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Pitfalls in photographing radiological images from computer screens

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Using mobile phones to acquire images in clinical practice enables rapid, collaborative decision making1 and is increasingly common. However, the practice is not completely foolproof, as a recent “near miss” at our institution demonstrates.

A 45-year-old woman presented with spontaneous subarachnoid haemorrhage secondary to a ruptured anterior communicating artery aneurysm. The anterior communicating artery aneurysm and an unruptured left middle cerebral artery aneurysm were clipped via craniotomy and a ventricular drain was inserted. Serial post-operative computed tomography (CT) brain scans showed an evolving infarction in the left middle cerebral artery territory, presumed to be secondary to temporary clipping at surgery, which became fully established after 28 hours. All cerebral vessels were patent, visualised on a post-operative CT angiogram. Elevated intracranial pressure (> 40 mmHg) and neurological fluctuation prompted a repeat CT scan, a photograph of which was taken from a computer screen using a mobile phone (Box, A). This image was sent by the intensive care unit consultant to the mobile phone of the on-call neurosurgeon, who noted apparent extensive bifrontal infarction. The patient was urgently transported to the operating room for decompressive craniectomy; however, on reviewing the scans at a radiology workstation before surgery (Box,…