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At least 433 records · Page 24Linked to original sources
PubMed1998

Reliability of telemedicine in evaluating skin tumors.

OBJECTIVES: To determine the reliability of videoconferencing technology in evaluating skin tumors, the impact of the technology on the clinicians' degree of suspicion that a skin tumor is malignant, and the recommendation to do a biopsy. MATERIALS AND METHODS: Four skin cancer screenings were conducted at rural health care facilities in eastern North Carolina that were connected to East Carolina University School of Medicine. A dermatologist saw the patients in person at the local facility, and the same patient was seen by a dermatologist via a T-1 connection to Greenville, North Carolina. RESULTS: The two physicians were in absolute agreement on 59% of the 107 skin tumors evaluated. There were five lesions identified by the on-site dermatologist as a probable or definite malignancy. The degree of concern about a lesion being malignant and the decision whether to do a biopsy were not significantly different, as shown by kappa analysis. CONCLUSION: The concern about the malignancy of a particular skin lesion and the recommendation whether to do a biopsy were not significantly affected by telemedicine technology.

Adult↗
PubMed2004

Is JPEG compression of videomicroscopic images compatible with telediagnosis? Comparison between diagnostic performance and pattern recognition on uncompressed TIFF images and JPEG compressed ones.

Early melanoma diagnosis is an important goal for dermatologists. Polarized light systems are increasingly employed for dermatoscopic diagnosis of melanocytic lesions. For the purpose of teledermoscopy, whose importance is increasingly growing for consultation and teaching purposes, it is of utmost importance to establish whether, after compression, polarized light images maintain their informativeness. The aim of our study was to check the effects of compression on melanocytic lesion images acquired by means of a digital videomicroscope on the identification of morphological details of the image and on diagnostic accuracy. A total of 170 50-fold-magnified pigmented skin lesion images, acquired in Tagged Image File Format (TIFF) by a digital videomicroscope, were compressed using Joint Photographic Experts Group (JPEG) algorithms (compression factor 30). Two experts in videomicroscopy evaluated both original and compressed images twice by describing single lesion features and expressing a diagnosis. Reproducibility in the assessment of dermoscopic parameters and observer performance were studied by kappa statistics and Receiver Operating Characteristic (ROC) analysis. Both intra- and interobserver reproducibility in the assessment of morphological details were higher when TIFF images were considered, indicating a better image quality. Nonetheless, there was no significant difference in the diagnostic accuracy between uncompressed images and compressed ones, although the intraobserver reproducibility in the diagnostic judgement was higher for uncompressed images. Despite loss in image details, factor 30 compressed videomicroscopic images enable a good diagnostic accuracy.

Algorithms↗
PubMed1996

Telecytology: diagnostic accuracy in cervical-vaginal smears.

Although cervical-vaginal telecytology is a promising tool, diagnostic accuracy has not been extensively evaluated. The authors examined the accuracy of five cytotechnologists who retrospectively reviewed 50 cervical-vaginal smears using the video monitor, and 2 months later, using the light microscope. Accuracy was expressed in terms of crude agreement with the original diagnosis and number of false positives (FPs) and false negatives (FNs). With a greater than one step difference as discrepant, the group crude agreement using the video monitor and the light microscope was 85.6% and 95.6%, respectively. The group number of FNs and FPs for the light microscope was 8 and 7, respectively, and for the video monitor was 34 and 7, respectively. There was a wide range of individual performance. We conclude that accuracy of telecytology is high, but less than that of light microscopy. The major reason for lower telecytologic accuracy was undercalling dysplasia.

Cytodiagnosis↗
PubMed2003

A practical method for the remote control of the scanning electron microscope.

We have developed a remote control system for the scanning electron microscope (SEM). It is called Web-SEM and can be accessed by anyone through the Web browser. It is not necessary to install special software to control the SEM. Because the operating performance changes with the amount of traffic on the Internet, we have connected the Web-SEM to a LAN/Internet in order to overcome this. We have checked the performance of the remote control operation and we were able to perform focus adjustment, stage movement, etc. over the Internet by improving the method of operation and image transfer.

Data Display↗
PubMed2003

Use of Joslin Vision Network digital-video nonmydriatic retinal imaging to assess diabetic retinopathy in a clinical program.

