectional data will be especially useful when diagnosing in the field, since it provides visual cues in addition to the audio annotation alone.

 

 

Fig 2

Prototype patient medical data application includes ability to access CT cross-sections and organ models.

 

 

CONCLUSION

The increasing reliance by clinicians on hand-held mobile devices such as PDA’s and Smart phones both in both civilian and military scenarios has heightened their importance in respect to routine clinical investigations. This trend will likely continue as the capability of PDA’s and cell phones increases. Mobile access to clinical information holds the promise to revolutionize the way that clinicians in-the-field and on-the-move gain access to patient data. This in turn, will have a profound affect on the speed and quality of patient care, particularly in harsh battlefield environments. As mobile CT scanning equipment comes to market for use in ambulances and mobile emergency room facilities, there will be a concurrent need for medics to quickly gain access to this information whilst working in remote, less-than-ideal conditions. Mobile access to high quality 2D and 3D data, and the ability to quickly and efficiently video-annotate this data, will be of critical importance to the field medic in being able to provide accurate patient diagnoses.