Smartphones for evaluation of computerized tomography scan of patients with suspected skull fractures and intracranial hemorrhage in emergency medicine



Smartphone, Computerized tomography, Intracranial hemorrhages, Emergency medicine, Telemedicine, Teleradiology


Background/Aim: It is generally not probable to employ a radiologist or an experienced physician for interpreting radiological images at emergency services. The importance of telemedicine has grown, especially during the coronavirus 2019 pandemic. There are a few studies on cranial tomography image transfer and correct evaluation rate with smartphones in the literature. This study aims to evaluate the effectiveness of smartphones for diagnosing mortal pathologies such as skull fractures and intracranial hemorrhages compared to the original images on LED displays of radiology terminals. Methods: This methodological study was designed to validate smartphones' usefulness in assessing cranial computerized tomography scans in emergency cases. Four sets of CT scans, each containing 10 case samples in four diagnostic groups, subarachnoid hemorrhage, subdural hemorrhage, epidural hemorrhage, and bone fractures, and a set of 10 non-pathological CT scans were evaluated first on 6.1-inches smartphone display for 1 minute, and then on the 17-inches LED display again for 1 minute. The internal camera of the smartphone was used to capture the image before assessments. Results: A total of 12 neurosurgeons evaluated 50 CT scan images both on smartphones and LED displays. The overall accuracy between both methods ranged between 80%-100% for subarachnoid and epidural hemorrhage and bone fractures, and between 90%-100% for subarachnoid hemorrhage and non-pathological CT scans. The individual kappa coefficients of neurosurgeons ranged between 0.725 to 1.0 (P<0.001). Conclusion: The overall accuracy of smartphone CT readings with computer LED displays was satisfactory. Our results showed that smartphones are useful for rapid communication between neurosurgeons and emergency department doctors, contributing to timely and accurate patient management in emergency situations.


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Van Asch CJ, Luitse MJ, Rinkel GJ, van der Tweel I, Algra A, Klijn CJ. Incidence, case fatality, and functional outcome of intracerebral haemorrhage over time, according to age, sex, and ethnic origin: a systematic review and meta-analysis. Lancet Neurol. 2010 Feb;9(2):167-76. doi: 10.1016/S1474-4422(09)70340-0. Epub 2010 Jan 5. PMID: 20056489.

Heit JJ, Iv M, Wintermark M. Imaging of Intracranial Hemorrhage. J Stroke. 2017 Jan;19(1):11-27. doi: 10.5853/jos.2016.00563. Epub 2016 Dec 12. PMID: 28030895; PMCID: PMC5307932.

Daneshvar DH, McKee AC. Traumatic Brain Injury. Neurobiology of Brain Disorders 2015. p. 219-235. doi: 10.1016/B978-0-12-398270-4.00016-1

Chakraborty S, Skolnick BE, Alves WM, Marshall LF, Narayan RK. Traumatic Brain Injury. Handbook of Neuroemergency Clinical Trials 2018. p. 85-109. doi: 10.1016/B978-0-12-804064-5.00005-9

Ouellet M-C, Beaulieu-Bonneau S, Morin CM. Traumatic Brain Injury. Handbook of Sleep Disorders in Medical Conditions 2019. p. 221-252.

Rincon S, Gupta R, Ptak T. Imaging of head trauma. Neuroimaging Part I. Handbook of Clinical Neurology 2016. p. 447-477.

World Health Organization. mHealth - New horizons for health through mobile technologies. 2011. accessable on:

Naqvi GA, Daly M, Dawood A, Kurkuri A, Kutty S. Smart consultation for musculoskeletal trauma: accuracy of using smart phones for fracture diagnosis. Surgeon. 2014 Feb;12(1):32-4. doi: 10.1016/j.surge.2013.09.001. Epub 2013 Oct 3. PMID: 24090680.

Tennant JN, Shankar V, Dirschl DR. Reliability and validity of a mobile phone for radiographic assessment of ankle injuries: a randomized inter- and intraobserver agreement study. Foot Ankle Int. 2013 Feb;34(2):228-33. doi: 10.1177/1071100712466849. Epub 2013 Jan 11. PMID: 23413062.

Ferrero A, Garavaglia G, Gehri R, Maenza F, Petri GJ, Fusetti C. Analysis of the inter- and intra-observer agreement in radiographic evaluation of wrist fractures using the multimedia messaging service. Hand (N Y). 2011 Dec;6(4):384-9. doi: 10.1007/s11552-011-9362-4. Epub 2011 Sep 23. PMID: 23204964; PMCID: PMC3213258.

