To evaluate the accuracy of appendicular trauma X-ray interpretation in next-generation Smartphones (including Apple iPhone) compared with gold-standard PACS workstations. 

To assess  interobserver variability between Smartphones and PACS workstation reading modalities.

Two radiology trainees and two consultant musculoskeletal radiologists prospectively evaluated 40 appendicular skeletal trauma radiographs. The set of radiographs were assessed on both the Apple iPhone sent as a file attachment (jpeg) and PACS workstations respectively by all four radiologists, two weeks apart.

Responses were recorded on proformas and assessed against a gold standard which was taken as a consultant opinion obtained on a diagnostic PACS workstation.

Accuracy of radiology trainee reporting using the iPhone was 93%. On the PACS workstation, the accuracy of reporting was 95%.

The accuracy of consultant reporting of the trauma radiographs on the iPhone was 98%. On the PACS workstations which is taken as gold-standard, the accuracy was 100%.

The error in reporting by the consultant team on the iPhone may be attributed to viewing of a subtle abnormality on a reporting screen with a small field-of-view and lack to imaging manipulation function.

Intraobserver variability (Kappa value) between the iPhone and PACS workstations reading modalities on the was 0.8, indicating almost perfect agreement. 

The accuracy of interpretation of appendicular trauma radiographs on the Apple iPhone is high at 93% to  98%.

However, for the radiology trainee, using a PACS workstation for interpretation of radiographs is more useful and reliable.

Smartphones such as the Apple iPhone have a future role in providing a second opinions in appendicular trauma. However, improvements in software and harware technology are vital to facilitate this.