title: Clinical decision making using teleradiology in urology.
abstract: OBJECTIVE
  Using a personal computer-based teleradiology system, we compared accuracy, confidence, and diagnostic ability in the interpretation of digitized radiographs to determine if teleradiology-imported studies convey sufficient information to make relevant clinical decisions involving urology. Variables of diagnostic accuracy, confidence, image quality, interpretation, and the impact of clinical decisions made after viewing digitized radiographs were compared with those of original radiographs.
  
  
  METHODS
  We evaluated 956 radiographs that included 94 IV pyelograms, four voiding cystourethrograms, and two nephrostograms. The radiographs were digitized and transferred over an Ethernet network to a remote personal computer-based viewing station. The digitized images were viewed by urologists and graded according to confidence in making a diagnosis, image quality, diagnostic difficulty, clinical management based on the image itself, and brief patient history. The hard-copy radiographs were then interpreted immediately afterward, and diagnostic decisions were reassessed. All analog radiographs were reviewed by an attending radiologist.
  
  
  RESULTS
  Ninety-seven percent of the decisions made from the digitized radiographs did not change after reviewing conventional radiographs of the same case. When comparing the variables of clinical confidence, quality of the film on the teleradiology system versus analog films, and diagnostic difficulty, we found no statistical difference (p > .05) between the two techniques. Overall accuracy in interpreting the digitized images on the teleradiology system was 88% by urologists compared with that of the attending radiologist's interpretation of the analog radiographs. However, urologists detected findings on five (5%) analog radiographs that had been previously unreported by the radiologist.
  
  
  CONCLUSIONS
  Viewing radiographs transmitted to a personal computer-based viewing station is an appropriate means of reviewing films with sufficient quality on which to base clinical decisions. Our focus was whether decisions made after viewing the transmitted radiographs would change after viewing the hard-copy images of the same case. In 97% of the cases, the decision did not change. In those cases in which management was altered, recommendation of further imaging studies was the most common factor.
authors.affiliation: Department of Urology, Johns Hopkins Bayview Medical Center, Baltimore, MD 21224, USA.
authors.forename: B R
authors.initials: BR
authors.lastname: Lee
authors.forename: M
authors.initials: M
authors.lastname: Allaf
authors.forename: R
authors.initials: R
authors.lastname: Moore
authors.forename: M
authors.initials: M
authors.lastname: Bohlman
authors.forename: G M
authors.initials: GM
authors.lastname: Wang
authors.forename: J T
authors.initials: JT
authors.lastname: Bishoff
authors.forename: S V
authors.initials: SV
authors.lastname: Jackman
authors.forename: J A
authors.initials: JA
authors.lastname: Cadeddu
authors.forename: T W
authors.initials: TW
authors.lastname: Jarrett
authors.forename: R
authors.initials: R
authors.lastname: Khazan
authors.forename: L R
authors.initials: LR
authors.lastname: Kavoussi
mesh_terms: D003657:Decision Making; D006801:Humans; D011856:Radiographic Image Enhancement; D019112:Teleradiology; D014567:Urography; D014570:Urologic Diseases / Q000000981:diagnostic imaging