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Development, Implementation, and Multicenter Clinical Validation of the TeleDICOM—Advanced, Interactive Teleconsultation System

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Abstract

There is a need to make medical diagnosis available to critically ill patients on-site, without the necessity of time-consuming and risky transportation to larger reference hospitals. The teleconsultation of medical images is possible with the use of Internet-based TeleDICOM software developed in Krakow, Poland. Interactive consultation between two or more centers offers real-time voice communication, visualization of synchronized Digital Imaging and Communications in Medicine images, and use of interactive pointers and specific calculation tools. If direct interaction between physicians is not needed, the system can also be used in “offline” mode. In 2006, TeleDICOM was successfully deployed in the John Paul II Hospital in Krakow as well as a dozen other cooperating medical centers throughout southeast Poland. It is used for routine referral for cardiosurgical procedures. Aims of the study were to evaluate the image quality, software stability, constant availability, data transmission speed, and quality of real-time synchronized viewing of the images during the TeleDICOM teleconsultation; to evaluate the clinical utility of the TeleDICOM system; and to analyze the compatibility of TeleDICOM with the storage data formats of various imaging machine manufacturers. The analysis of angiographic offline teleconsultations was based on 918 patients referred remotely for coronary artery bypass grafting (CABG). The echocardiographic teleconsultations were performed during 63 live interactive consultations, several of them were presented to live during medical conferences. Measurement tools of the TeleDICOM software were tested against original measurement tools of echocardiographic machines from four different manufacturers. As a result of TeleDICOM consultation, a CABG decision was made in 806 of 918 patients consulted (87.8%). In remaining 12 patients, medical therapy or percutaneous angioplasty was recommended. CABG was performed in 98.6% of the admitted patients. Treatment decisions were changed after admission in 1.4% of patients—however, in all cases, it was not related to analysis of angiography data but rather to the change of clinical condition of the patients. All medical personnel involved in both offline and interactive teleconsultations judged the system positively in all assessed aspects. Lesser scores were observed only in the centers connected by slower networks. Measurements performed in the ECHO-TeleDICOM module were accurate as compared with those performed on a standard echo-machine (correlation r > 0.980, p < 0.001), independently of the echocardiograph model. Conclusion: This study demonstrates that telemedicine can improve patients' management using a clinically effective teleconsultation system. The TeleDICOM system is suited for professional use in the field of cardiovascular disease. It is also prepared for remote live demonstrations of clinical cases during large medical meetings.

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Acknowledgement

Members of the TeleDICOM multicenter validation group:

Jarosław D. Kasprzak (II Department of Cardiology, University of Medicine, Lodz, Poland), Dariusz Dudek (II Department of Cardiology, Jagiellonian University, Krakow, Poland), Tomasz Masternak (Department of Computer Science, AGH University of Science and Technology, Krakow, Poland), Marcin Młotek (Service de Rythmologie, Hôpital Louis Pradel, Lyon, France), Piotr Sonecki (Western Infirmary, Glasgow, United Kingdom), Marek Konka (Department of Congenital Heart Disease, Institute of Cardiology, Warsaw, Poland), Piotr Szymański (Department of Congenital Heart Disease, Institute of Cardiology, Warsaw, Poland), Krzysztof Mokrzycki (Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland), Maciej Żabówka (Kardiomed Medical Center, Tarnów, Poland), Bogdan Kapelak (Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University, Krakow, Poland; John Paul II Hospital, Krakow, Poland), Jerzy Samitowski (Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University, Krakow, Poland; John Paul II Hospital, Krakow, Poland), Roman Pfitzner (Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University, Krakow, Poland; John Paul II Hospital, Krakow, Poland), Roman Rogóż (John Paul II Hospital, Krakow, Poland), Bogdan Januś (Hemodynamics Department, Szczeklik Hospital, Tarnow, Poland), Mariusz Kędzierski (Hemodynamics Department, District Hospital, Przemyśl, Poland), Marcin Dołemski (Hemodynamics Department, District Hospital, Przemyśl, Poland), Jacek Dragan (Department of Invasive Cardiology, Electrotherapy and Angiology, Nowy Scz, Poland), Wojciech Dobrowolski (Department of Invasive Cardiology, Electrotherapy and Angiology, Nowy Scz, Poland), Marek Ujda (Department of Cardiology, Specialist Hospital, Stalowa Wola, Poland), Jacek Legutko (Department of Invasive Cardiology, Electrotherapy and Angiology, Nowy Targ, Poland), Janusz Szczupak (Department of Invasive Cardiology, Electrotherapy and Angiology, Krosno, Poland), Wojciech Gutkowski (Hemodynamics Department, