[Optimizing radiological diagnostic management via mobile devices in trauma surgery]. / Anforderung von radiologischer Diagnostik in der Unfallchirurgie mittels mobiler Endgeräte.

BACKGROUND: Time is a scarce resource for physicians. One medical task is the request for radiological diagnostics. This process is characterized by high administrative complexity and sometimes considerable time consumption. Measures that lead to an administrative relief in favor of patient care have so far been lacking. AIM OF THE STUDY: Process optimization of the request for radiological diagnostics. As a proof of concept the request for radiological diagnostics was conducted using a mobile, smartphone and tablet-based application with dedicated voice recognition software in the Department of Trauma Surgery at the University Hospital of Würzburg (UKW). MATERIAL AND METHODS: In a prospective study, time differences and efficiency of the mobile app-based method (ukw.mobile based Application = UMBA) compared to the PC-based method (PC-based application = PCBA) for requesting radiological services were analyzed. The time from the indications to the completed request and the time required to create the request on the device were documented and assessed. Due to the non-normal distribution of the data, a Mann-Whitney U test was performed. RESULTS: The time from the indications to the completed request was significantly (p < 0.05) reduced using UMBA compared to PCBA (PCBA: mean ± standard difference [SD] 19.57 ± 33.24 min, median 3.00 min, interquartile range [IQR] 1.00-30.00 min vs. UMBA: 9.33 ± 13.94 min, median 1.00 min, IQR 0.00-20.00 min). The time to complete the request on the device was also significantly reduced using UMBA (PCBA: mean ± SD 63.77 ± 37.98 s, median 51.96 s, IQR 41.68-68.93 s vs. UMBA: 25.21 ± 11.18 s, median 20.00 s, IQR 17.27-29.00 s). CONCLUSION: The mobile, voice-assisted request process leads to a considerable time reduction in daily clinical routine and illustrates the potential of user-oriented, targeted digitalization in healthcare. In future, the process will be supported by artificial intelligence.

The impact of computed radiography and teleradiology on patients' diagnosis and treatment in Mweso, the Democratic Republic of Congo.

INTRODUCTION: High quality diagnostic imaging can provide increased diagnostic accuracy and help guide medical decision-making and management, however challenges for radiology in resource-limited settings are numerous. Diagnostic imaging and teleradiology have financial and logistical implications, so evidence of impact is crucial. We sought to test the hypothesis that the implementation of computed radiography with teleradiology consultation support will significantly change diagnoses and treatment plans in a resource limited setting. METHOD: Paired before-after study to determine the therapeutic impact of an add-on diagnostic test. 'Preliminary Plan' and 'Final Plan' forms allowed direct comparison of diagnosis and treatment plans at initial consultation and following radiography and teleradiology. Consecutive consenting patients were included until the sample size (600) was reached. Changes in both diagnosis and treatment plan were analysed in the whole cohort, with sub-analyses of children aged <5 years, and cases of chest radiography. RESULTS: Final analysis included 536 cases. Diagnosis changed following radiography and teleradiology in 62% of cases, and treatment plans changed in 61%. In chest radiography cases, 70% of diagnoses and 62% of treatment plans changed, while in children <5 years 66% of diagnoses and 58% of treatment plans changed. Reduced final treatment plans were most common for exploratory surgery (72% decrease), surgical orthopaedic intervention (62% decrease), and TB treatment (52% decrease), allowing more conservative medical or surgical management in 61 cases. Increased final treatment plans were highest in the orthopaedic and interventional surgery and referral categories. Of 42 cases requiring interventional surgery in the final plan, 26 (62%) were identified only after radiography and teleradiology. 16 additional cases were indicated for orthopaedic surgery, 10 cases required patient transfer, and TB treatment was indicated in 45 cases. A change in the original prescription plan occurred in 41% of 536 cases, with one or more prescriptions stopped in 28% of all cases. CONCLUSION: We found that computed radiography with teleradiology had significant clinical value in this resource-limited setting, with the potential to affect both patient outcomes and treatment costs through providing improved diagnostics and avoiding unnecessary treatments and medications.

Centralized expert HRCT Reading in suspected idiopathic pulmonary fibrosis: Experience from an Eurasian teleradiology program.

