In the case of the elderly and patients with underlying diseases, mortality rate increases. Because there is shortage of emergency physician or radiologist’s real-time consultation in many countries, it is necessary to receive a formal image reading remotely from an expert. We suggested the use of iPad in X-ray reading and compared the diagnostic validity of iPad with that of LCD monitor. Fifty four X-ray cases of rib fracture and 54 cases without rib fracture were randomized and reviewed by 10 emergency physicians.Total of 108 cases were divided 1stto 54th and 55thto 108th. If reviewer interpreted 1stto 54th with iPad, they did 55thto 108th with LCD monitor. Reviewers reported the presence of rib fracture, the number of fractured rib and diagnostic confidence of 5-scale. The interobserver agreement among reviewers in LCD and iPad were 0.551, 0.524 in Fleiss-kappa value. The intraobserver agreement between tools in each reviewers were 0.410-0.859 (0.628±0.150). Reviewers showed sensitivity over 0.810 regardless of the tool; 0.810-0.966(0.879±0.054) in LCD, 0.828- 1.000 (0.898±0.052) in iPad. The specificity was 0.520-0.860 (0.750±0.117) in LCD and 0.560-0.880 (0.708±0.111) in iPad. In our study, there was no statistical difference in the diagnosis of rib fracture by X-ray via iPad or LCD. Therefore, it was possible remote consultation of X-ray by iPad in the ER where specialist, with temporal and spatial limits by iPad.