Diagnostic performance of teleradiology in cervical spine fracture detection

This study was done to assess the diagnostic accuracy of high-resolution (5 lp/mm) teleradiology for detecting cervical spine fractures. Single radiographs from 25 patients with and 25 patients without cervical spine fractures were transmitted between two units of our teleradiology system (Dupont DTR 2000) located 5 miles apart. Each image was examined by four readers. Fracture detection accuracy was assessed by generating receiver operating characteristic (ROC) curves and comparing the areas under each reader's curves for original and transmitted images. Two readers had statistically significant better fracture detection using nontransmitted images, whereas two had no significant differences in accuracy. The authors conclude that high resolution in and of itself is not adequate for fracture detection, and that issues concerning image contrast manipulation also will have to be addressed before teleradiology systems can be used for clinical cervical spine fracture screening.