Digital wireless radiology consultations with a portable computer

Evaluation of a Novel Teleradiology Technology for Image-Based Distant Consultations: Applications in Neurosurgery

In emergency settings, fast access to medical imaging for diagnostic is pivotal for clinical decision making. Hence, a need has emerged for solutions that allow rapid access to images on small mobile devices (SMD) without local data storage. Our objective was to evaluate access times to full quality anonymized DICOM datasets, comparing standard access through an authorized hospital computer (AHC) to a zero-footprint teleradiology technology (ZTT) used on a personal computer (PC) or SMD using national and international networks at a regional neurosurgical center. Image datasets were sent to a senior neurosurgeon, outside the hospital network using either an AHC and a VPN connection or a ZTT (Image Over Globe (IOG)), on a PC or an SMD. Time to access DICOM images was measured using both solutions. The mean time using AHC and VPN was 250 ± 10 s (median 249 s (233–274)) while the same procedure using IOG took 50 ± 8 s (median 49 s (42–60)) on a PC and 47 ± 20 s (median 39 (33–88)) on a SMD. Similarly, an international consultation was performed requiring 23 ± 5 s (median 21 (16–33)) and 27 ± 1 s (median 27 (25–29)) for PC and SMD respectively. IOG is a secure, rapid and easy to use telemedicine technology facilitating efficient clinical decision making and remote consultations.

Extending a multimedia medical record to a regional service with electronic referral and discharge letters

Oulu University Hospital has a Web-based multimedia medical record in use. One key element in the creation of regional e-health networks is an electronic referral letter and discharge letter service. In Oulu an XML messaging system is used for an integral part of the medical record. The service has now been extended to primary care centres and hospitals in the Oulu region. Using a secure Web link, primary care physicians have direct remote access to the original hospital's electronic patient record, including medical images and laboratory results. According to the users, e-referral saves time and improves the quality of documentation. On the other hand, workflow development is still immature. Our experience suggests that the implementation of e-referrals is a process which requires careful handling, in relation to the technology as well as organizational changes and communication.

The effectiveness of low-cost teleconsultation for emergency head computer tomography in patients with suspected stroke

Teleradiology in an emergency situation can be used to support rapid neurological decision-making when specialists are remote from the hospital concerned. We have developed a low-cost system using a PDA phone as the receiving equipment. The experimental system was based on a notebook PC to send the images and a PDA phone to receive them. We used commercially available toolbar software for transmitting the information through the mobile phone network. A total of 100 images from clinically suspected strokes within the previous 24 hours were transmitted to a neurologist. The mean size of the original picture was 20.9 kByte and the images were compressed by approximately 2:1 before transmission. The mean transmission time was 48 s per image. The diagnosis from the PDA phone image was in complete agreement with the diagnosis from the original image in cases of acute ischaemic stroke, intracerebral haemorrhage, metastasis and in normal scans. However, there was agreement in only 7 of the 8 cases (88%) of subarachnoid haemorrhage. The overall transmission cost was 400 Thai baht per case. The study showed that good accuracy can be achieved with a low-cost system for teleradiology consultation in stroke.

EmerLoc: Location-based services for emergency medical incidents

BACKGROUND

Recent developments in positioning systems and telecommunications have provided the technology needed for the development of location aware medical applications. We developed a system, named EmerLoc, which is based upon this technology and uses a set of sensors that are attached to the patient's body, a micro-computing unit which is responsible for processing the sensor readings and a central monitoring unit, which coordinates the data flow.

OBJECTIVE

To demonstrate that the proposed system is technically feasible and acceptable for the potential users.

METHOD

Transmission speed is assessed mostly by means of transmission of DICOM compliant images in various operational scenarios. The positioning functionality was established both outdoor using GPS and indoor using the UCLA Nibble system. User acceptability was assessed in a hospital setting by 15 physicians who filled in a questionnaire after having used the system in an experimental setting.

