title: Smartphone teleradiology application is successfully incorporated into a telestroke network environment.
abstract: OBJECTIVE
  ResolutionMD mobile application runs on a Smartphone and affords vascular neurologists access to radiological images of patients with stroke from remote sites in the context of a telemedicine evaluation. Although reliability studies using this technology have been conducted in a controlled environment, this study is the first to incorporate it into a real-world hub and spoke telestroke network. The study objective was to assess the level of agreement of brain CT scan interpretation in a telestroke network between hub vascular neurologists using ResolutionMD, spoke radiologists using a Picture Archiving and Communications System, and independent adjudicators.
  
  
  METHODS
  Fifty-three patients with stroke at the spoke hospital consented to receive a telemedicine consultation and participate in a registry. Each CT was evaluated by a hub vascular neurologist, a spoke radiologist, and by blinded telestroke adjudicators, and agreement over clinically important radiological features was calculated.
  
  
  RESULTS
  Agreement (κ and 95% CI) between hub vascular neurologists using ResolutionMD and (1) the spoke radiologist; and (2) independent adjudicators, respectively, were: identification of intracranial hemorrhage 1.0 (0.92-1.0), 1.0 (0.93-1.0), neoplasm 1.0 (0.92-1.0), 1.0 (0.93-1.0), any radiological contraindication to thrombolysis 1.0 (0.92-1.0), 0.85 (0.65-1.0), early ischemic changes 0.62 (0.28-0.96), 0.58 (0.30-0.86), and hyperdense artery sign 0.40 (0.01-0.80), 0.44 (0.06-0.81).
  
  
  CONCLUSIONS
  CT head interpretations of telestroke network patients by vascular neurologists using ResolutionMD on Smartphones were in excellent agreement with interpretations by spoke radiologists using a Picture Archiving and Communications System and those of independent telestroke adjudicators using a desktop viewer.
  
  
  BACKGROUND
  www.clinicaltrials.gov unique identifier NCT00829361.
authors.affiliation: Department of Neurology, Mayo Clinic, 5777 East Mayo Boulevard, Phoenix, AZ 85054, USA. demaerschalk.bart@mayo.edu
authors.forename: Bart M
authors.initials: BM
authors.lastname: Demaerschalk
authors.forename: Jason E
authors.initials: JE
authors.lastname: Vargas
authors.forename: Dwight D
authors.initials: DD
authors.lastname: Channer
authors.forename: Brie N
authors.initials: BN
authors.lastname: Noble
authors.forename: Terri-Ellen J
authors.initials: TE
authors.lastname: Kiernan
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Gleason
authors.forename: Bert B
authors.initials: BB
authors.lastname: Vargas
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Ingall
authors.forename: Maria I
authors.initials: MI
authors.lastname: Aguilar
authors.forename: David W
authors.initials: DW
authors.lastname: Dodick
authors.forename: Bentley J
authors.initials: BJ
authors.lastname: Bobrow
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging; D040421:Cell Phone; D006801:Humans; D011859:Radiography; D020521:Stroke / Q000000981:diagnostic imaging*; D019112:Teleradiology / Q000295:instrumentation* / Q000379:methods