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Evaluation of a Digital Camera for Acquiring Teleradiology Images


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Evaluation of a Digital Camera for Acquiring Teleradiology Images

  1. 1. Evaluation of a Digital Camera for Acquiring Teleradiology Images
  2. 2. Elizabeth A. Krupinski, PhD University of Arizona Department of Radiology Arizona Telemedicine Program Ronald S. Weinstein, MD University of Arizona Department of Pathology Arizona Telemedicine Program Carlos Gonzales, MD Michael Gonzales Patagonia Family Health Center
  3. 3. This work was supported by: 1) US Dept. Agriculture, Rural Utilities Service Distance Learning and Telemedicine Grant 2) US Dept. Commerce, National Telecommunications and Information Administration TIIAP Grant 3) Office of Rural Health Policy, HRSA Dept. Health & Human Services Rural Telemedicine Grant Program 4) The State of Arizona
  4. 4. Goal To determine if a commercially available digital camera can be used to acquire photographs of radiologic images to transmit them via store-forward technology over a telemedicine network.
  5. 5. ATP Telemedicine Sites Tuba City Kingman Cottonwood Ganado Payson Springerville Whiteriver DOC - Phoenix DOC - Yuma Nogales Patagonia Douglas AHSC KinoTucson VA AHSC Hub Telemedicine Telepathology Teleradiology Flagstaff NARBHA Net
  6. 6. Arizona Rural Telemedicine Network (ARTN) ATM based network based on high-speed T1 carriers 3 ATM switches located in Northern (Flagstaff), Central (Phoenix) & Southern (Tucson) regions of the state Tandberg CANVAS Health Care Unit for real-time interactive teleconsults MedVision for store-forward teleconsults CompuRAD/Lumisys for teleradiology
  7. 7. Case Volume Telemedicine 0 20 40 60 80 100 120 140 160 180 NumberofCases 2nd Qtr 97 3rd Qtr 97 4th Qtr 97 1st Qtr 98 2nd Qtr 98 3rd Qtr 98 4th Qtr 98 1st Qtr 99
  8. 8. Teleradiology Network 3 of the sites (Kino Community Hospital in Tucson, Springerville & White River) are connected to the University Medical Center via the high-speed (T1) Arizona Rural Telemedicine Network (ARTN) 1 site (Tucson VA) uses dial-up service
  9. 9. Case Volume Teleradiology 0 50 100 150 200 250 300 350 Numberofcases 2nd Qtr 97 3rd Qtr 97 4th Qtr 97 1st Qtr 98 2nd Qtr 98 3rd Qtr 98 4th Qtr 98 1st Qtr 99
  10. 10. Sub-Specialties Covered Cardiology Ophthalmology Peds. Orthopedics Dental Orthoped. Surg. Peds. Psychiatry Dermatology Orthopedics Peds. Pulmonology Endocrinology Otorhinology Peds. Rheumatology Fam. & Comm. Med. Pain Clinic Peds. Urology Gastroenterology Pathology Psychiatry Genetics Peds. Cardiology Radiology Hematology/Oncology Peds. Dermatology Reprod/Infertility Infectious Disease Peds. Endocrinology Rheumatology Internal Medicine Peds. Gastroenterology Surgery MedicinePeds. Hem/Onc Surgical Oncology Nephrology Peds. Infec. Disease Toxicology Neurology Peds. Nephrology Urology Ob/Gyn Peds. Neurology Vascular
  11. 11. Types of Service Routine Diagnostic Consult 38% Second Opinion 18% Medication Check 19% Psych Therapy 15% Other 1% Psych Evaluation 6% Manage Chronic Condition 2% Manage Acute Condition 1%
  12. 12. Patient Information Lab Reports 51% Written* 10% Still Photos 23% Other 4% EKG/EEG/ EMG 2% Radiographs 10%
  13. 13. Rationale Teleradiology is an important part of an increasing number of Radiology & Telemedicine programs Saves time and feedback to referring clinician is faster than with other methods (e.g., courier) - 85% of our teleradiology cases have a “wet read” report generated within 6 hours
  14. 14. Rationale It can, however, be expensive! For digital modalities a merge box is needed For plain film a digitizer or video capture system is required Some sites just cannot afford these options A low-cost alternative had to be explored
  15. 15. Rationale The Patagonia Family Health Center needs consults especially in orthopedics & bone radiology Have no x-ray facilities so send patients to Nogales’ Mariposa Clinic, the report & films are sent over either with patients or later Problem - Mariposa only has a general radiologist so sub-specialty consults are often required
  16. 16. The Camera Canon PowerShot600 CCD image sensor 832 x 608 pixels 24-bit color resolution f/2.5 lens Built-in flash 150 kB file size
  17. 17. The Cases 40 bone trauma cases (e.g., fracture, subluxation, soft tissue damage) from the Patagonia Family Health Clinic Cases that required a consult in the past & were representative of the types of cases they would be sending for teleconsults in the future - typically subtle lesions
  18. 18. The Photographs Film images were placed on standard viewbox with extraneous light blocked out The physician identified region(s) of interest based on clinical history and nature of problem At least one global and one close up shot were acquired for each image using the Canon PowerShot camera
  19. 19. Display Images sent over ARTN to the MedVision workstation Color monitor, 1024 x 768 pixels Window/level, zoom/pan available for use during viewing Film images displayed on standard viewbox
  20. 20. Protocol 2 orthopedic surgeons & 2 bone radiologists reviewed the 40 cases on film & using the digital photographs displayed on the monitor Film reading 6 months after monitor reading Reported: • Diagnosis • Decision confidence using 6-level scale • Image quality using 4-level scale
  21. 21. Results - Image Quality 0 10 20 30 40 50PERCENT Film Photo Excellent Good Fair Poor
  22. 22. Results - Image Quality Χ2 = 20.32, df = 9, p = 0.02 9 of the photo cases were rated poor 4 film cases were rated poor Of the 9 photo cases, 4 (45%) were rated as poor because the region-of-interest was not captured sufficiently Some views (film & photo) were not what the readers were used to - different technologists
  23. 23. Results - Diagnoses* Reader Agreement (Kappa) 1 0.89 2 0.92 3 0.94 4 0.88 * Truth was determined by 2 radiologists not participating in the study from the film images
  24. 24. Results - Confidence 0 20 40 60 PERCENT FILM vs PHOTO CONFIDENCE Same* One* Two* * How many categories film & monitor confidences differ by
  25. 25. Conclusions A digital still camera can be used effectively to capture images of bone trauma radiographs for store-forward telemedicine consults Well-framed close-up shots of the region-of- interest are essential Good quality original films are essential
  26. 26. Other Applications? Other non-screening applications where a specific suspicious region-of-interest can be identified for close-up photographs Unless the lesion is fairly gross, the global shots are not adequate for consultation - close-up shots are required in the majority of cases