Diagnostic accuracy and reliability of smartphone captured radiologic images communicated via WhatsApp®.

Abstract

IntroductionSending radiographic images as instant messages have become a common means of communication between physicians, aiding in triaging and transfer decision-making in emergencies. While use of technology is increasing, this is not the case for the underserved or rural areas of South Africa with no picture archiving and communications system or advanced hardware in place. In these areas, the medical staffing population have nearly universal access to smartphones and could benefit from the ability to share images quickly and easily with trained radiologists. South African data on diagnostic reliability of smartphone captured radiology images is lacking. The objective of the study was to determine the accuracy and reliability of diagnoses made on radiologic images captured with smartphone compared to radiologic images on picture archiving and communication system(PACS).MethodsA cross-sectional study was conducted with radiographs from June 2018 to July 2019 selected from the PACS system at Pelonomi Tertiary Hospital. Images were displayed on PACS computer screen and captured by principal researcher using a smartphone. Five radiology registrars received the images via WhatsApp® and reviewed them on smartphones. After three weeks, registrars viewed images in random order on PACS stations. McNemar's test was used to compare the diagnostic accuracy of smartphone vs PACS and Kappa values calculated for agreement. Reliability was assessed by analysing the results of different registrars and diagnoses separately.Results135 X-rays, representative of common emergency conditions, were selected. For all registrars, PACS accuracy was generally higher than smartphone accuracy. The Kappa values all indicated fair to moderate agreement between smartphone and PACS diagnosis.ConclusionCapturing radiographic images using at least 12-megapixel smartphone and sharing them via WhatsApp® is a reliable method that can be used with a high degree of confidence in emergencies to aid clinical decision making. This method of viewing medical imaging is however not a substitution for images viewed on PACS.