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Diagnosis and treatment planning of acute aortic emergencies using a handheld DICOM viewer

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Abstract

Acute aortic syndromes and traumatic aortic injury are often diagnosed on CT angiography, possibly requiring emergent intervention. Advances in handheld computing have created the possibility of viewing full DICOM datasets from a remote location. We evaluated the ability to diagnose and characterize acute aortic pathologies on CT angiograms of the thorax using an iPhone-based DICOM viewer. This study was performed after Institutional Review Board approval. Fifteen CT angiograms of the thorax in suspected acute aortic syndromes were evaluated by three blinded radiologists on a handheld device using a DICOM viewer. Studies were evaluated for the ability to identify and classify aortic dissection, transection, or intramural hematoma, measure aortic dimensions, and identify mediastinal hematoma, arch variants, and pulmonary pathology. Studies were compared to blinded interpretations on a dedicated PACS workstation. The aortic pathology was correctly identified as aortic transection/pseudoaneurysm (n = 5), type A dissection (n = 2), and type A intramural hematoma (n = 1) by all reviewers, with no false-positive interpretations. This represents a sensitivity and specificity of 100 %. Mediastinal hematoma (n = 6), pneumothorax (five right, three left), and arch vessel involvement (n = 2) were identified in all cases. There was 88.5 % accuracy in identifying arch variants. Measurement of the size of the involved aortic segment was similar on handheld device and PACS workstation; however the adjacent normal aorta was 1.2 ± 1.0 mm larger on the handheld device (p = 0.03). Handheld DICOM viewers may be useful for emergent consultations and triage, and may expedite preprocedure planning to reduce the time interval between diagnostic scan and therapeutic intervention.

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References

  1. Parker MS, Matheson TL, Rao AV, Sherbourne CD, Jordan KG, Landay MJ et al (2001) Making the transition: the role of helical CT in the evaluation of potentially acute thoracic aortic injuries. AJR Am Journal Roentgenol 176(5):1267–1272

    Article  CAS  Google Scholar 

  2. Hardie AD, Wineman RW, Nandalur KR (2009) The natural history of acute non-traumatic aortic diseases. Emerg Radiol 16(2):87–95

    Article  PubMed  Google Scholar 

  3. Hayter RG, Rhea JT, Small A, Tafazoli FS, Novelline RA (2006) Suspected aortic dissection and other aortic disorders: multi-detector row CT in 373 cases in the emergency setting. Radiology 238(3):841–852

    Article  PubMed  Google Scholar 

  4. Steenburg SD, Ravenel JG, Ikonomidis JS, Schönholz C, Reeves S (2008) Acute traumatic aortic injury: imaging evaluation and management. Radiology 248(3):748–762

    Article  PubMed  Google Scholar 

  5. Yeow TN, Raju VM, Venkatanarasimha N, Fox BM, Roobottom CA (2011) Pictorial review: computed tomography features of cardiovascular emergencies and associated imminent decompensation. Emerg Radiol 18(2):127–138

    Article  PubMed  Google Scholar 

  6. Sangster GP, González-Beicos A, Carbo AI, Heldmann MG, Ibrahim H, Carrascosa P et al (2007) Blunt traumatic injuries of the lung parenchyma, pleura, thoracic wall, and intrathoracic airways: multidetector computer tomography imaging findings. Emerg Radiol 14(5):297–310, Springer-Verlag

    Article  PubMed  Google Scholar 

  7. Yee J, Hung RK (1999) Spiral CT angiography of aortic dissection. Emerg Radiol 6(1):24–31

    Article  Google Scholar 

  8. Thoongsuwan N, Stern EJ (2002) Chest CT scanning for clinical suspected thoracic aortic dissection: beware the alternate diagnosis. Emerg Radiol 9(5):257–261

    PubMed  Google Scholar 

  9. Stabile Ianora AA, Midiri M, Chiumarulo L, Scardapane A, Strada A, Angelelli G et al (2001) Helical CT: a useful technique in the evaluation of aortic intramural hematoma. Emerg Radiol 8(6):320–325

    Article  Google Scholar 

  10. Dake MD, Kato N, Mitchell RS, Semba CP, Razavi MK, Shimono T et al (1999) Endovascular stent-graft placement for the treatment of acute aortic dissection. N Engl J Med 340(20):1546–1552

