1
|
He T, Pu YY, Zhang YQ, Qian ZB, Guo LH, Sun LP, Zhao CK, Xu HX. 5G-Based Telerobotic Ultrasound System Improves Access to Breast Examination in Rural and Remote Areas: A Prospective and Two-Scenario Study. Diagnostics (Basel) 2023; 13:diagnostics13030362. [PMID: 36766467 PMCID: PMC9913989 DOI: 10.3390/diagnostics13030362] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 01/15/2023] [Accepted: 01/16/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVE Ultrasound (US) plays an important role in the diagnosis and management of breast diseases; however, effective breast US screening is lacking in rural and remote areas. To alleviate this issue, we prospectively evaluated the clinical availability of 5G-based telerobotic US technology for breast examinations in rural and remote areas. METHODS Between September 2020 and March 2021, 63 patients underwent conventional and telerobotic US examinations in a rural island (Scenario A), while 20 patients underwent telerobotic US examination in a mobile car located in a remote county (Scenario B) in May 2021. The safety, duration, US image quality, consistency, and acceptability of the 5G-based telerobotic US were assessed. RESULTS In Scenario A, the average duration of the telerobotic US procedure was longer than that of conventional US (10.3 ± 3.3 min vs. 7.6 ± 3.0 min, p = 0.017), but their average imaging scores were similar (4.86 vs. 4.90, p = 0.159). Two cases of gynecomastia, one of lactation mastitis, and one of postoperative breast effusion were diagnosed and 32 nodules were detected using the two US methods. There was good interobserver agreement between the US features and BI-RADS categories of the identical nodules (ICC = 0.795-1.000). In Scenario B, breast nodules were detected in 65% of the patients using telerobotic US. Its average duration was 10.1 ± 2.3 min, and the average imaging score was 4.85. Overall, 90.4% of the patients were willing to choose telerobotic US in the future, and tele-sonologists were satisfied with 85.5% of the examinations. CONCLUSION The 5G-based telerobotic US system is feasible for providing effective breast examinations in rural and remote areas.
Collapse
Affiliation(s)
- Tian He
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Yin-Ying Pu
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Ya-Qin Zhang
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Zhe-Bin Qian
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
| | - Le-Hang Guo
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
- Department of Medical Ultrasound, Chongming Second People’s Hospital, Shanghai 202157, China
| | - Li-Ping Sun
- Department of Medical Ultrasound, Center of Minimally Invasive Treatment for Tumor, Shanghai Tenth People’s Hospital, Ultrasound Research and Education Institute, Clinical Research Center for Interventional Medicine, School of Medicine, Tongji University, Shanghai 200072, China
- Shanghai Engineering Research Center of Ultrasound Diagnosis and Treatment, Shanghai 200072, China
- Department of Medical Ultrasound, Chongming Second People’s Hospital, Shanghai 202157, China
- Correspondence: (L.-P.S.); (C.-K.Z.)
| | - Chong-Ke Zhao
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
- Correspondence: (L.-P.S.); (C.-K.Z.)
| | - Hui-Xiong Xu
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| |
Collapse
|
2
|
Asynchronous telemedicine for clinical genetics consultations in the NICU: a single center's solution. J Perinatol 2022; 42:262-268. [PMID: 34302053 DOI: 10.1038/s41372-021-01070-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2021] [Revised: 04/01/2021] [Accepted: 04/22/2021] [Indexed: 11/09/2022]
Abstract
BACKGROUND Many infants in the neonatal intensive care unit (NICU) have genetic disorders or birth defects. The demand for genetic services is often complicated by a shortage of genetic providers. PROBLEM Our hospital experienced a significant reduction in genetic workforce, leading to insufficient genetic services to meet demand. METHODS The Plan-Do-Study-Act method of quality improvement was used to assess available resources, select an intervention plan, and collect patient outcome and provider satisfaction data. INTERVENTION An asynchronous telehealth model was deployed for clinical genetics consultations in our NICU utilizing a remote clinical geneticist. RESULTS The pilot study included 111 asynchronous telehealth consultations; 21% received a genetic diagnosis before discharge. Diagnoses were primarily chromosomal and single gene disorders. Referring NICU providers reported high satisfaction. CONCLUSION Asynchronous telehealth for clinical genetics is a feasible and successful alternative to an on-site clinical geneticist and should be considered in areas with a genetic workforce shortage.
