Table 1.

Summary List of Empirical Evidence in Teleradiology: Intermediate Outcomes

REFERENCE	YEAR	COUNTRY	STUDY DESIGN	SAMPLE SIZE	MODALITY/INVERVENTION	FINDINGS	COMMENTS
Cone et al.107	2005	Ecuador	Comparative analysis: Observational	196	Digital camera CT and US	>90% agreement in CT; 56% in US	Higher agreement in CT than US
Eze et al.108	2005	United Kingdom	Prospective case control	154	Mobile phone/ENT	100% agreement	More confidence in X-ray box
Muller et al.109	2005	Germany	RCT	1,080	Centralized network for oncology review	Disease improvement observed: early stage = 49%; intermediate stage = 67%	Participants benefited from program; high RT quality
Leader et al.110	2006	United States	Descriptive/observational	1,003	Multisite mammography	66% agreement in telemammography	Telemammography reduces recall for additional procedures by 50%
Yang et al.111	2006	United States	Observational	3,744	Grid-enabled CAD	Algorithm accuracy of 86.02%	Atypical ductal hyperplasia had the highest false-positive rates
Javadi et al.112	2006	Thailand	Comparative analysis: observational	192	Digital camera/pneumonia surveillance	Digital camera: sensitivity = 89%; specificity = 75%; digitizer: 90% and 65%	Digital camera did not compromise pneumonia
Tangtrakulwanich et al.113	2006	Thailand	Comparative analysis: observational	150	Digital camera/fracture	Digital camera; sensitivity = 90%, specificity 80.1%	Digital camera cost $965 vs. $3000 for digitizer
Nitrosi et al.115	2007	Italy	Observational	180,000	Digital radiology	Productivity ↑12%; turnaround time ↓60%; imaging procedures ↑7%; Length of stay ↓12%	Waiting time for outpatients ↓90 to 40 days for CT and from 90–180 to 30–60 days for US
Wardlaw et al.116	2007	5 Countries	Comparative analysis: observational	207	Internet/ischemic changes	Sensitivity and specificity are comparable	Neuroradiologists saw more early ischemic diagnoses than did stroke physicians
Platts-Mills et al.117	2008	United States	Comparative analysis: observational	787	Teleradiology vs. in-house/CT	Discrepancies observed in 5.8% of interpretations	Only one discrepancy in 550 paired comparisons resulted in adverse event
Kennedy et al.118	2009	United States	Survey and case control	2,266	CT pulmonary angiography	Improvement in number of studies completed in 20 min = 95% vs. 13%; percentage of writing interpretations improved from 51% to 62%	Significant process improvements in interpreting inpatient imaging
Duka et al.119	2009	Serbia	Comparative analysis: Observational	432	Camera for radiography in impacted molars	Sensitivity = 99%; specificity = 99%	Diagnosis from photographs was equal to real-time assessment
Hurlen et al.121	2010	Norway	Retrospective record review	3,088	Diagnostic imaging	PACS and RIS reduced LOS by 25%	LOS reduced from 5.3 to 3.9 days
Ninos et al.122	2010	Greece	Observational	144	PDA/diagnostic performance	PDA provided rapid, secure, and convenient access	Experts had difficulty diagnosing microcalcification
Lakkis et al.124	2011	Lebanon	RCT	385	SMS/breast cancer screening	Enhanced SMS equivalent	Detailed SMS did not affect mammography intake
Rudat et al.125	2011	Saudi Arabia	Observational	148	Online verification	Setup accuracy the same	Daily online verification recommended
Shaligram et al.127	2012	Multiple countries	Retrospective record review	13,288	CT/appendicitis	Readmissions (1.8% vs. 5.13%)	Improved postoperative complications; lower cost
Hohmann et al.128	2012	Switzerland	Observational	1,028	Outsourced radiology	No disagreement = 79%; inconclusive, 4%; 1.3% omission	Outsource radiology supported
John et al.129	2012	Singapore	Comparative analysis: observational	264	IPad vs. workstation	3.4% major discrepancy; 5.6% minor discrepancy	Variability accounted for by interobserver interpretations
Angileri et al.130	2012	Italy	Retrospective record review	733	Remote second opinion	Correct interpretation: 96.5%	Average duration 38 min vs. 160 for in-person
Fruehwald-Pallamar et al.131	2012	Austria	Comparative analysis: observational	200	Teleradiology network	Automatic readout agreement: 90% and 97%	Only 2.5% and 9.5% rated as poor at two institutions
Chang et al.133	2013	Taiwan	Observational	3,770	Online/osteoporosis	Sensitivity = 75%; specificity = 75%	System had high reliability and validity
Puetz et al.134	2013	Germany	Retrospective observational	536	Stroke teleneurology	Discrepant findings 8%, only 1.7% clinically relevant	Interobserver agreement κ = 0.62
Freeman et al.135	2013	United Kingdom	Observational	253	Internet/shoulder injury	Interobserver reliability κ = 0.81	Labeling accuracy higher in educational sites
Franczak et al.136	2014	United States	Retrospective rater analysis	2,000	EHR/CT	Inter-rater reliability = 0.82	EHR necessary for radiology in the ER
Lee et al.137	2014	United States	Observational	444	Osteoporosis screening	Increased treatment from 4.8% to 35.2%	Improved rate of osteoporosis treatment in the VA
Schwartz et al.138	2014	Botswana	Comparative analysis: observational	150	e-consult/dx accuracy	Correct diagnosis in both modalities in 79%	Image quality expected to improve
Lyon et al.139	2015	United States	Retrospective record review	1,445	Telemedicine/referral	Reduce patient referrals in rural areas	One in four trauma patients used to be referred
Jacobs et al.140	2015	The Netherlands	Retrospective record review	806	Teleradiology/fractures	Improved fracture diagnosis from 9 to 2	Reduced unnecessary trips among patients with fractures

CAD, computer-aided detection; CT, computed tomography; EHR, electronic health records; ER, emergency room; US, ultrasound; VA, veterans administration.