Background: The latest technological developments in the field of digital medical imaging have facilitated the transfer of the power and utility of the personal computer to mobile computing devices. One of these that have been used in diagnostic imaging is a tablet computer. Mobile tele-radiology using a tablet computer device is an apt extension of imaging services, for after-office-hours consultation. It is crucial to determine the diagnostic accuracy of these portable computer devices in order to determine safety for use in diagnostic image interpretation without compromising patient care. Objective: To find out the diagnostic accuracy of urolithiasis (urinary tract calculi) on an iPad4 tablet as compared to a 2 MP display monitor. Methods: This is a cross-sectional study. It was carried out in the Radiology department at Aga Khan University Hospital -Nairobi (AKUHN). The images of selected CT KUB examinations were anonymised, coded and stored in a PACS folder.The calculated sample size (n) was 115 CT KUB images. These were then reviewed by two radiologists independently on an iPad and on a 2 MP PACS workstation 4 weeks later to minimize recall bias. Data analysis: Study data was recorded by entered into a spreadsheet (Excel, Microsoft Corporation). Analysis was done using the statistical program for social scientists (SPSS) version 17. Two by two tables, were constructed. Diagnostic accuracy (sensitivity and specificity), were calculated from this data. Results: The IPAD tablet showed a sensitivity of 92.3% and specificity of 93.4%. Area under curve (AUC) for the IPAD tablet as compared to the 2 MP display monitor was 0.93 (95% CI 0.87-0.99) showing a very high diagnostic accuracy of iPad tablets. The two display instruments showed a very high degree of agreement of 93% with a kappa statistic of 0.847, p<0.001. Discussion: These findings therefore mean that the iPad 4 has high sensitivity and specificity for the diagnosis of urolithiasis and can be used to view these images. These findings replicate other similar studies Recommendations: This study and many other studies have shown a high sensitivity and specificity of the iPad in the diagnosis of pathology in CT images of the chest, head and abdomen. As such the radiology department should adopt the tablet to enable remote access of images.