Mobile MIM: a Portable Solution in Imaging

Abstract

Clinicians experience various situations, such as peer consultation or tumor boards, in which they need to access and view radiologic studies without a full radiologic workstation. Mobile MIM is a diagnostic medical imaging device on the Apple App Store that is FDA-approved and can meet the portable needs of clinicians. The goal of the app is to give physicians the opportunity to visualize scans from multiple modalities on a single iOS mobile device. The intended uses include reviewing complex aspects of radiation treatment plans and analyzing medical images from a wide array of modalities. The key limitation is incompatibility for mammography. The free app allows users to manipulate image sets from ten sample patients before an organization can commit to extensive systems integration with MIMcloud 2.0 to store, encrypt, and route image sets for real-time patients. This review explores the app’s strengths and weaknesses through discussion of its features and usability.

Full Review

Intro

Clinicians need to access and view radiologic studies in various situations in which a full radiologic workstation is not available. Mobile MIM is a diagnostic medical imaging device on the Apple App Store that is FDA-approved. The goal of the app is to give physicians the opportunity to visualize scans from multiple modalities on a single iOS mobile device.

Purpose/Features/Content

Mobile MIM serves two broad purposes and is explicitly contraindicated for two purposes. Clinicians can use the software to view, register, fuse, and display medical images from SPECT, PET, CT, MRI, X-ray, and Ultrasound, for the purpose of diagnosis. Clinicians can also use the software to approve radiation treatment plans and to review images, contours, DVH, and isodose curves from radiation treatment plans [1]. Mobile MIM is NOT used for mammography. Mobile MIM should NOT replace full radiologic workstations and should only be used when a workstation is not available. Before clinicians can use Mobile MIM for real-time patient images, extensive integration into the organization’s existing software systems is necessary. At minimum, information technology, security, HIPAA, and quality management departments should be consulted for systems integration. The app works in conjunction with MIMcloud 2.0 to store, encrypt, and route image sets.

The features of Mobile MIM were explored through the sample image sets provided by the free app

Series

• Allows the user to go through both individual scans and combination scans.

• For example, Sample_H7 was a SPECT/CT for parathyroid adenoma and the user can examine only the CT, only the nuclear medicine scan, and the CT/NM fusion (Fig. 1).2. Layouts

• Arrange different planes of view across the screen at the same time

• Allows the option to examine each plane of view by itself

Fig. 1.

Series of sample_H7. SPECT/CT image set for parathyroid adenoma. The figure demonstrates the tool that allows the user to manipulate scans from the individual modalities, play an image progression of the nuclear medicine scan, and examine the CT/NM fusion

Tools

• Annotate—Adds an arrow with a note attached to the image set. The annotations are saved to the image set and reappear when opening up the image set later. All annotations can be viewed at once and deleted one by one within the Overlays tab.

• Measure—Digital ruler measures the length from point A to point B in centimeters. All measurements can be viewed at once and deleted one by one within the Overlays tab (Fig. 2).

• Standard Uptake Value—When a spot on the image is tapped, the SUV tool measures the maximum, minimum, and mean SUV value within the green sphere. A pinch resizes the sphere. If the user is viewing multiple planes of view on the screen at the same time, the SUV tool displays a green circle around the area of interest in the respective planes.

• Localize—Allows the user to adjust contrast and brightness, zoom in and out, pan, change blend percentages for fusion scans, and scroll through slices in the set with a single finger. Users can learn more details in the Basic Image Manipulation User Guide before reading studies.

Fig. 2.

Manipulation of the measure tool. Lung X-ray image set. The figure demonstrates an example of using the measure tool during image analysis to measure the cardiothoracic ratio of the cardiac silhouette

Read Map

• Aids in reviewing large 2D images by indicating what has and has not been reviewed at full 1:1 resolution.

• Ensures adequate reading of large images that exceed the screen resolution.

The content of the free version of Mobile MIM was limited to image sets for 10 sample patients. These samples allow a user to explore all of the modalities of imaging, except for mammography as stated above. The user can experience reading studies with internet connectivity and with offline mode as image sets can be downloaded locally to the device, with the option to delete as necessary. Examples of the sample image sets include an x-ray of the hand, PT/MR of the brain, ultrasound of the carotid artery, and PETCT of the whole body (Fig. 3). In order to understand limitations, clinicians should explore these image sets and evaluate their ability to read studies with the Mobile MIM software compared with a full radiologic workstation. After a thorough understanding of what the clinicians can and cannot do on the Mobile MIM software, they should work with the various departments, as stated above, to integrate the application into the organization’s information systems. Clinicians can then access image sets of real patients through their MIM cloud account and download them to their devices to work offline as needed. The intended uses and limitations of the app should be transparent across all parties involved in the organization.

Fig. 3.

Sample image sets. The figure illustrates the list of sample image sets under “Sample Patients.” The samples include a variety of imaging modalities supported by the app. Users are able to manipulate the image sets in the context of different pathologies with the goal to compare their ability to analyze studies on the app versus on a full radiologic workstation

Usability

Mobile MIM was explored with the sample patients provided by the free app. The features and tools detailed above are intuitive and easy to use. The user guide is thorough and walks clinicians through accessing images through MIMcloud, calibrating the device, optimizing viewing conditions, and manipulating images. Just as importantly, the safety guide explains common pitfalls when using the technology and how to mitigate the risk for lower quality of diagnostic review. The Frequently Asked Questions Guide fills in any technical gaps and provides shortcuts for efficient review of image sets.

Good

As expected for medical software, Mobile MIM secures sensitive patient data with 256-bit AES hardware encryption for downloaded image sets and with Secure Socket Layer encryption for network transfers. In addition to data security, Mobile MIM is consistently transparent about the technology’s intended use. The app builds in repeated calibration checks to ensure that the user’s viewing conditions match those of a radiology reading room. The safety guide thoroughly explores various situations in which the integrity of the radiologic review may be compromised. If reading standards are not met, the user is not able to view the image sets, preventing low-quality diagnostic radiologic review.

Mobile MIM effectively manages the challenges inherent to data of the Digital Imaging and Communications in Medicine (DICOM) standard. The data is highly variable due to individual vendors mixing and matching optional aspects of the DICOM standard in order to meet different client needs. Mobile MIM does not read DICOM images directly. The backend servers process DICOM images, and MIM Software updates the servers to keep up with changes to DICOM reading bugs and capabilities. This framework allows continuous updates to the backend and minimizes the delay in updates for the front-end Mobile MIM app.

Room for Improvement

Mobile MIM’s main challenge to gaining users is accessibility. An institution’s IT and quality management departments must work closely with MIM software to integrate systems and adopt MIMcloud. While an intricate integration process is appropriate for technology that manages complex data and the security of patient information, it also requires complete buy-in from many parties within an organization. Furthermore, although the company provides some flexibility for security systems for the software, it recommends Apple enterprise tools for the best protection with their product. This may pose an additional systems challenge to organizations with limited financial resources or incompatible information systems.