Luther B. Adair Ii, MD

Growing up, I would occasionally go to work with my father who was a radiologist. The traditional sound of hanging film was enjoyable - until I became a radiologist and had to endure film review sessions during training hanging film, which is a tedious task. This, combined with the need to review imaging files on the go and the inconvenience of having to hover over my colleagues during board review sessions, encouraged me to figure out a way of utilizing my iPad more efficiently to view and present medical images.

Sure, you could upload your images to a jump drive or store them in a digital file locker, but this too can be cumbersome and these files are still not as accessible as they should be. Additionally, who is going to pull out a laptop on a subway or carry it around during teaching rounds, or even to a patient's room? That's where the iPad comes in handy.

So a few of my colleagues and I tried to address all of these issues when we created the Viewbox

 application. With future devices and integration by Apple, it will eventually be possible for radiologists to both dictate film and operate in a radiology workstation hands-free. This is just the beginning.

According to a survey compiled by Viewbox Holdings LLC, nearly 47 percent of physicians use mobile devices to view teaching cases, and a large number of this demographic are utilizing an Apple device. The research also demonstrated that users would like the ability to manipulate their teaching files for presentation from their mobile devices, which is currently available through the Viewbox application. These numbers are expected to grow as more 

business applications are developed and released

Viewbox is a newly released free application for the iPad that allows users mobile access to view, share, and present medical images. Created with the radiologist and medical professional in mind, Viewbox allows easy portability for your teaching file images in the workplace as well as the classroom. Radiologists won’t have to use multiple storage devices for images.

Viewbox offers radiology trainees and other medical professionals a method to create and share image teaching files which are the bedrock of radiology learning and education. In light of the recently reported controversy surrounding alleged cheating by U.S. radiology trainees and purported use of recalled exam questions, Viewbox offers trainees an alternative method to create and share image teaching files with the ability to link and reference their files with peer reviewed sources.

Users can search, view, and edit images from several sources on their iPads including their Apple Photo Stream accounts through the iCloud, Google Picasa, Dropbox, and the Radiology Society of North America’s MIRC Server. 

Luther B. Adair II, MD, is an abdominal imaging fellow at Thomas Jefferson University Hospital in Philadelphia. 

Articles

I wanted a better way to view and present medical images, so my colleagues and I created an iPad app.

New iPad App Allows for Sharing Radiology Teaching Files

Many smaller radiology departments are still using film-based radiographs to present teaching files in a conference format. This presents a challenge to both the viewer and the presenter due to space limitations around the view box, degradation of film quality, and lack of consistency with the actual American Board of Radiology oral boards’ format. This problem can be overcome by converting to a filmless environment.

In a recent article accepted for publication by the 

entitled "Our Path to a Filmless Future" my colleague, Eric Ledermann, and I describe the challenges that we faced in trying to address this issue.

We evaluated different options to digitize the film-based teaching files at our institution. The option that we found the most cost and time efficient was utilizing a consumer-grade scanner to scan the radiographs into the computer. This decision was also based on features such as resolution, shades of gray, a built-in transparency function in the scanner, and the physical attributes of the scanner. We suggested that after the teaching file library was stored in a HIPPA compliant manner in the cloud, it could be updated with additional information about the cases and hyperlinked to a Google document. This method would occur over time through resident interaction and be called "The Living Document," which denotes its dynamic nature.

I have already done this with a large number of my personal teaching cases from residency and was pleasantly surprised to see the results when I most recently purchased a Logitech Revue System (aka Google TV). Utilizing the gallery function, one is able to view their uploaded image database with almost diagnostic clarity on any flat panel TV for no additional monthly fee. In addition, one is able to access Google documents using this platform, which would allow for access to The Living Document.

After creating a Google account for your document and imaging database, one can access this information from any mobile device or any viewing device with access to a high speed Internet connection. I have no financial ties to Google and only suggest this method amongst others because of its ubiquity and high fidelity.

I envision a future where the myriad challenges we face in sharing and accessing information no longer exist. When it comes to digitizing film-based libraries and utilizing this information, either individually or in a conference format, the future is now.

