Telemedicine Peter Corr University of Natal S Africa

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TelemedicinePeter Corr University of Natal S
Africa

• Overview
• Lecture
• Links

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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

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Overview

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

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History of Telemedicine

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

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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

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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

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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

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Applications

• radiology
• ultrasound
• surgery
• opthalmology
• pathology
• dermatology

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Radiology Applications

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

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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

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Disadvantages

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

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Image Acquisition

• Digitiser to transfer hardcopy images into
  digital images
• requires resolution of 2kX2kX12bits resolution
• Nedd to compress data to reduce transmission time

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Image Transmission

• Telephone lines are very slow but inexpensive at
  64 kilobytes per second (baud)
• ISDN telephone lines- intergrated service digital
  network is faster 256kb
• ATM- asynchronous transfer mode gt1Mb
• Satellite- very fasy but expensive

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Image Display

• High quality resolution monitors essential for
  reading images
• resolution of 2kX2kX12bit required
• Good screen luminance

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Applications- Ultrasound

• Ultrasound-image files are small lt100kb and
  static images are easy to transmit
• Fetal ultrasound teleconsultation shows promise

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Applications- CT/MR Imaging

• CT and MR imaging are small files lt100kb and are
  easily transmitted for consultation

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Applications

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

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Pathology

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

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Hardware Software

• Standards- American College of Radiology

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Pitfalls

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

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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

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Links

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