Split view on iPad- playing two related videos side by side (no, playing not together!)

The recent updates to iOS 9.3 and YouTube’s app update for the iPad and iPad Pro now allows one to pull two related videos and view them in split screen mode. Here I have a YouTube Video pulled in through the YouTube app on the left half of the screen and a video on Vimeo on the right half of my iPad Air 2 screen. The second image shows how you can maximize the two screens and watch the videos side by side on a tablet. What an amazing world we live in! 

Are physicians being distracted from patient care by electronic devices?

With the ubiquitous nature of the electronic devices on our person (phones, smartwatches, tablets, computers), a physician’s attention is being pulled in various directions during a normal working day. This is more of an issue for radiologists who perform most of their work on a screen which has access to as many notifications as one would allow to come through. The constant stream of information from scanners with technologists updating patient status on dashboards, schedulers sending patient orders for protocols and clinicians asking for explanation of what is already on a report during a active reporting session is very distracting.

These updates and the requirement to answer each of these requests and notifications instantaneously in the name of “improving workflow” makes me switch my attention from my primary focus i.e. creating a good quality report and helping the clinician manage the patient’s illness.

I believe asking a physician to multitask during a patient care session is equivalent to asking a driver to take a phone call during a busy commute-prone to disaster when the unexpected comes up from the blind spot.

This problem is more acute when the physician is with a patient. My fellows are constantly paged to check a MRI when they are performing an ultrasound scan and my clinical colleagues complain about having to answer”status check” pages when they are examining a patient. The distraction of having to constantly answer a hospital issued phone within a few seconds of having received the notification while dealing with a patient can become extremely frustrating for both the physician and the patient.

In addition to the interruption to the chain of thought while formulating a report or examining a patient, there is a danger of “attention residue”, a term used by psychologists studying multitasking to describe how it is difficult for people to transition their attention away from an unfinished task, thereby adversely affecting their subsequent task performance.

My experience is that the many managers making these rules are either non-clinicians or clinicians who have moved on managerial posts and are no longer involved taking care of patients. Their focus is on metrics like time saved, increased throughput of cases and financial gain, and not about quality and patient safety, which should be the priority of all health care institutions.

I have consciously decided to switch my phone off and not look at emails during the workday in the reading room. I also read through and answer my emails in not more than three batches during the day. Also, I now refuse to answer pages when I am not on service and when the person paging you is asking for a non-urgent opinion about a case that I am not actively involved in. I do not have email or application alerts on my phone and have deleted all social media applications from my phone that I use in the hospital. I also batch up complex reports to revisit during a quiet period after my time in the reading room when I can switch off every single notification device on my person.

I would be interested in seeing if others have come up with solutions for the electronic/technology distraction problem.

Duet Display- Make the iPad a secondary display for your Mac or PC

 Even though I have a 15 inch MacBook Pro retina display, I often find myself needing more screen real estate when I am using my MacBook  while traveling. As a specific use case, I feel that academic radiologists can benefit from having an additional display especially when they are checking trainee reports on imaging studies or monitoring scans remotely. Or having an excel spreadsheet on a separate screen while going through a series of research studies. There are a number of iOS apps (with companion apps on the Mac) that let you use the iPad as a secondary display. However, many of these apps are pretty slow as they communicate using Wi-Fi which is not fast enough for what I would like to use the secondary display for.

I recently came across an app called Duet Display which works in conjunction with a companion Mac app and provides a wired connection using the lightning cable between the Mac and the iPad. It costs $15 on the iOS App Store and has been developed by ex-Apple employees.
This app provides a high-speed connection between the MacBook and the iPad and unlike its competitors, it works using a wired connection created between the two using the lightning cable. The combination of a custom driver and a wired connection means the speed of the connection is extremely fast. The app developers claim up to 60 frames per second and I personally did not have any trouble switching between the two monitors and also dragging windows around on the secondary display. There are two display options for the iPad display – one with a frame rate of 30 fps and the second at 60 fps, and if you have a retina display mac like me, you can also choose between retina and normal display modes via the app’s menu bar interface.
The only downside to using Duet Display that I could find is its relatively heavy usage of CPU capacity when running it using the discrete graphics as recommended. This can mean a battery drain when the MacBook is running on battery power, like in a coffee shop. This is easily remedied by ensuring that you are plugged into a power outlet. The developers have provided an option (via the menu bar) to use integrated graphics for energy savings, but this choice comes  at the cost of responsiveness. Apart from this minor drawback, this is a fantastic app for $15 that provides a fast and very responsive extra display for your Mac and is a boon when I travel with my Mac and iPad as my only display options. I now use this as my app of choice to connect my Mac to my iPad Air 2 and highly recommend this to anybody who wants to use an additional display for the MacBook. And all you Windows afficionados might be interested to know that I have friends who have used this app to use the ipad as a secondary display on their Windows laptops.

