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PubMed2005

Four years' experience of teleconsultations in daily clinical practice.

In the four-year period from 2000, the Department of Informatics and Telemedicine of the Donetsk R&D Institute of Traumatology and Orthopaedics organized 210 teleconsultations. In 91 cases the Institute was the enquiring party and in 119 the consulting one. Teleconsultations were carried out for 137 male and 73 female patients aged between one month and 85 years. A review of the results showed that the reliability of diagnosis of different traumas and diseases made using digital images was 88%. The efficiency of implementing the recommendations provided by remote consultants was 88%. We developed an algorithm to select the most suitable telemedical technique for a clinical situation. We also developed a list of indications for clinical teleconsultation. The optimum equipment for clinical teleconsultations consists of a PC, digital camera, dial-up Internet line and printer. Asynchronous formal and informal Internet-based teleconsultations are most expedient for routine clinical practice, supplemented by realtime teleconsultations where necessary.

Adolescent↗

PubMed1999

Digital images in the diagnosis of wound healing problems.

The use of digital wound images could allow remote consultation among patients, physicians, or other care-givers located at quite distant sites by means of the Internet. To evaluate the efficacy and validity of digital images for the evaluation of wounds, the ability and reliability of surgeons to diagnose and make treatment suggestions using digital images of several types of wounds were compared. Twenty-four wound images on 35-mm slides were selected for use in this study. Each slide image was digitized at 24-bit color with a resolution of 640 pixels horizontal by 425 pixels vertical and stored as a JPEG file. These images were then presented as a slide show on a video monitor, with resolution set at 640 x 480. Six physicians examined the images, first in digital format and later in the original slide form. Each observer assessed each wound and possible treatment options by filling out a questionnaire using a series of yes/no questions. For all observers, there was an 87 percent agreement between digital and slide images (p = 0.004). The agreement between the digital and slide images was measured for each individual observer using a kappa coefficient. The agreement level corresponded to the experience of the observer, with the kappa values ranging from greater than 0.8 (almost perfect agreement) for the attending plastic surgeon to just greater than 0.5 (moderate agreement) for the intern. With this study, the feasibility of distance wound consultation using digital images of a quality consistent with consumer-grade digital photography was demonstrated.

Feasibility Studies↗

PubMed2003

A real time collaboration system for teleradiology consultation.

Real time collaboration systems, in which participants share multimedia data and applications in real time, have attracted many researchers in recent years. A teleradiology consultation system based on the real time collaboration technology is presented in this paper. Under the platform-independence consideration, Java technologies are employed to construct the system. Applying this system, an off-duty on-call radiologist can make diagnoses and report easily by viewing the transferred images at home. Owing to the accessibility of image, all users can examine and manipulate images consistently such that a secluded hospital can be assisted to hold remote consultation. To reduce the network transmission time, the command-passing and local command execution techniques are utilized to achieve the screen synchronization. A pointer function is also developed to maintain the cursor consistency in a more efficient manner during consultation when a detail indication of the examined image is needed. Besides, a dialog window is also designed for on-line conversation. Since Java programs can run on heterogeneous platforms, the need for system maintenance and user training can be substantially reduced.

Internet↗

PubMed2003

Remote sessions and frequency analysis for improved insight into cerebral function during pediatric and neonatal intensive care.

A project involving recording and analysing EEG together with cardiovascular signals and temperature has been initiated. The aim of this project is to establish difficulties and possibilities involved with implementing a system for remote sessions and analysing EEG in correlation with other physiological signals. One objective is to find indicators of cerebral function during postasphyxia neonatal intensive care and pediatric cardiopulmonary bypass surgery with hypothermia. Remote sessions for joint interpretation have been carried out between pediatricians and clinical neurophysiologists, and EEG has been analyzed using frequency analyzing tools. One result is the discovery of reversible spectral changes coinciding with blood pressure falls, which may indicate loss of autoregulation function. This finding is one outcome from initial use of a system, developed during the project to facilitate communication about, and analysis of the recorded signals. Thus, already from a limited number of remote sessions and the use of basic signal processing techniques, important results have been achieved and better insight has been gained of how cerebral function is affected by cardiopulmonary bypass surgery. In this paper, we present our experiences from introducing a system for remote consultations, and evaluate the use for such a system in the current applications.

