Evaluation of personal digital assistants as an interpretation medium for computed tomography of patients with intracranial injury

Abstract

The objective of the study was to assess the feasibility of using a personal digital assistant (PDA) as a medium for the interpretation of cranial CT scans of trauma patients. Twenty-one noncontrast cranial CT scans were transferred in their entirety to a PDA from the picture archiving and communications system (PACS) utilizing General Electric (GE) PathSpeed PACS Web Server interface and synchronization. All CT scans had been interpreted by board-certified radiologists prior to the study. Seven of the scans demonstrated subarachnoid hemorrhage, seven demonstrated subdural hematomas, and the remaining scans were normal. After transfer to the PDA, all images were separately reviewed in a blinded manner by a radiologist and a neurosurgeon. Images were graded for their quality and diagnostic utility in the evaluation of intracranial hemorrhage. Image quality was categorized as excellent, very good, acceptable for diagnosis, or not acceptable for diagnosis. Based on the radiologic diagnosis, recommendation for surgical management was made by the reviewing neurosurgeon. The accuracy rate for both the radiologist and the neurosurgeon in the detection of intracranial hemorrhage was 95%. There was one false negative which was attributed to error in judgment rather than poor image quality. This diagnostic error did not affect patient management. The sensitivity and specificity for detection of intracranial hemorrhage were 93% and 100%, respectively. Image quality was judged to be excellent in 90% of the cases and very good in the remaining 10%. Our results suggest that the PDA is a robust medium for interpretation of CT scans in patients with suspected hemorrhage following intracranial injury. In this setting, the PDA should be considered for teleradiology purposes.