Interobserver Variability of Radiographic Assessment using a Mobile Messaging Application as a Teleconsultation Tool



1 Hand and Upper Extremity Service, Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA, Yawkey Center, USA

2 Department of Surgery and Perioperative Care, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA


Background: To examine whether interobserver reliability, decision-making, and confidence in decision-making in the
treatment of distal radius fractures changes if radiographs are viewed on a messenger application on a mobile phone
compared to a standard DICOM viewer.
Methods: Radiographs of distal radius fractures were presented to surgeons on either a smart phone using a mobile
messenger application or a laptop using a DICOM viewer application. Twenty observers participated: 10 (50%) were
randomly assigned to the DICOM viewer group and 10 (50%) to the mobile messenger group. Each observer was asked
to evaluate the cases and (1) classify the fracture type according to the AO classification, (2) recommend operative or
conservative treatment and (3) rate their confidence about this decision.
Results: There was no significant difference in interobserver reliability for AO classification and recommendation for
surgery for distal radius fractures in both groups. The percentage of recommendation for surgery was significantly
higher in the messenger application group compared to the DICOM viewer group (89% versus 78%, P=0.019) and the
confidence for treatment decision was significantly higher in the mobile messenger group compared to the DICOM viewer
group (8.9 versus 7.9, P=0.026).
Conclusion: Messenger applications on mobile phones could facilitate remote decision-making for patients with distal
radius fractures, but should be used with caution.


Main Subjects