A preliminary study of the feasibility of wound telecare for the elderly.

We have developed a method for remote wound assessment in the elderly. Wound images were taken with a digital camera at a resolution of 640x480 pixels. JPEG compression was then used to produce images of about 100 kByte. Selected clinical data were transmitted by email, together with standardized digital images of wounds. The remote physician then read the clinical data and viewed the digital images on a 38 cm colour display monitor, at a resolution of 800x600 pixels, in 16-bit colour, using standard software. Three elderly inpatients with pressure sores or leg ulcers had both bedside and remote examinations, by different physicians. The diagnosis and therapeutic recommendations proposed after each of the two examinations were compared qualitatively. There was reasonable agreement between the two physicians in the assessment of wound size, anatomical classification, wound bed and status of infection. However, the lack of palpation represented a major limitation to remote wound assessment, despite the use of probes to delineate the depth of any opening in the wound bed.     

A simple telemedicine system using a digital camera

Radiographs on a viewing box were photographed at a remote hospital in South Africa using a digital camera with a resolution of 1024 x 768 pixels at 24-bit colour depth. The resultant images were stored in JPEG format and transmitted as email attachments to be read on a PC monitor by radiologists in Durban and Cape Town. Twenty-seven images were received, of which 23 were of diagnostic quality (85%). The mean file size was 120 kByte. For quality control purposes, 100 chest radiographs were photographed at a base hospital and read by a radiologist blinded to the diagnosis. In this study 96 images were of diagnostic quality (96%) and the correct diagnosis was made in 90 cases (94%). Incorrect readings were made in six cases (6%): small pulmonary nodules (less than 1 cm in diameter) were missed in five cases and in one case early apical tuberculosis was missed. Digital camera technology permits simple, inexpensive telemedicine. Limited spatial resolution is a concern when reading chest images with small pulmonary nodules and infiltrates.     

Tele-ophthalmology screening for retinal and anterior segment diseases

A digital indirect ophthalmoscope (DIO) was developed and tested for use in tele-ophthalmology screening for posterior and anterior segment diseases. Using custom software, images from the DIO were digitized, compressed, stored and transmitted to a centralized eye clinic for interpretation. A total of 43 subjects were primarily screened for glaucoma using the DIO, a hand-held fundus camera and a stereo fundus camera. The photographic slides from the stereo fundus camera used as gold standards. Images (390 x 300 pixels x 3 bits) were stored using a laptop computer together with patient information. Image quality received at the central eye clinic was good and showed adequate diagnostic information. An ophthalmologist estimated cup-disc ratios and graded the quality of the images. The sensitivity and specificity of each instrument was calculated. A high sensitivity and specificity was found when using the DIO, indicating that it could be used in tele-ophthalmic screenings. Further modifications are needed to make the instrument more user-friendly and to enable it to be used with undilated pupils, so that it can be easily operated by health-care personnel in remote areas. The camera can also be used to image gross external eye pathology.     

International transmission of tele-ophthalmology images

Tele-ophthalmic consultations were conducted between a hospital in East Java, Indonesia, and an ophthalmology centre in Perth, Western Australia. Twenty-two eyes of 14 subjects were screened for glaucoma using a hand-held fundus camera. Optic disc images comprised 267 x 234 pixels at 24 bit/pixel (187 kByte). The images were compressed and stored together with patient information on a laptop computer. The images were then transmitted to Perth using either a mobile phone or a satellite phone, taking 170 s or 240 s, respectively. Images were also compressed to five different compression levels before transmission. At a compression ratio of 1:5, the images were 36 kByte in size and took 29 s to transmit by mobile phone and 60 s by satellite phone. To measure the loss of quality, the root mean square error was calculated for each colour component, comparing the transmitted and original images. The coefficients of variation were 10% (green), 15% (blue) and 22% (red). The images received in Perth were considered to be of excellent quality and readily interpreted by ophthalmologists in terms of the likely presence of glaucoma.     

Digital wireless radiology consultations with a portable computer.

