Photomessaging in orthopaedic trauma

Abstract

PurposeTo assess the efficacy and usefulness of photo messaging in orthopaedic surgery, specifically in the assessment of trauma radiology. MethodsProspectively, 100 sets of X-rays from patients presenting to our emergency department with a clinical hip fracture were collected. Digital images of these AP pelvis X-rays were taken using a Panasonic GD87 mobile picture-messaging phone ( Fig. 1) by one of the authors using a standard technique. These images were then blindly assessed by two orthopaedic surgeons for the presence of a fracture with a clinical history of a patient with hip pain and inability to weight bear after a fall. Results from the digital imaging were then correlated with the actual X-rays reviewed by the same two surgeons. ResultsFifty-eight patients had a hip fracture on plain Xrays, four had a pubic rami fracture, one had a cystic abnormality in the femoral head and 37 had normal X-rays. Digital imaging at 640  480 pixel resolution with images at 3.2 cm  4.4 cm correctly identified 47/58 fractured hips (Fig. 2) and three out of the four pubic rami fractures. Digital imaging missed four undisplaced fractured hips visible on plane films (Fig. 3) and the cystic abnormality. However, 18 out of 37 normal sets of digital images were thought to show possible undisplaced fractures or were inconclusive. ConclusionDigital images taken and viewed on currently available mobile phones were of insufficient quality to identify most fractures visible on standard plane films. A false positive rate of nearly 50% and a significant false negative rate however mean that this technology is not of sufficient accuracy to allow its safe use in orthopaedic practice.

Consultation of Orthopaedics Cases Using Multimedia Messaging Services

“…As per the guidelines of American College of Radiology, for teleradiology, a minimum resolution 2000 × 2000 pixels is required for the diagnosis of subtle skeletal disorders such as fractures with only disruption of trabecular pattern [ 8 ]. This requirement encompasses all radiology from X-Rays to mammograms.…”

“…reviewed 59 patients to assess diagnostic accuracy of teleconsultation using MMS [ 9 ] and found a misdiagnosis rate of 40%, over diagnosis rate of 12%, under diagnosis of 27% and concluded that teleconsultation via MMS demonstrated good reliability but poor diagnostic accuracy using a camera phone with a 1.2MP camera and screen resolution of 176X208. In existing literature, the resolution of the images and the screen quality formed the bottleneck in using MMS of radiographs as a diagnostic tool [ 8 ].…”