Algorithms↗

PubMed2000

Combining high-performance computing and networking for advanced 3-D cardiac imaging.

This paper deals with the integration of a powerful parallel computer-based image analysis and visualization system for cardiology into a hospital information system. Further services are remote access to the hospital Web server through an internet network. The visualization system includes dynamic three-dimensional representation of two types of medical images (e.g., magnetic resonance and nuclear medicine) as well as two images in the same modality (e.g., basal versus stress images). A series of software tools for quantitative image analysis developed for supporting diagnosis of cardiac disease are also available, including automated image segmentation and quantitative time evaluation of left ventricular volumes and related indices during cardiac cycle, myocardial mass, and myocardial perfusion indices. The system has been tested both at a specialized cardiologic center and for remote consultation in diagnosis of cardiac disease by using anatomical and perfusion magnetic resonance images.

Cardiac Output↗

PubMed2005

Instant wireless transmission of radiological images using a personal digital assistant phone for emergency teleconsultation.

The instant transmission of radiological images may be important for making rapid clinical decisions about emergency patients. We have examined an instant image transfer system based on a personal digital assistant (PDA) phone with a built-in camera. Images displayed on a picture archiving and communication systems (PACS) monitor can be captured by the camera in the PDA phone directly. Images can then be transmitted from an emergency centre to a remote physician via a wireless high-bandwidth network (CDMA 1 x EVDO). We reviewed the radiological lesions in 10 normal and 10 abnormal cases produced by modalities such as computerized tomography (CT), magnetic resonance (MR) and digital angiography. The images were of 24-bit depth and 1,144 x 880, 1,120 x 840, 1,024 x 768, 800 x 600, 640 x 480 and 320 x 240 pixels. Three neurosurgeons found that for satisfactory remote consultation a minimum size of 640 x 480 pixels was required for CT and MR images and 1,024 x 768 pixels for angiography images. Although higher resolution produced higher clinical satisfaction, it also required more transmission time. At the limited bandwidth employed, higher resolutions could not be justified.

Cell Phone↗

PubMed1997

A remote conference system for image diagnosis on the World-Wide Web.

OBJECTIVE: The World-Wide Web on the Internet enables an exchange of multimedia information among remote desktop computers. Therefore, a teleradiology system using the Web would allow remote consultation with expert radiologists. Our objective was to establish a Web-based prototype system for image interpretation. CONCLUSION: Our system allows a physician to transmit clinically useful images to an expert radiologist at a different location, who can see them on a Web browser and discuss diagnoses with the physician.

Computer Communication Networks↗

PubMedDate not supplied

Digital radiotherapy simulator.

We describe a prototype digital radiotherapy simulator which consists of a conventional simulator gantry, digital spot imager, and image correction and reconstruction software. The ability of the digital spot imager to acquire a diagnostic quality image directly in digital format during simulation offers unique possibilities in clinical practice. Applications include prescription of multileaf collimator, on-line patient setup verification, remote consultation and treatment planning. In addition, we discuss the possibility of using the digital simulator as a volume-CT scanner capable of obtaining three-dimensional anatomical information in a single scan.

Computer Simulation↗

PubMed1995

Design of a cooperative teleradiology system.

The article describes a teleradiology system intended to provide a user-friendly environment for exchanging images and working cooperatively on them. With the development of a hospital-wide picture archiving and communication system (PACS), the University Hospital of Geneva and several other health institutions in the region became interested in teleradiology. Because of the heterogeneous needs of the potential participants, the following requirements were identified: (1) remote consultation and interpretation of images; and (2) cooperative interpretation of medical images, allowing real-time interaction between physicians. To satisfy these needs, a multipoint teleradiology system has been implemented that incorporates an innovative image display and manipulation software program known as OSIRIS, which supports the full spectrum of imaging modalities. Images and data are transmitted over the public telecommunications Integrated Services Digital Network (ISDN). To accommodate different computing environments at the various locations, platform-independent software has been designed that has the same "look and feel" for PC-Windows, Macintosh, and UNIX-X11 work-stations. The teleradiology system can be used in two modes: synchronous (cooperative) or asynchronous. Special efforts have been made in the development of the synchronous mode. Within the European Telemed Project, a specific protocol has been designed to allow cooperative work between remotely located workstations.

Geriatrics↗

PubMed1997

Kaiser Permanente Medical Center's pilot Tele-Home Health Project.