A wireless system for radiological subspecialist consultation based on a portable personal computer and a GSM cellular phone was tested. A link with secure access to the hospital image network was built. A total of 68 emergency computerized tomography (CT) examinations were transmitted. Transmission time via GSM for a single CT image was 1 min and for a complete head scan was 18 min. The transmitted images were acceptable for final diagnosis in 72% of the cases, the rest being acceptable for preliminary diagnosis. The diagnosis from the transmitted images did not change after a later review of the original images in 97% of cases. The wireless link saved a hospital visit by the senior radiologist in 24% of cases. The results show that a remote consultation link can be built with readily available technology and that the technique is useful in radiological subspecialist consultations for CT images.     

Teledentistry in inner-city child-care centres

In Rochester, NY, telehealth centres were established in six inner-city elementary schools and seven child-care centres. The teledentistry project complemented the existing telehealth model. Using an intraoral camera, telehealth assistants record digital images of children's teeth (768 x 494 pixels) and send the images to a computer at the expert dental site (the Eastman Department of Dentistry at the University of Rochester). The paediatric dentist at the expert site reviews the images, and provides referral and treatment recommendations. Subsequently, the telehealth assistant contacts the child's parents or guardians and assists them to obtain appropriate dental care for their child. In the pilot study, we screened 50 children. In the first nine months of 2005, we screened 123 children. The results of our initial teledental screenings of children aged 12-48 months attending inner-city child-care centres revealed that almost 40% had active dental caries, mainly early childhood caries (ECC). For the first time, many children attending inner-city child-care centres have had their teeth examined at an early age and been given prompt feedback on the need for dental care.     

The use of mobile phones for acute wound care: attitudes and opinions of emergency department patients

There are a significant number of emergency department (ED) visits for lacerations each year. When individuals experience skin, soft tissue, or laceration symptoms, the decision to go to the ED is not always easy on the basis of the level of severity. For such cases, it may be feasible to use a mobile phone camera to submit images of their wound to a remote medical provider who can review and help guide their care choice decisions. The authors aimed to assess patient attitudes toward the use of mobile phone technology for laceration management. Patients presenting to an urban ED for initial care and follow-up visits for lacerations were prospectively enrolled. A total of 194 patients were enrolled over 8 months. Enrolled patients answered a series of questions about their injury and a survey on attitudes about the acceptability of making management decisions using mobile phone images only. A majority of those surveyed agreed that it was acceptable to send a mobile phone picture to a physician for a recommendation and diagnosis. Patients also reported few concerns regarding privacy and security and believe that this technology could be cost effective and convenient. In this study, the majority of patients had favorable opinions of using mobile phones for laceration care. Mobile phone camera images (a) may provide a useful modality for assessment of some acute wound care needs and (b) may decrease ED visits for a high-volume complaint such as acute wounds.     

An assessment of the video image quality required in a remote vision guidance system for visually impaired pedestrians

A study was carried out to determine the most acceptable quality of video images for use in remote guidance of visually impaired pedestrians. A video image clip of 20 s duration was captured using a digital camera, while walking a sample route. The video image clip was encoded at bit rates of 30 and 48 kbit/s, and frame rates of 10, 7.5, 5 and 2.7 fps. Two standard resolutions were used: Quarter Common Intermediate Format (QCIF) (176 x 144 pixels) and Common Intermediate Format (CIF) (352 x 288 pixels). Twelve participants gave their judgment on the picture update rate (smoothness of movement), the bit rate and the static resolution. The mean scores for total quality (five-point scale) ranged from 3.3 to 4.8, but there was no significant difference between them. The mean scores for smoothness (five-point scale) ranged from 3.0 to 4.7, but there was no significant difference between them. The mean score for the resolution of the QCIF video clips was 2.9 (SD = 0.9) and for the CIF recordings were 4.1 (SD = 0.7), but there was no significant difference between them. The majority of the participants were most comfortable with video which was transmitted at 48 kbit/s and 7.5 fps. Therefore, this quality can be considered satisfactory for remote guidance.     

Use of mobile phone cameras for after-hours triage in primary care

Mobile phone images might be useful in after-hours triage of primary care. We conducted a study to identify population access to mobile phone cameras and to assess the clinical usefulness of mobile phone cameras. The survey was conducted among 480 patients attending two rural New Zealand practices. There were significantly more Maori owners compared to non-Maori (P = 0.002). Age was a significant factor influencing the ownership of mobile phones. We also conducted a clinical quiz among health professionals to assess how the provision of images on a mobile phone and on CD-ROM (to simulate the image that would be seen if email was used to transmit the images) influenced diagnostic confidence. Ten photographable clinical conditions were used to quiz 30 health professionals who were randomized into three groups of 10 each on diagnostic confidence. Images were found to significantly increase diagnostic confidence in all cases except one. It appears that mobile phone cameras are generally acceptable to patients and likely to be of practical use to rural practitioners in a range of clinical scenarios.     

