Email and instant messaging applications as platforms for remote oral radiology consultation in maxillofacial fractures

Objective: The present study aimed to test the reliability and diagnostic efficacy of the evaluation of radiographs transmitted by email and through instant messaging in the diagnosis of maxillofacial fractures. Study Design: Screening of radiographs of 150 patients by a senior maxillofacial radiologist was performed as the gold standard method for the assessment of fractures by using a workstation monitor. The radiographs were sent to the Gmail accounts of 2 observers, who used their laptop computers to independently evaluate the radiographs for fractures. The same radiographs were sent to the smartphones of the observers via WhatsApp Messenger and were evaluated on the smartphone screens. Intra- and interobserver reliability, sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were calculated. Results: The reliability of the observers’ diagnoses for both modalities ranged from 0.96 to 1.00 compared with the gold standard. Intra- and interobserver reliability ranged from 0.85 to 0.98. Measures of diagnostic efficacy ranged from 93.5% to 100% for images sent by Gmail and from 95.2% to 99.9% for radiographs transmitted through WhatsApp Messenger. Conclusions: The present study demonstrated that email and instant messaging applications can be reliable tools for the assessment of maxillofacial fractures by radiologists located at remote sites.