I am excited by the possibilities of current technological advances in imaging storage and retrieval and will continue to research this topic. I look forward to developing relationships with individuals in other disciplines, such as 3D animation, digital art, and mathematics to make this technology as inexpensive and convenient to the end user as possible. Please join me in forging ahead to make the concept of The Living Document a reality and making teaching files that were once considered inaccessible readily available to those who can benefit from them. 
 

Many smaller radiology departments are still using film-based radiographs to present teaching files in a conference format. This presents a challenge to both the viewer and the presenter due to space limitations around the view box, degradation of film quality, and lack of consistency with format.

The Living Document: Digitizing Film-Based Radiographs

 without committing to a gym workout routine. 

Now let’s see if we can find a way to augment the 

 with reasonable diet modifications that will give us major bang for our buck. These modifications will focus on the three places that most of us get our food fixes - at home, at work, and at play.

1. Home - As busy professionals most of our eating is done at work, at play, or as leftovers from play. However, if your home eating is a result of your shopping skills, then you should be aware that your shopping skills are like any other learned behavior and are a result of what you were taught as a child. For example, we often balance how we shop with how our parents shopped for us and what we can afford at the moment (i.e. instead of Froot Loops, we get Hoola Hoops).

Help is here. An essential book called “Eat This Not That” by David Zinczenko gives a simplistic breakdown of many of the foods we already eat and how we can make simple changes to save hundreds of calories with each meal. The skinny of losing weight and feeling good is to eat better foods one day at a time - and it all starts with how we eat at home. One study suggests that men get as much as 50 percent of their sugar in liquids from drinks at home. Let's try to make our refrigerators our friends and trainers.

2. Work - Work has different meanings for all of us. For some, it is an on-the-go, non-stop, action-packed adventure each day. For others, it can be a dead zone where lunch is the most meaningful part of the day.

No matter where you lie on the spectrum of these workplace temperatures, it is undeniable that man has to eat when he works. I am not going to attempt to change your workplace rituals all at once, but slowly. For instance, if the vending machine is any part of your day, there are healthy alternatives within most vending machines that will save hundreds of calories as outlined in Zinczenko’s book. Most healthy alternatives are more expensive than your local Taco Bell; however, bringing your own lunch tops even the Bell. Start losing the soda and try water with a meal. Small changes in your daily routine add up to large gains overall.

3. Play - Finally, when most of us play or go out to eat, we feel that it is time to "let it go." However, some of our largest blunders happen here. We often lose our diet discipline because we "deserve it" or have "earned it." I won't be the guy to steal your sense of self-appreciation, but what you really want is to appreciate yourself in the right way.

Try ordering your alcoholic beverage with a diet soda instead of the real deal. Have more water with your meals to give yourself a sensation of being full and take the other half of your meal for later (healthy work option). Incorporate one plate of vegetables with every meal and share a dessert. Not only are these little things going to get you slimmer, but they will keep your pockets fatter.

Developing cost-efficient exercise and healthy-eating habits is one of the most difficult tasks that most of us will face while in training, but it is certainly one of the most important. Taking small steps to ensure that we are moving in the right direction of physical and dietary success will ensure that we will end up with more energy and a better quality of life. Until next time, cheers to staying slim and feeling great!

Let’s see if we can find a way to augment the regular workout with reasonable diet modifications that will give us major bang for our buck. These modifications will focus on the three places that most of us get our food fixes - at home, at work, and at play.

Healthy Eating for the Radiologist in Training

As I sit here thinking of the content of this month's article, I am reminded of what my mentor in internship taught me about perfecting my craft. He believed that without achieving harmony in five different areas, it would be very difficult to excel professionally. Financial, emotional, social, physical, and spiritual health, he professed, were the foundations for maintaining a strong professional life. I agree.

However, the physical aspect of this pentad often becomes taken for granted in our busy, youthful lives because our health is usually the last to betray us. In order to keep it that way, I would like to invite you to explore some issues that daunt men every day with regards to health, fitness, and healthy eating in a modern society. This article will attempt to answer questions that we all have asked at some point or another.