PURPOSE: To share experience from a large, ongoing expert reading teleradiology program in Europe and Asia aiming at supporting referring centers to interpret high-resolution computed tomography (HRCT) with respect to presence of Usual Interstitial Pneumonia (UIP)-pattern in patients with suspected Idiopathic Pulmonary Fibrosis (IPF). METHOD: We analyzed data from 01/2014 to 05/2019, including HRCTs from 239 medical centers in 12 European and Asian countries that were transmitted to our Picture Archiving and Communication System (PACS) via a secured internet connection. Structured reports were generated in consensus by a radiologist with over 20 years of experience in thoracic imaging and a pulmonologist with specific expertise in interstitial lung disease according to current guidelines on IPF. Reports were sent to referring physicians. We evaluated patient characteristics, technical issues, report turnaround times and frequency of diagnoses. We also conducted a survey to collect feedback from referring physicians. RESULTS: HRCT image data from 703 patients were transmitted (53.5% male). Mean age was 63.7 years (SD:17). In 35.1% of all cases diagnosis was "UIP"/"Typical UIP". The mean report turnaround time was 1.7 days (SD:2.9). Data transmission errors occurred in 7.1%. Overall satisfaction rate among referring physicians was high (8.4 out of 10; SD:3.2). CONCLUSIONS: This Eurasian teleradiology program demonstrates the feasibility of cross-border teleradiology for the provision of state-of-the-art reporting despite heterogeneity of referring medical centers and challenges like data transmission errors and language barriers. We also point out important factors for success like the usage of structured reporting templates.

Tablets for Image Review and Communication in Daily Routine of Orthopedic Surgeons-An Evaluation Study.

Medical images are essential in modern traumatology and orthopedic surgery. Access to images is often cumbersome due to a limited number of workstations. Moreover, due to the tremendous increase of data, the time to review or to communicate images has also become limited. One approach to overcome these problems is to make use of modern mobile devices, like tablet computers, to facilitate image access and associated workflows. Ten orthopedic surgeons were equipped with an Apple iPad mini 2 and specialized viewing software for medical images. The surgeons were able to send images from a workstation onto the tablets or to search for patient images directly. The software enabled the physicians to share images, annotated key slices, and messages instantly with their colleagues. The surgeons carried the tablets within or in the periphery of the hospital. The participants evaluated the software by means of daily questionnaires. Data was collected for a period of 9 months. Nearly 25 images were viewed in total by the surgeons per day. The tablet viewer was used for accessing approximately 30% of these images. On average, the surgeons were asked 1.7 times per day by a colleague for a second opinion. They used the tablets in approximately 29% of these cases. Furthermore, the mean time for accessing images was significantly lower using mobile software compared to conventional methods. Tablet computers can play a vital role for image access and communication in the daily routine of an orthopedic surgeon. Mobile image access is an important aspect for surgeons, especially in larger facilities, to facilitate and accelerate the clinical workflows.

The Damage Control Surgery in Austere Environments Research Group (DCSAERG): A dynamic program to facilitate real-time telementoring/telediagnosis to address exsanguination in extreme and austere environments.

Hemorrhage is the most preventable cause of posttraumatic death. Many cases are potentially anatomically salvageable, yet remain lethal without logistics or trained personnel to deliver diagnosis or resuscitative surgery in austere environments. Revolutions in technology for remote mentoring of ultrasound and surgery may enhance capabilities to utilize the skill sets of non-physicians. Thus, our research collaborative explored remote mentoring to empower non-physicians to address junctional and torso hemorrhage control in austere environments. Major studies involved using remote-telementored ultrasound (RTMUS) to identify torso and junctional exsanguination, remotely mentoring resuscitative surgery for torso hemorrhage control, understanding and mitigating physiological stress during such tasks, and the technical practicalities of conducting damage control surgery (DCS) in austere environments. Iterative projects involved randomized guiding of firefighters to identify torso (RCT) and junctional (pilot) hemorrhage using RTMUS, randomized remote mentoring of MedTechs conducting resuscitative surgery for torso exsanguination in an anatomically realistic surgical trainer ("Cut Suit") including physiological monitoring, and trained surgeons conducting a comparative randomized study for torso hemorrhage control in normal (1g) versus weightlessness (0g). This work demonstrated that firefighters could be remotely mentored to perform just-in-time torso RTMUS on a simulator. Both firefighters and mentors were confident in their abilities, the ultrasounds being 97% accurate. An ultrasound-naive firefighter in Memphis could also be remotely mentored from Hawaii to identify and subsequently tamponade an arterial junctional hemorrhage using RTMUS in a live tissue model. Thereafter, both mentored and unmentored MedTechs and trained surgeons completed resuscitative surgery for hemorrhage control on the Cut-Suit, demonstrating practicality for all involved. While remote mentoring did not decrease blood loss among MedTechs, it increased procedural confidence and decreased physiologic stress. Therefore, remote mentoring may increase the feasibility of non-physicians conducting a psychologically daunting task. Finally, DCS in weightlessness was feasible without fundamental differences from 1g. Overall, the collective evidence suggests that remote mentoring supports diagnosis, noninvasive therapy, and ultimately resuscitative surgery to potentially rescue those exsanguinating in austere environments and should be more rigorously studied.

