title: Diagnostic accuracy of coronary computed tomography angiography as interpreted on a mobile handheld phone device.
abstract: OBJECTIVE
  This study assessed the diagnostic performance of coronary computed tomography angiography (CTA) for the detection and exclusion of significant coronary artery stenosis as remotely interpreted on a mobile handheld device with dedicated medical imaging software.
  
  
  BACKGROUND
  Recent advances in technology now permit remote interpretation of medical imaging studies on mobile handheld devices, although the diagnostic performance of this approach is unknown.
  
  
  METHODS
  We evaluated 102 patients with stable chest pain and both 64-detector row coronary CTA and quantitative invasive coronary angiography. The diagnostic performance of remote coronary CTA interpretation was assessed using a mobile handheld device and employing dedicated software. The coronary CTA studies were examined in an intent-to-diagnose manner for the presence or absence of coronary artery stenosis > or =50% on a per-artery and per-patient level; results were compared with quantitative invasive coronary angiography. Two blinded imagers independently interpreted coronary CTA studies, with a third imager achieving consensus for discordance. Coronary CTAs were re-interpreted in random order to determine interobserver agreement. Finally, coronary CTAs were evaluated on a dedicated 3-dimensional imaging workstation; results were compared to mobile handheld device findings for intertechnology agreement.
  
  
  RESULTS
  The prevalence of significant coronary artery stenosis was 25% (26 of 102) at the per-patient level and 10% (40 of 405) at the per-artery level. Per-patient and per-artery sensitivity, specificity, and positive and negative predictive values were: 100% (26 of 26), 78% (59 of 76), 60% (26 of 43), and 100% (59 of 59), respectively; and 95% (38 of 40), 85% (310 of 365), 41% (38 of 93), and 99% (310 of 312), respectively. At the per-artery level, interobserver, intraobserver, and intertechnology agreement was 0.74, 0.89, and 0.75, respectively (p < 0.01 for all).
  
  
  CONCLUSIONS
  The interpretation of coronary CTA using a mobile handheld device with dedicated software for medical image evaluation possesses high diagnostic accuracy for detection and exclusion of significant coronary stenosis.
authors.affiliation: Department of Medicine, Weill Cornell Medical College-New York Presbyterian Hospital, New York, New York 10021, USA. tml9001@med.cornell.edu
authors.forename: Troy M
authors.initials: TM
authors.lastname: LaBounty
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Kim
authors.forename: Fay Y
authors.initials: FY
authors.lastname: Lin
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
authors.forename: Jonathan W
authors.initials: JW
authors.lastname: Weinsaft
authors.forename: James K
authors.initials: JK
authors.lastname: Min
mesh_terms: D000368:Aged; D000787:Angina Pectoris / Q000000981:diagnostic imaging / Q000209:etiology; D040421:Cell Phone; D034201:Computers, Handheld; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011237:Predictive Value of Tests; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000295:instrumentation*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012984:Software; D019112:Teleradiology / Q000295:instrumentation*; D014057:Tomography, X-Ray Computed; D014481:United States