Retrospective imaging evaluation of a cohort of pelvic ring injuries: a qualitative, user-friendly, and cost-effective methodology for transferring large volumes of DICOM data to remote experts, with a survey designed to isolate information obtained

Background: The methodology of a retrospective cohort study designed to evaluate pelvic ring injury radiographic images in three steps is presented: first, computed tomography (CT) alone; second, standard anteroposterior pelvic radiograph with a pelvic binder added; finally, standard anteroposterior pelvic radiograph without a pelvic binder added. The evaluations were performed by various international pelvic experts. Methods: The authors encountered several challenges during the study design, which were addressed through the following methodological strategies: 1) transferring a large volume of anonymized data [specifically DICOM (Digital Imaging and Communication in Medicine) CT images] to remote centers where the experts were located; 2) providing a high-quality DICOM viewer that enabled optimal image analysis, including the creation of multiplanar reconstructions; 3) designing a survey that prevented users from returning to previously completed steps, thereby avoiding potential modifications to initial analyses based on subsequent images; 4) utilizing free software whenever possible to ensure cost-effectiveness. Results: A total of 28 image series were thoroughly evaluated by six experts. No difficulties were reported regarding the reception and analysis of the image series, the installation and use of the DICOM viewer, or access to and completion of the online survey. The overall workflow, including the distribution of image series and the DICOM viewer, the development and distribution of the survey, and the collection of responses, proceeded without complications. The only notable challenge was encouraging timely participation from some experts to complete the analysis. Conclusion: A robust and effective methodology was developed for this study. The use of free software, applications, and online resources allowed the study to be cost-effective. Sharing this methodology may assist other research teams in the design and implementation of future similar studies.