Robotic Arm-Assisted Sonography: Review of Technical Developments and Potential Clinical Applications.

OBJECTIVE: Ultrasound imaging requires trained personnel. Advances in robotics and data transmission create the possibility of telesonography. This review introduces clinicians to current technical work in and potential applications of this developing capability. CONCLUSION: Telesonography offers advantages in hazardous or remote environments. Robotically assisted ultrasound can reduce stress injuries in sonographers and has potential utility during robotic surgery and interventional procedures.

Reliability of the BI-RADS Final Assessment Categories and Management Recommendations in a Telemammography Context.

PURPOSE: The aim of this study was to evaluate the intradevice and interdevice reliability of four alternatives for telemammography-computed radiography, printed film, a film digitizer, and a digital camera-in terms of interpretation agreement when using the BI-RADS® lexicon. METHODS: The ethics committee of the authors' institution approved this retrospective study. A factorial design with repeated measures with 1,960 interpretations was used (70 patients, seven radiologists, and four devices). Reliability was evaluated using the κ coefficient for intradevice and interdevice agreement on malignancy classification and on BI-RADS final assessment category. RESULTS: Agreement on malignancy classification was higher than agreement for BI-RADS final assessment category. Interdevice agreement on malignancy classification between the film digitizer and computed radiography was ranked as almost perfect (P < .001), whereas interdevice agreement for the other alternatives was ranked as substantial (P < .001), with observed agreement ranging from 85% to 91% and κ values ranging from 0.70 to 0.81. Interdevice agreement on BI-RADS final assessment category was ranked as substantial or moderate (P < .001), with observed agreement ranging from 64% to 77% and κ values ranging from 0.52 to 0.69. Interdevice agreement was higher than intradevice agreement. CONCLUSIONS: The results of this study show very high interdevice agreement, especially for management recommendations derived from malignancy classification, which is one of the most important outcomes in screening programs. This study provides evidence to suggest the interchangeability of the devices evaluated, thereby enabling the provision of low-cost medical imaging services to underserved populations.

Telemedicine Systems in Uterine Transplant: A Feasibility and Reliability Study of the Pre-Grafting Teleradiological Evaluation of the Uterus Graft.

The pre-grafting Tele-Radiological (TRE) evaluation of the Uterus Graft (UG) on Telemedicine Systems, in Uterus Transplant (UT) is studied by diagnostic sensitivity-specificity analysis based on simulation of TRE of the UG on 10 MR sets of female pelvic digital images by two radiologists, assessing a. The vascular variations of the grafts, and b. The inflammatory and neoplastic lesions of the UG. The pre-grafting TRE of the UG showed: a. Diagnostic unreliability for vascular variations, b. A high diagnostic reliability for inflammatory and neoplastic diseases of the UG (100%), making the MRI based TRE of the UG in UT, feasible and highly reliable for the remote pre-grafting diagnosis of UG pathologic lesions, but unreliable for integrated vascular anatomic and pathologic UG remote evaluation for pre-grafting and pre-transplant decision support and planning.

A statewide teleradiology system reduces radiation exposure and charges in transferred trauma patients.

