Download Telemedicine by Peter Corr, University of Natal, South 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
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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
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radiology
ultrasound
surgery
opthalmology
pathology
dermatology
Radiology Applications
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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
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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