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PubMed1999

Interactive volume visualizations for synchronous and asynchronous remote collaboration.

The value of information acquisition is not simply to acquire data at increased precision, but to make these data both available and usable to as many specialists as possible. We have developed a working prototype for intuitive realtime interaction over the Internet. Current scenarios include use by expert head and neck surgeons, for use in preoperative assessment of head and neck cancers, and remote synchronous collaboration scenarios such as expert-expert and expert-referring physician. This prototype demonstrates a shared virtual environment that allows multiple users to interactively manipulate large volumetric data sets across long distances. The system is easily extensible to many other applications that utilize discrete data sampling and thus is readily extensible to a wide range of scientific investigations.

Head and Neck Neoplasms↗
PubMed1999

Multiresolution browsing of pathology images using wavelets.

Digitized pathology images typically have very high resolution, making it difficult to display in their entirety on the computer screen and inefficient to transmit over the network for educational purposes. Progressive zooming of pathology images is desirable despite the availability of inexpensive networking bandwidth. An efficient progressive image resolution refining system for on-line distribution of pathology image using wavelets has been developed and is discussed in this paper. The system is practical for real-world applications, pre-processing and coding each 24-bit image of size 2400 x 3600 within 40 seconds on a Pentium II PC. The transmission process is in real-time. Besides its exceptional speed, the algorithm has high flexibility. The server encodes the original pathology images without loss. Based on the image request from a client, the server dynamically generates and sends out the part of the image at the requested scale and quality requirement. The algorithm is expandable for medical image databases such as PACS.

Algorithms↗
PubMed2000

[Telemedicine: perspectives and multidisciplinary approach].

BACKGROUND: Telemedicine is use of the new computer-based communication technologies for medical purposes. It augments the exchange of scientific information, while its applications in the fields of patient care and medical education cover remote diagnosis and therapy as well as remote education and training. METHOD: This article reviews the development of telemedicine and its application to specialties such as anaesthesiology, dermatology, medicine, surgery and pathology at the University Hospital of Basle, Switzerland. RESULTS: Since 1980 the Department of Medicine has held multidisciplinary teleconferences for expert consultation and medical education. Since 1992 the Institute of Pathology has been linked to remote hospitals for real-time biopsy, and, since 1997, remote dermato-histopathological diagnosis has been performed in conjunction with a number of centres and practitioners. International academic teleconferences have been held in the field of surgery since 1986 and there is an interactive education programme via telemedicine in the field of anaesthesiology. The technology in use must be adapted to needs: since few practitioners are currently connected to the Internet, teleconferencing will still be the rule in the Department of Medicine. Remote diagnosis in dermatology and pathology requires high-resolution images transmitted by self-developed software via 64 Kb/s ISDN connection, while surgery works with ISDN teleconferencing at 384 Kb/s to ensure live transmission of surgical procedures with high-quality images. CONCLUSION: Our practice, based on several hundred cases, suggests that telemedicine is useful in simplifying and expanding access to remote interdisciplinary expertise, as well as improving medical education in a number of specialties. Telemedicine's multidisciplinary approach is to be recommended.

Humans↗
PubMed2000

Methods and limits of digital image compression of retinal images for telemedicine.

PURPOSE: To investigate image compression of digital retinal images and the effect of various levels of compression on the quality of the images. METHODS: JPEG (Joint Photographic Experts Group) and Wavelet image compression techniques were applied in five different levels to 11 eyes with subtle retinal abnormalities and to 4 normal eyes. Image quality was assessed by four different methods: calculation of the root mean square (RMS) error between the original and compressed image, determining the level of arteriole branching, identification of retinal abnormalities by experienced observers, and a subjective assessment of overall image quality. To verify the techniques used and findings, a second set of retinal images was assessed by calculation of RMS error and overall image quality. RESULTS: Plots and tabulations of the data as a function of the final image size showed that when the original image size of 1.5 MB was reduced to 29 KB using JPEG compression, there was no serious degradation in quality. The smallest Wavelet compressed images in this study (15 KB) were generally still of acceptable quality. CONCLUSIONS: For situations where digital image transmission time and costs should be minimized, Wavelet image compression to 15 KB is recommended, although there is a slight cost of computational time. Where computational time should be minimized, and to remain compatible with other imaging systems, the use of JPEG compression to 29 KB is an excellent alternative.

Humans↗
PubMed1999

Telediagnosis of oral disease.

Computers have increasingly found application in dentistry over the past 15 years, but at present there has been no investigation of the application of the Internet for distance diagnosis purposes in oral medicine. As a consequence, the objective of this article was to determine the acceptability to patient and clinician of the distant diagnosis of common orofacial diseases using the Internet. The study group comprised 20 patients who attended the Oral Medicine unit of the Eastman Dental Institute and Hospital, London, UK, for the diagnosis and management of oral mucosal diseases. Digital images of each patient's oral mucosal lesion were captured and stored on a personal computer and later transmitted via the Internet to a distant site. Patients were asked to complete a self-administered questionnaire detailing their opinion of the use of an intra-oral camera and a group of clinicians were asked to compare and contrast the original and transmitted images. The majority of patients found the procedure of recording images of their mouth very comfortable, were happy to view the inside of their mouths, and found the procedure generally useful in understanding their clinical problem. The clinicians were often not able to differentiate between the original and transmitted image but were able to accurately diagnose the patient's oral mucosal problems in 64% of the instances. The results of the present study suggest that telediagnosis of orofacial disease may be a feasible prospect.

Adult↗
PubMed2000

Ophthalmology.

Explore the source record for details and available documents.

Diabetic Retinopathy↗
PubMed2000

[Will the use of still image electronic referrals save costs?].