BACKGROUND: Trauma transfer patients routinely undergo repeat imaging because of inefficiencies within the radiology system. In 2009, the virtual private network (VPN) telemedicine system was adopted throughout Oregon allowing virtual image transfer between hospitals. The startup cost was a nominal $3,000 per hospital. METHODS: A retrospective review from 2007 to 2012 included 400 randomly selected adult trauma transfer patients based on a power analysis (200 pre/200 post). The primary outcome evaluated was reduction in repeat computed tomography (CT) scans. Secondary outcomes included cost savings, emergency department (ED) length of stay (LOS), and spared radiation. All data were analyzed using Mann-Whitney U and chi-square tests. P less than .05 indicated significance. Spared radiation was calculated as a weighted average per body region, and savings was calculated using charges obtained from Oregon Health and Science University radiology current procedural terminology codes. RESULTS: Four-hundred patients were included. Injury Severity Score, age, ED and overall LOS, mortality, trauma type, and gender were not statistically different between groups. The percentage of patients with repeat CT scans decreased after VPN implementation: CT abdomen (13.2% vs 2.8%, P < .01) and cervical spine (34.4% vs 18.2%, P < .01). Post-VPN, the total charges saved in 2012 for trauma transfer patients was $333,500, whereas the average radiation dose spared per person was 1.8 mSV. Length of stay in the ED for patients with Injury Severity Score less than 15 transferring to the ICU was decreased (P < .05). CONCLUSIONS: Implementation of a statewide teleradiology network resulted in fewer total repeat CT scans, significant savings, decrease in radiation exposure, and decreased LOS in the ED for patients with less complex injuries. The potential for health care savings by widespread adoption of a VPN is significant.

NEW DIRECTIONS FOR IMPROVEMENT OF BREAST CANCER SCREENING.

Objective: to improve breast cancer diagnosis using an independent mammographic teleassessment by two radiologists. Material and methods. The results of a dual independent assessment of 3440 X-ray mammographic examinations were analyzed. The first assessment was made by a radiologist from a therapeutic-and-prophylactic establishment who had less than one year of practical experience in a mammography screening room. The second assessment was carried out by a radiologist with more than 5 years of experience from a specialized cancer institution. Results. According to the developed specialized interpretation software, recommendations and statistics for mammographic breast cancer screening, the investigators identified a group of 31 women who were recommended to be additionally examined at an oncology dispensary to verify the diagnosis of breast cancer. Eight of 17 (47%) women with morphologically confirmed cancers after dual assessments of X-ray mammographs were called again and referred to the oncology dispensary. Conclusion. Dual independent assessment of X-ray mammographs improved the diagnosis of BC with a maximum size of 1.5 cm or less, as well as that of malignant tumors manifesting as microcalcifications or imitating a benign process.

Client-side Medical Image Colorization in a Collaborative Environment.

The paper presents an application related to collaborative medicine using a browser based medical visualization system with focus on the medical image colorization process and the underlying open source web development technologies involved. Browser based systems allow physicians to share medical data with their remotely located counterparts or medical students, assisting them during patient diagnosis, treatment monitoring, surgery planning or for educational purposes. This approach brings forth the advantage of ubiquity. The system can be accessed from a any device, in order to process the images, assuring the independence towards having a specific proprietary operating system. The current work starts with processing of DICOM (Digital Imaging and Communications in Medicine) files and ends with the rendering of the resulting bitmap images on a HTML5 (fifth revision of the HyperText Markup Language) canvas element. The application improves the image visualization emphasizing different tissue densities.

The accuracy of mobile teleradiology in the evaluation of chest X-rays.

We assessed the diagnostic accuracy of digital photographs of plain film chest X-rays (CXRs) obtained using a mobile phone. The study was a randomized, non-inferiority trial, in which physical plain film CXRs viewed on a light box were compared with digital photographs of plain film CXRs. CXRs were selected from a database of radiology studies to show common pathologies found in Botswana associated with pneumonia, lung carcinoma, tuberculosis, pneumothorax and interstitial disease, as well as normal findings. The pre-selected diagnoses were subsequently verified by a second radiologist. Seven radiologists were randomized to review 75 plain film CXRs on light boxes before viewing 75 digital photographs, or vice versa. Their responses were considered correct if they matched the pre-defined diagnosis. For both modalities, the correct diagnosis was provided in 79% of cases; for plain film CXRs, the correct diagnosis was provided in 82% of cases and for digital photographs the correct diagnosis was provided in 76% of cases. The difference in diagnostic accuracy was -5.7% (95% CI: -10.8% to -0.5%), which confirmed non-inferiority (P<0.001) for the primary outcome of diagnostic accuracy. A subgroup analysis demonstrated non-inferiority for lung carcinoma and pneumonia images, although non-inferiority was not achieved for pneumothorax, tuberculosis, interstitial disease or normal images. The study demonstrates that digital photographs of CXRs obtained via a mobile phone equipped with a digital camera are non-inferior to plain film CXRs.

