Goals: Although tools for image acquisition are available to rural sites by means of on-site or mobile units, the expertise to make effective use of the imaging tools or the resultant image data is often missing. Advanced display and analysis methodologies to quantitatively evaluate and volumetrically display medical image data sets requires highly trained technologists. This is due to the complexity of the activities and the need to customize the analysis for a particular patient. The over-all goal of the project is to make advanced image display and analysis methodology broadly available without the need for on-site, dedicated personnel.
Setting: A physiologic imaging research facility which has been utilizing advanced volumetric imaging to study basic physiology of the heart and lungs serves as the development site for this project. Image analysis technologists are based within this facility and interact with local physicians to provide display and quantitative image analysis. The test environment for network based collaboration currently consists of three sites: the University of Iowa Hospitals and Clinics (UIHC), the Van Buren County Hospital (Keosaqua, IA) and the Ottumwa (IA) Regional Medical Center. All of these locations are in Iowa and are serviced through the use of the Iowa Communications Network (ICN: fiber based network). Dedicated links from the ICN to the actual medical facilities use various technologies, including frame relay, T-1 and full DS-3 communication lines.
Components and status: Our work related to taking volumetric imaging to rural Iowa to date has lead us to develop technology in four basic areas:
1) An extensive HTML based set of tutorials designed to introduce rural physicians to the utility of volumetric image display and analysis for medical diagnostic procedures1 is on-line.
2) Hardware allowing a patient to take intervening breaths between scan acquisitions and to return the patient to a repeatable lung volume for resumption of scanning, allowing for acquisition of standardized, high quality volumetric image set.2
3) A UNIX based software package integrating our quantitative image display and analysis package,VIDA3, into a teleradiology consultation environment4 has been deployed. Images from the mobile Picker helical CT scanner are being broadcast over the system for simultaneous consultations between the University of Iowa, Keosaqua, and Ottumwa.
4) A shared X application allowing multiple sites to simultaneously view the process of an interactive image analysis session has been successfully demonstrated.
Challenges and lessons: While successful, our initial experience with the development of the quantitative image display and analysis support system has lead us to hypothesize that an extension of our support services through the provision of asynchronous consultation through off-line annotation of image data sets and web-based reporting would significantly enhance the utility of the service and thus promote service usage. Additionally, we believe there to be the need for regular, between site, multi-disciplinary conferencing as part of an ongoing medical education process, much as is done with single sites currently. We believe that telecommunications technology, coupled with multi-modality, volumetric, and functional imaging, can be used to increase the quality of rural health care delivery. The largest problems relate to non-technology based, inter-enterprise issues.
Funding: National Library of Medicine: N01-NLM-4-3511 US PHS
1 http://dpi.radiology.uiowa.edu/
2 http://dpi.radiology.uiowa.edu/nlm/volcon/volctrl.html
3 http://dpi.radiology.uiowa.edu/vida/vidahome.html
4 http://dpi.radiology.uiowa.edu/nlm/consult/consult.html
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