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A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos

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Abstract

Our aim was to prove the feasibility of the remote interpretation of real-time transmitted ultrasound videos of dynamic and static organs using a smartphone with control of the image quality given a limited internet connection speed. For this study, 100 cases of echocardiography videos (dynamic organ)—50 with an ejection fraction (EF) of ≥50 s and 50 with EF <50 %—and 100 cases of suspected pediatric appendicitis (static organ)—50 with signs of acute appendicitis and 50 with no findings of appendicitis—were consecutively selected. Twelve reviewers reviewed the original videos using the liquid crystal display (LCD) monitor of an ultrasound machine and using a smartphone, to which the images were transmitted from the ultrasound machine. The resolution of the transmitted echocardiography videos was reduced by approximately 20 % to increase the frame rate of transmission given the limited internet speed. The differences in diagnostic performance between the two devices when evaluating left ventricular (LV) systolic function by measuring the EF and when evaluating the presence of acute appendicitis were investigated using a five-point Likert scale. The average areas under the receiver operating characteristic curves for each reviewer’s interpretations using the LCD monitor and smartphone were respectively 0.968 (0.949–0.986) and 0.963 (0.945–0.982) (P = 0.548) for echocardiography and 0.972 (0.954–0.989) and 0.966 (0.947–0.984) (P = 0.175) for abdominal ultrasonography. We confirmed the feasibility of remotely interpreting ultrasound images using smartphones, specifically for evaluating LV function and diagnosing pediatric acute appendicitis; the images were transferred from the ultrasound machine using image quality-controlled telesonography.

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Abbreviations

EF:

Ejection fraction

DSIS:

Double stimulation impairment scale

ROC:

Receiver operating characteristic

FPS:

Frames per second

OR-DBM-MRMC:

Obuchowski-Rockette and Dorfman-Berbaum-Metz software for diagnostic studies of multiple readers and multiple cases

KB:

Kilobytes

BPS:

Bits per second

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Acknowledgments

We thank Alpinion Medical Systems, which developed the tele-ultrasonography system in collaboration with us. Author CK and HC contributed equally.

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Authors and Affiliations

  1. Department of Emergency Medicine, Guri Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea

    Changsun Kim, Hyunmin Cha, Bo Seung Kang & Hyuk Joong Choi

  2. Department of Emergency Medicine, Seoul Hospital, Hanyang University College of Medicine, Seoul, Republic of Korea

    Tae Ho Lim & Jaehoon Oh

  3. Department of Emergency Medicine, Hanyang University Guri Hospital, 153, Gyeongchun-ro(st), Guri-si, GyeongGi-do, 471-701, Korea

    Bo Seung Kang

Authors
  1. Changsun Kim
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  2. Hyunmin Cha
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  3. Bo Seung Kang
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  4. Hyuk Joong Choi
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Corresponding author

Correspondence to Bo Seung Kang.

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Conflicts of Interest

The authors have no conflicts of interest to disclose.

Study Approval

This study was approved by the institutional review board of our institution.

Funding Source

No external funding was secured for this study.

Financial Disclosure

The authors have no financial relationships relevant to this article to disclose.

Additional information

Trial registration: Clinical trials.gov NCT02271048

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Kim, C., Cha, H., Kang, B.S. et al. A Feasibility Study of Smartphone-Based Telesonography for Evaluating Cardiac Dynamic Function and Diagnosing Acute Appendicitis with Control of the Image Quality of the Transmitted Videos. J Digit Imaging 29, 347–356 (2016). https://doi.org/10.1007/s10278-015-9849-6

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