The use of technology to reduce radiation exposure in trauma patients transferred to a level I trauma center.

BACKGROUND: Patients with traumatic injuries transferred from rural hospitals to tertiary centers in West Virginia frequently undergo repeat computed axial tomography (CT) imaging upon arrival. The traditional method of sending images on a compact disc (CD) with EMS can be unreliable due to software incompatibility, CD malfunction, or misplacement of the CD. Given the known risks associated with ionizing radiation, physicians are increasingly aware of the need to avoid unnecessary CT imaging. Image storage applications such as ImageGrid provide a means to store images securely without the issues and inherent problems of a CD. These images can be uploaded at the referring hospital and may be viewed from any computer at the receiving facility, by multiple providers--even prior to patient arrival. The goal of this study was to determine if utilizing ImageGrid compared to traditional data transfer by CD resulted in a decrease in the amount and type of images obtained in the initial Emergency Department (ED) evaluation at the tertiary center. METHODS: We analyzed data from the Jon Michael Moore Trauma Registry for patients transferred to the Emergency Department at WVU Hospitals from an outside facility. Two study periods were reviewed; prior to ImageGrid implementation and after implementation of the system. Medical records of all patients admitted to the Trauma Surgery Service after a trauma system activation in the ED were reviewed during these time periods. Number and type of CT studies obtained in the Emergency Department were recorded for analysis. RESULTS: In the month of July 2010, 183 patients were admitted to the Trauma Surgery service after trauma team activation. Transfers from referring hospitals accounted for 77 of the 108 (42.1%). WVU Hospitals implemented ImageGrid during 2011. In July 2012, 243 patients were admitted to the Trauma Service, of which 105 (41.1%) were transfer patients. After implementation of ImageGridTM there was a significant decrease in the number of repeat CT Scans of the brain (19/27 [70.4%] vs. 18/40 [45.0%], p < .05), as well as CT scans of the chest, abdomen or chest/ abdomen/pelvis (9/18 [50.0%] vs. 2/23 [8.7%], p < .05). CT of the face showed a decreasing trend (5/9 [55.6%] vs. 1/9 [11%], p > .05 [p = 0.06]), but did not achieve statistical significance. After implementation of ImageGrid there was a marked decrease in total CT scans repeated (46/79 [58.2%] vs. 28/107 [26.2%], p < .05). CONCLUSION: In West Virginia, the use of image archival systems such as ImageGrid appears to result in less repeat CT imaging upon arrival at a tertiary trauma center. Given risks associated with ionizing radiation and costs of repeat imaging the benefits have important implications for patient safety and cost containment.

Evaluation of low-cost telemammography screening configurations: a comparison with film-screen readings in vulnerable areas.

The aim of this study was to evaluate the diagnostic accuracy for detecting breast cancer using different telemammography configurations, including combinations of both low-cost capture devices and consumer-grade color displays. At the same time, we compared each of these configurations to film-screen readings. This study used a treatment-by-reader-by-case factorial design. The sample included 70 mammograms with 34 malignant cases. The readers consisted of four radiologists who classified all of the cases according to the categories defined by the Breast Imaging Reporting and Data System (BI-RADS). The evaluated capture devices included a specialized film digitizer and a digital camera, and the evaluated displays included liquid crystal display (LCD) and light-emitting diode (LED) consumer-grade color displays. Receiver operating characteristic curves, diagnostic accuracy (measured as the area under these curves), accuracy of the composition classification, sensitivity, specificity, and the degree of agreement between readers in the detection of malignant cases were also evaluated. Comparisons of diagnostic accuracy between film-screen and the different combinations of digital configurations showed no significant differences for nodules, calcifications, and asymmetries. In addition, no differences were observed in terms of sensibility or specificity when the degree of malignancy using the film-screen method was compared to that provided with digital configurations. Similar results were observed for the classification of breast composition. Furthermore, all observed reader agreements of malignant detection between film-screen and digital configurations were substantial. These findings indicate that the evaluated digital devices showed comparable diagnostic accuracy to the reference treatment (film-screen).

