Advances in handheld computing have created the possibility of viewing full DICOM datasets from a remote location. While this would not be advisable for formal interpretations, it may serve a role for emergent consultations. As the diagnostic ability of this tool is unproven, we sought to evaluate the ability to identify signs of acute appendicitis on abdominal CT studies using an iPhone based DICOM viewer.

25 Abdomen and Pelvis CT studies performed on patients with right lower quadrant pain were identified. All patients had either surgical confirmation of the diagnosis of acute appendicitis or followup clinical evaluation confirming no acute appendicitis. Each study was viewed by five blinded radiologists on a handheld device (iPhone) using a DICOM viewer (OsiriX). Studies were evaluated for the ability to find the appendix, the maximum appendiceal diameter, presence of an appendicolith, periappendicial stranding and fluid, abscess formation, and a binary assessment of the diagnosis of acute appendicitis. Studies were compared to a faculty-read of the study as performed on a dedicated PACS workstation.

15 cases of acute appendicitis were correctly identified on 74 of 75 interpretations (99%), with one false negative. No false positive readings were seen in this study. 8 appendicoliths were correctly identified on 35 of 40 interpretations (88%). 3 abscesses were correctly identified by all five readers. There was greater than 90% agreement on the presence of peri-appendiceal stranding and free fluid. The iPhone measurement of appendiceal diameter averaged 0.9 ± 0.7 mm larger than the value obtained on a PACS workstation (p=0.04).

Evaluation for acute appendicitis on abdominal CT studies using a portable device DICOM viewer can be performed with good concordance to reads performed on PACS workstations. Handheld device measurements of the appendix averaged almost 1 mm larger than measurements on a PACS workstation, suggesting that appedendical diameter should not be used as the sole basis for diagnosis. This technology may be useful for emergent consultations, in particular in an academic setting where on-call faculty physicians may not have immediate access to a computer.

Remote viewing of studies may be feasible for emergent consultation, which may be of particular benefit for subspecialist consultation for on-call residents.