Technique for neurosurgically relevant CT image transfers using inexpensive video digital technology

Teleradiology in neurosurgery: experience in 1024 cases

Between June 1995 and June 2000 teleradiology was performed in 1024 neurosurgical cases (945 patients). An analogue image transfer system was used for presentation of computed tomography (CT) and magnetic resonance imaging (MRI) scans from seven referring hospitals in southern Germany. The system used a 19,200 baud modem connection via the ordinary telephone network. The diagnoses on presentation were intracerebral haematoma (50%), trauma (27%), subarachnoid haemorrhage (4%), stroke (5%) and others (14%). Retrospective analysis showed that in 67% of cases admission and therefore ground-based transportation of the patients to our neurosurgical centre was not necessary for different reasons (moribund status, no surgical intervention required or no neurosurgical problem at all). If each patient had been transferred, then the potential savings for ground transportation were euro339.93 per case (with accompanying physician of the affiliated hospital) or euro373.96 per case (with accompanying experienced ICU physician), respectively (euro1 is US$1.4). The total cost of the image transfer system for all eight hospitals was euro96,000; this was amortised after 282 teleconsultations, which occurred after 15 months of usage. A simple teleradiology system in neurosurgery enables rapid and reliable telephone consultations, mainly on patients with trauma, stroke and intracerebral haematoma at low cost.

Telemedicine and neurosciences

It is well known that in most countries there is a perennial shortage of specialists in neurosciences. The available neurologists and neurosurgeons are clustered in the metropolitan, urban areas. Those living in suburban and rural areas may have limited or no access to neurological care. Concurrently, there has been an unprecedented growth in information and communication technology (ICT). In this article, the author will demonstrate how the practice of neurosciences will change, with increasing use of telemedicine and ICT. In addition to presenting the author's personal experience, the literature on telemedicine in neurosciences is reviewed.

Acquisition and evaluation of radiography images by digital camera

To determine applicability of low-cost digital imaging for different radiographic modalities used in consultations from remote areas of the Ecuadorian rainforest with limited resources, both medical and financial. Low-cost digital imaging, consisting of hand-held digital cameras, was used for image capture at a remote location. Diagnostic radiographic images were captured in Ecuador by digital camera and transmitted to a password-protected File Transfer Protocol (FTP) server at VCU Medical Center in Richmond, Virginia, using standard Internet connectivity with standard security. After capture and subsequent transfer of images via low-bandwidth Internet connections, attending radiologists in the United States compared diagnoses to those from Ecuador to evaluate quality of image transfer. Corroborative diagnoses were obtained with the digital camera images for greater than 90% of the plain film and computed tomography studies. Ultrasound (U/S) studies demonstrated only 56% corroboration. Images of radiographs captured utilizing commercially available digital cameras can provide quality sufficient for expert consultation for many plain film studies for remote, underserved areas without access to advanced modalities.