Interpretation of remotely downloaded pocket-size cardiac ultrasound images on a web-enabled smartphone

Validation against workstation evaluation

Brian G. Choi, Monica Mukherjee, Praveen Dala, Heather A. Young, Cynthia M. Tracy, Richard J. Katz, Jannet F. Lewis

Research output: Contribution to journalArticle

Abstract

Background: Pocket-size ultrasound has increased echocardiographic portability, but expert point-of-care interpretation may not be readily available. The aim of this study was to test the hypothesis that remote interpretation on a smartphone with dedicated medical imaging software can be as accurate as on a workstation. Methods: Eighty-nine patients in a remote Honduran village underwent echocardiography by a nonexpert using a pocket-size ultrasound device. Images were sent for verification of point-of-care diagnosis to two expert echocardiographers in the United States reading on a workstation. Studies were then anonymized, randomly ordered, and reinterpreted on a smartphone with a dedicated, Health Insurance Portability and Accountability Act-compliant application. Point-of-care diagnosis was considered accurate if any abnormal finding was matched and categorized at the same level of severity (mild, moderate, or severe) by either expert interpretation. Results: The mean age was 54 ± 23 years, and 57% of patients were women. The most common indications for echocardiography were arrhythmia (33%), cardiomyopathy (28%), and syncope (15%). Using the workstation, point-of-care diagnoses were changed in 38% of cases by expert overread (41% left ventricular function correction, 38% valvulopathy correction, 18% poor image quality). Expert interobserver agreement was excellent at 82%, with a Cohen's κ value of 0.82 (95% confidence interval, 0.70-0.94). Intraobserver agreement comparing interpretations on workstations and smartphones was 90%, with a Cohen's κ value of 0.86 (95% confidence interval, 0.76-0.97), signifying excellent intertechnology agreement. Conclusions: Remote expert echocardiographic interpretation can provide backup support to point-of-care diagnosis by nonexperts when read on a dedicated smartphone-based application. Mobile-to-mobile consultation may improve access in previously inaccessible locations to accurate echocardiographic interpretation by experienced cardiologists.

Original languageEnglish (US)
Pages (from-to)1325-1330
Number of pages6
JournalJournal of the American Society of Echocardiography
Volume24
Issue number12
DOIs
StatePublished - Dec 2011
Externally publishedYes

Fingerprint

Point-of-Care Systems
Echocardiography
Confidence Intervals
Health Insurance Portability and Accountability Act
Syncope
Diagnostic Imaging
Cardiomyopathies
Left Ventricular Function
Cardiac Arrhythmias
Reading
Referral and Consultation
Software
Smartphone
Equipment and Supplies

Keywords

  • Echocardiography
  • Pocket-size ultrasound
  • Telemedicine

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Interpretation of remotely downloaded pocket-size cardiac ultrasound images on a web-enabled smartphone : Validation against workstation evaluation. / Choi, Brian G.; Mukherjee, Monica; Dala, Praveen; Young, Heather A.; Tracy, Cynthia M.; Katz, Richard J.; Lewis, Jannet F.

In: Journal of the American Society of Echocardiography, Vol. 24, No. 12, 12.2011, p. 1325-1330.

Research output: Contribution to journalArticle

Choi, Brian G. ; Mukherjee, Monica ; Dala, Praveen ; Young, Heather A. ; Tracy, Cynthia M. ; Katz, Richard J. ; Lewis, Jannet F. / Interpretation of remotely downloaded pocket-size cardiac ultrasound images on a web-enabled smartphone : Validation against workstation evaluation. In: Journal of the American Society of Echocardiography. 2011 ; Vol. 24, No. 12. pp. 1325-1330.
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