Telemedicine for Paediatric  Cardiology:   practical experience using  ISDN-6 & ISDN-2 technology
<ul><li>Gwyn Weatherburn </li></ul><ul><li>Reader in Medical Imaging </li></ul><ul><li>Research Centre for Health Studies ...
<ul><ul><ul><li>Dejan Mijin </li></ul></ul></ul><ul><ul><ul><li>Research student, BNU </li></ul></ul></ul><ul><ul><ul><li>...
ISDN-6 or ISDN-2? <ul><li>Integrated Services Digital Network </li></ul><ul><li>Each line has a transmission rate of 64 kb...
ISDN-6 or ISDN-2? <ul><li>How many lines are needed for  paediatric cardiology? </li></ul>
Royal Brompton’s experience with ISDN-6 for paediatric cardiology <ul><li>RBH has used ISDN-6 technology for many years </...
TelePaed <ul><li>Department of Health funded evaluation of the cost effectiveness of TM for the provision of Specialist Fo...
Video recorder/player for echo examinations Typical ISDN-6 teleconference equipment 3x ISDN-2 connections ISDN-6 codec and...
Accuracy of decisions made during teleconferences <ul><li>Audits have shown the suitability of  ISDN-6 to enable correct d...
RBH and Belgrade study using ISDN-2 technology
Research hypotheses <ul><li>When ISDN-2 technology is used to provide a clinical service to link clinicians in Belgrade wi...
Equipment <ul><li>At Royal Brompton (RBH),London: </li></ul><ul><li>ISDN-6 existing teleconferencing technology was used <...
WIRING REQUIREMENTS RBH  ISDN-6 Belgrade ISDN-2
RBH  ISDN-6  Belgrade  ISDN-2
Viewing equipment for radiographs, ECGs etc RBH  Object camera Belgrade  Standard viewing box
The teleconferences <ul><li>Live discussions between clinicians without  patients present commenced in December 2003 </li>...
Ultrasound examinations <ul><li>Pre-recorded cross sectional echocardiograms as routinely used by paediatric cardiologists...
Results <ul><li>To September 9 th  2004, there were </li></ul><ul><li>6 consultations during which, </li></ul><ul><li>17 p...
Results <ul><li>Picture & sound quality was usually good </li></ul><ul><li>Connection time was short (< 1 min) </li></ul><...
Results  <ul><li>NB.  Data missing for one patient </li></ul>5 11 Xrays viewed 8 8 ECG viewed 2 14 Echo viewed No Yes
Effect of teleconsultation on diagnosis
Management changes after teleconsultation 17 patients Management change (11) Management unchanged (6) More invasive treatm...
Some of the medical conditions discussed  (some children had multiple abnormalities) <ul><li>ASD </li></ul><ul><li>VSD </l...
 
 
Standard video  recorder/player for echo examinations Simple teleconferencing equipment used in Belgrade Single ISDN-2 con...
Conclusions <ul><li>This clinical service based on ISDN-2 technology,  </li></ul><ul><li>successfully uses simple, inexpen...
Conclusion <ul><li>Expert advice on Paediatric Cardiology can be provided by the transmission of echocardiograms, radiogra...
Belgrade study was possible because: <ul><li>BNU loaned ISDN-2 equipment to Belgrade </li></ul><ul><li>BNU had a student f...
Plans for the future <ul><li>To continue this clinical service </li></ul><ul><li>To extend the service to include other sp...
<ul><li>For further details please email </li></ul><ul><li>[email_address] </li></ul>
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  1. 1. Telemedicine for Paediatric Cardiology: practical experience using ISDN-6 & ISDN-2 technology
  2. 2. <ul><li>Gwyn Weatherburn </li></ul><ul><li>Reader in Medical Imaging </li></ul><ul><li>Research Centre for Health Studies </li></ul><ul><li>Buckinghamshire New University </li></ul><ul><li>& </li></ul><ul><li>Mike Rigby </li></ul><ul><li>Consultant Paediatric Cardiologist </li></ul><ul><li>Royal Brompton Hospitals NHS Trust </li></ul>
  3. 3. <ul><ul><ul><li>Dejan Mijin </li></ul></ul></ul><ul><ul><ul><li>Research student, BNU </li></ul></ul></ul><ul><ul><ul><li>Jovan Kosutic </li></ul></ul></ul><ul><ul><ul><li>Paediatric Cardiologist, </li></ul></ul></ul><ul><ul><ul><li>Mother & Child Institute, Belgrade </li></ul></ul></ul><ul><ul><ul><li>Tom Carter </li></ul></ul></ul><ul><ul><ul><li>Telemedicine Co-ordinator </li></ul></ul></ul><ul><ul><ul><li>Royal Brompton Hospitals NHS Trust </li></ul></ul></ul>
  4. 4. ISDN-6 or ISDN-2? <ul><li>Integrated Services Digital Network </li></ul><ul><li>Each line has a transmission rate of 64 kb/s </li></ul><ul><li>ISDN-6 provides 384 kb/s </li></ul><ul><li>ISDN-2 provides 128 kb/s (15 frames/sec) </li></ul>
  5. 5. ISDN-6 or ISDN-2? <ul><li>How many lines are needed for paediatric cardiology? </li></ul>
  6. 6. Royal Brompton’s experience with ISDN-6 for paediatric cardiology <ul><li>RBH has used ISDN-6 technology for many years </li></ul><ul><li>For the last 9 years, RBH has provided advice to Brazil, Greece and Portugal using ISDN-6 technology </li></ul><ul><li>More recently, in the UK, RBH has provided advice to 4 DGHs using ISDN-6 teleconference equipment for the TelePaed study </li></ul>
  7. 7. TelePaed <ul><li>Department of Health funded evaluation of the cost effectiveness of TM for the provision of Specialist Foetal and Paediatric Cardiology advice by Specialists at RBH to Obstetricians and Paediatricians in four DGHs </li></ul><ul><li>The 4 reports of this study are available (Dowie et al) </li></ul>
