Emergency image transfer system through a mobile telephone in Japan: technical note

OBJECTIVE: We report the first application and usefulness of image transfer through a mobile telephone, which can be used between the hospital and another location. METHODS: With this system, brain computed tomographic scans, magnetic resonance images, and angiograms obtained from more than 100 patients in the emergency department were transferred and diagnostically analyzed via a mobile phone. The mobile phone had a 110,000-pixel digital camera and a built-in thin-film transistor liquid crystal display. We reviewed the distribution of pathological characteristics on the transferred images and compared them with the diagnoses made using full-scale original film. RESULTS: This system of transferring images was useful in all cases for correct early diagnosis and early treatment. The quality of magnetic resonance images received was better than that of computed tomographic scans. Hemorrhage provided better contrast than infarction for allowing easy identification. Cerebral angiography revealed small aneurysms if the target area was focused properly. Image quality was sufficient for interpretation despite the small dimensions of the monitor. Ease of operation and portability were both satisfactory. The mean time from commencement of image uptake to complete reception was 2 to 3 minutes. CONCLUSION: The mobile phone system is adequately useful for early diagnosis and initiation of treatment in emergent cases. This is attributable to its low cost and ease of handling for sending images to remote areas and between hospitals, despite the small dimensions of the monitor. Better-quality image transfer will be realized through an advanced mobile phone system based on the new International Mobile Telecommunication 2000 standards, which also will be useful in the development of telemedicine and telecare.     

The current state of neurosurgery in Japan

JAPAN HAS TWO large neurosurgical societies, the Japan Neurosurgical Society (JNS) and the Japanese Congress of Neurological Surgeons (Japanese CNS). The JNS was founded in 1948, and the Japanese CNS in 1981. The total number of neurosurgeons in Japan exceeds 7500, with 5432 board certified. There are 1340 training centers for neurosurgery in Japan; they are classified into two categories: Category A centers and Category C centers (training subcenters). For a neurosurgeon to be eligible to take the specialty board examination, he or she is required to have finished at least 6 years of training at a designated training center. A characteristic of Japanese neurosurgery is that neurosurgeons are engaged not only in surgical operations but also in various related activities, including performing radiological diagnostic procedures, such as angiography and endovascular surgery; working in the emergency room; and sometimes participating in neurorehabilitation and gamma knife treatment. In addition, a large number of neurosurgeons are engaged in research in various related fields. The JNS began to publish its official journal in 1948, initially in the Japanese language. Since 1990, the journal has been published exclusively in English (Neurologia Medico-chirurgica), whereas the official journal of the Japanese CNS is published in Japanese (Japanese Journal of Neurosurgery). Japan is blessed with advanced diagnostic and surgical technologies and instruments. They are available as needed throughout the country. Medical insurance is fully covered by the government or public insurance system; there is basically no private insurance in Japan. This article mentions socioeconomic problems relating to neurosurgical practice.     

Intraoperative angiography using a portable digital subtraction unit. Technical note

A portable digital subtraction unit has been used in the operating room as an important improvement in obtaining high-quality intraoperative angiograms. This digital subtraction system offers several advantages over previously described techniques for intraoperative studies. Not only are the images of good quality, but also the dose of contrast medium is reduced and a real-time imaging capability allows the surgeon to visualize the passage of contrast agent dynamically. Arterial injections may be performed by selective femoral cerebral catheterization, puncture of the cervical carotid artery, retrograde catheterization via the superficial temporal artery, or puncture of an intracranial vessel at the time of surgery.