Which Apple product should you buy??

Apple_-_MacBookAfter Apple’s keynote earlier this week, there is one question on the minds of the Mac/Apple fans- what product should one buy?? Between the new Macbook, the upgraded Macbook Air, the Macbook Pro and the Apple Watch, it is hard to decide. Is it worth being an early adopter and choosing the ultra-thin Macbook with one USB-C port, the all new keyboard and the retina display? Having studied the specs on the new Macbook, I have come to the conclusion that there is a specific type of customer for whom this would be well suited. This type of customer typically has a more beefier laptop or desktop computer at home for heavy lifting tasks like video editing and relies on a tablet (like an iPad) or a small laptop (like the 11 inch Macbook Air) while out and about. The new Macbook would be good for road warriors with ready access to Wi-Fi at hotels and airports. It would suit a student who relies on his or her laptop for taking notes in school or checking email etc, and reserves the multitasking for the second computer at home. With the slower processor it ships with, the new Macbook will struggle when multiple windows are open and one wants to surf, watch videos and monitor Twitter at the same time (yes, there are people I have seen do just this!). Also note that it has a 480p camera which is far inferior than even the 720p front facing camera in an iPad. It is a good travel computer as long as one remembers to take the adapters for peripherals and the ethernet adapter for use in the hotels where wireless internet is sold at a steep premium compared to the wired option. In all other cases, the choice to be made is between the longer battery life and lightweight form factor of the Macbook Air (which has the updated keyboard with Force Touch) and the more powerful Macbook Pro with retina display suited for any professional who wants to work with media-rich files on the road.


And what about the watch, you ask? Well, if you have disposable income lying around or an IRS refund that you want to spend, then I suggest choosing one of the lower end models (which cost between $350 and $1000. Remember that you will feel the need to upgrade to the next version in a year, so choose wisely. It is a fitness band built into a good looking watch. Is it overpriced for a first generation device? Absolutely! Just like the first iPhone, there will be a premium paid by early adopters and prices will fall with successive versions even as more features will be added. The higher models are being sold as fashion accessories for the ultra rich and will stay unchanged in price to mark their premium status. 

And you may well ask- which Apple product am I buying? Well, I am buying Apple stock for now, This is the only product that is actually going to rise in value in a year. Everything else will be upgraded and a better version will be released in a year after the early adopters have found the flaws in the first version. Plus, I have a Macbook Pro with Retina Display that works brilliantly  well and irrespective of what Apple wants me to believe, I think its keyboard is just fine! And my Fitbit Charge is as good a fitness tracker as I need. Perhaps I will change my mind when I hold the Apple Watch in my hand. But for now, I will stay away from the version 1 devices and wait for the believers to worship at the shrine of Apple and hope it drives the stock up!

5 ways a radiologist can play an active role in medical school education


In my opinion, the use of radiology as a way to show function of various tissues has not been emphasized enough in most undergraduate curricula. Seeing a cine image of a gated CT or MRI of a patient with arrythmogenic right ventricular dysplasia or pulmonary regurgitation or seeing the turbulence of flow at the site of coarctation of the aorta can go a long way in cementing knowledge and developing an appreciation of the role that radiology plays in assessing the patient and the role it can play in determining treatment.


I often find medical students understand anatomy better when there is pathology affecting an area. A good example is the excellent delineation of the fascial spaces in the neck in a patient with subcutaneous emphysema. I find that this is better than any drawing made with high end tools like Adobe Ilustrator. This is where a radiologist’s case base can come in handy for the teacher of medical anatomy. This kind of cooperation between the non-clinical and clinical specialties should be encouraged.


