Digital radiographic imaging transfer: comparison with plain radiographs

Comparison of digitized and conventional radiographic images for assessment of hip joint conformation in dogs

OBJECTIVE

To determine agreement between assessments of canine hip joint conformation provided by board-certified radiologists after evaluation of digitized and conventional radiographic images.

SAMPLE POPULATION

200 pelvic radiographs previously evaluated by radiologists using the Orthopedic Foundation for Animals standard grading system for canine hip joint conformation.

PROCEDURES

Each of 20 board-certified radiologists evaluated conventional and digitized pelvic radiographs from each of 200 dogs for hip joint conformation. A weighted kappa coefficient and intraclass correlation were used to determine agreement between assessments derived from digitized radiographic images and conventional radiographs and between the original Orthopedic Foundation for Animals conformation ratings and assessments derived from each image format.

RESULTS

Overall, agreement between assessments derived from the digitized images and conventional radiographs was good, with all but 1 radiologist attaining a weighted kappa coefficient > 0.61. Intraclass correlation for each radiologist ranged from 0.75 to 0.98 (95% confidence interval, 0.67 to 0.984). On comparison of conformation assessments, 95.7% of those derived from conventional radiographs and digitized images were within 1 grade. On comparison of digitized radiographic conformation assessments and conformation ratings, 94.2% were within 1 grade. On comparison of conventional radiographic conformation assessments and conformation ratings, 92.3% were within 1 grade.

CONCLUSIONS AND CLINICAL RELEVANCE

The use of digitized radiographic images does not appear to impact the radiographic assessments of canine hip joint conformation made by consultant radiologists. Compared with conventional radiographs, the use of digitized radiographic images decreases storage space requirements and enables more rapid reporting of assessment results for individual dogs.

Wireless teleradiology for renal colic and renal trauma

BACKGROUND PURPOSE

Image transmission is an integral part of telemedicine, allowing evaluation of patients at remote sites. We developed a simple method of wireless transmission of digital images to a hand-held computer (PDA) and evaluated its feasibility and diagnostic accuracy in patients with acute renal colic or renal trauma.

MATERIALS AND METHODS

The CT images from 11 patients with suspected renal colic and one patient with renal trauma were transmitted using a cellular telephone with a wireless modem link to a PDA (Sony Clie 615C). A diagnostic interpretation was recorded for the presence/absence of an upper-tract stone, stone location, estimated stone size, and signs of upper-tract obstruction. Radiologic staging of trauma was provided in the patient with a renal injury. Comparison was made with the final dictated report of a staff radiologist.

RESULTS

Ten CT sets of patients with renal colic were used for comparison, the remaining one being excluded because of ambiguity in the final radiology report. An average of 5.9+/-1.6 images, average size 32.2+/-5.2 kb (range 21-42 kb) for each patient were sent at an average speed of 1 kb/sec. Interpretation correctly identified stone presence in 80%, hydronephrosis in 100%, and perinephric stranding in 80% and stone size within 1+/-1 mm. A stage-3 renal trauma was correctly identified and staged.

CONCLUSION

Wireless teleradiology to PDA units provides image quality sufficient for diagnostic interpretation. Anticipated improvements in wireless transmission and PDA screen image resolution will enhance the speed, quality, and quantity of images transmitted. Wireless teleradiology may facilitate convenient rapid evaluation of patients at remote sites.

Real-time radiology--new concepts for teleradiology

We propose two new concepts for teleradiology: 'real-time radiology' and 'seamless operation of a workstation to view images from both local and remote hospitals'. In this paper, we describe an experimental real-time radiology system with a new multimedia diagnostic workstation, which has been established under teleradiology concepts and can be used for cooperative diagnosis by interchanging radiographic images bilaterally in real-time during an audio-visual discussion. The clinical evaluation of real-time radiology using a newly developed diagnostic workstation demonstrated the system to be practical and routinely available to enhance the radiological diagnostic quality of teleradiology.

Alterations of preliminary readings on radiographic examinations minimally affect outcomes of trauma patients discharged from the emergency department

BACKGROUND

We hypothesized that trauma patients could be discharged safely from the emergency department (ED) before the availability of official readings for their radiologic examinations. We also sought to determine whether trauma patients were more prone to alterations of preliminary interpretations than other ED patients.

METHODS

Alterations of preliminary readings (PR) for patients discharged from the ED were reviewed. If the official readings conflicted with the PR used for the patient's disposition, attempts were made to contact the patient and provide the appropriate follow-up. Data recorded included the type of radiographic examination, the presence of a missed injury, and the follow-up. By using institutional data, the incidence of inaccurate PR were compared for trauma patients and other ED patients (chi2 test, Fisher exact test, p < 0.05).

RESULTS

Between January of 1998 and December of 1998, 102 of 38,260 discharged ED patients had official readings differing from PR. Forty-three of the changed readings involved 42 of the 1,073 discharged trauma patients, who were more likely to harbor inaccurate PR (<0.0001) than other discharged ED patients. Twenty-eight altered readings involved plain films and 15 involved computed tomographic scans. The most common altered readings involved computed tomographic scans of the head and face (n = 13). Twelve missed injuries were detected, most commonly related to a missed injury of the extremity (7 cases). Nine other cases involved the detection of incidental pathologic conditions. Eight patients required repeat ED visits for clinical and radiographic evaluation, and one patient required subsequent hospital admission.

CONCLUSION

Discharged trauma patients are more likely to harbor alterations of preliminary interpretations than other ED patients. Although the official readings for these trauma patients will occasionally reveal previously undetected pathologic conditions, the majority of such cases can be managed with outpatient follow-up.