title: Multimedia Messaging Service teleradiology in the provision of emergency neurosurgery services.
abstract: BACKGROUND
  Neurosurgical emergencies constitute a significant proportion of workload of a tertiary neurosurgical service. Prompt diagnosis and emergent institution of definitive treatment are critical to reduce neurological mortality and morbidity. Diagnosis is highly dependent on accurate interpretation of scans by experienced clinicians. This expertise may not be readily available especially after office hours because many neurosurgical units are manned by middle-level neurosurgical staff with varying levels of experience in scan interpretation. Multimedia Messaging Service mobile phone technology offers a simple, cheap, quick, and effective solution to the problem of scan interpretation. An MMS takes only a few minutes to send and receive and allows senior doctors to view important images and make important clinical decisions to enhance patient management in an emergency situation.
  
  
  METHODS
  A mobile phone (with VGA camera and MMS capabilities) was provided to the neurosurgery registrar on call. The on-call mobile phone is passed on to the corresponding registrar on-call the next day. All consultants had personal mobile phones that are MMS-enabled. Relevant representative CT/MRI images can be taken directly from the mobile phone from the PACS off the computer screen. When only hard copies are available, the images can be taken off the light box. After a 12-month trial period, a questionnaire was given to all staff involved in the project to ascertain the usefulness of the MMS teleradiology service.
  
  
  RESULTS
  The survey on the use of the MMS service in a tertiary neurosurgical service demonstrated that the technology significantly improved the level of confidence of the senior-level staff in emergent clinical decision making. Significantly, the MMS images were of sufficient quality and resolution to obviate the need to view the actual scans. The impact of MMS is less pronounced in the middle-level staff, but there was a trend that most of the junior staff found the service more useful.
  
  
  CONCLUSIONS
  The MMS technology is demonstrated to be a useful media for the transmission of high-quality images to assist in the diagnostic process and implementation of emergent clinical therapy. It is already in widespread use and can be seamlessly and rapidly implemented in the clinical arena to improve the quality of patient care.
authors.affiliation: Department of Neurosurgery, National Neuroscience Institute, 308433 Singapore. wai_hoe_ng@nni.com.sg
authors.forename: Wai Hoe
authors.initials: WH
authors.lastname: Ng
authors.forename: Ernest
authors.initials: E
authors.lastname: Wang
authors.forename: Ivan
authors.initials: I
authors.lastname: Ng
mesh_terms: D001291:Attitude of Health Personnel; D040421:Cell Phone; D004636:Emergency Service, Hospital; D006801:Humans; D019212:Multimedia; D009493:Neurosurgery; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D019112:Teleradiology