1. Telemedicine Peter Corr University of Natal S Africa Overview Lecture Links

2. 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

3. Overview History Goals Definitions Applications Hardware &software requirements Pitfalls Future directions

4. History of Telemedicine First used in the sixties to transmit chest radiographs from Boston airport to Massachusetts General Hospital radiologists for reporting

5. 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

6. 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

7. 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

8. Applications radiology ultrasound surgery opthalmology pathology dermatology

9. Radiology Applications Plain radiographs Computerised tomography (CT) Ultrasound Magnetic resonance (MR) Angiograms Nuclear medicine

10. 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

11. Disadvantages Incorrect diagnoses Cost of hardware Need good telecommunication network Training of staff Medicolegal concerns- patient confidentiality

12. Image Acquisition Digitiser to transfer hardcopy images into digital images requires resolution of 2kX2kX12bits resolution Nedd to compress data to reduce transmission time

13. 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

14. Image Display High quality resolution monitors essential for reading images resolution of 2kX2kX12bit required Good screen luminance

15. Applications- Ultrasound Ultrasound-image files are small <100kb and static images are easy to transmit Fetal ultrasound teleconsultation shows promise

16. Applications- CT/MR Imaging CT and MR imaging are small files <100kb and are easily transmitted for consultation

17. Applications Surgery- used for transmitting angiograms to vascular surgeons for consultation Opthalmology- slit lamp and retinal images transmitted to opthalmologist using a retinal camera

18. Pathology Histology slides can be transmitted to pathologists using a digital camera attached to a microscope

19. Hardware & Software Standards- American College of RadiologyAmerican College of Radiology

20. Pitfalls Cost- digitizers are expensive Telecommunications limited in many parts of Africa and Asia- satellite shows promise Medicolegal issues- patient confidentiality Training of physicians

21. 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

22. Links American College of Radiology University of Iowa Health Web Radiological Society of North America