BACKGROUND: The use of still images in an electronic referral makes it possible for patients with uncomplicated skin disorders to receive treatment at their local health clinic by their own physician. The aim of this study was to analyse whether investing in technology to forward still images via telemedicine is cost-effective and to assess how many municipalities in the counties of Troms and Finnmark that have a sufficient workload to reach this requirement. MATERIAL AND METHODS: The additional costs of using still images were compared to patient travel costs to the University Hospital of Tromsø. RESULTS: The results showed that whether the use of still image telemedicine is cost-effective or not, depends on distance and annual workload. Given the assumption in this study, 18 out of 44 municipalities have a sufficient number of patients with a dermatological problem to make telemedicine cost-effective. INTERPRETATION: Less than half of the municipalities in the two northernmost counties have an efficiency potential in using still images. However, telemedicine may be justified because it save time for patients and it increases equal access to care.

Cold Climate↗
PubMed2000

[Teledermatology--experiences from Northern Norway].

BACKGROUND: Distant diagnosing by two-way interactive motion video (videoconference) appeared in the 1980s, the last four years with weekly teleconsultations to Hammerfest and Kirkenes. MATERIAL AND METHODS: Patients are mostly referred from general practitioners. A physician with a 20% position is responsible for organising the videoconferences and participates in the consultation. A close-up camera is used for detailed examination of skin lesions. Photographs of skin areas may be transmitted directly to the specialist screen (still images). The studio physician writes prescriptions and sick leave notes. The specialist writes a reply to the referring physician. Referrals using still images are as yet at a pilot stage. RESULTS: Patients view early diagnosis, time saved, reduced costs, and less need for leave from work as important advantages with videoconferences. Patient satisfaction is high, although 10% are dissatisfied. Having a physician in the studio makes patients feel safer, and they understand the specialist better. This is a new role for the specialist; the doctor/patient relationship is often taken care of by the studio physician. Comparisons between videoconference and face-to-face consultations have shown up to 90% diagnostic agreement. A pilot study using still image referrals showed similar results. INTERPRETATION: Videoconferences are well suited in everyday dermatology, when follow-up by specialist is necessary, and for patients in regular treatment at local clinics for skin disease. Still image referral seems promising. The studio physician's diagnostic abilities are enhanced. Many patients are not suited for teleconsultation, but telemedical solutions will have a role in the years to come.

Cost Savings↗
PubMed2000

Determining the feasibility of diagnosing meningiomas using static teleneuropathy images transmitted electronically.

The feasibility of using still images sent via the Internet for remote neuropathological consultation was examined. We assessed the diagnostic agreement between three groups of neuropathologists and a reference laboratory. All groups independently evaluated pictorial data exchanged by e-mail or ftp server. In the group of benign meningothelial meningioma agreement was reached in 100%, 100%, 92% of cases. In three cases of malignant meningioma agreement was achieved in 100%, 33%, 33% of cases, and in ten cases of atypical meningioma agreement was achieved in 50%, 30%, 40% of cases. Average concordance for all three groups was 83.33%, 54.33%, 57.67%. Our experiment showed that there were no discrepancies in the typical cases of benign meningothelial meningiomas. Disagreement related to the grade II and III lesions i.e. atypical and malignant meningioma. Atypical as well as malignant meningioma seems to need more direct discussion to achieve consensus. The main problem was the subjectivity of the local pathologist who overstated the informational content of the images, and an insufficient number of pictures. This may be prevented in the future by employment of dynamic teleneuropathology using a very high-resolution camera.

Humans↗
PubMed2000

Real-time teleneuropathology for a second opinion of neurooncological cases.

A teleneuropathology system directed by Java programs through a standard Internet browser was evaluated in the present study. Assessment of neurooncological cases was done by remote microscope through the "Case Study" Web page at the Department of Pathology Web site (http:¿ampat.amu.edu.pl). The site was used to control a remote automatic microscope, the Axioplan 2 (Zeiss), which was connected to a computer that acts as an Internet server. The Java program for the control of the microscope server is automatically downloaded and started if the user selects the Web site of the corresponding microscope server. The microscope server receives microscope operation commands from the telemicroscopy clients, executes them, and distributes the new microscope image to all of the connected telemicroscopy clients. Fifteen cases were evaluated over several weeks. The percentage of correctly classified cases sent by remote consultation was 100%. Since the system does not require specialized software for the remote side and since the number of possible discussion partners is unlimited, this system may help to overcome obstacles to the practice of teleneuropathology.

Adenoma↗
PubMed2000

Technological requirements of teleneuropathological systems.

Teleneuropathology is the practice of conducting remote neuropathological examinations with the use of telecommunication links. Because of a limited number of expert neuropathologists, some, especially smaller departments have the equipment to conduct the examination but do not have a specialist who would be able to evaluate material from the central nervous system. In case of teleneuropathology, a neuropathologist examines tissue fragments taken during an operation by means of a telemicroscope connected with the computer through a telecommunications network. It enables the neuropathologist to operate the microscope and camera remotely. Two basic systems exist for performing remote neuropathological examination: static and dynamic. Both have different needs in medical, computing and telecommunication aspect. Depending on the type of service the public telephone network, the integrated services digital network, or optical fibre should be used. Conditionally Internet can be used as a link for teleneuropathological system. However, for the newest developments in teleneuropathology such as teleconference and remote operation on robotized microscope only transmission over the integrated service digital network, which guarantees high speed of transmission gives a possibility to communicate. Because images are basic information element in teleneuropathological systems the high capacity of acquisition, processing, storing, transmission, and visualization equipment is necessary. The farther development of telecommunication as well as standardization of recording and transmission procedures of pictorial data is necessary.

Computer Communication Networks↗