Influence of the teleradiology technology (N-ISDN and ATM) on the inter-hospital management of neurosurgical patients

Abstract

We set out to assess the influence of a teleradiology network on the relations between a general hospital and a 100 km distant university hospital in the context of neurosurgical emergencies, and compared a commercially available technology, N-ISDN (Narrowband Integrated Service/Digital Network), to an emerging technology, ATM (Asynchronous Transfer Mode). The evaluation was conducted using records of advice request calls and patient transfers. Three phases were considered: without teleradiology, with transfer of digitized images over N-ISDN at 64 kbps, and with an experimental ATM network at 10.5 Mbps with DICOM image transfers and videoconferencing. Additionally, staff meetings over ATM videoconferencing were set up. To assess the ATM service, we used log files and questionnaires, 108 advice requests were studied over a 18 month period. The average transmission time for one examination was 38 s with full DICOM image resolution over ATM, versus 150 s with 10:1 JPEG (Joint Photographic Expert Group) compression over N-ISDN. Up to 50% unnecessary patient transfers were avoided. Advice requests increased fourfold, and non-urgent advice requests increased from 0 to 21%. Despite the experimental configuration of the ATM network, the service gave satisfaction to all the physicians. Videoconferencing was unanimously regarded as a prominent tool to improve the quality of interaction. It was particularly useful for non-urgent cases and distant staff meetings. Teleradiology can improve the relations between hospitals through an increase of urgent and non-urgent advice requests. Asynchronous transfer mode is an efficient way for fast transfer of radiological examinations in DICOM format and for discussing them through high-quality videoconferencing.

Evaluation of a "no-cost" Internet technology-based system for teleradiology and Co-operative Work

“…There are two approaches [4]: the first is known as "Application or Screen Sharing" [5,6,7,8,9,10,11] to whom also the Shared Whiteboard belongs; and the other is the socalled Command Passing or also "event/control sharing" [4,12,13,14,15,16,17,18,19,20]. There are two approaches [4]: the first is known as "Application or Screen Sharing" [5,6,7,8,9,10,11] to whom also the Shared Whiteboard belongs; and the other is the socalled Command Passing or also "event/control sharing" [4,12,13,14,15,16,17,18,19,20].…”

Telemedicine and neurosciences

“…There are a large number of publications that discuss in depth, the advantages and disadvantages of different methods of data transfer and maintaining cost effectiveness without compromising quality. [57][58][59][60][61][62] Stroke Stroke is a common clinical problem. Rapid treatment is crucial for effective intervention in acute ischemic stroke.…”

“…129 New communication systems using international digital networks, including the internet, may allow re-distribution of medical resources between advanced countries and developing countries in neurosurgery. Telemedicine in neurosurgery between Japan and Malaysia using international digital telephone services has been accomplished.…”

Expert Interpretation Compensates for Reduced Image Quality of Camera‐digitized Images Referred to Radiologists

“…Medicine has adopted this simpler form of teleradiology for distant and overseas hospitals and clinics. [2][3][4][5][6][7][8] Although there are conflicting reports on the effect of camera-digitization on image quality and radiographic interpretation, some studies have found that subtle lesions such as small nodules, small fractures, and pneumothoraces may be missed, although most have found no loss in interpretive accuracy. 3,[5][6][7][8][9] Both image quality and expertise affect the accuracy of image interpretation.…”