Smartphone Based Teleradiology for Evaluation of Thoraco-Lumbar Fractures. A Reliability Study

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

Methods: CT imaging of 30 patients with fractures of the thoraco-lumbar spine. Using iPhone 6 smartphone, CT scans were captured as video-clips from a computer screen displaying the images on PACS and sent to five orthopedic spine surgeons by `WhatsApp` instant messaging application. Using their smartphones, evaluators were asked to diagnose, classify and determine 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 (κ, K-Score).

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: CT examinations can be captured and transmitted as video clips using smartphones. Diagnosis, classification and treatment decision making can be made with equal reliability by this technique or standard PACS. Remote viewing of CT images is accessible, simple and inexpensive and can be used for consultation between orthopedic resident and on-call spine specialist. Applying this method can also create a substantial means of communication between rural/community ED physicians and surgeons in tertiary referral centers.