The use of multiple modality overlays is another area where radiologists can play a role. For example, overlaying a CT over a MRI in a patient with a juvenile nasopharyngeal angiofibroma is the best way I have found to teach a medical student or radiology trainees about the anatomy of the pterygopalatine region.

While watching videos online and listening to lectures is certainly an acceptable way to learn, it is far better to utilize interactive ways of learning from audiovisual material. Sites like e-anatomy are good examples where labels of various structures can be switched on and off to test knowledge.


With regards to medical school exams, most radiologists would say that static images presented on a printed page are probably the least optimal way to show a radiology image, particularly ones in gray scale (like a chest radiograph). With the increasing availability of handheld electronic display devices like tablets, most medical students and educators would argue that preparation and administration of medical exams which require radiology images should be moved over as far as possible to these devices from paper.




pre-operative imaging in epilepsy RSSA talk 2014

PDF of webinar presentation on June 3rd 2014 for the RSSA.

Slow death by a million micropayments!!

Just made a list of my “small” monthly or yearly subscriptions to various services – Netflix, Evernote, Dropbox, Spotify, icloud, Google Drive, Amazon Prime, HBO, Tripit, Audible and Wunderlist Pro- when you add this all up, the micropayments do not seem that “micro” any more! Based on this list, I cancelled my Netflix, Audible and HBO subscriptions- far cheaper to buy or rent a book or movie when I feel I need one. I  will be canceling my Evernote subscription when it comes up for renewal. Is it just me or will others wake up and find this, leading to a crumbling of the freemium model as the payments add up. Or is there a place for a service that bundles some of the services and provides a sort of bulk discount?

Optimizing imaging in pediatric epilepsy

Handout on pediatric white matter disorders- RSNA 2013 talk

MRI of pediatric white_matter_disorders- final version RSNA

iPad air or mini- which one should you buy?


I received the new iPad mini with retina display from Apple this week. And as expected, it is faster and has a sharper screen than the first generation iPad mini. It is a touch heavier and thicker than its predecessor. It has excellent battery life, at least as good as the previous model.
But here is the thing- the difference in the screen is apparent only if you compare the old and new iPad mini next to each other or when you are looking at text-rich material. Also, the speed of the new A7 processor is apparent when one plays a graphic rich game like Infinity blade. So, if you have an older iPad mini and if you play a lot of games or read books on the mini, it might be worth the upgrade. The sharper screen and the faster processor make it worthwhile for this kind of discerning user.

But here is the question asked by my colleagues- which one should I buy- the iPad air or iPad mini with retina display? With the previous generation mini, the lack of a retina display screen and the slower processor meant that the larger iPad came out ahead in every comparison. This time around, Apple has narrowed the gap between the two devices. Both new tablets have been equipped with the A7 chip and the retina screen. The differences boil down to size and the marginal differences in speed (which most people will not notice during routine use).
If you feel the need for a larger screen and are going to use the tablet to do a lot of typing like writing papers, reading a MRI scan on the go or editing photographs, I would suggest choosing the iPad Air. It is lighter, marginally faster and the screen provides real estate to do more. Also, the color gamut reproducibility is better on the iPad Air. The reds, blues and magentas look a lot better on the iPad Air as pointed out by many observers. I checked this out on my devices and as you can see from the photograph of my home screen, the reds of the Netflix and Flipboard icons look a lot more “redder” on the iPad Air screen.
Also, the choice will be based on whether you consume more than you create on the tablet. In other words, do you watch movies, YouTube and read a lot more than you edit documents, write blogposts, edit photographs and movies. In that case, the iPad mini is a good option.
The final question is- does a smaller size and increased portability ? The iPad Mini offers the ability to carry it in your jacket pocket or in purses. To many, this is a significant advantage that cannot be ignored.
To me, the choice is clear- I still choose the larger iPad Air over the mini. It is lighter than the previous generation, faster than any other tablet I have used, the screen is super-sharp and the 9.7 inch screen gives me a lot more real estate to work with.
As for my 10 year-old son, who plays games, reads books and watches movies on the device, the new retina iPad mini is an excellent companion. He loves it and the flaws I see in it do not bother him. To each his own, I say!