RESULTS

Transmission speeds ranged from 88kB/s for a IEEE 802.11 infrastructure to 2.5kB/s for a GSM/GPRS scenario. Positioning accuracy based on GPS was 5-10m. The physicians rated the technical aspects on average above 3 on a 5-point scale. Only the data presentation was assessed to be not satisfactory (2.81 on a 5-point scale).

CONCLUSION

The reported results prove the feasibility of the proposed architecture and its alignment with widely established practices and standards, while the reaction of potential users who evaluated the system is quite positive.

A mobile teleconference system for homecare services

Telemedicine with mobile communications is a new research area aimed at providing highly flexible medical services that are not possible with standard telephony. In this article, a teleconference system via mobile Internet connections for homecare service is presented. An important purpose of this system is the realization of real time communication between the service station (experts) and the service providers (nurses) in mobile conditions. The following functions are realized via mobile internet connections: 1) a communication control platform for data transmission and process management; 2) whiteboard function to share image and draw free lines; 3) voice transmission between service station and service providers; 4) system management including data maintenance and database access. In this system, still images and voice data are transmitted in real time between service providers (patient's home site) and service managers (station site). This study is a new trial to support homecare service with mobile telecommunication technology.

The use of multi-media messaging in the referral of musculoskeletal limb injuries to a tertiary trauma unit using: a 1-month evaluation

OBJECTIVES

New developments in telecommunications will have a profound effect on the delivery of medical care throughout the world. In Northern Ireland three trauma centres provide fracture care for their own and surrounding Emergency Departments. All trauma referrals are currently taken by telephone. It is our experience that the verbal description of the radiographs of a musculoskeletal limb injury can be inaccurate, necessitating us to view the plain films of the patient. By utilising a recent advance in telecommunications technology, the launch of mobile handsets with multi-media messaging (MMS) service capability, it is now possible to digitally capture and instantly send an image of a plain film.

PURPOSE

To evaluate the use of multi-media messaging as a supplement to the telephone referral of musculoskeletal limb injures.

METHOD

: Following a referral using, the emergency physician and the trauma surgeon evaluated the multi-media consult through a survey questionnaire.

RESULTS

Between the 1st December 2003 and the 1st January 2004, 46 multi-media consultations were performed. Picture quality was acceptable in all but one of the referrals. In 35 of the 46 referrals the multi-media image of the plain films was felt to improve the management of the patient. In 8 of the 46 referrals the multi-media image of the plain films was felt to change the management of the patient.

CONCLUSION

A multi-media messaging store- and forward telemedicine system has potential to facilitate the rapid, cost-effective management of musculoskeletal limb injuries thereby enhancing clinical care.

Radiology as a part of a comprehensive telemedicine and eHealth network in Northern Finland

Oulu University Hospital is the northernmost tertiary hospital in Finland and its responsibility area is the largest in the country, covering nearly half of the Finnish territory, also including the arctic regions. Because of vast distances and a sparse population, Oulu has been a forerunner in developing telemedicine and eHealth services in the country. The development started in 1990 and has resulted in the establishment of teleradiology and televideoconferencing services, distance education and a multimedia medical record with remote access capabilities. Wireless technology has been a special focus area, as has the development of an efficient communication between primary care and secondary care. This review highlights some of the key success elements.

Radiology on handheld devices: image display, manipulation, and PACS integration issues

Handheld personal digital assistants (PDAs) have undergone continuous and substantial improvements in hardware and graphics capabilities, making them a compelling platform for novel developments in teleradiology. The latest PDAs have processor speeds of up to 400 MHz and storage capacities of up to 80 Gbytes with memory expansion methods. A Digital Imaging and Communications in Medicine (DICOM)-compliant, vendor-independent handheld image access system was developed in which a PDA server acts as the gateway between a picture archiving and communication system (PACS) and PDAs. The system is compatible with most currently available PDA models. It is capable of both wired and wireless transfer of images and includes custom PDA software and World Wide Web interfaces that implement a variety of basic image manipulation functions. Implementation of this system, which is currently undergoing debugging and beta testing, required optimization of the user interface to efficiently display images on smaller PDA screens. The PDA server manages user work lists and implements compression and security features to accelerate transfer speeds, protect patient information, and regulate access. Although some limitations remain, PDA-based teleradiology has the potential to increase the efficiency of the radiologic work flow, increasing productivity and improving communication with referring physicians and patients.

