Diagnostic concordance between mobile interfaces and conventional workstations for emergency imaging assessment.

INTRODUCTION: Mobile devices and software are now available with sufficient computing power, speed and complexity to allow for real-time interpretation of radiology exams. In this paper, we perform a multivariable user study that investigates concordance of image-based diagnoses provided using mobile devices on the one hand and conventional workstations on the other hand. METHODS: We performed a between-subjects task-analysis using CT, MRI and radiography datasets. Moreover, we investigated the adequacy of the screen size, image quality, usability and the availability of the tools necessary for the analysis. Radiologists, members of several teams, participated in the experiment under real work conditions. A total of 64 studies with 93 main diagnoses were analyzed. RESULTS: Our results showed that 56 cases were classified with complete concordance (87.69%), 5 cases with almost complete concordance (7.69%) and 1 case (1.56%) with partial concordance. Only 2 studies presented discordance between the reports (3.07%). The main reason to explain the cause of those disagreements was the lack of multiplanar reconstruction tool in the mobile viewer. Screen size and image quality had no direct impact on the mobile diagnosis process. CONCLUSION: We concluded that for images from emergency modalities, a mobile interface provides accurate interpretation and swift response, which could benefit patients' healthcare.

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.

Diagnostic accuracy of digitized chest X-rays using consumer-grade color displays for low-cost teleradiology services: a multireader-multicase comparison.

INTRODUCTION: In teleradiology services and in hospitals, the extensive use of visualization displays requires affordable devices. The purpose of this study was to compare three differently priced displays (a medical-grade grayscale display and two consumer-grade color displays) for image visualization of digitized chest X-rays. MATERIALS AND METHODS: The evaluated conditions were interstitial opacities, pneumothorax, and nodules using computed tomography as the gold standard. The comparison was accomplished in terms of receiver operating characteristic (ROC) curves, the diagnostic power measured as the area under ROC curves, accuracy in conditions classification, and main factors affecting accuracy, in a factorial study with 76 cases and six radiologists. RESULTS: The ROC curves for all of the displays and pathologies had similar shapes and no differences in diagnostic power. The proportion of cases correctly classified for each display was greater than 71.9%. The correctness proportions of the three displays were different (p<0.05) only for interstitial opacities. The evaluation of the main factors affecting these proportions revealed that the display factor was not significant for either nodule size or pneumothorax size (p>0.05). CONCLUSIONS: Although the image quality variables showed differences in the radiologists' perceptions of the image quality of the three displays, significant differences in the accuracy did not occur. The main effect on the variability of the proportions of correctly classified cases did not come from the display factor. This study confirms previous findings that medical-grade displays could be replaced by consumer-grade color displays with the same image quality.

Clinical applicability of real-time, prehospital image transmission for FAST (Focused Assessment with Sonography for Trauma).

We evaluated a real-time, prehospital ultrasound image transmission system for use in focused assessment with sonography for trauma (FAST). The wireless, real-time ultrasound image transmission system comprised an ultrasound scanner with a convex abdominal transducer and a notebook computer connected to a 3 G wireless network for video data transmission. In our simulation experiment, ultrasonography was performed by emergency medical technicians (EMTs) on a human body phantom with simulated haemoperitoneum. Transmitted ultrasound video clips were randomly rearranged and presented to emergency physicians to make a diagnosis of haemoperitoneum. A total of 21 ultrasound video clips was used and 13 emergency physicians participated in the study. The sensitivity and specificity were 90.0% (95% Confidence Interval, CI, 83.5-94.6) and 85.3% (95% CI 78.4-90.7) respectively, and the accuracy of detecting abnormal ultrasound results was 87.7% (95% CI 83.8-91.6). Diagnosis of hemoperitonuem in trauma patients by an emergency physician based on the transmitted video images of FAST performed by an EMT is feasible, and has an accuracy of about 88%.

[Technological advances and hospital-at-home care]. / L'innovazione tecnologica e l'ospedalizzazione a domicilio.

Advances in the miniaturization and portability of diagnostic technologies, information technologies, remote monitoring, and long-distance care have increased the viability of home-based care, even for patients with serious conditions. Telemedicine and teleradiology projects are active at the Hospital at Home Service of Torino.

A low cost method of digitizing radiographs using a photo light box.

We evaluated a low cost device for digitizing X-ray films. It consisted of a locally-made wooden box and a readily-available digital camera. Two experienced paediatric radiologists interpreted the original X-ray films (the reference standard) and the corresponding images obtained in the photo light box. Ninety paediatric chest X-ray films were used (30 were normal chest radiographs, 30 showed pneumonic-consolidation and 30 had interstitial infiltrates). The presence or absence of the three signs most frequently found in acute respiratory pathologies were evaluated: normal pulmonary transparency, pneumonic consolidation and interstitial infiltration. There was very good agreement between the X-ray films and the digitized images, with kappa values from 0.86 to 0.98. There was good agreement between the two observers, with kappa values from 0.67 to 0.90. The low-cost photo light box represents an accessible and low-cost approach to transmitting X-ray images, allowing findings or a second opinion from a specialist radiologist to be obtained from a distance.

Comparison between different cost devices for digital capture of X-ray films: an image characteristics detection approach.

A common teleradiology practice is digitizing films. The costs of specialized digitizers are very high, that is why there is a trend to use conventional scanners and digital cameras. Statistical clinical studies are required to determine the accuracy of these devices, which are very difficult to carry out. The purpose of this study was to compare three capture devices in terms of their capacity to detect several image characteristics. Spatial resolution, contrast, gray levels, and geometric deformation were compared for a specialized digitizer ICR (US$ 15,000), a conventional scanner UMAX (US$ 1,800), and a digital camera LUMIX (US$ 450, but require an additional support system and a light box for about US$ 400). Test patterns printed in films were used. The results detected gray levels lower than real values for all three devices; acceptable contrast and low geometric deformation with three devices. All three devices are appropriate solutions, but a digital camera requires more operator training and more settings.

A mobile tele-radiology imaging system with JPEG2000 for an emergency care.

The aim of this study was to design a tele-radiology imaging system for rapid emergency care via mobile networks and to assess the diagnostic feasibility of the Joint Photographic Experts Group 2000 (JPEG2000) radiological imaging using portable devices. Rapid patient information and image exchange is helpful to make clinical decisions. We assessed the usefulness of the mobile tele-radiology system by measuring both a quantitative method, PNSR calculation, for image qualities, and its transmission time via mobile networks in different mobile networks, respectively; code division multiple access evolution-data optimized, wireless broadband, and high-speed downlink packet access; and the feasibility of the JPEG2000 computed tomography (CT) images by qualitatively assessing with the Alberta stroke program early CT score method with 12 CT image cases (seven normal and five abnormal cases). We found that the quality of the JPEG2000 radiological images was satisfied quantitatively and was judged as acceptable qualitatively at 5:1 and 10:1 compression levels for the mobile tele-radiology imaging system. The JPEG2000-format radiological images achieved a fast transmission while maintaining a diagnosis quality on a portable device via mobile networks. Unfortunately, a PDA device, having a limited screen resolution, posed difficulties in reviewing the JPEG2000 images regardless of the compression levels. An ultra mobile PC was preferable to study the medical image. The mobile tele-radiology imaging systems supporting JPEG2000 image transmission can be applied to actual emergency care services under mobile computing environments.

Potential impact of HITECH security regulations on medical imaging.

Title XIII of Division A and Title IV of Division B of the American Recovery and Reinvestment Act (ARRA) of 2009 [1] include a provision commonly referred to as the "Health Information Technology for Economic and Clinical Health Act" or "HITECH Act" that is intended to promote the electronic exchange of health information to improve the quality of health care. Subtitle D of the HITECH Act includes key amendments to strengthen the privacy and security regulations issued under the Health Insurance Portability and Accountability Act (HIPAA). The HITECH act also states that "the National Coordinator" must consult with the National Institute of Standards and Technology (NIST) in determining what standards are to be applied and enforced for compliance with HIPAA. This has led to speculation that NIST will recommend that the government impose the Federal Information Security Management Act (FISMA) [2], which was created by NIST for application within the federal government, as requirements to the public Electronic Health Records (EHR) community in the USA. In this paper we will describe potential impacts of FISMA on medical image sharing strategies such as teleradiology and outline how a strict application of FISMA or FISMA-based regulations could have significant negative impacts on information sharing between care providers.