  8. 8. Video recorder/player for echo examinations Typical ISDN-6 teleconference equipment 3x ISDN-2 connections ISDN-6 codec and monitor(s) Object camera to show x-rays etc
  9. 9. Accuracy of decisions made during teleconferences <ul><li>Audits have shown the suitability of ISDN-6 to enable correct diagnosis and management decisions to be made about difficult or complicated cases </li></ul><ul><li>But can such decisions be made using lower transmission rates? </li></ul>
  10. 10. RBH and Belgrade study using ISDN-2 technology
  11. 11. Research hypotheses <ul><li>When ISDN-2 technology is used to provide a clinical service to link clinicians in Belgrade with RBH (1800 miles) </li></ul><ul><li>The clinical service is acceptable to all clinicians </li></ul><ul><li>There is change in diagnosis </li></ul><ul><li>There is change in patient management </li></ul>
  12. 12. Equipment <ul><li>At Royal Brompton (RBH),London: </li></ul><ul><li>ISDN-6 existing teleconferencing technology was used </li></ul><ul><li>At Mother &Child Institute (M&C), Belgrade: </li></ul><ul><li>an ISDN-2 line was installed </li></ul><ul><li>an ISDN-2 videophone was loaned by BNU </li></ul>
  13. 13. WIRING REQUIREMENTS RBH ISDN-6 Belgrade ISDN-2
  14. 14. RBH ISDN-6 Belgrade ISDN-2
  15. 15. Viewing equipment for radiographs, ECGs etc RBH Object camera Belgrade Standard viewing box
  16. 16. The teleconferences <ul><li>Live discussions between clinicians without patients present commenced in December 2003 </li></ul><ul><li>Transmission and discussion of : </li></ul><ul><li>recorded echocardiograms, </li></ul><ul><li>radiographs, </li></ul><ul><li>ECGs </li></ul>
  17. 17. Ultrasound examinations <ul><li>Pre-recorded cross sectional echocardiograms as routinely used by paediatric cardiologists, conventional </li></ul><ul><li>Subcostal, </li></ul><ul><li>Apical parasternal, </li></ul><ul><li>Suprasternal images </li></ul>
  18. 18. Results <ul><li>To September 9 th 2004, there were </li></ul><ul><li>6 consultations during which, </li></ul><ul><li>17 patients were discussed </li></ul>
  19. 19. Results <ul><li>Picture & sound quality was usually good </li></ul><ul><li>Connection time was short (< 1 min) </li></ul><ul><li>Mean discussion time for each patient was about 15 mins </li></ul>
  20. 20. Results <ul><li>NB. Data missing for one patient </li></ul>5 11 Xrays viewed 8 8 ECG viewed 2 14 Echo viewed No Yes
  21. 21. Effect of teleconsultation on diagnosis
  22. 22. Management changes after teleconsultation 17 patients Management change (11) Management unchanged (6) More invasive treatment (6) No previous plan (2) Less invasive treatment (3) Different surgery (4) Refer to other Specialist at RBH (1) Surgery at RBH where device available (1) No surgery (2) No action at present (1)
  23. 23. Some of the medical conditions discussed (some children had multiple abnormalities) <ul><li>ASD </li></ul><ul><li>VSD </li></ul><ul><li>Aorto-pulmonary collateral vessels </li></ul><ul><li>Pulmonary artery stenosis </li></ul><ul><li>Aortic valve stenosis </li></ul><ul><li>Aortic coarctation </li></ul><ul><li>Fallots Tetralogy </li></ul><ul><li>Mitral valve atresia </li></ul><ul><li>DORV </li></ul><ul><li>Pulmonary atresia </li></ul><ul><li>Mitral regurgitation </li></ul><ul><li>Cardiomyopathy </li></ul><ul><li>Epstein’s anomaly </li></ul>
  24. 26. Standard video recorder/player for echo examinations Simple teleconferencing equipment used in Belgrade Single ISDN-2 connection ISDN-2 videophone & standard film viewing box
  25. 27. Conclusions <ul><li>This clinical service based on ISDN-2 technology, </li></ul><ul><li>successfully uses simple, inexpensive equipment in Belgrade to link to more expensive existing equipment in London for Paediatric Cardiology Specialist advice </li></ul><ul><li>enables patients in Serbia to obtain additional specialist advice which is unavailable in their own country </li></ul>
  26. 28. Conclusion <ul><li>Expert advice on Paediatric Cardiology can be provided by the transmission of echocardiograms, radiographs and ECGs using ISDN-2 technology at 128 kb/s </li></ul>
  27. 29. Belgrade study was possible because: <ul><li>BNU loaned ISDN-2 equipment to Belgrade </li></ul><ul><li>BNU had a student from Belgrade who spoke both languages and could act as a co-ordinator </li></ul><ul><li>Belgrade Paediatric Cardiology Consultant had worked at RBH </li></ul><ul><li>Consultant at RBH was willing to give his time & advice </li></ul><ul><li>RBH had a telemedicine co-ordinator to organise teleconsultations </li></ul>
  28. 30. Plans for the future <ul><li>To continue this clinical service </li></ul><ul><li>To extend the service to include other specialties </li></ul><ul><li>To extend the ISDN-2 system to allow M&C to provide specialist advice within Serbia </li></ul>
  29. 31. <ul><li>For further details please email </li></ul><ul><li>[email_address] </li></ul>
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