Telemedicine was perceived by cardiologists, district clinicians, and families as reliable and efficient. The equivocal 6-month cost results indicate that investment in the technology is warranted to enhance pediatric and perinatal cardiology services.

A comparison has been made of the reject rates of plain images for three separate periods when film, computed radiography (CR) and PACS systems were in operation throughout the Hammersmith Hospital, London. There was a statistically significant reduction in the overall percentage reject rate across all examinations from 9.9% to 8.1% when the hospital changed from using a conventional film based system to a CR system. There was a further reduction in the reject rate to 7.3% when the hospital moved to a hospital-wide PACS system, but this change was not statistically significant. Using estimations of the total number of images used, the percentage reject rates were 6.6% for film, 5.5% for CR and 5.5% for PACS. Thus, if the radiation dose for each image is unchanged, and the same types of images are used for the examination of each body area, a move from conventional film imaging to phosphor plate imaging provides the potential to reduce the patient population dose.

et al.The costeffectiveness of magnetic resonance imaging for investigation of the knee joint. Health Technol Assess 2001;5(27). Health Technology Assessment is indexed in Index Medicus/MEDLINE and Excerpta Medica/ EMBASE. Copies of the Executive Summaries are available from the NCCHTA website (see opposite). NHS R&D HTA Programme T he NHS R&D Health Technology Assessment (HTA) Programme was set up in 1993 to ensure that high-quality research information on the costs, effectiveness and broader impact of health technologies is produced in the most efficient way for those who use, manage and provide care in the NHS. Initially, six HTA panels (pharmaceuticals, acute sector, primary and community care, diagnostics and imaging, population screening, methodology) helped to set the research priorities for the HTA Programme. However, during the past few years there have been a number of changes in and around NHS R&D, such as the establishment of the National Institute for Clinical Excellence (NICE) and the creation of three new research programmes: Service Delivery and Organisation (SDO); New and Emerging Applications of Technology (NEAT); and the Methodology Programme. This has meant that the HTA panels can now focus more explicitly on health technologies ('health technologies' are broadly defined to include all interventions used to promote health, prevent and treat disease, and improve rehabilitation and long-term care) rather than settings of care. Therefore the panel structure has been redefined and replaced by three new panels: Pharmaceuticals; Therapeutic Procedures (including devices and operations); and Diagnostic Technologies and Screening. The HTA Programme will continue to commission both primary and secondary research. The HTA Commissioning Board, supported by the National Coordinating Centre for Health Technology Assessment (NCCHTA), will consider and advise the Programme Director on the best research projects to pursue in order to address the research priorities identified by the three HTA panels. The research reported in this monograph was funded as project number 93/26/16. The views expressed in this publication are those of the authors and not necessarily those of the HTA Programme or the Department of Health. The editors wish to emphasise that funding and publication of this research by the NHS should not be taken as implicit support for any recommendations made by the authors. Criteria for inclusion in the HTA monograph series Reports are published in the HTA monograph series if (1) they have resulted from work commissioned for the HTA Programme, and (2) they are of a sufficiently high scientific quality as assessed by the referees and editors. Reviews in Health Technology Assessment are termed 'systematic' when the account of the search, appraisal and synthesis methods (to minimise biases and random errors) would, in theory, permit the replication of the review by others.

Comparisons of parental satisfaction were made after specialist paediatric cardiology consultations were conducted either by conventional face-to-face delivery or telemedicine. Satisfaction statements were rated by 100 parents: 20 who experienced telemedicine; 56 with new children seen in the outreach clinics; 24 with children on review whose next appointment was at the specialist centre. There was general satisfaction with both types of consultations, but significant differences were noted. Those who had videoconferences felt that they had received an explanation about how the specialist advice would be obtained, and that they could see the pictures being discussed clearly. Those who had experienced telemedicine believed that teleconsultations could save them travelling time and money and they found the technical aspects of sound and picture quality acceptable. They were not discomforted by the technology and felt reassured by the consultation with the specialist. However, there was some ambivalence towards the statements suggesting that teleconsultations could take the place of conventional face-to-face consultations.

PACS was almost universally preferred by users and brought many operational and clinical benefits. However, these advantages came at a significant capital and net running cost.