TelemedicinePeter 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 2kX2kX12bits 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 256kb

• ATM- asynchronous transfer mode >1Mb• Satellite- very fasy but expensive

Image Display

• High quality resolution monitors essential for reading images

• resolution of 2kX2kX12bit required

• Good screen luminance

Applications- Ultrasound

• Ultrasound-image files are small <100kb and static images are easy to transmit

• Fetal ultrasound teleconsultation shows promise

Applications- CT/MR Imaging

• CT and MR imaging are small files <100kb 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