This is an interim report of a Kaiser Home Health Department study of the use of telemedicine technology in the home care setting. We present our study design and some early findings from the first six months of the project. Preliminary findings indicate the technology is dependable, and that average telehealth video visits are cost-effective and are about 60% shorter (18 minutes vs. 45 minutes) than on-site visits, with no decrease in patient satisfaction. The study will be completed in September of 1997. This study was initiated in 1996 to explore improving access to health services while maintaining quality of care, and to demonstrate the cost effectiveness of remote consultation technology in the home health setting. The the study, which began in May 1996, employs a randomized design approved by the Institutional Review Board and will be completed in approximately one year. This project was titled Tele-Home Health to acknowledge that a multi-disciplinary team would be composed mainly of nurse case managers, but would also include physical therapists, speech therapists, occupational therapists, home health aides, licensed

Aged↗

PubMedDate not supplied

Telepathology applications of the Internet multimedia electronic mail.

Telepathology is based on the sharing of medical images coming from the microscope, and comprises different applications: intra-operative telediagnosis, second opinion teleconsultation, reference case archives, remote data and image processing, quality assessment. Since the Internet is available worldwide, it can be of interest to define which of these tasks can be performed by means of some telepathology method based on it. This paper focuses particularly on the use of Internet multimedia electronic mail for exchanging multimedia cases. To test the validity of the proposed approach for transmission of multimedia cases, the first step is to evaluate its diagnostic accuracy. Trials involving the transmission of 299 cases have been carried out between two departments of Pathology in Italy (at the University of Udine and at the City Hospital of Trento, respectively) in order to evaluate the diagnostic accuracy as well as the time needed for acquisition and transmission. First results show that good diagnostic agreement can be reached, but the time needed for transmission, generally low, is not sufficiently affordable to be adopted in those cases where time is important. In particular, telepathology through multimedia e-mail can be adopted for second opinion consultation, remote image processing, quality assessment and continuing education possibly by means of software that integrates acquisition and delivery of cases with HIS functionalities.

Evaluation Studies as Topic↗

PubMed2004

Real-time emergency telemedicine system: prototype design and functional evaluation.

In this paper, an emergency telemedicine system was designed for the transmission of real-time multimedia for remote consultation, including radiological images, patient records, video-conferencing, full-quality video, ECG, BP, respiration, temperature, SpO(2), systolic and diastolic pressures and heart rate. The standardized, modular, software-based design architecture, without resorting to external hardware compression boards, enables the low-cost implementation of the telemedicine system, using the unified, systematic and compact integration of multimedia on general personal computers. Experimental tests on local networks analyze the technical aspects of designed systems, and inter-hospital experiments demonstrate its clinical usefulness.

Computer Systems↗

PubMed2004

[Is transmission of heart murmurs via e-mail cost saving?].

BACKGROUND: The use of pre-recorded heart murmur in an electronic referral for a remote consultation can save children and their parents from having to travel to the nearest out-patient clinic. The heart sound can be recorded by the GP at the local health clinic and sent by e-mail to the specialist. 41 clinics in the North Norway healt region have invested in equipment that makes pre-recorded sound referrals possible. This study analyses whether this investment is a cost-saving technology or not. METHODS: A yearly average of 50 children with a heart murmur are referred to a specialist in Troms. The costs of using pre-recorded telemedicine were compared to the costs of patient travelling to the nearest secondary care centre. RESULTS: Pre-recorded heart sound referrals cost from 216 000 NOK more per year than the alternative of bringing patients to the out-patient clinic. The number of children with a heart murmur needed in order to break even must exceed 195 per year, i.e. 1.7 children per GP per year. INTERPRETATION: The number of children with a heart murmur in Troms is too low for this method to be a cost-saving approach.

Child↗

PubMed2005

[Virtual polyclinic--consultant health service for rural areas and islands].

The development of medical sciences and digital revolution in health care have made possible the creation of new models for hospital care and primary health care. Health care management usually does not follow all possible solutions of new computer technology. Croatian health system is based on large hospital centers in the mainland and small, poorly equipped remote medical units. The possibility of sharing medical information using telematic technologies brings all knowledge of the large, powerful hospital centers close to remote medical units. Working in a small, remote consultation office on the island Cres, the author A. M. became part of medical periphery far from the security of hospital on the mainland. After five years of the work on telemedicine projects for the islands, we have introduced a new medical practice concept of communication between remote medical units and clinical hospital centers in the mainland. The pilot project Virtual Polyclinic-Medical Consultation System for the Islands and Remote Areas is a good example of the possible new models in health care structure. Our experience indicates that organization of health care in remote areas depends not only on advanced technical solutions but also on team work and medical professionals.