    Article  PubMed  CAS  Google Scholar 

  11. Moainie SL, Neschis DG, Gammie JS, Brown JM, Poston RS, Scalea TM et al (2008) Endovascular stenting for traumatic aortic injury: an emerging new standard of care. Ann Thorac Surg 85(5):1625–1629, discussion 1629–30

    Article  PubMed  Google Scholar 

  12. Neschis DG, Scalea TM, Flinn WR, Griffith BP (2008) Blunt aortic injury. N Engl J Med 359(16):1708–1716

    Article  PubMed  CAS  Google Scholar 

  13. Lupattelli T, Garaci FG, Basile A, Casini A, Dalainas I, Minnella DP et al (2008) Emergency stent grafting of type B aortic dissection: technical considerations. Emerg Radiol 15(6):375–382

    Article  PubMed  Google Scholar 

  14. Patel PJ, Grande W, Hieb RA (2011) Endovascular management of acute aortic syndromes. Semin Interv Radiol 28(1):10–23

    Article  Google Scholar 

  15. Choudhri AF, Radvany MG (2011) Initial experience with a handheld device digital imaging and communications in medicine viewer: OsiriX mobile on the iPhone. J Digit Imaging 24(2):184–189

    Article  PubMed  Google Scholar 

  16. Choudhri AF, Carr TM, Ho CP, Stone JR, Gay SB, Lambert DL (2012) Handheld device review of abdominal CT for the evaluation of acute appendicitis. J Digit Imaging 25(4):492–496

    Article  PubMed  Google Scholar 

  17. Andrade R, Wangenheim A, Bortoluzzi M (2003) Wireless and PDA: a novel strategy to access DICOM-compliant medical data on mobile devices. Int J Med Inform 71(2–3):157–163

    Article  PubMed  Google Scholar 

  18. McNulty JP, Ryan JT, Evanoff MG, Rainford LA (2012) Flexible image evaluation: iPad versus secondary-class monitors for review of MR spinal emergency cases, a comparative study. Acad Radiol. 19(8):1023–1028. doi:10.1016/j.acra.2012.02.021

    Google Scholar 

  19. Tang F-H, Law MYY, Lee ACH, Chan LWC (2004) A mobile phone integrated health care delivery system of medical images. J Digit Imaging 17(3):217–225

    Article  PubMed  Google Scholar 

  20. Engelmann U, Schröter A, Borälv E, Schweitzer T, Meinzer H (2001) Mobile teleradiology: all images everywhere. Int Congr Ser 1230:844–850

    Article  Google Scholar 

  21. Rosset A, Spadola L, Ratib O (2004) OsiriX: an open-source software for navigating in multidimensional DICOM images. J Digit Imaging 17(3):205–216

    Article  PubMed  Google Scholar 

  22. Federal Information Processing Standard 140–2. Accessed December 17, 2012 (http://csrc.nist.gov/publications/fips/fips140-2/fips1402.pdf)

  23. Patel B (2011) Draft Guidance for Industry and Food and Drug Administration Staff. 1–29. Jul 19

  24. Mc Laughlin P, Neill SO, Fanning N, Mc Garrigle AM, Connor OJO, Wyse G et al (2011) Emergency CT brain: preliminary interpretation with a tablet device: image quality and diagnostic performance of the Apple iPad. Emerg Radiol 19(2):127–133, Springer-Verlag

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Radiology, University of Virginia, Charlottesville, VA, USA

    Asim F. Choudhri, Patrick T. Norton, Thomas M. Carr III, James R. Stone, Klaus D. Hagspiel & Michael D. Dake

  2. Departments of Radiology and Neurosurgery, University of Tennessee Health Science Center, Memphis, TN, USA

    Asim F. Choudhri

  3. Department of Cardiothoracic Surgery, Stanford University, Stanford, CA, USA

    Michael D. Dake

  4. Department of Radiology, Le Bonheur Children’s Hospital, 848 Adams Ave-G216, Memphis, TN, 38103, USA

    Asim F. Choudhri

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  1. Asim F. Choudhri
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  2. Patrick T. Norton
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  3. Thomas M. Carr III
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  4. James R. Stone
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  5. Klaus D. Hagspiel
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  6. Michael D. Dake
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Correspondence to Asim F. Choudhri.

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Choudhri, A.F., Norton, P.T., Carr, T.M. et al. Diagnosis and treatment planning of acute aortic emergencies using a handheld DICOM viewer. Emerg Radiol 20, 267–272 (2013). https://doi.org/10.1007/s10140-013-1118-8

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  • DOI: https://doi.org/10.1007/s10140-013-1118-8

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