MOBILE MULTIMEDIA MESSAGING SERVICE TELERADIOLOGY- IN OTORHINOLARYNGOLOGICAL EMERGENCIES

Introduction: The diagnosis of many otolaryngological emergencies is based on radiological investigations like x-rays and CT-Scans. The reliability of the mobile phone digital images of emergency radiological investigations send via multi- media messaging, a cheap and rapid modality for telemedicine, has not been explored for otolaryngological emergencies in India. The present study is probably the first of its kind in the field of otolaryngology in India, being undertaken for benefit as a tool for medical communication, especially for consultation by the resident doctors in situations where specialists are not immediately available.

Methods: The study was conducted over an 18 month period in 125 consecutive patients attending otolaryngology emergency with conditions like faciomaxillary trauma, foreign bodies and infective emergencies where radiology[X-ray/ Computed Tomography (CT-Scan)/Magnetic Resonance Imaging (MRI)]was needed for diagnosis. The digital images of all the radiographs viewed on an illuminated view box in Ear Nose and Throat (ENT) emergency were clicked by one resident doctor by a cell phone with camera equipped with multimedia message service (MMS) under a constant environment. These were collectively sent via MMS to another phone of the same make and model. The study was a blinded one to avoid observer bias. The cell phone digital images (index test) were then compared with reporting of the actual radiograph films viewed on a view box (reference standard) with regards to their diagnostic accuracy. Presence of a radiological sign was coded as 1 and its absence as 0. Sensitivity, specificity, positive and negative predictive values were determined for each modality of imaging.

Results: MMS has a diagnostic accuracy comparable to the actual radiographs (X-rays, CT-Scans, MRI) viewed on a view box for most of the otolaryngological emergencies except undisplaced fracture of nasal bones and surgical emphysema where the results were dependent on the technique of clicking the image and the resolution of the camera.

Conclusion: MMS teleradiology can be incorporated as ahandy and readily available communication tool for handling otolaryngological emergencies as it would enhance the confidence in remote decision making and improve patient care in emergency settings.