Moldes individualizados para alineación de la artroplastía primaria de rodilla / Individualized molds for alignment of primary knee arthroplasty

Introducción: Los sistemas de bloque de corte específicos (BCE) se han presentado como una interesante medida para obtener una correcta alineación en la artroplastía de rodilla, aunque se desconoce cuál de todos los métodos existentes para realizar la planificación es el adecuado. Material y métodos: Se ha diseñado un estudio prospectivo comparando dos sistemas de BCE con planificaciones diferentes (Signature con TAC + teleradiografia; Visionaire con RMN) con el sistema convencional de alineación. Se analizaron parámetros radiográficos, funcionales preoperatorios y postoperatorios, estancia hospitalaria, necesidad de transfusión, tiempo quirúrgico y complicaciones asociadas. Resultados: Un total de 10 pacientes fueron intervenidos por cada grupo. No se observaron diferencias estadísticamente significativas entre los dos sistemas de alineamiento específicos y el sistema convencional (p > 0.05), aunque se objetivó una mayor precisión con estos sistemas, siendo discretamente superior en el sistema Signature. También se observó un menor tiempo quirúrgico en los pacientes intervenidos con los BCE, ligeramente inferior en los intervenidos con el sistema Visionaire (p > 0.05). Conclusiones: Los nuevos sistemas BCE pueden ser útiles para mejorar la alineación en la artroplastía de rodilla así como disminuir el tiempo quirúrgico. A la espera de series mayores que corroboren estos datos, los autores recomiendan estos sistemas en aquellos casos en los que los sistemas convencionales no sean adecuados.

Introduction: Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve appropriate alignment in knee arthroplasty. However, there is no information as to which of the available planning methods is the right one. Material and methods: A prospective study was designed to compare two PSCB systems using different planning methods (Signature with CAT scan + teleradiography; Visionaire with MRI) with the standard alignment method. Radiographic and functional pre- and postoperative parameters were analyzed, together with hospital stay, blood transfusion needs, operative time and associated complications. Results: A total of 10 patients per group were operated on. No statistically significant differences were observed between both of the patient-specific alignment systems and the standard system (p > 0.05). However, greater precision was achieved with the former systems and the Signature system was slightly more accurate. Operative time was shorter in patients in whom PSCBs were used, and it was still slightly shorter in those in whom the Visionaire system was used (p > 0.05). Conclusions: The new PSCB systems may be useful to improve alignment in knee arthroplasty and reduce the operative time. While larger case series confirming these data become available, the authors recommend using these systems in cases in which the standard systems do not work properly.

Pooled assessment of computed tomography interpretation by vascular neurologists in the STRokE DOC telestroke network.

BACKGROUND AND PURPOSE: The objective of this pooled analysis was to determine the level of agreement between central read and each of 2 groups (spoke radiologists and hub vascular neurologists) in interpreting head computed tomography (CT) scans of stroke patients presenting to telestroke network hospitals. METHODS: The Stroke Team Remote Evaluation Using a Digital Observation Camera (STRokE DOC and STRokE DOC-AZ TIME) trials were prospective, randomized, and outcome blinded comparing telemedicine and teleradiology with telephone-only consultations. In each trial, the CT scans of the subjects were interpreted by the hub vascular neurologist in the telemedicine arm and by the spoke radiologist in the telephone arm. We obtained a central read for each CT using adjudicating committees blinded to treatment arm and outcome. The data were pooled and the results reported for the entire population. Kappa statistics and exact agreement rates were used to assess interobserver agreement for radiographic contraindication to recombinant tissue plasminogen activator (rt-PA), presence of hemorrhage, tumor, hyperdense artery, acute stroke, prior stroke, and early ischemic changes. RESULTS: Among 261 analyzed cases, the agreement with central read for the presence of radiological rt-PA contraindication was excellent for hub vascular neurologist (96.2%, κ = .81, 95% CI .64-.97), spoke radiologist report (94.7%, κ = .64, 95% CI .39-.88), and overall (95.4%, κ = .74, 95% CI .59-.88). For rt-PA-treated patients (N = 65), overall agreement was 98.5%, and vascular neurologist agreement with central read was 100%. CONCLUSIONS: Both vascular neurologists and reports from spoke radiologists had excellent reliability in identifying radiologic rt-PA contraindications. These pooled findings demonstrate that telestroke evaluation of head CT scans for acute rt-PA assessments is reliable.

