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Evaluation of a Digital Camera for Acquiring Teleradiology Images

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Evaluation of a Digital Camera for Acquiring Teleradiology Images

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    1. Evaluation of a Digital Camera for Acquiring Teleradiology Images

    3. This work was supported by: 1) US Dept. Agriculture, Rural Utilities Service Distance Learning and Telemedicine Grant 2) US Dept. Commerce, National Telecommunications and Information Administration TIIAP Grant 3) Office of Rural Health Policy, HRSA Dept. Health & Human Services Rural Telemedicine Grant Program 4) The State of Arizona

    4. Goal 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.

    6. 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

    13. Rationale 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

    14. Rationale 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

    15. Rationale 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

    16. The Camera

    17. 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

    18. 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

    19. Display 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

    23. Protocol 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

    24. Results - Image Quality

    25. 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

    26. 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

    27. Results - Confidence

    28. Conclusions 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

    29. 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

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