Interdisciplinary expert consultation via a teleradiology platform--influence on therapeutic decision-making and patient referral rates to an academic tertiary care center.

In addition to teleradiological reporting as a nighthawking or a regular service, teleradiological communication can be used for interdisciplinary expert consultation. We intended to evaluate an interdisciplinary consultation system based on a teleradiology platform with regard to its impact on therapeutic decision-making, directed patient referrals to an academic tertiary care center and the economic benefit for the hospital providing the service. Therefore, consultations from five secondary care centers and consecutive admissions to an academic tertiary care center were prospectively evaluated over a time period of six months. A total of 69 interdisciplinary expert consultations were performed. In 54 % of the cases the patients were consecutively referred to the university hospital for further treatment. In all acutely life-threatening emergencies (n = 9), fast and focused treatment by referral to the academic tertiary care center was achieved (average time to treat 130 min). The admissions to the academic tertiary care center led to improved utilization of its facilities with additional revenue of more than 1,000000 euro p. a. An interdisciplinary expert consultation via a teleradiology platform enables fast and efficient expert care with improved and accelerated patient management and improved utilization of the service providing hospital.

The effectiveness of low-cost teleconsultation for emergency head computer tomography in patients with suspected stroke.

Teleradiology in an emergency situation can be used to support rapid neurological decision-making when specialists are remote from the hospital concerned. We have developed a low-cost system using a PDA phone as the receiving equipment. The experimental system was based on a notebook PC to send the images and a PDA phone to receive them. We used commercially available toolbar software for transmitting the information through the mobile phone network. A total of 100 images from clinically suspected strokes within the previous 24 hours were transmitted to a neurologist. The mean size of the original picture was 20.9 kByte and the images were compressed by approximately 2:1 before transmission. The mean transmission time was 48 s per image. The diagnosis from the PDA phone image was in complete agreement with the diagnosis from the original image in cases of acute ischaemic stroke, intracerebral haemorrhage, metastasis and in normal scans. However, there was agreement in only 7 of the 8 cases (88%) of subarachnoid haemorrhage. The overall transmission cost was 400 Thai baht per case. The study showed that good accuracy can be achieved with a low-cost system for teleradiology consultation in stroke.

Diagnosing pneumonia in rural Thailand: Digital cameras versus film digitizers for chest radiograph teleradiology.

BACKGROUND: Accurate surveillance for pneumonia requires standardized classification of chest radiographs. Digital imaging permits rapid electronic transfer of data to radiologists, and recent improvements in digital camera technology present high quality, yet cheaper, options. METHODS: We evaluated the comparative utility of digital camera versus film digitizer in capturing chest radiographs in a pneumonia surveillance system in rural Thailand using a panel of radiologists; the gold standard was the hard-copy radiograph. We calculated sensitivity and specificity and conducted a receiver operator characteristics (ROC) analysis. RESULTS: Of the 192 radiographs from patients with clinical pneumonia, 166 (86%) were classified as pneumonia on the hard copies. Sensitivity and specificity for identifying pneumonia were 89% and 73% for the camera and 90% and 65% for the digitizer. In the ROC analysis, there was no statistically significant difference in the area under the curve (camera, 0.86; film digitizer, 0.91, p = 0.29). The digital camera set cost 965 dollars compared to 3000 dollars for the film digitizer. CONCLUSION: Detection of pneumonia was not measurably compromised by using digital cameras compared with film digitizers. The 3-fold lower cost of the digital camera makes this technology an affordable and widely accessible alternative for surveillance systems, vaccine trials, and perhaps clinical use.

A framework supporting the development of a Grid portal for analysis based on ROI.