[On the state and prospects of development of remote neutron therapy].

The state and prospects of remote neutron therapy were analyzed in this review. Years of experience with fast neutrons, both positive and negative, allow evaluating the most promising ways of further development of this area of radiation therapy. These include conducting targeted research for those tumors which received some encouraging results, a use of the combination of fast neutron therapy and conformal photon therapy as well as the creation of specialized medical facilities for neutron therapy based on optimization of both parameters of spatial distribution of the dose and radiobiological characteristics.

[Individualized molds for alignment of primary knee arthroplasty]. / Moldes individualizados para alineación de la artroplastía primaria de rodilla.

INTRODUCTION: Patient-specific cutting blocks (PSCB) have been proposed as an interesting option to achieve appropriate alignment in knee arthroplasty. However, there is no information as to which of the available planning methods is the right one. MATERIAL AND METHODS: A prospective study was designed to compare two, PSCB systems using different planning methods (Signature with CAT scan + teleradiography; Visionaire with MRI) with the standard alignment method. Radiographic and functional pre- and postoperative parameters were analyzed, together with hospital stay, blood transfusion needs, operative time and associated complications. RESULTS: A total of 10 patients per group were operated on. No statistically significant differences were observed between both of the patient-specific alignment systems and the standard system (p > 0.05). However, greater precision was achieved with the former systems and the Signature system was slightly more accurate. Operative time was shorter in patients in whom PSCBs were used, and it was still slightly shorter in those in whom the Visionaire system was used (p > 0.05). CONCLUSIONS: The new PSCB systems may be useful to improve alignment in knee arthroplasty and reduce the operative time. While larger case series confirming these data become available, the authors recommend using these systems in cases in which the standard systems do not work properly.

[Remote radiation planning support system].

We constructed a remote radiation planning support system between Kyushu University Hospital (KUH) in Fukuoka and Kyushu University Beppu Hospital (KBH) in Oita. Between two institutions, radiology information system for radiotherapy division (RT-RIS) and radiation planning system (RTPS) were connected by virtual private network (VPN). This system enables the radiation oncologists at KUH to perform radiotherapy planning for the patients at KBH. The detail of the remote radiation planning support system in our institutions is as follows: The radiation oncologist at KBH performs radiotherapy planning and the data of the patients are sent anonymously to the radiation oncologists at KUH. The radiation oncologists at KUH receive the patient's data, access to RTPS at KBH, verify or change the radiation planning at KBH: Radiation therapy is performed at KBH according to the confirmed plan by the radiation oncologists at KUH. Our remote radiation planning system is useful for providing radiation therapy with safety and accuracy.

Image and diagnosis quality of X-ray image transmission via cell phone camera: a project study evaluating quality and reliability.

INTRODUCTION: Developments in telemedicine have not produced any relevant benefits for orthopedics and trauma surgery to date. For the present project study, several parameters were examined during assessment of x-ray images, which had been photographed and transmitted via cell phone. MATERIALS AND METHODS: A total of 100 x-ray images of various body regions were photographed with a Nokia cell phone and transmitted via email or MMS. Next, the transmitted photographs were reviewed on a laptop computer by five medical specialists and assessed regarding quality and diagnosis. RESULTS: Due to their poor quality, the transmitted MMS images could not be evaluated and this path of transmission was therefore excluded. Mean size of transmitted x-ray email images was 394 kB (range: 265-590 kB, SD ± 59), average transmission time was 3.29 min ± 8 (CI 95%: 1.7-4.9). Applying a score from 1-10 (very poor - excellent), mean image quality was 5.8. In 83.2 ± 4% (mean value ± SD) of cases (median 82; 80-89%), there was agreement between final diagnosis and assessment by the five medical experts who had received the images. However, there was a markedly low concurrence ratio in the thoracic area and in pediatric injuries. DISCUSSION: While the rate of accurate diagnosis and indication for surgery was high with a concurrence ratio of 83%, considerable differences existed between the assessed regions, with lowest values for thoracic images. Teleradiology is a cost-effective, rapid method which can be applied wherever wireless cell phone reception is available. In our opinion, this method is in principle suitable for clinical use, enabling the physician on duty to agree on appropriate measures with colleagues located elsewhere via x-ray image transmission on a cell phone.