Collapse
|
3
|
Duan S, Liu L, Chen Y, Yang L, Zhang Y, Wang S, Hao L, Zhang L. A 5G-powered robot-assisted teleultrasound diagnostic system in an intensive care unit. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:134. [PMID: 33827638 PMCID: PMC8025902 DOI: 10.1186/s13054-021-03563-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 04/01/2021] [Indexed: 12/01/2022]
Abstract
Background Teleultrasound provides an effective solution to problems that arise from limited medical resources, a lack of local expertise, and scenarios where the risk of infection is high. This study aims to explore the feasibility of the application of a 5G-powered robot-assisted teleultrasound diagnostic system in an intensive care unit. Methods In this study, the robot-assisted teleultrasound diagnostic system MGIUS-R3 was used. Using 5G network technology, the doctor manipulates the robotic arm to perform teleultrasound examination. The doctor can adjust parameters via the teleultrasound control panel, and real-time transmission of audio, video and ultrasound images can facilitate simultaneous communication between both parties. All patients underwent robot-assisted teleultrasound examination and bedside ultrasound examination of the liver, gallbladder, pancreas, spleen, kidney, as well as assessment for pleural effusion and abdominal effusion. We evaluated the feasibility of the application of the robot-assisted teleultrasound diagnosis system in the intensive care unit in terms of consultation duration, image quality, and safety. We also compared diagnostic consistency and differences. Results Apart from one patient who was excluded due to severe intestinal gas interference and poor image quality, a total of 32 patients were included in this study. Every patient completed all relevant examinations. Among them, 20 patients were male; 12 were female. The average age of the patients was 61 ± 20 years. The average duration of teleultrasound diagnosis was 17 ± 7 min. Of the 32 patients, 26 had positive results, 6 had negative results, and 5 had inconsistent diagnoses. The overall diagnostic results were basically the same, and there were no differences in diagnostic levels between the two. The overall average image quality score was 4.73 points, which represented a high-quality image. After robot-assisted teleultrasound examination, no significant changes were observed in the vital signs of patients as compared to before examination, and no examination-related complications were found. Conclusion The 5G-powered robot-assisted teleultrasound diagnostic system was associated with the benefits of clear images, simple operation, relatively high levels of consistency in terms of diagnostic results, higher levels of safety, and has considerable application value in the intensive care unit.
Collapse
Affiliation(s)
- Shaobo Duan
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.,Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Luwen Liu
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Yongqing Chen
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China
| | - Long Yang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.,Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Ye Zhang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.,Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Shuaiyang Wang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.,Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Liuwei Hao
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China.,Henan University People's Hospital, Zhengzhou, 450003, Henan, China
| | - Lianzhong Zhang
- Henan Provincial People's Hospital, Zhengzhou University People's Hospital, No. 7, Weiwu Road, Jinshui District, Zhengzhou, 450003, Henan, China. .,Henan University People's Hospital, Zhengzhou, 450003, Henan, China.
| |
Collapse
|
4
|
Makkar A, Milsten J, McCoy M, Szyld EG, Lapadula MC, Ganguly A, DeShea LA, Ponniah U. Tele-Echocardiography for Congenital Heart Disease Screening in a Level II Neonatal Intensive Care Unit with Hybrid Telemedicine System. Telemed J E Health 2021; 27:1136-1142. [PMID: 33449839 DOI: 10.1089/tmj.2020.0440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Introduction: The nationwide shortage of pediatric cardiologists in medically underserved areas poses a challenge to congenital heart disease (CHD) screening requiring echocardiography, resulting in transfer of neonates to regional Level III/IV Neonatal Intensive Care Units (NICUs). This study aimed to evaluate the accuracy, safety, and cost-effectiveness of tele-echocardiography for advanced CHD screening at a Level II NICU managed by a hybrid telemedicine system. Methods: Retrospective chart review of infants requiring tele-echocardiography at a Level II NICU. Patient demographics, echocardiography indications, and findings were analyzed. Agreement between tele-echocardiography and conventional echocardiography findings was assessed. Transport cost savings were calculated based on preventable transfers to Level IV NICU. Descriptive statistics were computed for demographic and clinical variables. Results: Over 5 years, 52 infants were screened for CHD. Thirty-two infants (62%) had findings consistent with minor CHD or normal neonatal transitional physiology. Twenty infants (38%) had abnormal findings requiring follow-up with either a conventional echocardiography as inpatient at the regional Level IV NICU or as outpatient after discharge. Only 5 infants (10%) required transfer to a Level IV NICU for CHD management, whereas 15 infants (29%) were scheduled for outpatient follow-up. Strong agreement was noted between tele-echocardiography and conventional echocardiography findings. No case of critical congenital heart disease (CCHD) was missed. Tele-echocardiography saved $260,000 in transport costs. Conclusions: Tele-echocardiography can be accurate, safe, and effective in CHD screening, preventing unnecessary transfer of most infants to regional Level III/IV NICUs, saving transfer costs.
