Diagnostic accuracy and reliability of smartphone captured radiologic images communicated via WhatsApp®
Background: Sending radiographic images as instant messages have become a common means of communication between physicians, aiding in triaging and transfer decision-making in emergencies. While the use of technology is increasing, this is not the case for the underserved or rural areas of South Africa with no picture archiving and communications system (PACS) or advanced hardware in place. In these areas, however, the medical population tends to have nearly universal access to smartphones and would benefit from the ability to share images quickly and easily with trained radiologists. South African data on diagnostic reliability of smartphone radiology images is lacking. Objectives: The objective of the study was to determine the accuracy and reliability of diagnoses made on radiologic images with a smartphone compared to radiologic images on PACS. Method: This was a cross-sectional study. Radiographs from 1 June 2018 to 1 July 2019 were selected from the PACS system at a tertiary hospital in the east-central South Africa. The images were displayed on a PACS computer screen and captured by the researcher using a smartphone. Five radiology registrars received the images via WhatsApp® and reviewed them on their phones. After three weeks, the registrars viewed the images in random order on a PACS station. McNemar’s test was used to compare the diagnostic accuracy of smartphone and PACS. Kappa values were calculated for agreement. Reliability was assessed by analyzing the results of different registrars and diagnoses separately. Results: One hundred and thirty-five X-rays, representative of common emergency conditions, were selected. For all registrars, the PACS accuracy was generally higher than the smartphone accuracy. The Kappa values all indicated fair to moderate agreement between smartphone and PACS diagnosis. Conclusion: Capturing radiographic images using at least a 12-megapixel smartphone and sharing them via WhatsApp® is a reliable method that can be used with a high degree of confidence in emergencies to aid clinical decision making. This method of viewing medical imaging is however not a substitution for images viewed on PACS.