The functionality, and reliability of an Internet interface for assessments of endoscopic still images and video clips: distributed research in gastroenterology

Background: Validation studies of medical images are required before the general use of new imaging techniques, and they necessitate a substantial number of observers. Multicenter studies are desirable but the logistic challenges are considerable. Objective: The aim of the present study was to develop and test the functionality and reliability of an Internet interface for distributed evaluation of endoscopic still images and video clips. Design: An Internet site for assessment of endoscopic still images and video clips was developed. To avoid limitations of the bandwidth, a solution was developed to launch and score high-quality video clips on digital video disks (DVDs) from the Internet interface. Setting: Fifty-five observers were enrolled in the randomized, prospective multicenter study of still images. The feasibility study of video clips included 7 observers. Patients: Four patients presenting with various degree of ulcerative colitis, ranging from normal to severe, were included. Main Outcome Measurements: We tested the reliability of the interface by dual-image assessment, as well as the feasibility of Internet assessment of endoscopic images. We physically distributed high-quality DVD video footage. Results: We recorded 2084 assessments of endoscopic still images and 35 assessments of video clips. The reliability of the Internet interface was confirmed by adequate repeatability and intraobserver agreement of the assessments. Video clips running from a DVD were also successfully shown on the Internet interface. Thus, high-quality video may be assessed independently of the Internet bandwidth. Conclusions: The present Internet-based tool is functional, efficient, and reliable for high-volume assessment of endoscopic images and video clips.