O'Sullivan D C, Averch T D, Cadeddu J A, Moore R G, Beser N, Breitenbach C, Khazan R, Kavoussi L R
Brady Urological Institute, and Department of Radiology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA.
J Urol. 1997 Dec;158(6):2216-20. doi: 10.1016/s0022-5347(01)68202-8.
Teleradiology systems are now being evaluated as a mechanism to provide rapid, accurate and cost-effective diagnostic radiographs to off-site physicians. Little data are available on the role and safety of teleradiology in urology. To address these issues a personal computer based system was developed to assess the diagnostic accuracy and ease of use of transmitted digital images when evaluating for urinary calculi.
A total of 100 plain abdominal scout films from excretory urograms performed during acute urological referrals was digitized on a laser scanner. The 10 megabyte files were transferred over public telephone lines and written to compact disks. The images were viewed on a 1280 x 1640 resolution monitor using "Imager-3D" software run on a 133 MHz. pentium personal computer with 32 megabytes of random access memory. Two faculty urologists and 2 urology fellows each looked at 50 original radiographs and 50 digital images. Diagnostic interpretations of the presence and location of calculi were recorded, and confidence in the diagnosis, assessment of image quality and diagnostic difficulty were scored using a numerical scale.
The accuracy for all readers was 86.5% for plain radiographs and 81.5% for digital images (p >0.2). There was no statistical difference between faculty and fellows. Diagnostic accuracy did not differ between plain films and screen images when the results were assessed with respect to image quality, diagnostic difficulty or the reader confidence in the diagnosis (p >0.1). Compared to plain films, more screen images were classified as lower image quality (60 versus 40%) and the diagnostic confidence was lower (low and medium grade 50 versus 35%), although this did not interfere with diagnostic accuracy.
These data imply that a high quality affordable teleradiology system is effective and accurate compared to plain films for assessing urinary calculi.
远程放射学系统目前正作为一种向非现场医生提供快速、准确且具成本效益的诊断性X光片的机制进行评估。关于远程放射学在泌尿外科中的作用和安全性的资料很少。为解决这些问题，开发了一种基于个人计算机的系统，以评估在评估尿路结石时传输的数字图像的诊断准确性和易用性。
在急性泌尿外科转诊期间进行的排泄性尿路造影的100张腹部平片在激光扫描仪上进行数字化处理。10兆字节的文件通过公用电话线传输并写入光盘。使用运行在133兆赫兹奔腾个人计算机上、具有32兆字节随机存取内存的“Imager - 3D”软件，在分辨率为1280×1640的显示器上查看图像。两名泌尿外科教员和两名泌尿外科住院医师分别查看了50张原始X光片和50张数字图像。记录结石存在和位置的诊断解释，并使用数字量表对诊断的信心、图像质量评估和诊断难度进行评分。
所有读者对平片的诊断准确率为86.5%，对数字图像的诊断准确率为81.5%（p>0.2）。教员和住院医师之间无统计学差异。当根据图像质量、诊断难度或读者对诊断的信心评估结果时，平片和屏幕图像之间的诊断准确率没有差异（p>0.1）。与平片相比，更多的屏幕图像被归类为图像质量较低（60%对40%），诊断信心较低（低和中等等级50%对35%），尽管这并不影响诊断准确性。
这些数据表明，与平片相比，高质量且价格合理的远程放射学系统在评估尿路结石方面是有效且准确的。
