Reliability of Smartphone Based Teleradiology for Evaluation of Thoraco-Lumbar Fractures

Background Context: The on call spine surgeon is often asked to evaluate the CT imaging of patients in the Emergency Department who sustain trauma to the thoraco-lumbar spine in order to diagnose and determine the appropriate course of urgen treatment. The use of smartphones for out of hospital viewing of imaging examinations has become prevalent in clinical practice.

Purpose: The aim of this study was to evaluate the reliability of viewing CT scans on smartphone-based instant messaging applications for the diagnosis, classification and treatment planning of thoraco-lumbar spine fractures, as compared to the interpretation of the same images on computer-based Picture Archiving and Communication System (PACS).

Methods: We obtained CT imaging of in 30 patients with fractures of the thoraco-lumbar spine. Using the iPhone 6 smartphone, CT scans were captured from a computer screen displaying PACS and sent to five orthopedic spine surgeons by the WhatsApp instant messaging application. Using their personal smartphones, evaluators were asked to diagnose, classify and determine the course of treatment for each case. Evaluation of the cases was repeated four weeks later, this time using the standard method of computer-based PACS. Intraobserver agreement was calculated by Cohen`s Kappa statistics.

Results: Intraobserver reliability for diagnosis of fracture level was excellent with agreement percentage of 95.3% and κ=0.94. Agreement percentage and K-Score for intraobserver reliability for penetration into neural canal, loss of vertebral height and kyphosis were 84%/κ=0.72, 73%/κ=0.55 and 85.3%/κ=0.45 respectively. Agreement and K-score for Denis and AO classification were 81.3%/κ=0.69 and 90%/κ=0.75 respectively and finally, agreement and K-Score for intraobserver reliability for formulation of treatment plan, based solely on radiographic images, were 83.3%/κ=0.73 which is considered to be substantial agreement.

Conclusion: Smartphone based teleradiology is a reliable, accessible and inexpensive method for out of hospital specialist consultation for urgent decision making regarding fractures of the thoraco-lumbar spine