title: Myocardial perfusion imaging determination using an appropriate use smartphone application.
abstract: BACKGROUND
  Inappropriate cardiac imaging has been a significant cost concern and cause of radiation burden to patients.
  
  
  OBJECTIVE
  To assess if a smartphone application (app) based on 2009 Appropriate Use Criteria (AUC) for Cardiac Radionuclide Imaging published by American College of Cardiology would be feasible at the point of order.
  
  
  METHODS
  We evaluated stress myocardial perfusion imaging (MPI) (N = 403) (mean age = 62.23 years; 47.89% males) over a 4 month period using a smartphone app to determine whether the study ordered was Appropriate, Inappropriate, or Uncertain per 2009 AUC. We also monitored the time needed to use the app to determine the level of appropriateness of each stress MPI. The results of the stress MPI were noted.
  
  
  RESULTS
  Of the 403 stress MPIs evaluated, 267 (66.25%) were noted to be Appropriate, 118 (29.28%) were Inappropriate, and 13 (3.23%) were Uncertain, per AUC; 5 (1.25%) remained unclassified. Average time needed to use the app to assess each stress MPI for appropriateness was noted to be 44 (±9) seconds. Non-teaching physicians ordered 70 (38.89%) inappropriate stress MPIs as compared to 20 (23.53%) ordered by physicians on resident teaching service, and 28 (23.33%) by cardiologists (P = .0045). Among inappropriately ordered stress MPIs, 87 (42.65%) were ordered in females as compared to 31 (17.13%) in males (P < .0001). 70 (26.22%) stress MPIs among appropriately ordered were abnormal (reversible ischemia or fixed perfusion defect) as compared to 15 (12.17%) among inappropriately ordered stress MPIs (P = .0032).
  
  
  CONCLUSIONS
  A free and convenient smartphone app provides an easy-to-use tool to assist physicians in determining the level of appropriateness of stress MPI in a time- and cost-effective manner at the point of order. The smartphone app may have potential to promote the usage of the AUC and possibly aid reduction of healthcare cost and ionizing radiation burden.
authors.affiliation: Department of Internal Medicine, Kettering Medical Center, 3535 Southern Boulevard, Kettering, OH, 45429, USA. mahajan_82@yahoo.com
authors.forename: Ashish
authors.initials: A
authors.lastname: Mahajan
authors.forename: Susan
authors.initials: S
authors.lastname: Bal
authors.forename: Harvey
authors.initials: H
authors.lastname: Hahn
mesh_terms: D000368:Aged; D002309:Cardiology / Q000592:standards; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging*; D005260:Female; D006300:Health Services Misuse; D006801:Humans; D008297:Male; D008875:Middle Aged; D063731:Mobile Applications; D055414:Myocardial Perfusion Imaging; D011877:Radionuclide Imaging; D000068997:Smartphone; D015899:Tomography, Emission-Computed, Single-Photon