SUBTLE ORTHOPEDIC FRACTURES - TELERADIOLOGY WORKSTATION VERSUS FILM INTERPRETATION

The purpose of this study was to evaluate whether radiologists perform equally well with plain radiographs or digitized images displayed on a video monitor in interpretation of difficult orthopedic trauma cases . Interpretations with film and those made from a teleradiology system with spatial resolution of 2.35 line pairs per millimeter were compar ed in 120 difficult cases, 60 with the selected abnormality (ie, fract ure or dislocation) and 60 that were control cases. Seven senior radio logy residents and one radiology fellow each interpreted 60 randomly o rdered cases with the teleradiology system (1,280 x 1,024-pixel monito rs) and 60 cases with the original radiographs. The overall accuracy o f the readers was 80.6% for film interpretations and 59.6% for telerad iology screen readings (P < .001). Sensitivity was 78.5% for film and 48.8% for on-screen images (P < .001), and specificity was 83.2% for f ilm and 72.3% for on-screen images (P < .025). Receiver operating char acteristic analysis showed rejection of the null hypothesis in favor o f film interpretation (P < .0049). It was concluded that the teleradio logy system was not acceptable for primary diagnostic interpretation o f difficult fracture cases.