title: Near real-time echocardiography teleconsultation using low bandwidth and MPEG-4 compression: feasibility, image adequacy and clinical implications.
abstract: We assessed the feasibility, image adequacy and clinical utility of a tele-echocardiography service which combined video compression with low-bandwidth store-and-forward transmission. Echocardiograms were acquired by a hospital geriatrician, compressed and transmitted using both near real-time (urgent) and delayed (pre-programmed) protocols via an Internet connection to the notebook PC of a remote cardiologist. Clinical utility was evaluated as a change in therapeutic management. During a one-year period, 101 tele-echocardiography consultations were successfully performed (feasibility = 100%) on 95 patients (age 22-95 years), admitted with cardiovascular or neurological diagnoses (24% of the consultations were urgent). In total, 4617 files (1.4 GByte of data) were transmitted, 2669 of which were short video clips. On average, 46 files (13.8 MByte) were transmitted (mean duration 10 min) at each examination. Consultations (both urgent and pre-programmed) were clinically useful in 83% of examinations. Logistic regression analysis showed that both a low left ventricular systolic function and the examination indication were determinants of clinical utility. The transmitted images were considered adequate for diagnosis in 100% of the pre-programmed teleconsultations. Tele-echocardiography using MPEG-4 video compression is a feasible, adequate and clinically useful tool for telemedicine.
authors.affiliation: Echocardiography Laboratory, Centro Cardiologico Monzino, IRCCS, Milano, Italy. pbar@iol.it
authors.forename: Paolo
authors.initials: P
authors.lastname: Barbier
authors.forename: Laura
authors.initials: L
authors.lastname: Dalla Vecchia
authors.forename: Gianluca
authors.initials: G
authors.lastname: Mirra
authors.forename: Silvia
authors.initials: S
authors.lastname: Di Marco
authors.forename: Dario
authors.initials: D
authors.lastname: Cavoretto
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging; D044962:Data Compression / Q000379:methods* / Q000592:standards; D004452:Echocardiography; D005260:Female; D006801:Humans; D020407:Internet; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000000981:diagnostic imaging; D011446:Prospective Studies; D019114:Remote Consultation / Q000379:methods* / Q000592:standards; D015203:Reproducibility of Results; D013686:Telemetry / Q000295:instrumentation; D055815:Young Adult