Smartphones and laptops as accurate as medical monitors for interpreting head CT in Acute Stroke

Acute stroke is such a medical emergency that can lead to disability and even death. Therefore, in acute stroke treatment, time is the brain, the longer you wait for more damage to occur. Fast and accurate clinical assessment is imperative to determine whether immediate on-site treatment, prompt referral to a comprehensive stroke center, or supportive management with no further interventions are appropriate.

Over the past decades, electronic devices such as smartphones, tablets, laptops, etc. have become key methods of communication, data access and data sharing for the population. Their processing power is often enough to handle the large data sets of radiology studies and is used to manipulate images and studies directly on hand-held devices. They are not recommended for primary interpretation of radiology studies but can be used to transmit and view radiology studies, often in locations remote from the source of the imaging data and can be used to facilitate sharing of studies for second opinions, viewing of studies and reports by clinicians at the bedside, etc.

To evaluate and compare the clinical performance of observers interpreting head CT images from patients with symptoms of acute stroke with a medical workstation or a smartphone or laptop reading system the authors conducted a retrospective study where they employed a factorial design including 2,256 interpretations (188 patients × 4 neuroradiologists × 3 reading systems). Accuracy equivalence tests, at a threshold of 5% and 10%, were performed for the following variables: detection of imaging contraindications for intravenous recombinant tissue-type plasminogen activator administration (eg, hemorrhagic lesions), ischemic lesions, hyperdense arteries, and acute ischemic lesions. For each clinical variable, the sensitivity, specificity, and receiver operating characteristic (ROC) curves were evaluated.

The authors observed that

• For each variable, the shapes of the ROC curves were very similar for all of the reading systems, indicating similar observer performance with different specificities and sensitivities.


• For all the clinical variables, the areas under the ROC curves were equivalent for all of the reading systems at a 10% threshold and were equivalent at a 5% threshold for hemorrhagic lesions, hyperdense middle cerebral artery, and acute ischemic lesion in the middle cerebral artery territory.


• There were no more than 30 seconds of difference between the reading time of the mobile devices compared with that for the medical workstation.

The authors conclude, equivalent diagnostic accuracy to interpret head CT images of patients with symptoms of acute stroke when using smartphone and laptops compared with medical monitors

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