The Feasibility Study for Real-time Remote CT Reading for Suspected Acute Appendicitis Using iPhone

Study Overview
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Brief Summary
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Purpose - The investigators aim to evaluate the feasibility of iPhone based remote control system as a real-time remote CT reading tool for suspected appendicitis under 3G network and the suboptimal illumination. Methods A total of 120 abdominal CT examinations; sixty had no findings of appendicitis, while the other sixty showed signs of acute appendicitis, were selected. The 16 raters reviewed these images using an LCD monitor of the PACS workstation and also an iPhone which was connected to the PACS workstation via remote control system, grading the probability of presence of acute appendicitis on each examination by a five Likert scale. The investigators will compare the diagnostic performance between two devices.

Detailed Description
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The 16 raters were randomly divided into two groups The raters in group one reviewed the CT examinations numbered from one to 60 using LCD monitor and reviewed the remaining CT examinations numbered from 61 to 120 using iPhone with TeamViewer at their first visit The other group firstly reviewed the CT scans numbered from one to 60 using iPhone with TeamViewer and 61 to 120 with the LCD monitor. They visited twice with an interval of four weeks and reviewed the CT scans using revered devices at each session. The raters were instructed to rate the likelihood of the presence or absence of appendicitis in each case using a five-Likert scale (1 = obvious no appendicitis, 2 = unlikely appendicitis, 3 = unsure, 4 = likely appendicitis, 5 = obvious appendicitis).

Official Title
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The Feasibility Study for Remote CT Reading for Suspected Acute Appendicitis Using iPhone With Remote Control System in Realtime Under the Ambient Bright.

Conditions
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Telemedicine

Intervention / Treatment
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* Device: Remote CT reading using the iPhone
* Device: CT reading using LCD monitor


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Board certified emergency physicians with a clinical experience of 5 years and over. Exclusion Criteria: Corrected eyesight < 20/30 Color weakness or blindness

Ages Eligible for Study
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Minimum Age: 33 Years
Maximum Age: 45 Years

Sexes Eligible for Study
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Male

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Basic Science
Allocation: Randomized
Intervention Model: Crossover Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Group I<br>The raters in this group one firstly reviewed the CT scans numbered from one to 60 using LCD monitor and after mandatory rests of 20 minutes, reviewed the remaining CT examinations numbered from 61 to 120 using iPhone with TeamViewer at their first visit. They visited twice with an interval of four weeks and reviewed the CT scans using revered devices at each session. | Device: Remote CT reading using the iPhone<br> <br> * Other names: Smartphone (A1530, iPhone 5S, USA);Device: CT reading using LCD monitor<br> <br> * Other names: LCD monitor (MX210, EIZO, Japan);|
| Experimental: Group II<br>The raters in this group II firstly reviewed the CT scans numbered from one to 60 using iPhone with TeamViewer and 61 to 120 with the LCD monitor. They visited twice with an interval of four weeks and reviewed the CT scans using revered devices at each session. | Device: Remote CT reading using the iPhone<br> <br> * Other names: Smartphone (A1530, iPhone 5S, USA);Device: CT reading using LCD monitor<br> <br> * Other names: LCD monitor (MX210, EIZO, Japan);|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Diagnostic performance between iPhone and LCD monitor | Dorfman-Berbaum-Metz method with RSCORE and semi-parametric estimation of ROC indices by using the DMB-MRMC software (version 2.3, available at http://perception.radiology.uiowa.edu) 95% confidence interval The reviewers and cases are taken as random factors | within one day | 
| Diagnostic accuracy between the iPhone and the LCD monitor | ◆ Sensitivity, specificity gold standard: The pathology report and the results of clinical follow up grade 1, 2 and 3 = negative appendicitis findings grade 4 and 5 = positive appendicitis findings McNemar's test to compare the sensitivity and specificity between the iPhad and the LCD monitor | within one day | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Telemedicine, appendicitis, remote consultation