Personal smartphones for neonatal diagnostic imaging: A prospective crossover study

Westberg, Margreta; Vasko, Theresia; Owen, Louise; Bhatia, Risha; Lluch, M. Thió; Donath, Susan; Davis, Peter G; Dawson, Jennifer A

doi:10.1111/jpc.13467

Cited by 7 publications

(8 citation statements)

References 14 publications

(24 reference statements)

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“…Nonetheless, mobile consultations are becoming more and more common in assisting clinical decision‐making 20 . Also, studies show that a digital photo of a CXR on a mobile phone is not inferior to standard modalities 21,22 . In addition, there was no difference in mobile use or screen resolution between study groups (Table 1).…”

Section: Discussionmentioning

confidence: 96%

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The effect of C‐reactive protein on chest X‐ray interpretation: A decision‐making experiment among pediatricians

Barak–Corren

Barak‐Corren

Gileles‐Hillel

et al. 2021

Pediatric Pulmonology

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Introduction: Clinical decision-making is complex and requires the integration of multiple sources of information. Physicians tend to over-rely on objective measures, despite the lack of supportive evidence in many cases. We sought to test if pediatricians over-rely on C-reactive protein (CRP) results when managing a child with suspected pneumonia.Methods: A nationwide decision-making experiment was conducted among 337 pediatricians in Israel. Each participant was presented with two detailed vignettes of a child with suspected pneumonia, each with a chest X-ray (CXR) taken from a reallife case of viral pneumonia. Participants were randomly assigned to one of three groups: Controls-where no lab tests were provided, and two intervention groups where the vignettes also noted a high or a low CRP value, in varying orders.Between-participant and within-participant analyses were conducted to study the effect of CRP on CXR interpretation. The three groups were presented with identical medical history, vital signs, findings on physical examination, blood count, and CXR.Results: Three-hundred and one pediatricians (89.3% of those approached) completed the study. Pediatricians were 60%-90% more likely to diagnose viral pneumonia as bacterial when presented with high CRP levels versus low CRP levels, despite the identical clinical data and CXR (62% vs. 39% and 58% vs. 31% of physicians; p = .002). Accordingly, they were 60%-90% more likely to prescribe antibiotics in these cases (86% vs. 53% and 78% vs. 41% of physicians; p < .001).Conclusions: CRP by itself may modify the way in which pediatricians interpret a CXR, leading to the overprescription of antibiotics.

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Section: Discussionmentioning

confidence: 96%

“…show that a digital photo of a CXR on a mobile phone is not inferior to standard modalities. 21,22 In addition, there was no difference in mobile use or screen resolution between study groups (Table 1).…”

Section: Limitationsmentioning

confidence: 95%

The effect of C‐reactive protein on chest X‐ray interpretation: A decision‐making experiment among pediatricians

Barak–Corren

Barak‐Corren

Gileles‐Hillel

et al. 2021

Pediatric Pulmonology

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show abstract

“…To the best of our knowledge, the clarity and interpretability of chest radiographs transferred via smartphone have not yet been comprehensively validated. We were only able to find one study that addressed this issue in the field of neonatology, but it was limited to the diagnosis of pneumothorax .…”

Section: Discussionmentioning

confidence: 99%

“…However, smartphones and web applications have not yet been recommended for interpreting chest radiographs. A study of the online diagnosis of neonatal pneumothorax showed that neonatal clinicians could interpret chest radiographs viewed on a smartphone or on a computer screen with equal accuracy .…”

Section: Introductionmentioning

confidence: 99%

Questionnaire‐based study showed that neonatal chest radiographs could be reliably interpreted using the WhatsApp messaging application

et al. 2018

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“…However, there can be different resolutions due to differences in digital imaging software and hardware, hence, producing different qualities of digital X-ray films. 8 These variations open an opportunity to explore image enhancement techniques on images of digitized X-ray films. [9][10][11][12][13][14][15] In this paper, we investigate the use of CLAHE image processing techniques as a proof of concept and we validate the output via quantitative metrics and qualitative evaluation by a medical practitioner.…”

Section: Introductionmentioning

confidence: 99%

Enhancement of digitized X-ray films using Contrast-Limited Adaptive Histogram Equalization (CLAHE)

et al. 2021

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Background: Rural clinics still have X-ray facilities that produce physical films, which are sent to the nearest hospital for evaluation. Purchasing digitalization facilities is costly, thus, sending digitized films to the radiologist may be a solution. This can be achieved via digital photo capture. However, there can be different output resolutions that may not be optimized for online diagnosis. This paper investigates if digitized X-ray films can be enhanced using image processing techniques of Contrast-Limited Adaptive Histogram Equalization (CLAHE), Normalized-CLAHE (N-CLAHE) and Min-Max Normalized-CLAHE (MMCLAHE). Methods: We collected and digitized 21 X-ray films with low, medium, and high resolutions and implemented the CLAHE, N-CLAHE and MMCLAHE image enhancement. These methods introduced a limit to clip the histogram of image intensities so as to reduce any noise amplification before file compression with the Fast Fourier Transform (FFT) and Discrete Cosine Transform (DCT). Quantitative metrics of the Peak Signal-to-Noise Ratio (PSNR) and Mean-Squared Error (MSE) were used to compare the accuracies between digitized and processed X-ray films. A qualitative evaluation was performed by a medical practitioner to validate the accuracy of enhanced digitized X-ray. Results: It had been found that both CLAHE and MMCLAHE provided good average PSNR values of 31dB - 32dB and produced low MSE values compared to N-CLAHE. The results of qualitative evaluation attained 89.9% correct diagnosis on nine randomly selected images. Generally, the evaluation indicated that the results fulfill the acceptable criteria for further evaluation and there seemed to be no pathological differences observed. Conclusion: This paper presented a proof of concept on an implementation of the CLAHE technique and its variations on digitized X-ray films. This paper had shown potential improvements with the proposed enhancement methods that may contribute to an increase efficiency in healthcare processes at rural clinics.

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Personal smartphones for neonatal diagnostic imaging: A prospective crossover study

Abstract: Diagnosis of neonatal pneumothorax was as accurate using a smartphone as viewing CXR images displayed on a computer screen when clinicians were presented with X-rays with diagnosis of pneumothorax.

Cited by 7 publications

References 14 publications

The effect of C‐reactive protein on chest X‐ray interpretation: A decision‐making experiment among pediatricians

The effect of C‐reactive protein on chest X‐ray interpretation: A decision‐making experiment among pediatricians

Questionnaire‐based study showed that neonatal chest radiographs could be reliably interpreted using the WhatsApp messaging application

Enhancement of digitized X-ray films using Contrast-Limited Adaptive Histogram Equalization (CLAHE)

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