Smartphones supplying second opinions for on-call radiologists
In a study simulating an iPhone consultation with offsite abdominal radiologists, a team from Seoul National University Bundang Hospital reported that the diagnostic performance of offsite smartphone readings did not differ significantly from in-house preliminary reports. In addition, the smartphone yielded higher diagnostic confidence.
“Based on this result, we calculated that a mobile consultation is recommended to be used as an adjunct to an on-call radiologist's preliminary report when the on-call radiologist's diagnosis of appendicitis is not conclusive,” said Dr Nak Jong Seong, a radiology and clinical assistant professor.
Seoul National University Bundang Hospital uses on-call radiologists (usually radiology residents) to read emergency radiology studies in the evenings and at weekends. On-call radiologists sometimes require a second opinion on inconclusive or difficult cases that affect surgical decision-making.
“Although we have a Web-based PACS for the secondary opinion to the experienced radiologists, they can't be at their workstation seven days a week,” he said. With the recent advances in mobile device technology in mind, researchers sought to evaluate image readings on smartphones by simulating a mobile consultation on cases with an inconclusive diagnosis of appendicitis.
Sixty-eight cases (32 men and 36 women) with inconclusive reports were gathered from a previous randomized, controlled trial involving acute appendicitis. These reports had a diagnostic confidence grade by the on-call radiologist of 2 (probably absent, clinical observation is recommended), 3 (indeterminate, clinical observation or surgical exploration is recommended) or 4 (probably present, surgical exploration is recommended) on a Likert five-point scale.
Two offsite abdominal radiologists reviewed the CT images using an Apple iPhone 4 and a commercial mobile PACS image viewing application. Images were viewed in JPEG format on the iPhone in standard stack view in axial and coronal planes.
Using the diagnosis of acute appendicitis as the reference standard, the researchers employed receiver operator characteristics (ROC) analysis to compare the diagnostic performance of the preliminary reports from the on-call radiologist, the final reports produced by the in-house attending abdominal radiologist and the retrospective review by the two offsite iPhone readers. Sensitivity and specificity were also determined.
“Interobserver agreement between the abdominal radiologist and smartphone readers 1 and 2 was good,” Seong said.
“The AUC of the in-house attending abdominal radiologist reader was greater than the on-call radiologist, but the smartphone readers did not differ [significantly] from the on-call radiologist and the abdominal radiologist,” he said.
Heat map and dendrogram analysis revealed that the smartphone readers had higher diagnostic confidence than the on-call radiologist; there was no statistically significant difference between the smartphone readers and the attending abdominal radiologist.
“Although the offsite smartphone reading did not [differ significantly] from the on-call radiologist report, the smartphone reading shows higher diagnostic confidence than the preliminary report,” Seong said.