PEDIATRIC RADIOLOGY AT A RURAL HOSPITAL - VALUE OF TELERADIOLOGY AND SUBSPECIALTY CONSULTATION

OBJECTIVE. We performed a field study and subsequent laboratory invest igation of pediatric radiology at a small rural hospital. Our investig ation had three components: to describe the characteristics of pediatr ic radiology in a rural primary care facility, to test the diagnostic accuracy of interpretation of pediatric images transmitted by teleradi ology, and to compare relative diagnostic accuracy of general and pedi atric radiologists who interpreted pediatric images at a rural institu tion. MATERIALS AND METHODS. All 196 pediatric radiographs obtained du ring a 4-month period comprised the database from which we determined practice characteristics. Reports of 153 unselected cases interpreted by general radiologists using teleradiology were compared with interpr etation of the same cases by a pediatric radiologist who interpreted t he original radiographs. Discrepant cases were further investigated by a receiver-operating-characteristic curve experiment in which general and pediatric radiologists interpreted each case twice: once viewing teleradiologic images and once viewing the original radiographs at ano ther setting. We then compared interpretive accuracy of observers and techniques. RESULTS. The pediatric radiographs were predominantly simp le examinations for common acute disease, particularly pneumonia and f ractures. Discrepancies of interpretation between teleradiology and or iginal radiographs, which occurred in 13% of images, showed no signifi cant difference in accuracy of interpretation for either teleradiologi c images or original radiographs. Likewise, we found no significant ad vantage for accuracy of interpretation by general or pediatric radiolo gists. Receiver-operating-characteristic analysis of 18 discrepant cas es showed slightly increased accuracy for interpretation of original r adiographs by pediatric subspecialists. CONCLUSION. Simple pediatric r adiographs obtained at a rural primary care institution and transmitte d by teleradiology can be adequately interpreted by general radiologis ts.