数字化眼底血管造影图像处理系统的研制

介绍一种基于Visual Basic语言的数字化眼底血管造影图像系统(DFFAS),提供了系统的硬件组成和软件设计思路。该系统以现有的荧光眼底镜为基础,通过采用专业数字相机、视频采集卡,结合应用软件,动、静态采集眼底血管造影图像,最终实现眼底信息的数字化采集、处理和报告管理等一系列功能。实验结果表明,该系统采集图像清晰,操作简便,可广泛应用于临床诊断和教学。     

基于手机的液晶热成像方法及其医学应用

介绍了在以手机为核心的医学成像新模式下,将热色液晶热成像技术与手机相结合,借助手机摄像头获取热色液晶的图像的方法。并基于实验中建立的温度-色调校对曲线,采用数字图像处理方法重建出定量化的人体体表温度分布热图。进一步将该方法用于手部测温及热动力学检查,并根据人体生物传热模型获得了与人体温度分布密切相关的热学参数。本文方法可望发展成为一种泛在的获取人体体表温度图谱的低成本影像技术。     

Teleconsultation for emergency orthopaedic patients using the multimedia messaging service via mobile phones

We investigated the accuracy and usefulness of teleconsultation using the mobile phone multimedia messaging service (MMS) in emergency orthopaedic patients. Pictures of radiographs were taken using a built-in 1.3 megapixel mobile phone camera from a digital display screen in the emergency room and then transmitted to the camera phones of four assessors. The cases comprised 59 emergency orthopaedic patients diagnosed with non- or minimally displaced fractures and 34 age-matched normal patients visiting the emergency department. Both clinical and radiographic follow up data were used as the gold standard. Inter- and intra-observer agreement were good (kappa>0.60). The overall sensitivity, specificity and accuracy were 78%, 54% and 65%, respectively. The overall misdiagnosis rate was 40%, with over-diagnosis of 12% and under-diagnosis of 27%. The consequence of misdiagnosis would have resulted in mismanagement in up to 48% of the cases. No association was found between the experience of the assessors, the region of the fracture or the age group of the patients and the misdiagnosis rate. Teleconsultation via MMS demonstrated good reliability, but poor diagnostic accuracy which could have major consequences in emergency orthopaedic patients.     

Electronic follow-up of facial lacerations in the emergency department

It is often difficult for emergency department staff to follow up the primary closure of simple facial lacerations. This is important to allow closure of the feedback loop. Consecutive patients who were sutured by a single operator using the same technique were asked to send a photograph of the laceration six months and 12 months afterwards. The patients had Internet access and a digital camera, or a mobile phone with a camera. They were given a leaflet with the details of the email address or mobile number to send the picture to. A reminder telephone call was made to each patient at six months and 12 months, and the email address or mobile number to send the picture to was given again. In each telephone call patients were asked to grade the healing on a 5-point scale from 1 = very happy to 5 = very unhappy. At 13 months all patients were re-contacted and reminded again. Fifty patients were included in the study (33 males). The cause of injury was sport in 17 patients, assault in 18 and accidents in 15. At six months, 23 patients stated that they were happy and 27 were very happy with the scar. The mean score was 1.5. At 12 and 13 months, four patients were happy and 46 very happy. The mean score was 1.1. Twenty-four patients said they would use a computer/camera to send in the follow-up image, and 26 patients had a mobile phone with a camera and said they would use that. Despite the reminders, no patients sent a photograph. The results provide no evidence to support the use of photographs sent by email or text message for the follow-up of facial lacerations sutured in the emergency department.     

Clinical applications of integrated 3-D stereoscopic imaging in neurosurgery

Stereotactic neurosurgery planning, an intrinsically three-dimensional procedure, is generally performed on the basis of two-dimensional tomographic or projection images. We present extensions to these conventional approaches that use stereoscopic digital subtraction angiography, three-dimensional volume rendered computed tomography or magnetic resonance images, or a combination of these modalities. The stereoscopic DSA images are analysed interactively on a 3-D workstation. This system employs a liquid-crystal polarizing shutter to display alternate left- and right-eye views to a user wearing polarized glasses. Quantitative planning operations may be performed on the basis of the angiograms alone, or in conjunction with tomographic images of the anatomy. We also describe the procedures used to produce volume-rendered three-dimensional images from MR and CT data-sets, as well as the methodology for combining the stereoscopic angiograms with the volumetric anatomical images.     

