The objectives of the study were to determine whether diagnostic accuracy and reliability by on-call teams is affected by communicating chest radiograph (CXR) images via instant messaging on smartphones in comparison to viewing on a workstation. 12 residents viewed 100 CXR images each with a 24% positive rate for significant or acute findings sent to their phones via a popular instant messaging application and reported their findings if any. After an interval of 42 days they viewed the original DICOM images on personal computers and again reported their findings. There were no statistically significant differences in accuracy, agreement, sensitivity, specificity, positive predictive value or negative predictive value between desktop workstation viewed images and images sent via the mobile application. Media messaging is a useful adjunct for quick second opinions on radiological images, without significant decay in diagnostic accuracy. If technical, ethical and legal issues are addressed, it could be incorporated into practice as a useful adjunct.
Teleradiology Ethics, medical Mobile applications Liability, legal Near miss, healthcare, chest X-ray
Digital imaging and communications in medicine
Picture archiving and communication system
Joint photographic experts group
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The authors declare no sources of funding were used for this work.
Compliance with ethical standards
Conflict of interest
The Authors declare that they have no conflict of interest.
For this type of study formal ethical approval is not required.
Statement of human and animal rights
The procedures followed were in accordance with the standards of the medical ethics committee and with the Helsinki Declaration of 1975, as revised in 2008.
Informed consent was not required for this study.
Patel RK, Sayers AE, Patrick NL, Hughes K, Armitage J, Hunter IA (2015) A UK perspective on smartphone use amongst doctors within the surgical profession. Ann Med Surg 4:107–112CrossRefGoogle Scholar
Mobasheri MH, King D, Johnston M, Gautama S, Purkayastha S, Darzi A (2015) The ownership and clinical use of smartphones by doctors and nurses in the UK: a multicentre survey study. BMJ Innov 1:174–181CrossRefGoogle Scholar
Johnston MJ, King D, Arora S et al (2015) Smartphones let surgeons know WhatsApp: an analysis of communication in emergency surgical teams. Am J Surg 209:45–51CrossRefGoogle Scholar
Migliore M (2015) The use of smartphones or tablets in surgery. What are the limits? Ann Ital Chir 86:185–186PubMedGoogle Scholar
Astarcioglu MA, Sen T, Kilit C et al (2015) Time-to-reperfusion in STEMI undergoing interhospital transfer using smartphone and WhatsApp messenger. Am J Emerg Med 33:1382–1384CrossRefGoogle Scholar
Khanna V, Sambandam SN, Gul A, Mounasamy V (2015) “WhatsApp”ening in orthopedic care: a concise report from a 300-bedded tertiary care teaching center. Eur J Orthop Surg Traumatol 25:821–826CrossRefGoogle Scholar
Kaliyadan F, Ashique KT, Jagadeesan S, Krishna B (2016) What’s up dermatology? A pilot survey of the use of WhatsApp in dermatology practice and case discussion among members of WhatsApp dermatology groups. Indian J Dermatol Venereol Leprol 82:67CrossRefGoogle Scholar
Giordano V, Koch HA, Mendes CH, Bergamin A, de Souza FS, do Amaral NP (2015) WhatsApp messenger is useful and reproducible in the assessment of tibial plateau fractures: inter- and intra-observer agreement study. Int J Med Inform 84:141–148CrossRefGoogle Scholar
O’Sullivan DM, O’Sullivan E, O’Connor M, Lyons D, McManus J (2017) WhatsApp Doc? BMJ Innov 3:238–239 CrossRefGoogle Scholar
Al Zadjali N, Al-Senawi R, Al Reesi A, Al-Zakwani I, Nemeth J, Perry JJ (2009) Predictors of positive chest radiography in non-traumatic chest pain in the emergency Department. Oman Med J 24:22–26PubMedPubMedCentralGoogle Scholar
Sharif BAR, O’Kane K, McWilliams S (2013) An audit of chest X-ray requests in acute medical settings at a London teaching hospital—are guidelines being met? European Congress of Radiology, ViennaGoogle Scholar
Radiologists Fo (2011) Guidelines for the implementation of a national quality assurance programme in radiology—Version 2.0 Royal College of Surgeons in Ireland, OnlineGoogle Scholar
Radiologists. TRCo (2012) Standards for the communication of critical, urgent and unexpected radiological findings, Second. The Royal College of Radiologists, LondonGoogle Scholar
Satia I, Bashagha S, Bibi A, Ahmed R, Mellor S, Zaman F (2013) Assessing the accuracy and certainty in interpreting chest X-rays in the medical division. Clin Med (Lond) 13:349–352CrossRefGoogle Scholar
Goost H, Witten J, Heck A et al (2012) Image and diagnosis quality of X-ray image transmission via cell phone camera: a project study evaluating quality and reliability. PLoS One 7:e43402CrossRefGoogle Scholar
Dey K (2014) Whatsapp—an innovative solution for the stroke care. J Neurol Neurosurg Psychiatry 85:e4CrossRefGoogle Scholar
Free C, Phillips G, Watson L et al (2013) The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Med 10:e1001363CrossRefGoogle Scholar
Fiadino P, Schiavone M, Casas P (2014) Vivisecting whatsapp through large-scale measurements in mobile networks. ACM SIGCOMM Comput Commun Rev 44:133–134CrossRefGoogle Scholar
Liukkonen E, Jartti A, Haapea M et al (2016) Effect of display type and room illuminance in chest radiographs. Eur Radiol 26:3171–3179CrossRefGoogle Scholar
Office of Public Sector Information (1998) Data Protection Act 1998 (c.29) [online] HMSO, LondonGoogle Scholar
Confidentiality: good practice in handling patient information (2009) General Medical Council, Manchester, Paragraph 8CrossRefGoogle Scholar