TELERADIOLOGY IN UROLOGY - COMPARISON OF DIGITAL IMAGE QUALITY WITH ORIGINAL RADIOGRAPHIC FILMS TO DETECT URINARY CALCULI

Purpose: Teleradiology systems are now being evaluated as a mechanism to provide rapid, accurate and cost-effective diagnostic radiographs t o off-site physicians. Little data are available on the role and safet y of teleradiology in urology. To address these issues a personal comp uter based system was developed to assess the diagnostic accuracy and ease of use of transmitted digital images when evaluating for urinary calculi. Materials and Methods: A total of 100 plain abdominal scout f ilms from excretory urograms performed during acute urological referra ls was digitized on a laser scanner. The 10 megabyte files were transf erred over public telephone lines and written to compact disks. The im ages were viewed on a 1280 x 1640 resolution monitor using ''Imager-3D '' software run on a 133 MHz. pentium personal computer with 32 megaby tes of random access memory. Two faculty urologists and 2 urology fell ows each looked at 50 original radiographs and 50 digital images. Diag nostic interpretations of the presence and location of calculi were re corded, and confidence in the diagnosis, assessment of image quality a nd diagnostic difficulty were scored using a numerical scale. Results: The accuracy for all readers was 86.5% for plain radiographs and 81.5 % for digital images (p >0.2). There was no statistical difference bet ween faculty and fellows. Diagnostic accuracy did not differ between p lain films and screen images when the results were assessed with respe ct to image quality, diagnostic difficulty or the reader confidence in the diagnosis (p >0.1). Compared to plain films, more screen images w ere classified as lower image quality (60 versus 40%) and the diagnost ic confidence was lower (low and medium grade 50 versus 35%), although this did not interfere with diagnostic accuracy. Conclusions: These d ata imply that a high quality affordable teleradiology system is effec tive and accurate compared to plain films for assessing urinary calcul i.