A Protocol for the Assessment of Diagnostic Accuracy in Tele-echocardiography Imaging

WhatsApp in mHealth: design and evaluation of an mHealth tool to share dynamic images in hemodynamics

BACKGROUND

WhatsApp, like many other messaging Apps, enables messages, documents, and multimedia elements to be exchanged through a chat-based tool. Among the many potentialities of WhatsApp are: (I) the possibility to create groups (WhatsApp Groups) and (II) the possibility to install the app on a personal computer using the WhatsApp Web application.

METHODS

The two functionalities (I, II) were used to set-up an mHealth environment for teleconsultation in telecardiology which will support the exchange of the dynamic images in hemodynamics. A proper client/server architecture was proposed to supply the mHealth environment. The files related to the dynamic study were preliminarily converted [using picture archiving and communication system (PACS) functions] into an audio-video interleave (AVI) format, which is compatible with mobile technology.

RESULTS

The mHealth environment was configured. Five dynamic images were extracted from the PACS in the format AVI. The images were exchanged using WhatsApp Web on the server side and WhatsApp on the client side (smartphones). An acceptance analysis of five observers showed high satisfaction with the methodology.

CONCLUSIONS

From a global perspective, our contribution aligns with those of scholars in the field concerning the use of WhatsApp in medical imaging. Furthermore, this study suggests that research in the telecardiology field can be strengthened through the use of dynamic images and WhatsApp.

Tele-obstetric ultrasound: analysis of first-trimester ultrasound images transmitted in realtime

We evaluated the diagnostic quality of first-trimester ultrasound images transmitted in realtime using low-cost telecommunications. A prospective sample of fetal ultrasound images from 11 weeks to 13 weeks and six days of pregnancy was obtained from pregnant women over 18 years old. The examinations were transmitted in realtime to three independent examiners who carried out a qualitative assessment based on parameters established by the Fetal Medicine Foundation. All fetal structures could be viewed and the quality of images received by the examiners was considered normal. There were significant differences for crown-rump length and nuchal translucency in the transmitted images but the loss in definition was acceptable. Thus the quality of images transmitted via the Internet through the use of low-cost software appeared suitable for screening for chromosomal abnormalities in the first trimester of pregnancy.

The design of a health technology assessment system in telepathology

Up to a few years ago, the management of the information on the slides (virtual slides) in telepathology applications was principally based on the design and construction of a few identical and expensive platforms with microscope units and software tools for the display and for electronic control (zooming, moving, and cutting of images). The development of information technology tools allows the diffusion of new visualization strategies and the availability of low cost or free visualization proprietary tools. New competitive systems such as client-server architectures are available in telepathology today. The investigation of the new technologies for telepathology is a basic and core aspect in telemedicine technology assessment. A new interactive environment to investigate the health technology assessment of a telepathology system has been studied. In particular, in consideration of previous experience the methodology focused both on the senior pathologist and younger student pathologist. Two interactive forms were created by a working group: a feedback form and a diagnostic form. The first was designed to investigate the technology characteristics and acceptance of the telepathology systems. The second tool was designed to investigate the diagnostic accuracy on a significant sample of virtual slides by two different groups of pathologists (senior and younger students). The acceptance of the methodology was very high.

Validation of an automatic tool for the assessment of image quality in digital tele-echocardiography

We investigated a novel tool for assessing image degradation in tele-echocardiography. Different video recordings from an echocardiographic examination were transmitted using commercial videoconferencing equipment via a local area network. Different compression schemes were selected, ranging from MPEG 1 to MPEG 4, with transmission at different bit rates ranging from 1.0 to 4.5 Mbit/s. Three methods were used to compare the transmitted and received video sequences: the peak signal to noise ratio, the Double Stimulus Impairment Scale (DSIS) and the National Telecommunication and Information Administration Virtual Quality Metric (VQM). The results showed that the most useful grading procedure was the subjective DSIS. There was a high correlation between the DSIS results and the VQM. The VQM could be thus an effective tool for evaluating tele-echocardiography transmission systems, avoiding the costs and times associated with conducting subjective tests in repeatable conditions.