Croatia↗

PubMed1998

Spinal cord emergencies: false reassurance from reflexes.

Emergency physicians need to understand the potential for false reassurance in the interpretation of reflex examination data. Neurologic consultation should be sought when classic signs are lacking, but other evidence causes suspicion. Changes in teaching emphasis and acute practice are needed, since the stakes may be high and time is of the essence. We have responded to the insights gained from this study by augmenting in-service and continuing medical education teaching and by implementing guidelines to assist EPs. We have emphasized the importance of spotlighting high-risk patients, as exemplified above, and of taking advantage of neurologic or neurosurgical consultation. Where in-person consultation is less available, the use of guidelines and remote consultation should be able to help direct further examination, diagnostic formulation, and the need for imaging decisions. Given the potential for severe negative outcome if spinal emergencies are not optimally managed, we must give the teaching of these issues high priority.

Adult↗

PubMed2006

Robotic assistant for laparoscopy.

BACKGROUND: With the advent of technologies allowing for wider application of minimally invasive surgeries, the integration of telerobotics for mentoring by a surgeon at a remote site will make it possible to include a wider audience in surgical consultations and collaboration. MATERIALS AND METHODS: Two surgery research fellows performed 8 laparoscopic cholecystectomies each in a swine model, as the animate portion of the study. Using the Zeus robotic system, a senior surgeon participated as a robotic assistant and consulted remotely. Teleconsultation was achieved using Hermes voice-activated software to display an on-screen pointer highlighting significant anatomic structures. To clarify the workspace space constraints on the robotic arms, an inanimate study was conducted to carry out retrieval, delivery, and complex object movement. RESULTS: All the laparoscopic cholecystectomies were completed successfully, with minimal blood loss and no complications. The robotic assistant surgeon participated in all surgeries and instructed on anatomical landmarks. The robotic tools were at a disadvantage due to the radius of movement. The simpler tasks were easier to complete than the complex movement, which required bimanual coordination. CONCLUSION: This study confirms the feasibility of integrating robotics as a surgical assistant and to consult distant audiences by a single senior surgeon. Incorporating remote access assistance and education capacities extends the limits of physical restrictions in completing surgical procedures safely.

Animals↗

PubMed2001

An evaluation of telehealth in the provision of rheumatologic consults to a remote area.

OBJECTIVE: To evaluate the feasibility and acceptability of providing telehealth consultations in rheumatology. METHODS: A prospective review of new consults from a rural area assessed by a rheumatologist in an urban area using telehealth. Patient demographics were recorded along with a self-administered questionnaire reporting assessment of the acceptability of the process. Referring physician and consultant provided open ended feedback as to relative strengths and weaknesses of telehealth versus traditional consult. A simple cost and time benefit analysis was undertaken. RESULTS: The spectrum of patients with rheumatic disease assessed was similar to a traditional consultation clinic. Patients found the overall process to be acceptable and effective. Apart from accessibility to specialist consultation, the greatest benefit was improved communication among patient, referring physician, and consultant. The process was determined to be efficient in both time and cost savings. CONCLUSION: Telehealth rheumatology consultations are feasible, acceptable, and cost/time effective and are therefore advocated for those geographic areas where traditional consultations are not readily available.

Adolescent↗

PubMed1993

MicroPACS: a PC-based small PACS implementation.

To make picture archiving and communication systems (PACS) a practical reality for small-scale structures, it appears necessary to build a network that integrates and optimises production management, analysis and storage of images, and to include the ability to communicate with other similar remote structures. To solve the various technical problems related to small-scale PACS implementation, MicroPACS, a local area network, was developed around PC-like microcomputers. Every necessary function is assessed and implemented, including a centralised data-base, a distributed image bank, different storage levels and a specific task for image exchanges. An additional protocol was also developed for remote consultation through ISDN. Standardisation of image encapsulation and a point-to-point link between remote sites ensure easy transfers between heterogeneous local networks or bases and integrity of local databases.

Computer Communication Networks↗