Low-cost printing of computerised tomography (CT) images where there is no dedicated CT camera

Many developing countries still rely on conventional hard copy images to transfer information among physicians. We have developed a low-cost alternative method of printing computerised tomography (CT) scan images where there is no dedicated camera. A digital camera is used to photograph images from the CT scan screen monitor. The images are then transferred to a PC via a USB port, before being printed on glossy paper using an inkjet printer. The method can be applied to other imaging modalities like ultrasound and MRI and appears worthy of emulation elsewhere in the developing world where resources and technical expertise are scarce.     

Proposed patient motion monitoring system using feature point tracking with a web camera

Patient motion monitoring systems play an important role in providing accurate treatment dose delivery. We propose a system that utilizes a web camera (frame rate up to 30 fps, maximum resolution of 640?×?480 pixels) and an in-house image processing software (developed using Microsoft Visual C++ and OpenCV). This system is simple to use and convenient to set up. The pyramidal Lucas–Kanade method was applied to calculate motions for each feature point by analysing two consecutive frames. The image processing software employs a color scheme where the defined feature points are blue under stable (no movement) conditions and turn red along with a warning message and an audio signal (beeping alarm) for large patient movements. The initial position of the marker was used by the program to determine the marker positions in all the frames. The software generates a text file that contains the calculated motion for each frame and saves it as a compressed audio video interleave (AVI) file. We proposed a patient motion monitoring system using a web camera, which is simple and convenient to set up, to increase the safety of treatment delivery.     

眼底血管荧光造影机改造为数码眼底血管造影系统

在原有的RC-310眼底血管造影机基础上购置一套数字化摄像系统，将原来配备的普通光学相机改造成数字化成像影机及打印系统。该系统可以立即获得成像结果，病人可以马上拿到图文并茂的彩色检查报告，同时可长期保存清晰的数字化图像。     

Initial experience with a wireless personal digital assistant as a teleradiology terminal for reporting emergency computerized tomography scans

A new type of terminal device, a wireless personal digital assistant (PDA) based on a GSM digital cellular phone, was used to transmit computerized tomography scans of 21 patients to a neuroradiologist. All transmitted images were suitable for a preliminary consultation and in one case a final report could be made. In 18 cases the findings were compatible with the reference film reading performed later and in three cases there were minor differences of no clinical importance. Transmission of a single image lasted 1 min 30 s and the transmission of a complete brain scan (14 images) took on average 21 min. The total process of transmission and interpretation of a brain examination series took on average 40 min. In this pilot study the neuroradiologist gained essential information in 24% of the cases and beneficial information in 62%. The neuroradiologist considered that the image consultation saved a hospital visit in 15 cases (71%). Although PDA technology is at an early stage of development and has numerous limitations, it is likely that future technical improvements will allow easier clinical consultations for neurosurgeons and neurologists.     

眼底血管荧光造影机改造为数码眼底血管造影系统

在原有的RC-310眼底血管造影机基础上购置一套数字化摄像系统,将原来配备的普通光学相机改造成数字化成像影机及打印系统。该系统可以立即获得成像结果,病人可以马上拿到图文并茂的彩色检查报告,同时可长期保存清晰的数字化图像。     

Technical evaluation of a low-bandwidth, Internet-based system for teleconsultations

A low-bandwidth telemedicine system was evaluated in eight community hospitals connected to a central hospital via the Internet. PCs were used with videoconferencing software and modem connections to the telephone network. The average data connection rates, still-image transfer times and live-video transmission rates were determined. The time to send 640 x 480, 320 x 240 and 160 x 120 pixel, 24-bit still images ranged from 29 s to 411 s. The average file transfer times for a 10 s MPEG video-clip was 8.6 min. The average live video frame rate was 1 frame/s (at the best image quality), with an average latency of 3 s. The results suggest that Internet-based videoconferencing is acceptable for certain telemedicine applications.