title: Teleradiology in urology: comparison of digital image quality with original radiographic films to detect urinary calculi.
abstract: OBJECTIVE
  Teleradiology systems are now being evaluated as a mechanism to provide rapid, accurate and cost-effective diagnostic radiographs to off-site physicians. Little data are available on the role and safety of teleradiology in urology. To address these issues a personal computer based system was developed to assess the diagnostic accuracy and ease of use of transmitted digital images when evaluating for urinary calculi.
  
  
  METHODS
  A total of 100 plain abdominal scout films from excretory urograms performed during acute urological referrals was digitized on a laser scanner. The 10 megabyte files were transferred over public telephone lines and written to compact disks. The images were viewed on a 1280 x 1640 resolution monitor using "Imager-3D" software run on a 133 MHz. pentium personal computer with 32 megabytes of random access memory. Two faculty urologists and 2 urology fellows each looked at 50 original radiographs and 50 digital images. Diagnostic interpretations of the presence and location of calculi were recorded, and confidence in the diagnosis, assessment of image quality and diagnostic difficulty were scored using a numerical scale.
  
  
  RESULTS
  The accuracy for all readers was 86.5% for plain radiographs and 81.5% for digital images (p >0.2). There was no statistical difference between faculty and fellows. Diagnostic accuracy did not differ between plain films and screen images when the results were assessed with respect to image quality, diagnostic difficulty or the reader confidence in the diagnosis (p >0.1). Compared to plain films, more screen images were classified as lower image quality (60 versus 40%) and the diagnostic confidence was lower (low and medium grade 50 versus 35%), although this did not interfere with diagnostic accuracy.
  
  
  CONCLUSIONS
  These data imply that a high quality affordable teleradiology system is effective and accurate compared to plain films for assessing urinary calculi.
authors.affiliation: Brady Urological Institute, and Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
authors.forename: D C
authors.initials: DC
authors.lastname: O'Sullivan
authors.forename: T D
authors.initials: TD
authors.lastname: Averch
authors.forename: J A
authors.initials: JA
authors.lastname: Cadeddu
authors.forename: R G
authors.initials: RG
authors.lastname: Moore
authors.forename: N
authors.initials: N
authors.lastname: Beser
authors.forename: C
authors.initials: C
authors.lastname: Breitenbach
authors.forename: R
authors.initials: R
authors.lastname: Khazan
authors.forename: L R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D006801:Humans; D012372:ROC Curve; D011856:Radiographic Image Enhancement; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D019112:Teleradiology; D014545:Urinary Calculi / Q000000981:diagnostic imaging*