Asim F. Choudhri MD, Presenter: Nothing to Disclose

Patrick T. Norton MD, Abstract Co-Author: Nothing to Disclose

Thomas Martin Carr MD, Abstract Co-Author: Nothing to Disclose

James Radford Stone MD, Abstract Co-Author: Nothing to Disclose

Klaus D. Hagspiel MD, Abstract Co-Author: Grant, Siemens AG, Malvern, PA

Michael David Dake MD, Abstract Co-Author: Scientific Advisory Board, W. L. Gore & Associates, Inc Scientific Advisory Board, Abbott Laboratories Scientific Advisory Board, Medtronic, Inc Research grant, Siemens AG Research grant, Cook Group Incorporated

Acute aortic syndromes are often diagnosed on CT angiography of the thorax, possibly requiring emergent intervention. Advances in handheld computing have created the possibility of viewing full DICOM datasets from a remote location. We sought to evaluate the ability to diagnose acute aortic injuries and the accuracy of aortic measurements on CT angiograms of the thorax using an iPhone based DICOM viewer.

15 CT angiograms of the thorax in suspected acute aortic syndromes were identified. Studies were evaluated by three blinded radiologists on a handheld device (iPhone) using a DICOM viewer (OsiriX). Studies were evaluated for the ability to identify and classify aortic dissection, transection, or intramural hematoma. Ability to accurately measure aortic dimensions, and assess for presence of mediastinal hematoma, arch variants, and pulmonary pathology was evaluated. 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. Mediastinal hematoma (n=6), pneumothorax (5 right, 3 left), and arch vessel involvement (n=2) were identified in all cases. Of the 3 arch variants present, which were correctly identified by all viewers except for a separate aortic origin of the left vertebral artery in one case not identified by one reader on the iPhone. Aortic measurements were 14± 12 % larger when performed on the handheld device (p=0.03).

Diagnosis of acute aortic pathology on CT angiograms of the thorax using a portable device DICOM viewer can be performed with good concordance to reads performed on PACS workstations in this preliminary investigation. Differences in aortic measurements suggest that endovascular treatment planning ultimately requires validation on a dedicated workstation for possible endograft sizing.

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.

Choudhri, A, Norton, P, Carr, T, Stone, J, Hagspiel, K, Dake, M, Diagnosis and Treatment Planning of Acute Aortic Emergencies Using a Handheld DICOM Viewer.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8016270.html