Skip to main content

Advertisement

SpringerLink
Log in

Accuracy and reliability of tablet computer as an imaging console for detection of radiological signs of acute appendicitis using PACS workstation as reference standard

  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To ascertain the accuracy and reliability of tablet as an imaging console for detection of radiological signs of acute appendicitis [on focused appendiceal computed tomography (FACT)] using Picture Archiving and Communication System (PACS) workstation as reference standard.

Methods

From January, 2014 to June, 2015, 225 patients underwent FACT at our institution. These scans were blindly re-interpreted by an independent consultant radiologist, first on PACS workstation and, two weeks later, on tablet. Scans were interpreted for the presence of radiological signs of acute appendicitis. Accuracy of tablet was calculated using PACS as reference standard. Kappa (κ) statistics were calculated as a measure of reliability.

Results

Of 225 patients, 99 had radiological evidence of acute appendicitis on PACS workstation. Tablet was 100% accurate in detecting radiological signs of acute appendicitis. Appendicoliths, free fluid, lymphadenopathy, phlegmon/abscess, and perforation were identified on PACS in 90, 43, 39, 10, and 12 scans, respectively. There was excellent agreement between tablet and PACS for detection of appendicolith (к = 0.924), phlegmon/abscess (к = 0.904), free fluid (к = 0.863), lymphadenopathy (к = 0.879), and perforation (к = 0.904).

Conclusions

Tablet computer, as an imaging console, was highly reliable and was as accurate as PACS workstation for the radiological diagnosis of acute appendicitis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Petroianu A (2012) Diagnosis of acute appendicitis. Int J Surg 10:115–119

    Article  PubMed  Google Scholar 

  2. Ball WR, Privitera A (2013) Subhepatic appendicitis: a diagnostic dilemma. BMJ Case Rep . doi:10.1136/bcr-2013-009454

    Google Scholar 

  3. Palanivelu C, Rangarajan M, John SJ, Senthilkumar R, Madhankumar MV (2007) Laparoscopic appendectomy for appendicitis in uncommon situations: the advantages of a tailored approach. Singap Med J 48:737–740

    CAS  Google Scholar 

  4. Gilmore OJ, Browett JP, Griffin PH, et al. (1975) Appendicitis and mimicking conditions. A prospective study. Lancet 306:421–424

    Article  Google Scholar 

  5. Kalan M, Talbot D, Cunliffe WJ, Rich AJ (1994) Evaluation of the modified Alvarado score in the diagnosis of acute appendicitis: a prospective study. Ann R Coll Surg Engl 76:418–419

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Raja AS, Wright C, Sodickson AD, et al. (2010) Negative appendectomy rate in the era of CT: an 18-year perspective. Radiology 256:460–465

    Article  PubMed  Google Scholar 

  7. The SCOAP Collaborative (2008) Negative appendectomy and imaging accuracy in the Washington State Surgical Care and Outcomes Assessment Program. Ann Surg 248:557–563

    Google Scholar 

  8. Coursey CA, Nelson RC, Patel MB, et al. (2010) Making the diagnosis of acute appendicitis: do more preoperative CT scans mean fewer negative appendectomies? A 10-year study. Radiology 254:460–468

    Article  PubMed  Google Scholar 

  9. Poletti PA, Platon A, De Perrot T, et al. (2011) Acute appendicitis: prospective evaluation of a diagnostic algorithm integrating ultrasound and low-dose CT to reduce the need of standard CT. Eur Radiol 21:2558–2566

    Article  PubMed  Google Scholar 

  10. van Randen A, Laméris W, van Es HW, et al. (2011) A comparison of the accuracy of ultrasound and computed tomography in common diagnoses causing acute abdominal pain. Eur Radiol 21:1535–1545

    Article  PubMed  PubMed Central  Google Scholar 

  11. Doria AS, Moineddin R, Kellenberger CJ, et al. (2006) US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology 241:83–94

    Article  PubMed  Google Scholar 

  12. Pritchett CV, Levinsky NC, Ha YP, Dembe AE, Steinberg SM (2010) Management of acute appendicitis: the impact of CT scanning on the bottom line. J Am Coll Surg 210:699–707

    Article  PubMed  Google Scholar 

  13. Flum DR, Morris A, Koepsell T, Dellinger EP (2001) Has misdiagnosis of appendicitis decreased over time? A population-based analysis. JAMA 286:1748–1753