Eranki V, Munt J, Lim MJ, Atkinson R. Consultation of orthopaedics cases using multimedia messaging services. Open Orthop J. 2010 Apr 23;4:164-8. doi: 10.2174/1874325001004010164. PMID: 21249168; PMCID: PMC3023093.

Chandhanayingyong C, Tangtrakulwanich B, Kiriratnikom T. Teleconsultation for emergency orthopaedic patients using the multimedia messaging service via mobile phones. J Telemed Telecare. 2007;13(4):193-6. doi: 10.1258/135763307780908049. PMID: 17565775.

Yang XJ, Wei W, Zhang Y, Wang YN, Zhang N, Li TQ, et al. What Is the Best Way for Patients to Take Photographs of Medical Images (Radiographs, CT, and MRI) Using a Smartphone? Clin Orthop Relat Res. 2021 Oct 1;479(10):2228-2235. doi: 10.1097/CORR.0000000000001731. PMID: 33787525; PMCID: PMC8445547.

Vandenbroucke JP, von Elm E, Altman DG, Gøtzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Epidemiology 2007;18(6):805-35

Paryavi E, Schwartz BS, Meyer CL, Herman MJ, Abzug JM. Reliability and Effectiveness of Smartphone Technology for the Diagnosis and Treatment Planning of Pediatric Elbow Trauma. J Pediatr Orthop. 2016 Jul-Aug;36(5):483-7. doi: 10.1097/BPO.0000000000000477. PMID: 25851688.

Stahl I, Katsman A, Zaidman M, Keshet D, Sigal A, Eidelman M. Reliability of Smartphone-Based Instant Messaging Application for Diagnosis, Classification, and Decision-making in Pediatric Orthopedic Trauma. Pediatr Emerg Care. 2019 Jun;35(6):403-406. doi: 10.1097/PEC.0000000000001211. PMID: 28697157.

Giordano V, Koch HA, Mendes CH, Bergamin A, de Souza FS, do Amaral NP. WhatsApp Messenger is useful and reproducible in the assessment of tibial plateau fractures: inter- and intra-observer agreement study. Int J Med Inform. 2015 Feb;84(2):141-8. doi: 10.1016/j.ijmedinf.2014.11.002. Epub 2014 Nov 11. PMID: 25468642.

Yamamoto LG, Williams DR. A demonstration of instant pocket wireless CT teleradiology to facilitate stat neurosurgical consultation and future telemedicine implications. Am J Emerg Med. 2000 Jul;18(4):423-6. doi: 10.1053/ajem.2000.6316. PMID: 10919531.

Yaghmai V, Kuppuswami S, Berlin JW, Salehi SA. Evaluation of personal digital assistants as an interpretation medium for computed tomography of patients with intracranial injury. Emerg Radiol. 2003 Oct;10(2):87-9. doi: 10.1007/s10140-003-0300-9. Epub 2003 Aug 22. PMID: 15290513.

Sakai K, Komatsu T, Iguchi Y, Takao H, Ishibashi T, Murayama Y. Reliability of Smartphone for Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Scores in Acute Ischemic Stroke Patients: Diagnostic Test Accuracy Study. J Med Internet Res. 2020 Jun 9;22(6):e15893. doi: 10.2196/15893. PMID: 32515744; PMCID: PMC7312257.

Waran V, Bahuri NF, Narayanan V, Ganesan D, Kadir KA. Video clip transfer of radiological images using a mobile telephone in emergency neurosurgical consultations (3G Multi-Media Messaging Service). Br J Neurosurg. 2012 Apr;26(2):199-201. doi: 10.3109/02688697.2011.605482. Epub 2011 Oct 4. PMID: 21970777.

Shivapathasundram G, Heckelmann M, Sheridan M. Using smart phone video to supplement communication of radiology imaging in a neurosurgical unit: technical note. Neurol Res. 2012 Apr;34(3):318-20. doi: 10.1179/1743132812Y.0000000006. Epub 2012 Mar 12. PMID: 22449291.

Park JH, Kim YK, Kim B, Kim J, Kwon H, Kim K, et al. Diagnostic performance of smartphone reading of the coronary CT angiography in patients with acute chest pain at ED. Am J Emerg Med. 2016 Sep;34(9):1794-8. doi: 10.1016/j.ajem.2016.06.009. Epub 2016 Jun 7. PMID: 27396538.






Research Article

How to Cite

Aldinc H, Gun C. Smartphones for evaluation of computerized tomography scan of patients with suspected skull fractures and intracranial hemorrhage in emergency medicine. J Surg Med [Internet]. 2021 Dec. 1 [cited 2023 Feb. 9];5(12):1206-9. Available from: