title: Fetal diagnosis of congenital heart disease by telemedicine.
abstract: OBJECTIVE
  This study aimed to evaluate the feasibility, accuracy and user acceptability of performing remote fetal echocardiograms (FEs).
  
  
  METHODS
  A regional fetal cardiology unit and a district general hospital (DGH).
  
  
  METHODS
  A prospective study over 20 months. An initial FE was performed by a radiographer in the DGH (D1) followed by a second FE transmitted to the regional centre, in real time, via a telemedicine link with live guidance by a fetal cardiologist (D2). A FE was performed later at the regional centre (D3, reference standard). Structured questionnaires were employed to evaluate the technical quality of each tele-link and the radiographers' confidence at performing FE.
  
  
  RESULTS
  69 remote FEs were performed and showed 58 normal hearts and 11 with congenital heart disease (CHD). D2 was accurate in 97% of cases compared with D3 (κ score=0.89) indicating excellent agreement. All tele-links connected at first attempt with a mean study time = 13.9 min. Overall tele-link quality was rated highly (median=4/5). In 94% of tele-links, at least 11/12 components of the FE were confidently assessed. The mean composite radiographer's questionnaire score increased significantly during the study period (p<0.05).
  
  
  CONCLUSIONS
  To date this is the largest study of its kind. CHD can be confidently diagnosed and excluded by remote FE. Radiographers report increased confidence and proficiency following involvement in real-time telemedicine. This application of telemedicine could improve access to fetal cardiology and support radiographers screening for CHD.
authors.affiliation: Department of Paediatric Cardiology, Royal Belfast Hospital for Sick Children, Falls Road, Belfast BT 12 6BE, UK. brianmccrossan@doctors.org.uk
authors.forename: Brian A
authors.initials: BA
authors.lastname: McCrossan
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Sands
authors.forename: Theresa
authors.initials: T
authors.lastname: Kileen
authors.forename: Chris R
authors.initials: CR
authors.lastname: Cardwell
authors.forename: Frank A
authors.initials: FA
authors.lastname: Casey
mesh_terms: D000293:Adolescent; D000328:Adult; D001291:Attitude of Health Personnel; D016507:Cardiology Service, Hospital / Q000458:organization & administration; D003199:Computer Systems; D005240:Feasibility Studies; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006767:Hospitals, District / Q000458:organization & administration; D006769:Hospitals, General / Q000458:organization & administration; D006801:Humans; D009660:Northern Ireland; D011247:Pregnancy; D011446:Prospective Studies; D019112:Teleradiology / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods; D055815:Young Adult