    Article  CAS  PubMed  Google Scholar 

  14. Raman SS, Osuagwu FC, Kadell B, et al. (2008) Effect of CT on false positive diagnosis of appendicitis and perforation. N Engl J Med 358:972–973

    Article  CAS  PubMed  Google Scholar 

  15. Rao PM, Rhea JT, Rattner DW, Venus LG, Novelline RA (1999) Introduction of appendiceal CT: impact on negative appendectomy and appendiceal perforation rates. Ann Surg 229:344–349

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Rhea JT, Halpern EF, Ptak T, et al. (2005) The status of appendiceal CT in an urban medical center 5 years after its introduction: experience with 753 patients. AJR Am J Roentgenol 184:1802–1808

    Article  PubMed  Google Scholar 

  17. Awais M, Hilal K, Waheed A, et al. (2015) Detection and communication of critical findings noted on thoracic CT scans by radiology residents: a view from abroad. J Am Coll Radiol 12:1324–1329

    Article  PubMed  Google Scholar 

  18. Binkhuysen FHB, Ranschaert ER (2011) Teleradiology: evolution and concepts. Eur J Radiol 78:205–209

    Article  Google Scholar 

  19. Rodríguez Recio FJ, Oquillas Izquierdo D (2011) Teleradiology in the emergency department: opportunity and danger. Radiologia 53:78–81

    Article  PubMed  Google Scholar 

  20. Raman B, Raman R, Raman L, Beaulieu CF (2004) Radiology on handheld devices: image display, manipulation, and PACS integration issues. Radiographics 24:299–310

    Article  PubMed  Google Scholar 

  21. Rao PM, Rhea JT, Novelline RA (1997) Sensitivity and specificity of the individual CT signs of appendicitis: experience with 200 helical appendiceal CT examinations. J Comput Assist Tomogr 21:682–692

    Article  Google Scholar 

  22. Buckius MT, McGrath B, Monk J, et al. (2012) Changing epidemiology of acute appendicitis in the United States: study period 1993–2008. J Surg Res 175:185–190

    Article  PubMed  Google Scholar 

  23. Brenner DJ (2012) Minimising medically unwarranted computed tomography scans. Ann ICRP 41:161–169

    Article  CAS  PubMed  Google Scholar 

  24. Ashraf K, Ashraf O, Bari V, et al. (2006) Role of focus appendiceal computed tomography in clinically equivocal acute appendicitis. J Pak Med Assoc 56:200–203

    PubMed  Google Scholar 

  25. Ege G, Akman H, Sahin A, et al. (2002) Diagnostic value of unenhanced helical CT in adult patients with suspected acute appendicitis. Br J Radiol 75:721–725

    Article  CAS  PubMed  Google Scholar 

  26. Keyzer C, Zalcman M, De Maertelaer V, et al. (2005) Comparison of US and unenhanced multi-detector row CT in patients suspected of having acute appendicitis. Radiology 236:527–534

    Article  PubMed  Google Scholar 

  27. Stacher R, Portugaller H, Preidler KW, et al. (1999) Acute appendicitis in non-contrast spiral CT: a diagnostic luxury or benefit? Rofo 171:26–31

    Article  CAS  PubMed  Google Scholar 

  28. Tamburrini S, Brunetti A, Brown M, et al. (2007) Acute appendicitis: diagnostic value of nonenhanced CT with selective use of contrast in routine clinical settings. Eur Radiol 17:2055–2061

    Article  PubMed  Google Scholar 

  29. Bendeck SE, Nino-Murcia M, Berry GJ, et al. (2002) Imaging for suspected appendicitis: negative appendectomy and perforation rates. Radiology 225:131–136

    Article  PubMed  Google Scholar 

  30. Morris KT, Kavanagh M, Hansen P, et al. (2002) The rational use of computed tomography scans in the diagnosis of appendicitis. Am J Surg 183:547–550

    Article  PubMed  Google Scholar 

  31. Torbati SS, Guss DA (2003) Impact of helical computed tomography on the outcomes of emergency department patients with suspected appendicitis. Acad Emerg Med 10:823–829