PURPOSE: To incorporate a nonmydriatic, digital-video retinal imaging system into a Diabetes Outpatient Intensive Treatment Program and to evaluate the system's ability to assess diabetic retinopathy (DR), determine follow-up, and appropriately refer to retinal specialist ophthalmologists. METHODS: Fundus images were obtained according to Joslin Vision Network (JVN) protocol and evaluated by certified JVN readers. Patients with significant retinal disease underwent evaluation by retinal specialists. RESULTS: A total of 268 (51.0%) of 525 imaged patients had comprehensive eye examination by a retinal specialist owing to referable JVN-assessed clinical level of DR, nondiabetic ocular disease, ungradeable images, last eye examination >/=12 months prior, or patient request for examination. JVN diagnosis of a clinical level of DR agreed exactly with clinical findings in 388 eyes (72.5%) or within one level in 478 eyes (89.3%). JVN referral based on most severe diagnosis in either eye matched retinal specialist-recommended follow-up in 248/268 of patients (92.5%). A total of 136/525 (25.9%) of JVN patients had nondiabetic ocular abnormalities requiring referral. CONCLUSIONS: Recommended follow-up from JVN imaging compared favorably to clinical examination by a retinal specialist. Nondiabetic ocular pathology was identified. JVN assessment of DR level compares favorably to clinical practice, potentially improving access to eye care and enhancing diabetes management.

Adolescent↗
PubMedDate not supplied

Teleassessment compared with live assessment of pressure ulcers in a wound clinic: a pilot study.

OBJECTIVE: To compare teleassessment of pressure ulcers in individuals with spinal cord injury in a simulated remote setting with in-person assessments in a wound clinic. DESIGN: Pressure ulcers were assessed using a 3-megapixel digital camera; images of each ulcer were forwarded to a laptop in a separate room. Nurses completed a medical history and wound database form. A plastic surgeon reviewed the images and database and completed a questionnaire concerning the "remote" teleassessment or teleconsultation. When needed, the plastic surgeon obtained additional information using live audio-video interaction with the participant or nurse. After the teleassessment was completed, the plastic surgeon then assessed the individual and wound live and completed the same questionnaire used for the teleassessment. SETTING: Wound clinic of a rehabilitation hospital. PARTICIPANTS: Individuals with a spinal cord injury and 1 or more pressure ulcers who were seen for initial or follow-up evaluations. MAIN OUTCOME MEASURES: Percentage of agreement for teleassessment versus live responses to 4 yes/no questions regarding the need to change wound management, satisfaction with teleassessment, need for referral, and need for additional information. MAIN RESULTS: Seventeen individuals with 20 wounds were evaluated. The total percentage of agreement for teleassessment versus live decisions was 89% (80% to 95%). The highest percentages of agreement were for the need to change wound management and the need for referral (both 95%); the lowest percentages of agreement were for satisfaction with teleassessment for making treatment decisions (85%) and the need to obtain additional information (80%). CONCLUSIONS: Teleassessment of pressure ulcers in individuals with a spinal cord injury using digital images and a standard database compared well with in-person assessment, which is similar to results reported for other pathologic conditions.

Adult↗
PubMed2000

Computer-assisted discrimination among malignant lymphomas and leukemia using immunophenotyping, intelligent image repositories, and telemicroscopy.

The process of discriminating among pathologies involving peripheral blood, bone marrow, and lymph node has traditionally begun with subjective morphological assessment of cellular materials viewed using light microscopy. The subtle visible differences exhibited by some malignant lymphomas and leukemia, however, give rise to a significant number of false negatives during microscopic evaluation by medical technologists. We have developed a distributed, clinical decision support prototype for distinguishing among hematologic malignancies. The system consists of two major components, a distributed telemicroscopy system and an intelligent image repository. The hybrid system enables individuals located at disparate clinical and research sites to engage in interactive consultation and to obtain computer-assisted decision support. Software, written in JAVA, allows primary users to control the specimen stage, objective lens, light levels, and focus of a robotic microscope remotely while a digital representation of the specimen is continuously broadcast to all session participants. Primary user status can be passed as a token. The system features shared graphical pointers, text messaging capability, and automated database management. Search engines for the database allow one to automatically identify and retrieve images, diagnoses, and correlated clinical data of cases from a "gold standard" database which exhibit spectral and spatial profiles which are most similar to a given query image. The system suggests the most likely diagnosis based on majority logic of the retrieved cases. The system was used to discriminate among three lymphoproliferative disorders and healthy cells. The system provided the correct classification in more than 83% of the cases studied. System performance was evaluated using rigorous statistical assessment and by comparison with human observers.

