title: Detection rates in pediatric diagnostic imaging: A picture archive and communication system compared with a web-based imaging system.
abstract: OBJECTIVE
  This prospective study assesses whether there are differences in accuracy of interpretation of diagnostic images among users of a picture archive and communication system (PACS) diagnostic workstation, compared with a less costly Web-based imaging system on a personal computer (PC) with a high-resolution monitor.
  
  
  METHODS
  One hundred consecutive pediatric chest or abdomen and skeletal X-rays were selected from hospital inpatient and outpatient studies over a 5-month interval. They were classified as normal (n = 32), obviously abnormal (n = 33), or having subtle abnormal findings (n = 35) by 2 senior radiologists who reached a consensus for each individual case. Subsequently, 5 raters with varying degrees of experience independently viewed and interpreted the cases as normal or abnormal. Raters viewed each image 1 month apart on a PACS and on the Web-based PC imaging system. McNemar tests were used to compare accuracy of interpretation across both imaging systems. Confidence intervals (CIs) were calculated for differences in the proportion assessed incorrectly on the PACS, compared with the Web-based PC imaging system.
  
  
  RESULTS
  There was no relation between accuracy of detection and the system used to evaluate X-ray images (P = 0.92). The total percentage of incorrect interpretations on the Web-based PC imaging system was 23.2%, compared with 23.6% on the PACS (P = 0.92). For all raters combined, the overall difference in proportion assessed incorrectly on the PACS, compared with the PC system, was not significant at 0.4% (95%CI, -3.5% to 4.3%).
  
  
  CONCLUSIONS
  The high-resolution Web-based imaging system via PC is an adequate alternative to a PACS clinical workstation. Accordingly, the provision of a more extensive network of workstations throughout the hospital setting could have potentially significant cost savings.
authors.affiliation: Discipline of Radiology, Faculty of Medicine, Memorial University, St John's NL. h54ljm@mun.ca
authors.forename: Lori
authors.initials: L
authors.lastname: McDonald
authors.forename: Benvon
authors.initials: B
authors.lastname: Cramer
authors.forename: Brendan
authors.initials: B
authors.lastname: Barrett
mesh_terms: D000367:Age Factors; D001842:Bone and Bones / Q000000981:diagnostic imaging; D002648:Child; D002675:Child, Preschool; D016288:Computer Terminals / Q000706:statistics & numerical data; D016001:Confidence Intervals; D017046:Cost Savings; D003627:Data Interpretation, Statistical; D050723:Fractures, Bone / Q000000981:diagnostic imaging; D006801:Humans; D020407:Internet / Q000191:economics / Q000295:instrumentation; D008838:Microcomputers / Q000191:economics / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011860:Radiography, Abdominal; D013902:Radiography, Thoracic; D011873:Radiology Information Systems / Q000191:economics