    Article  PubMed  Google Scholar 

  32. Yüksekkaya R, Akgül E, I˙nal M, et al. (2004) Unenhanced spiral CT in the diagnosis of acute appendicitis. Tani Girisim Radyol 10:131–139

    PubMed  Google Scholar 

  33. Hlibczuk V, Dattaro JA, Jin Z, Falzon L, Brown MD (2010) Diagnostic accuracy of noncontrast computed tomography for appendicitis in adults: a systematic review. Ann Emerg Med 55:51–59

    Article  PubMed  Google Scholar 

  34. McLaughlin P, McGarrigle AM, Maher MM (2011) Comparison of handheld devices for emergency radiology. Am J Roentgenol 196:W487

    Article  Google Scholar 

  35. Mobasheri MH, Johnston M, Syed UM, King D, Darzi A (2015) The uses of smartphones and tablet devices in surgery: a systematic review of the literature. Surgery 158:1352–1371

    Article  PubMed  Google Scholar 

  36. Mosa ASM, Yoo I, Sheets L (2012) A systematic review of healthcare applications for smartphones. BMC Med Inform Decis Mak 12:67

    Article  PubMed  PubMed Central  Google Scholar 

  37. Boonn WW, Flanders AE (2005) Survey of personal digital assistant use in radiology. Radiographics 25:537–541

    Article  PubMed  Google Scholar 

  38. Al-Hasani H, Abboudi H, Ninan T, Shaygi B, Roobottom C (2013) Smartphone applications for the radiologist. Open J Radiol 3:231–237

    Article  Google Scholar 

  39. Székely A, Talanow R, Bágyi P (2013) Smartphones, tablets and mobile applications for radiology. Eur J Radiol 82:829–836

    Article  PubMed  Google Scholar 

  40. De Maio P, White LP, Bleakney R, Menezes RJ, Theodoropoulos J (2014) Diagnostic accuracy of an iPhone DICOM viewer for the interpretation of magnetic resonance imaging of the knee. Clin J Sport Med 24:308–314

    Article  PubMed  Google Scholar 

  41. Naqvi GA, Daly M, Dawood A, Kurkuri A, Kutty S (2014) Smart consultation for musculoskeletal trauma: accuracy of using smart phones for fracture diagnosis. Surgeon 12:32–34

    Article  CAS  PubMed  Google Scholar 

  42. Seong NJ, Kim B, Lee S, et al. (2014) Off-site smartphone reading of CT images for patients with inconclusive diagnoses of appendicitis from on-call radiologists. AJR Am J Roentgenol 203:3–9

    Article  PubMed  Google Scholar 

  43. John S, Poh ACC, Lim TCC, Chan EHY, Chong LR (2012) The iPad tablet computer for mobile on-call radiology diagnosis? Auditing discrepancy in CT and MRI reporting. J Digit Imaging 25:628–634

    Article  PubMed  PubMed Central  Google Scholar 

  44. Körner H, Söndenaa K, Söreide JA, et al. (1997) Incidence of acute nonperforated and perforated appendicitis: age-specific and sex-specific analysis. World J Surg 21:313–317

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Aga Khan University Hospital, P.O. Box 3500, Stadium Road, Karachi, 74800, Sindh, Pakistan

    Muhammad Awais, Dawar Burhan Khan, Muhammad Danish Barakzai & Naila Nadeem

  2. Department of Biological & Biomedical Sciences, Aga Khan University, P.O. Box 3500, Stadium Road, Karachi, 74800, Sindh, Pakistan

    Abdul Rehman & Noor Ul-Ain Baloch

  3. Internal Medicine Section, Department of Medicine, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar

    Abdul Rehman

Authors
  1. Muhammad Awais
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dawar Burhan Khan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Muhammad Danish Barakzai
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Abdul Rehman
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Noor Ul-Ain Baloch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Naila Nadeem
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Muhammad Awais.

Ethics declarations

Conflict of interest

The authors have no conflict of interests to declare.

Electronic supplementary material

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Awais, M., Khan, D.B., Barakzai, M.D. et al. Accuracy and reliability of tablet computer as an imaging console for detection of radiological signs of acute appendicitis using PACS workstation as reference standard. Abdom Radiol 43, 1254–1261 (2018). https://doi.org/10.1007/s00261-017-1284-3

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00261-017-1284-3

Keywords

Search

Navigation