Implementation of a WAP-based telemedicine system for patient monitoring

Many parties have already demonstrated telemedicine applications that use cellular phones and the Internet. A current trend in telecommunication is the convergence of wireless communication and computer network technologies, and the emergence of wireless application protocol (WAP) devices is an example. Since WAP will also be a common feature found in future mobile communication devices, it is worthwhile to investigate its use in telemedicine. This paper describes the implementation and experiences with a WAP-based telemedicine system for patient-monitoring that has been developed in our laboratory. It utilizes WAP devices as mobile access terminals for general inquiry and patient-monitoring services. Authorized users can browse the patients' general data, monitored blood pressure (BP), and electrocardiogram (ECG) on WAP devices in store-and-forward mode. The applications, written in wireless markup language (WML), WMLScript, and Perl, resided in a content server. A MySQL relational database system was set up to store the BP readings, ECG data, patient records, clinic and hospital information, and doctors' appointments with patients. A wireless ECG subsystem was built for recording ambulatory ECG in an indoor environment and for storing ECG data into the database. For testing, a WAP phone compliant with WAP 1.1 was used at GSM 1800 MHz by circuit-switched data (CSD) to connect to the content server through a WAP gateway, which was provided by a mobile phone service provider in Hong Kong. Data were successfully retrieved from the database and displayed on the WAP phone. The system shows how WAP can be feasible in remote patient-monitoring and patient data retrieval.

Construction of DICOM-WWW Gateway by Open Source, and Application to PDAs Using the High-speed Mobile Communications Network

The author constructed a medical image network system using open source software that took security into consideration. This system was enabled for search and browse with a WWW browser, and images were stored in a DICOM server. In order to realize this function, software was developed to fill in the gap between the DICOM protocol and HTTP using PHP language. The transmission speed was evaluated by the difference in protocols between DICOM and HTTP. Furthermore, an attempt was made to evaluate the convenience of medical image access with a personal information terminal via the Internet through the high-speed mobile communication terminal. Results suggested the feasibility of remote diagnosis and application to emergency care.

Accuracy of diagnosis of fractures by maxillofacial and accident and emergency doctors using plain radiography compared with a telemedicine system: a prospective study

Ten facial radiographs with fractures and 10 without fractures were viewed by eight oral and maxillofacial surgery (OMFS) and eight accident and emergency (A&E) doctors who were each asked questions about the presence and site of any fractures as well as the quality of the images and diagnostic confidence. Each radiograph was then transmitted over a teleradiology link and viewed by the same OMFS doctors who answered the same questions. The position of the fracture was more accurately assessed using plain radiography. Diagnosis by OMFS doctors using telemedicine was broadly comparable with fracture diagnosis by A&E doctors using plain radiography. Poor quality radiographs and frontozygomatic and infraorbital rim fractures were poorly diagnosed by telemedicine. This telemedicine system was a useful tool to aid diagnosis of most facial fractures. The need for appropriate clinical information is vital. Diagnosis of frontozygomatic and infraorbital rim disruption using telemedicine is less reliable than plain radiography.

Telemedicine and isolated communities: a UK perspective

There are still considerable inequalities in the provision of primary care in the UK in relation to need. Recruitment and retention of general practitioners (GPs) is a problem, although this is worse in inner-city than in rural areas. The main problem in rural areas of the UK is the accessibility of health services. GP consultation rates, hospital outpatient attendance rates and inpatient admissions all decline with distance both to the doctors' surgeries and to hospitals. There is evidence that health services can be successfully and effectively delivered to isolated communities by telemedicine, but almost all of it relates to work done outside the UK. The experience has been generally good and should certainly be taken into account when planning future physician requirements and distribution.