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Evaluation of a Digital Camera for Acquiring Teleradiology Images Elizabeth A. Krupinski, PhD University of Arizona Department of Radiology Arizona Telemedicine Program Ronald S. Weinstein, MD University of Arizona Department of Pathology Arizona Telemedicine Program Carlos Gonzales, MD

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Elizabeth A. Krupinski, PhD

University of Arizona

Department of Radiology

Arizona Telemedicine Program

Ronald S. Weinstein, MD

University of Arizona

Department of Pathology

Arizona Telemedicine Program

Carlos Gonzales, MD

Michael Gonzales

Patagonia Family Health Center


This work was supported by:1) US Dept. Agriculture, Rural Utilities Service Distance Learning and Telemedicine Grant2) US Dept. Commerce, National Telecommunications and Information Administration TIIAP Grant3) Office of Rural Health Policy, HRSA Dept. Health & Human Services Rural Telemedicine Grant Program4) The State of Arizona

  • To determine if a commercially available digital camera can be used to acquire photographs of radiologic images to transmit them via store-forward technology over a telemedicine network.

ATP Telemedicine Sites

Tuba City










DOC - Phoenix



DOC - Yuma




Tucson VA




arizona rural telemedicine network artn
Arizona Rural Telemedicine Network (ARTN)
  • ATM based network based on high-speed T1 carriers
  • 3 ATM switches located in Northern (Flagstaff), Central (Phoenix) & Southern (Tucson) regions of the state
  • Tandberg CANVAS Health Care Unit for real-time interactive teleconsults
  • MedVision for store-forward teleconsults
  • CompuRAD/Lumisys for teleradiology

Teleradiology Network

  • 3 of the sites (Kino Community Hospital in Tucson, Springerville & White River) are connected to the University Medical Center via the high-speed (T1) Arizona Rural Telemedicine Network (ARTN)
  • 1 site (Tucson VA) uses dial-up service

Sub-Specialties Covered

Cardiology Ophthalmology Peds. Orthopedics

Dental Orthoped. Surg. Peds. Psychiatry

Dermatology Orthopedics Peds. Pulmonology

Endocrinology Otorhinology Peds. Rheumatology

Fam. & Comm. Med. Pain Clinic Peds. Urology

Gastroenterology Pathology Psychiatry

Genetics Peds. Cardiology Radiology

Hematology/Oncology Peds. Dermatology Reprod/Infertility

Infectious Disease Peds. Endocrinology Rheumatology

Internal Medicine Peds. Gastroenterology Surgery

Medicine Peds. Hem/Onc Surgical Oncology

Nephrology Peds. Infec. Disease Toxicology

Neurology Peds. Nephrology Urology

Ob/Gyn Peds. Neurology Vascular

  • Teleradiology is an important part of an increasing number of Radiology & Telemedicine programs
  • Saves time and feedback to referring clinician is faster than with other methods (e.g., courier) - 85% of our teleradiology cases have a “wet read” report generated within 6 hours
  • It can, however, be expensive!
  • For digital modalities a merge box is needed
  • For plain film a digitizer or video capture system is required
  • Some sites just cannot afford these options
  • A low-cost alternative had to be explored
  • The Patagonia Family Health Center needs consults especially in orthopedics & bone radiology
  • Have no x-ray facilities so send patients to Nogales’ Mariposa Clinic, the report & films are sent over either with patients or later
  • Problem - Mariposa only has a general radiologist so sub-specialty consults are often required
the camera
The Camera

Canon PowerShot600

CCD image sensor

832 x 608 pixels

24-bit color resolution

f/2.5 lens

Built-in flash

150 kB file size

the cases
The Cases
  • 40 bone trauma cases (e.g., fracture, subluxation, soft tissue damage) from the Patagonia Family Health Clinic
  • Cases that required a consult in the past & were representative of the types of cases they would be sending for teleconsults in the future - typically subtle lesions
the photographs
The Photographs
  • Film images were placed on standard viewbox with extraneous light blocked out
  • The physician identified region(s) of interest based on clinical history and nature of problem
  • At least one global and one close up shot were acquired for each image using the Canon PowerShot camera
  • Images sent over ARTN to the MedVision workstation
  • Color monitor, 1024 x 768 pixels
  • Window/level, zoom/pan available for use during viewing
  • Film images displayed on standard viewbox
  • 2 orthopedic surgeons & 2 bone radiologists reviewed the 40 cases on film & using the digital photographs displayed on the monitor
  • Film reading 6 months after monitor reading
  • Reported:
    • Diagnosis
    • Decision confidence using 6-level scale
    • Image quality using 4-level scale
results image quality25
Results - Image Quality
  • C2 = 20.32, df = 9, p = 0.02
  • 9 of the photo cases were rated poor

4 film cases were rated poor

  • Of the 9 photo cases, 4 (45%) were rated as poor because the region-of-interest was not captured sufficiently
  • Some views (film & photo) were not what the readers were used to - different technologists
results diagnoses
Results - Diagnoses*

Reader Agreement (Kappa)

1 0.89

2 0.92

3 0.94

4 0.88

* Truth was determined by 2 radiologists not participating in the study from the film images

results confidence
Results - Confidence

* How many categories film & monitor confidences differ by

  • A digital still camera can be used effectively to capture images of bone trauma radiographs for store-forward telemedicine consults
  • Well-framed close-up shots of the region-of-interest are essential
  • Good quality original films are essential
other applications
Other Applications?
  • Other non-screening applications where a specific suspicious region-of-interest can be identified for close-up photographs
  • Unless the lesion is fairly gross, the global shots are not adequate for consultation - close-up shots are required in the majority of cases