Comprehensive Telestroke Network to Optimize Health Care Delivery for Cerebrovascular Diseases: Algorithm Development.

BACKGROUND: Health care delivery for cerebrovascular diseases is a complex process, which may be improved using telestroke networks. OBJECTIVE: The purpose of this work was to establish and implement a protocol for the management of patients with acute stroke symptoms according to the available treatment alternatives at the initial point of care and the transfer possibilities. METHODS: The review board of our institutions approved this work. The protocol was based on the latest guidelines of the American Heart Association and American Stroke Association. Stroke care requires human and technological resources, which may differ according to the patient's point of entry into the health care system. Three health care settings were identified to define the appropriate protocols: primary health care setting, intermediate health care setting, and advanced health care setting. RESULTS: A user-friendly web-based telestroke solution was developed. The predictors, scales, and scores implemented in this system allowed the assessment of the vascular insult severity and neurological status of the patient. The total number of possible pathways implemented was as follows: 10 in the primary health care setting, 39 in the intermediate health care setting, and 1162 in the advanced health care setting. CONCLUSIONS: The developed comprehensive telestroke platform is the first stage in optimizing health care delivery for patients with stroke symptoms, regardless of the entry point into the emergency network, in both urban and rural regions. This system supports health care personnel by providing adequate inpatient stroke care and facilitating the prompt transfer of patients to a more appropriate health care setting if necessary, especially for patients with acute ischemic stroke within the therapeutic window who are candidates for reperfusion therapies, ultimately contributing to mitigating the mortality and morbidity associated with stroke.

Agreement and reading time for differently-priced devices for the digital capture of X-ray films.

We assessed the reliability of three digital capture devices: a film digitizer (which cost US $15,000), a flat-bed scanner (US $1800) and a digital camera (US $450). Reliability was measured as the agreement between six observers when reading images acquired from a single device and also in terms of the pair-device agreement. The images were 136 chest X-ray cases. The variables measured were the interstitial opacities distribution, interstitial patterns, nodule size and percentage pneumothorax size. The agreement between the six readers when reading images acquired from a single device was similar for the three devices. The pair-device agreements were moderate for all variables. There were significant differences in reading-time between devices: the mean reading-time for the film digitizer was 93 s, it was 59 s for the flat-bed scanner and 70 s for the digital camera. Despite the differences in their cost, there were no substantial differences in the performance of the three devices.

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.