Original ContributionDiagnostic performance of smartphone reading of the coronary CT angiography in patients with acute chest pain at ED☆
Introduction
Chest pain accounts for a substantial proportion of ED visits. Approximately one third to two thirds of patients presenting with chest pain are admitted, and only 15% to 25% are diagnosed with acute coronary syndromes [1]. Therefore, efficient and accurate determination of acute coronary syndromes is important in the ED.
Coronary computed tomography (CT) angiography (CCTA) is a robust and fast tool for noninvasive evaluation of coronary artery disease (CAD) [2]. Several randomized clinical trials revealed the CCTA-based strategy for patients at low to intermediate risk of CAD is useful in the ED [1], [3]. In the ED, timely and accurate CCTA interpretation is needed to reduce crowding, which is associated with adverse cardiovascular outcome in patients with chest pain [4]. For the interpretation of CCTA, the reader's level of experience is a strong determinant of proficiency [5], [6]. However, the after-hour CT interpretations in the ED usually rely on less experienced on-call residents for night time coverage or training purpose [7], [8]. Therefore, real-time consultation of CCTA to the specialists will be beneficial in triaging the patients with chest pain in ED.
Advancement in smartphone technology with combination of specialized medical applications has proven its value in hospital environments, especially in the ED setting [9], [10]. Pocket-sized teleradiology terminals using a smartphone have been tested for its technical feasibility in consultation purposes in previous studies [11]. Many studies have suggested the potential role of off-site smartphone reading as a radiology consultant in critical situations such as acute stroke, intracranial hemorrhage, and inconclusive diagnosis of appendicitis [12], [13], [14]. To our knowledge, there is no previous study demonstrating feasibility and accuracy of off-site smartphone reading for the CCTA in the ED.
Thus, the aims of our study were to simulate mobile consultation for the CCTA at ED and to measure the diagnostic performance of the mobile consultation.
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Materials and methods
The institutional review board approved the study protocol and waived informed consent for this retrospective study.
Results
There was no event of malfunction or delay in terms of image query, transmission, display, or navigation during off-site mobile consultation simulation.
Discussion
The main findings of this study were as follows: (1) the smartphone reader's reading was more similar to the CAG results and in-house radiologists' reports than the reading of on-call residents, and (2) the diagnostic performance of smartphone reading for the detection of obstructive stenosis was significantly greater than that of the on-call residents and did not significantly differ from that of the in-house radiologists.
Our study is the first to show the possible role of off-site smartphone
References (15)
- et al.
A meta-analysis and systematic review of computed tomography angiography as a diagnostic triage tool for patients with chest pain presenting to the emergency department
J Nucl Cardiol
(2012) - et al.
Coronary computed tomography angiography as a screening tool for the detection of occult coronary artery disease in asymptomatic individuals
J Am Coll Cardiol
(2008) - et al.
Influence of observer experience and training on proficiency in coronary CT angiography interpretation
Eur J Radiol
(2013) - et al.
Radiology resident interpretations of on-call imaging studies: the incidence of major discrepancies
Acad Radiol
(2008) - et al.
Smartphones, tablets and mobile applications for radiology
Eur J Radiol
(2013) - et al.
Coronary CT angiography versus standard evaluation in acute chest pain
N Engl J Med
(2012) - et al.
The association between emergency department crowding and adverse cardiovascular outcomes in patients with chest pain
Acad Emerg Med
(2009)
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This work was supported by the Seoul National University Bundang Hospital Research Fund (grant number 14-2015-021). The funding source had no involvement in study design; in the collection, analysis, and interpretation of data; in the writing of the report; and in the decision to submit the article for publication.