Clinical decision making using teleradiology in urology

OBJECTIVE. Using a personal computer-based teleradiology system, we compare d accuracy, confidence, and diagnostic ability in the interpretation of dig itized radiographs to determine if teleradiology-imported studies convey su fficient information to make relevant clinical decisions involving urology. Variables of diagnostic accuracy, confidence, image quality, interpretatio n, and the impact of clinical decisions made after viewing digitized radiog raphs were compared with those of original radiographs. MATERIALS AND METHODS. We evaluated 956 radiographs that included 94 IV pye lograms, four voiding cystourethrograms, and two nephrostograms. The radiog raphs were digitized and transferred over an Ethemet network to a remote pe rsonal computer-based viewing station. The digitized images were viewed by urologists and graded according to confidence in making a diagnosis, image quality, diagnostic difficulty, clinical management based on the image itse lf and brief patient history. The hard-copy radiographs were then interpret ed immediately afterward, and diagnostic decisions were reassessed. All ana log radiographs were reviewed by an attending radiologist. RESULTS. Ninety-seven percent of the decisions made from the digitized radi ographs did not change after reviewing conventional radiographs of the same case. When comparing the variables of clinical confidence, quality of the film on the teleradiology system versus analog films, and diagnostic diffic ulty, we found no statistical difference (p > .05) between the two techniqu es. Overall accuracy in interpreting the digitized images on the teleradiol ogy system was 88% by urologists compared with that of the attending radiol ogist's interpretation of the analog radiographs. However, urologists detec ted findings on five (5%) analog radiographs that had been previously unrep orted by the radiologist. CONCLUSION. Viewing radiographs transmitted to a personal computer-based vi ewing station is an appropriate means of reviewing films with sufficient qu ality on which to base clinical decisions. Our focus was whether decisions made after viewing the transmitted radiographs would change after viewing t he hard-copy images of the same case. In 97% of the cases, the decision did not change. In those cases in which management was altered, recommendation of further imaging studies was the most common factor.