Telemedicine Peter Corr University of Natal S Africa

Telemedicine Peter Corr University of Natal S Africa • Overview • Lecture • Links

Peter Corr • I am a professor of radiology working in South Africa. I have been involved with telemedicine projects in Africa for the last five years • What excites me about telemedicine is its potential impact in providing diagnosis and consultation in developing countries

Overview • • History Goals Definitions Applications Hardware &software requirements Pitfalls Future directions

History of Telemedicine • First used in the sixties to transmit chest radiographs from Boston airport to Massachusetts General Hospital radiologists for reporting

Definitions • Digitise- process to convert analogue data (continuous) into digital data (discrete) • Bit-smallest piece of digital information • Byte- a group of 8 bits used to represent a value or character • Baud- number of bits transmitted in 1 second

Definitions • Lossless compression- no alteration of original image after reconstruction • DICOM- a standard for interconnecting digital imaging devices • telemedicine- the electronic transmission of medical images from one site to another for interpretation and consultation

Goals of Telemedicine • To provide consultation and interpretation in regions of demonstrated need • To provide specialist services in hospitals without on site support • To promote educational opportunities for physicians

Applications • • • radiology ultrasound surgery opthalmology pathology dermatology

Radiology Applications • • • Plain radiographs Computerised tomography (CT) Ultrasound Magnetic resonance (MR) Angiograms Nuclear medicine

Advantages • Specialist advice without the patient having to travel to the central hospital • Cost saving in transport and patient accommodation • Better utilisation of specialist resources • Educational opportunities

Disadvantages • • • Incorrect diagnoses Cost of hardware Need good telecommunication network Training of staff Medicolegal concerns- patient confidentiality

Image Acquisition • Digitiser to transfer hardcopy images into digital images • requires resolution of 2 k. X 12 bits resolution • Nedd to compress data to reduce transmission time

Image Transmission • Telephone lines are very slow but inexpensive at 64 kilobytes per second (baud) • ISDN telephone lines- intergrated service digital network is faster 256 kb • ATM- asynchronous transfer mode >1 Mb • Satellite- very fasy but expensive

Image Display • High quality resolution monitors essential for reading images • resolution of 2 k. X 12 bit required • Good screen luminance

Applications- Ultrasound • Ultrasound-image files are small <100 kb and static images are easy to transmit • Fetal ultrasound teleconsultation shows promise

Applications- CT/MR Imaging • CT and MR imaging are small files <100 kb and are easily transmitted for consultation

Applications • Surgery- used for transmitting angiograms to vascular surgeons for consultation • Opthalmology- slit lamp and retinal images transmitted to opthalmologist using a retinal camera

Pathology • Histology slides can be transmitted to pathologists using a digital camera attached to a microscope

Hardware & Software • Standards- American College of Radiology

Pitfalls • Cost- digitizers are expensive • Telecommunications limited in many parts of Africa and Asia- satellite shows promise • Medicolegal issues- patient confidentiality • Training of physicians

Future Directions • Digital cameras may replace digitizers and are much cheaper • Wireless communications are rapidly expanding in developing countries • Internet II may provide sufficient bandwidth for telemedicine • Offers many educational opportunities

Links • American College of Radiology • University of Iowa Health Web • Radiological Society of North America