title: Personal computer teleradiology interhospital image transmission of neonatal radiographs to facilitate tertiary neonatology telephone consultation and patient transfer.
abstract: OBJECTIVE
  Our purpose was to study the ability of personal computer teleradiology (PCT) to improve the quality of communication between physicians during newborn infant transfers and consultations.
  
  
  METHODS
  In the first part of the study 36 radiographs of neonatal intensive care unit patients were transmitted by PCT. The pediatrician reviewed the original films and three neonatologists reviewed the PCT images. Their interpretations were scored by use of criteria established by a neutral reader. In the second part chest x-ray films (CXR) of 31 newborns weighing > 2000 gm with respiratory distress were transmitted by PCT. A pediatrician and three neonatologists participated in an exercise to simulate a telephone neonatology consultation. Patient severity assessments as measured by assignments to receive intermediate or intensive care were compared before and after neonatologists viewed the PCT image of the CXR.
  
  
  RESULTS
  In part 1 of the study neonatologists correctly identified 98%, 91%, and 98% of the x-ray interpretation scoring items, whereas at best the pediatrician identified 82% of the scoring items (p = 0.002). In part 2 neonatologists correctly assigned patient care levels an average of 73% after reviewing a standard clinical profile and a written description of the infant's CXR. After reviewing a PCT image of the infant's CXR, patient care level assignments were correctly assigned an average of 67%. The interpretation of the PCT CXR image was consistent with the radiologic report of record in 90 of 93 interpretations (31 cases read by three neonatologists).
  
  
  CONCLUSIONS
  PCT represents an inexpensive means to accurately send a radiographic image over the phone as part of a telephone consultation. Neonatologists were able to interpret teleradiology images more accurately than a pediatrician reviewing the original film. Although this did not result in an improvement in the neonatologists' ability to determine patient severity on the basis of the model used in part 2, their identification of serious radiographic findings missed by the pediatrician can only suggest that teleradiology may be beneficial in certain instances. Although verbal communication can often suffice in a telephone consultation or transfer, there may be specific instances when visualizing a radiographic image such as an x-ray film or computed tomographic scan can provide important information that cannot be optimally described verbally. Rural hospitals can form interhospital image transmission links with tertiary center resources.
authors.affiliation: Emergency Service, University of Hawaii John A. Burns School of Medicine, Honolulu, USA.
authors.forename: L G
authors.initials: LG
authors.lastname: Yamamoto
authors.forename: K M
authors.initials: KM
authors.lastname: Ash
authors.forename: R B
authors.initials: RB
authors.lastname: Boychuk
authors.forename: V
authors.initials: V
authors.lastname: Balaraman
authors.forename: L K
authors.initials: LK
authors.lastname: Iwaishi
authors.forename: S A
authors.initials: SA
authors.lastname: Sommer-Candelario
authors.forename: C M
authors.initials: CM
authors.lastname: Amell
authors.forename: M I
authors.initials: MI
authors.lastname: Bennett
mesh_terms: D006801:Humans; D007231:Infant, Newborn; D007232:Infant, Newborn, Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging*; D008838:Microcomputers / Q000706:statistics & numerical data; D010360:Patient Transfer; D011859:Radiography; D019114:Remote Consultation / Q000379:methods / Q000639:trends; D012680:Sensitivity and Specificity; D019112:Teleradiology / Q000379:methods / Q000639:trends