iPad app for CT scan interpretation

The developers of the Crit-IQ critical care education website have launched a new iPad app that replicates a training session for medical students, registrars and consultants to learn the art of CT interpretation.

The CT scanning in critical and emergency care app contains 70 fully scrollable CT scans along with audible radiology reports and allows students to study common pathologies, listen to a radiologist discussing them and zoom in on abnormalities. Users are then able to click on a tutorial about the particular pathology.

Todd Fraser, an intensivist at the Nambour General Hospital and The Noosa Hospital in Queensland who first developed the Crit-IQ resource with co-founder Neil Orford, director of intensive care at The Geelong Hospital, said the app was designed for its ability to give trainees a 3D appreciation of CT scans, something not really achievable either in a textbook or a website.

“We have been trying to put CT onto our website, as we have a section called data interpretation that includes questions about things like ECGs and blood gases,” Dr Fraser said.

“We tried to put CT on there, but because CT is really a three-dimensional structure viewed as two-dimensional images, you need the ability to scroll up and down to get a 3D appreciation. So it occurred to me that the iPad was the ideal platform for this.”

Dr Fraser, along with radiologist Craig Maskiell and registrar Renee Battson, worked with Geelong-based custom app and software design firm JNH Software to create the app, which replicates a normal teaching environment in which a trainee sits next to a radiologist and reviews scans one on one.

On an iPad, there is the ability to scroll through a full series of images, and to view them in multiple planes, such as in cross-section or longitudinally. “Then when you've decided what you think is the abnormality, you can put your headphones in, hit the play button and you can listen to a radiologist reporting the film in front of you,” Dr Fraser said.

“Rather than just have a static report, the radiology report will say an abnormality is best seen for example in slide 56 at A3, and you can pause it, and navigate to slide 56 and then zoom on to A3 on the grid. Then you can press play again and continue the report.

“Once you get to the end of that, you can click on a tutorial that reviews the abnormality that was the subject of the case.”

The app is very well priced at about $10 from the iTunes store, far cheaper than a traditional textbook. “And a textbook doesn't give you anywhere near the utility that this does because they have static images, and that's not how CT is viewed,” Dr Fraser said. “For something that gives you a similar level of information you'd be looking at $100 to $200 for a textbook.”

Further updates are planned, as are versions for paediatric CT interpretation and MRI.

The team is also adding new functionality to Crit-IQ this year, offering critical care department-based memberships to allow departments to use the resources for their own internal education purposes.

Dr Fraser said there are currently about 35 member departments across Australia, New Zealand, Hong Kong, the Netherlands, the UK, Ireland, Fiji and Israel.

“Departments like it because they can use it for controlling the online and self-directed learning for their junior staff and provide a consistent framework for how they develop their skills,” he said.

Dr Fraser and Associate Professor Orford first established Crit-IQ when they were new consultants as a way to provide education and support for trainees living in regional areas who were going through the College of Intensive Care Medicine (CICM) fellowship exam.

“It struck us that the internet was the obvious venue for that,” Dr Fraser said. “We had both been working independently on small projects and we merged them together, and that was well received and we kept on being asked to provide new resources. It has really snowballed from there.”

Crit-IQ was provided with seed funding by medical device company Edwards Life Sciences, and currently receives support from Mayo Healthcare along with subscription membership.

The site is well regarded by the CICM and is accredited under its CPD program for time spent on the website, and the team is hoping to develop similar relationships with the College of Emergency Medicine and international colleges as well, Dr Fraser said.

“There is a lot of information online now but the problem is it's very fragmented, so what we have tried to develop is a one-stop shop where you can get access to everything you need,” he said. “We believe that there is a lot on there for clinicians of all different disciplines, from a medical student or a resident starting out in intensive care, all the way through to senior consultants.”

Specifically for senior consultants is the Journal Club, in which Dr Orford chooses and reviews the major papers that have been published in that month that he believes will make a difference in practice. “We've enhanced that feature by enabling a discussion forum around each of the papers, so readers can leave their comments about the papers and others can read the comments, which really enables a bit more discussion and peer review of the articles,” Dr Fraser said.

“We also have a series of podcasts with interviews with interesting people in intensive care, not only senior intensivist, but other experts too - for example one was with a nurse who is very interested in enhancing sleep for intensive care patients, and another with a physio whose major interest is very early rehabilitation.

“I've also spoken to medical ethicists about end of life care for intensive care patients. They are all boiled down to a 20-minute interview that you can listen to in your car or while you are exercising. They have proven very popular.”

There are a number of learning modules covering different areas from basic topics like chest x-ray interpretation in ICU and blood gas analysis to tracheostomy insertion, along with an extensive echocardiograph database.

There is also a similar service for critical care nurses, called Crit-Nurse, which uses some of the resources from Crit-IQ as well as nursing-specific programs developed by two experienced nurse educators.

There is quite a deal of overseas interest as well, Dr Fraser said. In addition to the international critical care departments that have joined as members, international associations of critical care nurses have also shown interest in coming on board, he said.

“Australasian intensive care is regarded as one of the best platforms for training in the world and we feel that what we can offer is those principles and deliver them.”

Posted in Australian eHealth

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