Diagnostic performance of smartphone reading of the coronary CT angiography in patients with acute chest pain at ED☆

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Abstract

Purpose:

The aims of this study were to simulate mobile consultation for the coronary computed tomography angiography (CCTA) at the emergency department (ED) and to measure the diagnostic performance of the mobile reading.

Materials and methods:

A total of 107 patients with acute chest pain who underwent CCTA and coronary angiography (CAG) were included. The CCTA images were reviewed by a cardiac radiologist using a smartphone. The degree of stenosis at each coronary segment was scored with 4-point scale (score 1, < 50%; score 2, 51%-70%; score 3, 71%-90%; score 4, > 90%). The degree of stenosis at each coronary segments were also scored with preliminary CCTA report by on-call residents, final CCTA reports by in-house attending cardiac radiologists, and CAG. Interobserver agreement was measured using κ statistics. The areas under the receiver operating characteristic curves (AUCs) for diagnosing segments with obstructive stenosis were compared between each reader and CAG.

Results:

The smartphone reader's reading was more similar to the CAG results and in-house radiologists' reports than reading of on-call residents. The diagnostic performance of smartphone reading for detection of obstructive stenosis was significantly greater than that of on-call residents (AUC, 0.89 vs 0.75; P < .001) and did not significantly differ from that of the in-house radiologists (AUC, 0.89 vs 0.90; P = .05).

Conclusion:

Smartphone reading by the cardiac radiologist was superior to the on-call residents' reading. Further study with real-time mobile consultation needs to be investigated to evaluate whether improvement in diagnostic competency can make a difference in the outcome of patients.

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