iPhone-Based Teleradiology for the Diagnosis of Acute Cervico-Dorsal Spine Trauma

Abstract

An instant image transfer system can be used to support rapid medical and imaging decision making in an emergency situations when doctors are away from the hospital [1][2][3] . There are several Web-based picture archiving and communication systems, which allows access to a patient's radiological images from outside the hospital 1 . However, they are felt to be not appropriate for use in time-critical emergency cases as mentioned in previous studies 4,5 . Handheld devices like smart-phones and personal digital assistants (PDAs) have become increasingly prevalent in modern society [6][7][8] and 46% of attending physicians and trainees 9 and 45% of radiologists are using handheld devices [8][9][10] . However, ABSTRACT:Objective: To assess the feasibility of iPhone-based teleradiology as a potential solution for the diagnosis of acute cervico-dorsal spine trauma. Materials and Methods: We have developed a solution that allows visualization of images on the iPhone. Our system allows rapid, remote, secure, visualization of medical images without storing patient data on the iPhone. This retrospective study is comprised of cervico-dorsal computed tomogram (CT) scan examination of 75 consecutive patients having clinically suspected cervico-dorsal spine fracture. Two radiologists reviewed CT scan images on the iPhone. Computed tomogram spine scans were analyzed for vertebral body fracture and posterior elements fractures, any associated subluxation-dislocation and cord lesion. The total time taken from the launch of viewing application on the iPhone until interpretation was recorded. The results were compared with that of a diagnostic workstation monitor. Inter-rater agreement was assessed. Results: The sensitivity and accuracy of detecting vertebral body fractures was 80% and 97% by both readers using the iPhone system with a perfect inter-rater agreement (kappa:1). The sensitivity and accuracy of detecting posterior elements fracture was 75% and 98% for Reader 1 and 50% and 97% for Reader 2 using the iPhone. There was good inter-rater agreement (kappa: 0.66) between both readers. No statistically significant difference was noted between time on the workstation and the iPhone system. Conclusion: iPhone-based teleradiology system is accurate in the diagnosis of acute cervicodorsal spinal trauma. It allows rapid, remote, secure, visualization of medical images without storing patient data on the iPhone.RÉSUMÉ: Téléradiologie basée sur le iPhone pour le diagnostic du traumatisme aigu de la colonne cervicale et dorsale. Objectif : Le but de l'étude était d'évaluer la faisabilité de la téléradiologie basée sur le iPhone comme ressource pour le diagnostic du traumatisme de la colonne cervicale et dorsale. Méthodologie : Nous avons développé une ressource qui permet la visualisation d'images sur le iPhone. Notre système permet la visualisation rapide, à distance et sécurisée d'images médicales sans sauvegarder les informations concernant le patient dans le iPhone. Cette étude rétrospective inclut l'examen de tomodensitométrie ...

The iPad Tablet Computer for Mobile On-Call Radiology Diagnosis? Auditing Discrepancy in CT and MRI Reporting

“…Researchers investigating the accuracies of a smartphone client-server teleradiology system compared to a dedicated workstation for acute stroke diagnosis reported specificity of 100 %, sensitivity of 94-97 %, and accuracy rates of 98-99 % [15]. We did not restrict the selection of emergency cases by diagnosis or body region, e.g., stroke, spine trauma, or acute appendicitis as in these studies [8,[15][16][17] but included a range of common emergent pathologies encountered in our hospital, including large angiographic studies with post-processed images. Our results suggest that the iPad is a viewing platform that has high levels of reporting concordance compared to PACS, regardless of the body region scanned, imaging protocols, and diagnosis.…”

Telemedicine for Trauma and Emergency Management: an Overview

“…Initial experience with such communication ranged from the use of digital cameras to obtain and transmit pictures of radiographic studies of orthopedic injuries [13,14] to closed circuit television and recording devices in the on-site evaluation, to provision of trauma care from the distance in real time. The simplicity of using smartphone technology to transmit images and recordings of patient wounds and radiographic images has been shown to be efficacious in more than one study [15,16], although their ubiquitous use has not occurred due to Health Insurance Portability and Accountability Act (HIPAA) concerns and the security of patient data. Within the last decade, more advanced technologic programs were created and demonstrated to be highly functional.…”

A Feasibility Study of Real-Time Remote CT Reading for Suspected Acute Appendicitis Using an iPhone

“…Several previous reports have demonstrated that there is no difference in the diagnostic accuracy for CT readings between smartphones and typical PACS workstations in various diseases [7,18,[20][21][22]. However, to the best of our knowledge, this is the first study to demonstrate the diagnostic Bperformance^of remote CT reading for acute appendicitis using a smartphone, which has good concordance with the performance of the PACS workstation LCD monitor under bright ambient lighting in a Brealistic ED setting^and using Breal-time data transmission^with a 3G network.…”

“…The iPhone 5 provides a similar image viewing quality compared to the clinical LCD monitor [7,18,[20][21][22]. The iPhone 5 has sufficient pixel pitch to support the radiology images at their original size and sufficient brightness and contrast to meet the ACR guideline recommendations for medical monitors [24].…”