OBJECTIVES: In our research on brain function analysis, users require two different simultaneous types of processing: interactive processing to a specific part of data and high-performance batch processing to an entire dataset. The difference between these two types of processing is in whether or not the analysis is for data in the region of interest (ROI). In this study, we propose a Grid portal that has a mechanism to freely assign computing resources to the users on a Grid environment according to the users' two different types of processing requirements. METHODS: We constructed a Grid portal which integrates interactive processing and batch processing by the following two mechanisms. First, a job steering mechanism controls job execution based on user-tagged priority among organizations with heterogeneous computing resources. Interactive jobs are processed in preference to batch jobs by this mechanism. Second, a priority-based result delivery mechanism that administrates a rank of data significance. RESULTS: The portal ensures a turn-around time of interactive processing by the priority-based job controlling mechanism, and provides the users with quality of services (QoS) for interactive processing. The users can access the analysis results of interactive jobs in preference to the analysis results of batch jobs. The Grid portal has also achieved high-performance computation of MEG analysis with batch processing on the Grid environment. CONCLUSION: The priority-based job controlling mechanism has been realized to freely assign computing resources to the users' requirements. Furthermore the achievement of high-performance computation contributes greatly to the overall progress of brain science. The portal has thus made it possible for the users to flexibly include the large computational power in what they want to analyze.

Acquisition and evaluation of radiography images by digital camera.

To determine applicability of low-cost digital imaging for different radiographic modalities used in consultations from remote areas of the Ecuadorian rainforest with limited resources, both medical and financial. Low-cost digital imaging, consisting of hand-held digital cameras, was used for image capture at a remote location. Diagnostic radiographic images were captured in Ecuador by digital camera and transmitted to a password-protected File Transfer Protocol (FTP) server at VCU Medical Center in Richmond, Virginia, using standard Internet connectivity with standard security. After capture and subsequent transfer of images via low-bandwidth Internet connections, attending radiologists in the United States compared diagnoses to those from Ecuador to evaluate quality of image transfer. Corroborative diagnoses were obtained with the digital camera images for greater than 90% of the plain film and computed tomography studies. Ultrasound (U/S) studies demonstrated only 56% corroboration. Images of radiographs captured utilizing commercially available digital cameras can provide quality sufficient for expert consultation for many plain film studies for remote, underserved areas without access to advanced modalities.

[Interdisciplinary surgery and telemedicine]. / Operative Interdisziplinarität und Telematik.

Surgical therapy is becoming increasingly complex. Besides new surgical techniques, sophisticated diagnostic methods and innovative interventional procedures must be integrated into the therapeutic concept to increase the efficacy of surgery. Accurate application of these techniques requires close cooperation between surgeons, other medical specialists, and technicians. Consequently, there is a significant need for structures promoting efficient communication, organization, and interaction in surgical departments. New techniques developed from telecommunication and information technology enable the transferal of complex medical data at any time to any place and are therefore the basis for telemedical applications. Telemedicine and other new techniques such as virtual operation planning, simulation, and intraoperative navigation promise to increase the efficacy of surgical therapy in the future. This paper provides an overview of the applications of telesurgery and currently available techniques.

Diagnostic accuracy of chest X-rays acquired using a digital camera for low-cost teleradiology.

Store-and-forward telemedicine, using e-mail to send clinical data and digital images, offers a low-cost alternative for physicians in developing countries to obtain second opinions from specialists. To explore the potential usefulness of this technique, 91 chest X-ray images were photographed using a digital camera and a view box. Four independent readers (three radiologists and one pulmonologist) read two types of digital (JPEG and JPEG2000) and original film images and indicated their confidence in the presence of eight features known to be radiological indicators of tuberculosis (TB). The results were compared to a "gold standard" established by two different radiologists, and assessed using receiver operating characteristic (ROC) curve analysis. There was no statistical difference in the overall performance between the readings from the original films and both types of digital images. The size of JPEG2000 images was approximately 120KB, making this technique feasible for slow internet connections. Our preliminary results show the potential usefulness of this technique particularly for tuberculosis and lung disease, but further studies are required to refine its potential.

Minimum technical requirements and evaluating effectiveness of teleradiology.

Teleradiology, the electronic transmission of radiological images for the purposes of interpretation and consultation, has successfully entered routine health services. It is, therefore, currently one of the single largest applications of telemedicine. This technology is predicted to play a significant role in improving service access to rural and remote areas. However, teleradiology services are currently characterized by a compromise between expense and quality of digital images. This paper reviews minimum equipment requirements and the technical issues and limits that are experienced when utilizing current teleradiological technology. Categories of service evaluation, including measures of user satisfaction, clinical outcome and financial benefit, are discussed in relation to facilitating a radiology service of the highest quality possible.