The application of teleradiolgoy (using A 3 Dimensional ultrasound telemedicine equipment) at Mulago Hospital.

Abstract

BACKGROUND: Most of the telemedicine experience to-date has been in the industrialized world. During the past years, due to an extraordinary pace of technological innovations and development, telecommunication services have become more widely available. In 1999-2001 two maiden projects, the TeleLnVivo project and the National Telemedicine pilot project (NTPP) have been implemented in Uganda. These projects have used information and communication technology to improve health care and medical education. Much of this has involved exchange of radiological images, Teleradiology. OBJECTIVE: The aim of the study was to evaluate the application of teleradiogy using a 3D ultrasound Telemedicine equipment at Mulago Hospital. METHODS: A retrospective study was carried out in a period of seven months at Mulago hospital. Eighty medical records of patients who underwent 3D ultrasonography using the telemedical equipment and teleconsultation done between Mulago hospital and the Hospital University of Coimbra (HUC) were reviewed. Several parameters were evaluated which included image quality, body parts for which teleconsultation was carried out, transmission time and teleconsultation results. Image quality was characterized by organ visualization, image contrast and anatomical coverage. In depth information on the advantages and challenges of teleconsultation was obtained from the key informants. RESULTS: The study shows that images of diagnostic quality were achieved at the 2 validation sites. Complete anatomical coverage and organ visualization both at acquisition and after transmission was achieved in 98% of cases. Ninety five percent of the cases had adequate contrast both at acquisition and after transmission. Over 98% of the images were of diagnostic quality at 95% confidence level. The abdomen was the body part most teleconsulted on and accounted for 46.3% of all the cases. The liver was the commonest organ f interest and accounted for 89.2% compared to other organs of the abdomen. The pelvis accounted for 30% obstetrics 17.5%, musculoskeletal 3.8% and the brain 2.5%. The minimum and maximum time, which were taken for data transfer from Mulago hospital to HUC were I minute and 35 minutes respectively. The mean time was 4.26 minutes. Differences among the physician’s interpretation aroused the need for standardization of the acquisition and reviewing protocols for the sonographer and physician. CONCLUSION: The results show that 3D ultrasonographic data can be transferred between two distant sites without loss of the diagnostic quality of the images. Several benefits of using a 3D ultrasound telemedicine equipment were also identified. It enhanced the ability to make accurate diagnosis, providing second opinion, improvement of patient management and continuing medical education for the participatory personnel. The challenges during teleconsultation were predominantly due to technological failure.