Col. San Miguel Chapultepec, Del. Miguel Hidalgo, México D.F., México
The term telemedicine is defined by the WHO as "the delivery of health care services, where distance is a critical factor" and it is a tool intended to exchange valid medical information for the diagnosis, prevention and treatment of disease, but also a an effective way to provide and receive continuing education and research.1
Traditionally, telemedicine services offer interpretation of medical images including radiographs, CT scans, MRI scans, images of cytology slides, internal medicine, surgical and oncology consults. The interpretation of ultrasound images has been challenging especially if videos are not included or more importantly due to the great variably or lack of standarized protocols.
Nowadays in the veterinary field the use of ultrasound is common practice, however, the availability for specialists in the field of diagnostic imaging or internal medicine is scarce. The fact that ultrasound is safe, does not utilize ionizing radiation, is noninvasive and affordable for the pet owners makes this diagnostic tool indispensable for the day to day practice of veterinary medicine.
The need for improving the quality of scans sent to telemedicine platforms is imperative and real time sonography or tele-ultrasonography could be the solution to this problem when continuing education is involved.
There are two main categories of tele-ultrasonography when it comes to the methodology use for transmission of images. The synchronous transmission (real time) and the asynchronous transmission (store-and-forward).2
The recent advances in the field are related to real time transmission as well as image quality of the transmitted images, however, a special focus on training is also necessary. This entails the use of broadband technology of medium and high speed as well as the use of streaming video as well as intensive training programs for the professionals involved in the transmission of images.3
There is no universal criteria as to how the sonographers in distant locations should be trained. The current literature regarding this topic is scarce. Some authors think that at least one moth of extensive hands-on training is required to ensure that the images sent are of enough quality to be interpreted by a radiologist. A second author stated that remote assistance by a specialist be given in real time to instruct inexperienced sonographers or doctors in acquiring the appropriate images during examinations.3-5
In conclusion, tele-ultrasonography is a valuable addition to telemedicine services to improve quality of health care for the areas where large referral specialty practices are not available that requires a reliable internet of broad band technology connection and transmission rates to maintain diagnostic quality as well as reliable image compression technology as well as a great deal of training and education to the professionals involved in the transmission of images.
References
1. World Health Organization. Telemedicine: opportunities and developments in Member States. Reports on the Second Global Survey on eHealth, 2009, http://www.who.int/goe/publications/goe_telemedicine_2010.pdf.
2. Sutherland JE, Sutphin D, Redican K, Rawlins F. Telesonography: foundations and future directions. Journal of Ultrasound in Medicine. 2011;30(4)517–522.
3. Hussain P, Deshpande A, Shridhar P, Saini G, Kay D. The feasibility of telemedicine for the training and supervision of general practitioners performing ultrasound examinations of patients with urinary tract symptoms. Journal of Telemedicine and Telecare. 2004;10(3):180–182.
4. Chan FY, Taylor A, Soong B, et al. Randomized comparison of the quality of realtime fetal ultrasound images transmitted by ISDN and by IP video conference. Journal of Telemedicine and Telecare. 2002;8(2):91–96.
5. Chan FY, Soong B, Watson D, Whitehall J. Realtime fetal ultrasound by telemedicine in Queensland. A successful venture? Journal of Telemedicine and Telecare. 2001;7(2):S7–S11.