If you are like me, a starving medical resident, and a lot of other people in the face of the current economic situation, you are looking to make some budget cuts. One of the first things people do is cut the gym membership, according to Money magazine. But what about your intense desire to balance the pentad? My friend, help is on the way. Even if you don’t have the latest Soloflex machine, you should be happy to know that there are plenty of opportunities for a thorough sans gym workout routine. Let’s take a look at some options:

1. Walking/ Jogging -- First, let’s not forget that walking is usually how most of us get around daily so we can incorporate this activity into our everyday lives. For instance, if you are a driver, try parking a block or two further from your destination everyday. If you ride the subway, try walking and not taking the bus to short destinations. Take the stairs – at least when you are going down a flight! Neighborhood walking or jogging is just as good as the treadmill and you can get a distance by using an online provider such as Google maps to design your course.

2. Fitness Equipment -- Now when I say fitness equipment, I am not trying to put a Soloflex back in your pool room/bedroom/living room (nothing against Soloflex). What I am talking about are very storable, affordable pieces like fitness balls to work on your abs, a fitness mat for those of us who have hard wood floors, dumbbells, and handle bars that can be mounted in doorways for pull-ups or placed on the floor for pushups. These are all small pieces that can add a variety to your workout to cut down on the monotony of doing what has to be done.

3. Hydration -- Let’s face it; we are going to get thirsty after 200 crunches and push-ups. We need to hydrate – and no better way to do it than a reusable water filter for your sink. These run anywhere from $20 to $80 and can be found in any drugstore. In addition to saving money on the latest athlete-sponsored water, they will also contribute to your green thumb in that you are able to use less plastic (Nader would be proud).

This is just a start. In my next post, I’ll outline a few ways to augment the regular workout and make reasonable diet modifications at home, work, and play.

I am reminded of what my mentor in internship taught me about perfecting my craft. He believed that without achieving harmony in five different areas, it would be very difficult to excel professionally. Financial, emotional, social, physical, and spiritual health, he professed, were the foundations for maintaining a strong professional life. I agree.

Healthy Living for the Radiologist In Training

I recently had the misfortune of having to explain to a patient why we were performing a nuclear medicine bone scan on her. She was admitted to the hospital with a presumptive diagnosis of ovarian cancer and we were performing this test to see if the cancer had invaded her bones. 

Her symptoms started when she noticed that her abdomen had grown over the course of the last two months, at which point she had been told by her doctor to lose weight. Her current provider believed that she may have ovarian cancer because ovarian cancer causes a large amount of fluid to accumulate within the abdomen and pelvis. This is known as a peritoneal effusion, which can be sampled for cancer by drainage and sending it for pathological diagnosis. Ovarian cancer is the third most deadly cancer among female patients because of this insidious pattern of presentation.

This experience elucidated two points for me: First, I felt really good about being able explain a complex situation to her because she seemed very upset that she didn't know what was going on with her body. When I asked her why she was so distraught, she said that it was because she had been looking information up on the computer and that none of her providers could explain why she was having this "big belly."

I call this situation mismanaged elements of patient interaction. For example, this happens when a patient tells her doctor that she is having a headache and he then suggests an incorrect diagnosis because he didn't remember to ask her when the headache began. In this case her initial provider failed to identify her symptoms and later her providers failed to address her need for information.

Secondly, this situation addressed the need for better use of technology to provide patients with information. I couldn't help but thinking, “If only I had my iPad, I would have been able to provide her with a visual representation of her presumed diagnosis in addition to the verbal explanation.” The iPad and other mobile devices are able to provide access to an enormous amount of information quickly. When combined with the knowledge and expertise of a skilled professional such as a doctor, these tools are amplified in their efficiency. With an iPad, every physician can become an instant library, theater, and in the case of this patient, assistant.

Modern hospitals are currently under tremendous budgetary constraints with the future possibly even more abysmal; however, with tools that increase the quality of interactions between patients and their providers, I believe we will save money and time in the long run. By helping patients to understand their bodies and illnesses better physicians provide an invaluable service. This is something that the Internet cannot provide a patient alone.

The use of technology such as the iPad can help physicians maximize their impact with visual aids and quick access to information. When combined, the efficient use of technology along with a better understanding of a patient's concerns can lead to a better informed, compliant patient. Additionally, I believe that this will also lead to more rewarding patient encounters for providers.

Luther B. Adair II, MD, is a senior radiology resident at Long Island College Hospital. He will begin an abdominal imaging fellowship at Thomas Jefferson University Hospital in Philadelphia in June.  