Diagnostic accuracy of coronary computed tomography angiography as interpreted on a mobile handheld phone device

Objectives: This study assessed the diagnostic performance of coronary computed tomography angiography (CTA) for the detection and exclusion of significant coronary artery stenosis as remotely interpreted on a mobile handheld device with dedicated medical imaging software. Background: Recent advances in technology now permit remote interpretation of medical imaging studies on mobile handheld devices, although the diagnostic performance of this approach is unknown. Methods: We evaluated 102 patients with stable chest pain and both 64-detector row coronary CTA and quantitative invasive coronary angiography. The diagnostic performance of remote coronary CTA interpretation was assessed using a mobile handheld device and employing dedicated software. The coronary CTA studies were examined in an intent-to-diagnose manner for the presence or absence of coronary artery stenosis <50% on a per-artery and per-patient level; results were compared with quantitative invasive coronary angiography. Two blinded imagers independently interpreted coronary CTA studies, with a third imager achieving consensus for discordance. Coronary CTAs were re-interpreted in random order to determine interobserver agreement. Finally, coronary CTAs were evaluated on a dedicated 3-dimensional imaging workstation; results were compared to mobile handheld device findings for intertechnology agreement. Results: The prevalence of significant coronary artery stenosis was 25% (26 of 102) at the per-patient level and 10% (40 of 405) at the per-artery level. Per-patient and per-artery sensitivity, specificity, and positive and negative predictive values were: 100% (26 of 26), 78% (59 of 76), 60% (26 of 43), and 100% (59 of 59), respectively; and 95% (38 of 40), 85% (310 of 365), 41% (38 of 93), and 99% (310 of 312), respectively. At the per-artery level, interobserver, intraobserver, and intertechnology agreement was 0.74, 0.89, and 0.75, respectively (p < 0.01 for all). Conclusions: The interpretation of coronary CTA using a mobile handheld device with dedicated software for medical image evaluation possesses high diagnostic accuracy for detection and exclusion of significant coronary stenosis.