DICOM Calibration of the iPhone Display; Should We be Concerned?

The ever popular iPhone continues to amaze as it makes headway into industries that while logical, may not have seemed obvious – at first. One such industry is iPhone usage in the radiological sciences, where physicians have access to patient data in the standard DICOM image file format. In most cases, the delivery of the image data is achieved by incorporating the iPhone into the radiology workflow.

The actual mechanism is typically via a PACS solution, whereby, the iPhone is recognized as an “application entity”, therefore, recognizable as a device on the DICOM network that can receive and send medical image data from other DICOM enabled devices.

A number of companies have DICOM compliant applications that can be installed on the iPhone. They range from open source applications such as OsiriX Mobile (http://www.osirix-viewer.com/MobileOsiriXWorkflow.pdf) to commercially available applications such as MIMvista’s Mobile MIM (http://www.mimvista.com/iphone). Even major players such as GE Healthcare are getting involved. In the case of MIMvista, the company is very serious about its commitment to the iPhone as evidenced by its pursuit of FDA clearance for Mobile MIM.

These efforts are in response to a demand by the end users themselves, and have been presented at premier events in radiology, including the Radiological Society of North America (http://trusted.md/blog/radrounds/2008/11/10/apple_at_rsna_2008_osirix_iphone_and...).

There is one gap that I have yet to see properly addressed within a regulatory framework in order to assure that variability in image display has been minimized. My research thus far has not uncovered any serious efforts to properly calibrate the iPhone display to the DICOM standard when used as a diagnostic tool for clinical interpretation. Because the iPhone has an internal ambient light sensor, my concern is even greater.

A white paper (http://www.planar.com/Advantages/WhitePapers/docs/WP_DICOM_Calibration.pdf) was written in 2005 by Planar (formally Dome Imaging), a company that provides DICOM compliant medical displays, which I consider to be essential reading on this topic. While this may appear to be self-serving, it is in fact a well written document on not only why this is important, but provides and analyses two approaches for calibrating LCD displays.

Theoretically, a USB-based photometer used in conjunction with a DICOM test pattern application should suffice with the initial and continual DICOM conformance. In practice, it may not be so easily achieved when all the variables of a mobile device are considered versus fixed devices usually found in reading rooms.

I would be interested to hear from end users, developers, and providers of medical imaging technology for the iPhone about this issue and the sense of significance and relevance it has on mobile devices used as medical devices.