Beruflich Dokumente
Kultur Dokumente
Gwyn Weatherburn
Reader in Medical Imaging
Research Centre for Health Studies Buckinghamshire New University &
Mike Rigby
Consultant Paediatric Cardiologist
Royal Brompton Hospitals NHS Trust
Dejan Mijin Research student, BNU Jovan Kosutic Paediatric Cardiologist, Mother & Child Institute, Belgrade Tom Carter Telemedicine Co-ordinator Royal Brompton Hospitals NHS Trust
ISDN-6 or ISDN-2?
Integrated Services Digital Network
Each line has a transmission rate of 64 kb/s ISDN-6 provides 384 kb/s ISDN-2 provides 128 kb/s (15 frames/sec)
ISDN-6 or ISDN-2?
TelePaed
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 The 4 reports of this study are available (Dowie et al)
3x ISDN-2 connections
Research hypotheses
When ISDN-2 technology is used to provide a clinical service to link clinicians in Belgrade with RBH (1800 miles) The clinical service is acceptable to all clinicians There is change in diagnosis There is change in patient management
Equipment
At Royal Brompton (RBH),London: ISDN-6 existing teleconferencing technology was used At Mother &Child Institute (M&C), Belgrade: an ISDN-2 line was installed an ISDN-2 videophone was loaned by BNU
WIRING REQUIREMENTS
RBH ISDN-6
Belgrade ISDN-2
The teleconferences
Live discussions between clinicians without patients present commenced in December 2003
Transmission and discussion of : recorded echocardiograms, radiographs, ECGs
Ultrasound examinations
Pre-recorded cross sectional echocardiograms as routinely used by paediatric cardiologists, conventional Subcostal, Apical parasternal, Suprasternal images
Results
To September 9th 2004, there were 6 consultations during which, 17 patients were discussed
Results
Picture & sound quality was usually good
Connection time was short (< 1 min) Mean discussion time for each patient was about 15 mins
Results
Yes Echo viewed ECG viewed 14 8 No 2 8
Xrays viewed
11
17 patients
No surgery (2)
Some of the medical conditions discussed (some children had multiple abnormalities)
ASD VSD Aorto-pulmonary collateral vessels Pulmonary artery stenosis Aortic valve stenosis Aortic coarctation
Fallots Tetralogy Mitral valve atresia DORV Pulmonary atresia Mitral regurgitation Cardiomyopathy Epsteins anomaly
Standard video recorder/player for echo examinations ISDN-2 videophone & standard film viewing box
Conclusions
This clinical service based on ISDN-2 technology, successfully uses simple, inexpensive equipment in Belgrade to link to more expensive existing equipment in London for Paediatric Cardiology Specialist advice
enables patients in Serbia to obtain additional specialist advice which is unavailable in their own country
Conclusion
Expert advice on Paediatric Cardiology can be provided by the transmission of echocardiograms, radiographs and ECGs using ISDN-2 technology at 128 kb/s