Decision Support Techniques↗
PubMed2003

Design and analysis of a content-based pathology image retrieval system.

A prototype, content-based image retrieval system has been built employing a client/server architecture to access supercomputing power from the physician's desktop. The system retrieves images and their associated annotations from a networked microscopic pathology image database based on content similarity to user supplied query images. Similarity is evaluated based on four image feature types: color histogram, image texture, Fourier coefficients, and wavelet coefficients, using the vector dot product as a distance metric. Current retrieval accuracy varies across pathological categories depending on the number of available training samples and the effectiveness of the feature set. The distance measure of the search algorithm was validated by agglomerative cluster analysis in light of the medical domain knowledge. Results show a correlation between pathological significance and the image document distance value generated by the computer algorithm. This correlation agrees with observed visual similarity. This validation method has an advantage over traditional statistical evaluation methods when sample size is small and where domain knowledge is important. A multi-dimensional scaling analysis shows a low dimensionality nature of the embedded space for the current test set.

Abstracting and Indexing↗
PubMed2005

The use of digital 'virtual slides' in the quality assessment of haematological morphology: results of a pilot exercise involving UK NEQAS(H) participants.

We report the results of a pilot study assessing the use of digital 'virtual slides' in haematological quality assessment. Conducted together with the UK National External Quality Assessment Scheme for General Haematology, the study involved 166 separate participants, using the format of a typical assessment exercise. The results revealed substantial concordance of observations made using digital slides with those reported in previous glass slide surveys that used identical cases. Participant feedback strongly supported the use of electronic slides in teaching and assessment roles. Our results suggest roles for this new electronic resource in external quality assessment (EQA), education and continuing professional development.

Attitude of Health Personnel↗
PubMed1998

Tele-ophthalmic screening using digital imaging devices.

BACKGROUND: Digital imaging systems provide immediate, magnified images that can easily be analysed, enhanced, archived, printed on near photographic-quality paper and transferred electronically to remote computers. We have assembled a digital ophthalmic system and tested it on patients with some common causes of blindness: corneal scarring and cataract, diabetic retinopathy, macular degeneration and glaucoma. METHODS: Digital images were obtained using a variety of ophthalmic imaging devices ranging from slit-lamp, fundus camera, indirect ophthalmoscope and scanning laser ophthalmoscope. These images were compressed in order to concentrate image information (image size reduced by 90-95%) and minimize transmission time (reduced by 97-98%). Standard or mobile telephone lines were used to transmit images to remote terminals. RESULTS/DISCUSSION: Transmission time was reduced from 15-20min to 20-30s and the image size was reduced from 1.3 MB to 20-30 kB by compressing the images before transmission. Image quality is still excellent.

Cataract↗
PubMedDate not supplied

Jumping into the future using teledermoscopy.

BACKGROUND: Teledermoscopy uses telecommunication technologies to transfer images of pigmented skin lesions via the Internet for teleconsultation. DESIGN: Clinical and dermoscopic images of 66 and 43 pigmented skin lesions achieved in two consecutive studies were sent by e-mail to dermatologists with different degrees of experience in dermoscopy for a telediagnosis. All lesions included in these studies were surgically excised and diagnosed histopathologically. RESULTS: The diagnostic concordance between the face-to-face diagnosis and the telediagnosis was 91% in the first study, whereas, in the second study, it varied from 76.7%-95.3%. The accuracy of the diagnoses in both studies was not related to the quality of the images, but did highly depend on the level of diagnostic difficulty of a given pigmented skin tumor and on the level of experience of each observer. CONCLUSIONS: Teleconsultation of dermoscopic images of pigmented skin lesions via e-mail provides a similar degree of diagnostic accuracy as face-to-face diagnosis when the diagnosis is made by a dermatologist confident with dermoscopy.

Dermatology↗