title: A low-cost tele-imaging platform for developing countries.
abstract: OBJECTIVE
  To design a "low-cost" tele-imaging method allowing real-time tele-ultrasound expertise, delayed tele-ultrasound diagnosis, and tele-radiology between remote peripherals hospitals and clinics (patient centers) and university hospital centers (expert center).
  
  
  METHODS
  A system of communication via internet (IP camera and remote access software) enabling transfer of ultrasound videos and images between two centers allows a real-time tele-radiology expertise in the presence of a junior sonographer or radiologist at the patient center. In the absence of a sonographer or radiologist at the patient center, a 3D reconstruction program allows a delayed tele-ultrasound diagnosis with images acquired by a lay operator (e.g., midwife, nurse, technician). The system was tested both with high and low bandwidth. The system can further accommodate non-ultrasound tele-radiology (conventional radiography, mammography, and computer tomography for example). The system was tested on 50 patients between CHR Tsevie in Togo (40 km from Lomé-Togo and 4500 km from Tours-France) and CHU Campus at Lomé and CHU Trousseau in Tours.
  
  
  RESULTS
  A real-time tele-expertise was successfully performed with a delay of approximately 1.5 s with an internet bandwidth of around 1 Mbps (IP Camera) and 512 kbps (remote access software). A delayed tele-ultrasound diagnosis was also performed with satisfactory results. The transmission of radiological images from the patient center to the expert center was of adequate quality. Delayed tele-ultrasound and tele-radiology was possible even in the presence of a low-bandwidth internet connection.
  
  
  CONCLUSIONS
  This tele-imaging method, requiring nothing by readily available and inexpensive technology and equipment, offers a major opportunity for telemedicine in developing countries.
authors.affiliation: Unité de Télémédecine du Centre Hospitalier Universitaire Campus, Université de Lomé , Lomé , Togo ; Unité de Médecine et Physiologie Spatiales (UMPS-CERCOM), Centre Hospitalier Universitaire Trousseau de Tours , Tours , France.
authors.forename: Kokou
authors.initials: K
authors.lastname: Adambounou
authors.affiliation: Unité de Télémédecine du Centre Hospitalier Universitaire Campus, Université de Lomé , Lomé , Togo.
authors.forename: Victor
authors.initials: V
authors.lastname: Adjenou
authors.affiliation: Chelsea and Westminster Hopital , London , UK.
authors.forename: Alex P
authors.initials: AP
authors.lastname: Salam
authors.affiliation: Unité de Médecine et Physiologie Spatiales (UMPS-CERCOM), Centre Hospitalier Universitaire Trousseau de Tours , Tours , France.
authors.forename: Fabien
authors.initials: F
authors.lastname: Farin
authors.affiliation: Unité de Télémédecine du Centre Hospitalier Universitaire Campus, Université de Lomé , Lomé , Togo.
authors.forename: Koffi Gilbert
authors.initials: KG
authors.lastname: N'Dakena
authors.affiliation: Unité de Télémédecine du Centre Hospitalier Universitaire Campus, Université de Lomé , Lomé , Togo.
authors.forename: Messanvi
authors.initials: M
authors.lastname: Gbeassor
authors.affiliation: Unité de Médecine et Physiologie Spatiales (UMPS-CERCOM), Centre Hospitalier Universitaire Trousseau de Tours , Tours , France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Arbeille
keywords: developing country; low-cost; tele-diagnosis; tele-expertise; tele-imaging