title: Flexible image evaluation: iPad versus secondary-class monitors for review of MR spinal emergency cases, a comparative study.
abstract: OBJECTIVE
  Studies have highlighted the potential of handheld viewing devices for rapid diagnosis and increased smartphone usage among physicians and radiologists is known as is the clinical applicability of hand-held devices for computed tomography (CT) spinal injury cases. Magnetic resonance (MR), however, is the accepted gold standard for spinal imaging, providing visualization of both ligament and spinal cord pathology. This study investigated the diagnostic accuracy of the iPad, the most probable alternative display device outside the radiology environment and financially viable alternative, when reviewing emergency spinal MR images, in comparison with secondary-class LCD devices in the case of the interpretation of CT and MR imaging examinations.
  
  
  METHODS
  In total 31 MR cases including both positives (n = 13) containing one of four possible presentations: spinal cord compression, cauda equine syndrome, spinal cord hemorrhage, or spinal cord edema and controls (n = 18) were reviewed. Ziltron iPad software facilitated the display of cases and the receiver operating characteristic (ROC) analysis. Thirteen American Board of Radiology board-certified radiologists reviewed all cases on both displays. Standardized viewing conditions were maintained.
  
  
  RESULTS
  Dorfman-Berbaum-Metz multireader-multicase (DBM MRMC) analysis was performed including random readers/random cases, fixed readers/random cases and random readers/fixed cases. No differences of statistical significance (P ≤ .05) could be found in terms of area under the curve, sensitivity and specificity between the iPad and secondary-class display.
  
  
  CONCLUSIONS
  The iPad performed with equal diagnostic accuracy when compared with the secondary-class LCD device after DBM MRMC analysis, demonstrating the iPad as an option to aid initial review of MR spinal emergency cases.
authors.affiliation: Diagnostic Imaging, School of Medicine and Medical Science, Health Science Centre, University College Dublin, Belfield, Ireland. jonathan.mcnulty@ucd.ie
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: McNulty
authors.forename: John T
authors.initials: JT
authors.lastname: Ryan
authors.forename: Michael G
authors.initials: MG
authors.lastname: Evanoff
authors.forename: Louise A
authors.initials: LA
authors.lastname: Rainford
mesh_terms: D000293:Adolescent; D000328:Adult; D034201:Computers, Handheld; D003626:Data Display; D004632:Emergency Medical Services / Q000379:methods*; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013119:Spinal Cord Injuries / Q000473:pathology*; D055815:Young Adult