We investigated whether head CT images captured using a mobile phone would be of sufficient quality for neurosurgeons at a level 1 trauma centre to make decisions about whether to transfer patients from referring hospitals. All patients who had been transferred from outside facilities with reported intracranial pathology during 2008 were identified. Two emergency medicine physicians selected 1-3 images from the hospital archive that best represented the pathology described by the radiologist and the medical record. The images were photographed in a darkened room using a smart phone. The mobile phone images and clinical history were reviewed by two neurosurgeons independently. The neurosurgeons rated the adequacy and quality of the images, and indicated whether the images would have changed their transfer decision. Based on clinical data alone, neurosurgeon A would have transferred 64 (73%) patients and neurosurgeon B 39 (44%). After images were provided, A would have transferred 67 (76%) and B would have transferred 49 (56%). The availability of the images significantly altered the transfer decision by A in 25 cases (28%) (P = 0.024) and by B in 28 cases (32%) (P < 0.001). The level of agreement between the two neurosurgeons significantly increased from 53% (kappa = 0.11) to 75% (kappa = 0.47) (P < 0.001). Mobile-phone images of CT scans appear to provide adequate images for triaging patients and helping with transfer decisions of neurosurgical cases.