Collapse
Affiliation(s)
- Abhishek Makkar
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Jennifer Milsten
- University of Oklahoma College of Medicine, Oklahoma City, Oklahoma, USA
| | - Mike McCoy
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Edgardo G Szyld
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Maria C Lapadula
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Abhrajit Ganguly
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Lise A DeShea
- Division of Newborn Medicine, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Umakumaran Ponniah
- Division of Cardiology, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| |
Collapse
|
5
|
Luwen LMS, Shaobo DMD, Yaqiong LP, Ruiqing LMD, Yuejin WMS, Lianzhong ZMD. Development Status and Prospect of Remote Diagnosis and Treatment of Echocardiography Worldwide. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
|
6
|
Liu L, Duan S, Zhang Y, Wu Y, Zhang L. Initial Experience of the Synchronized, Real-Time, Interactive, Remote Transthoracic Echocardiogram Consultation System in Rural China: Longitudinal Observational Study. JMIR Med Inform 2019; 7:e14248. [PMID: 31287062 PMCID: PMC6643765 DOI: 10.2196/14248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 05/19/2019] [Accepted: 06/11/2019] [Indexed: 11/13/2022] Open
Abstract
Background China has a vast territory, and the quality of health care services provided, especially transthoracic echocardiography (TTE), in remote regions is still low. Patients usually need to travel long distances to tertiary care centers for confirmation of a diagnosis. Considering the rapid development of high-speed communication technology, telemedicine will be a significant technology for improving the diagnosis and treatment of patients at secondary care hospitals. Objective This study aimed to discuss the feasibility and perceived clinical value of a synchronized, real-time, interactive, remote TTE consultation system based on cloud computing technology. Methods By using the cloud computing platform coupled with unique dynamic image coding and decoding and synchronization technology, multidimensional communication information in the form of voice, texts, and pictures was integrated. A remote TTE consultation system connecting Henan Provincial People’s Hospital and two county-level secondary care hospitals located 300 km away was developed, which was used for consultation with 45 patients. Results This remote TTE consultation system achieved remote consultation for 45 patients. The total time for consultation was 341.31 min, and the mean time for each patient was 7.58 (SD 6.17) min. Among the 45 patients, 3 were diagnosed with congenital heart diseases (7%) and 42 were diagnosed with acquired heart diseases (93%) at the secondary care hospitals. After expert consultation, the final diagnosis was congenital heart diseases in 5 patients (11%), acquired heart disease in 34 patients (76%), and absence of heart abnormalities in 6 patients (13%). Compared with the initial diagnosis at secondary care hospitals, remote consultation using this system revealed new abnormalities in 7 patients (16%), confirmation was obtained in 6 patients (13%), and abnormalities were excluded in 6 patients (13%). The expert opinions agreed with the initial diagnosis in the remaining 26 patients (58%). In addition, several questions about rare illnesses raised by the rural doctors at the secondary care hospitals were answered. Conclusions The synchronized real-time interactive remote TTE consultation system based on cloud computing service and unique dynamic image coding and decoding technology had high feasibility and applicability.
Collapse
Affiliation(s)
- Luwen Liu
- People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Shaobo Duan
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Ye Zhang
- Henan Provincial People's Hospital, Zhengzhou, China
| | - Yuejin Wu
- People's Hospital of Zhengzhou University, Zhengzhou, China
| | - Lianzhong Zhang
- People's Hospital of Zhengzhou University, Zhengzhou, China.,Henan Provincial People's Hospital, Zhengzhou, China
| |
Collapse
|
7
|
Caldarola P, Gulizia MM, Gabrielli D, Sicuro M, De Gennaro L, Giammaria M, Grieco NB, Grosseto D, Mantovan R, Mazzanti M, Menotti A, Brunetti ND, Severi S, Russo G, Gensini GF. ANMCO/SIT Consensus Document: telemedicine for cardiovascular emergency networks. Eur Heart J Suppl 2017; 19:D229-D243. [PMID: 28751844 PMCID: PMC5520753 DOI: 10.1093/eurheartj/sux028] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Telemedicine has deeply innovated the field of emergency cardiology, particularly the treatment of acute myocardial infarction. The ability to record an ECG in the early prehospital phase, thus avoiding any delay in diagnosing myocardial infarction with direct transfer to the cath-lab for primary angioplasty, has proven to significantly reduce treatment times and mortality. This consensus document aims to analyse the available evidence and organizational models based on a support by telemedicine, focusing on technical requirements, education, and legal aspects.
Collapse
Affiliation(s)
- Pasquale Caldarola
- Cardiology Department, San Paolo Hospital, Via Caposcardicchio, 70123 Bari, Italy
| | - Michele Massimo Gulizia
- Cardiology Department, Garibal-Nesima Hospital, Ospedale Nesima-Garibaldi, Azienda di Rilievo Nazionale e Alta Specializzazione "Garibaldi", Catania, Italy
| | | | - Marco Sicuro
- Cardiology and Cardiac Intensive Care, Regionale Umberto Parini Hospital, Aosta, Italy
| | - Luisa De Gennaro
- Cardiology Department, San Paolo Hospital, Via Caposcardicchio, 70123 Bari, Italy
| | | | | | | | - Roberto Mantovan
- Cardiology Unit, Ospedale Santa Maria dei Battuti, Conegliano (Treviso), Italy
| | - Marco Mazzanti
- Cardiology Hemodynamics-CCU Department, University "Ospedali Riuniti" Hospital, Ancona, Italy
| | | | | | - Silva Severi
- Cardiology Unit, Misericordia Hospital, Grosseto, Italy
| | - Giancarmine Russo
- Italian Society for Telemedicine and eHealth (Digital SIT), Rome, Italy
| | | |
Collapse
|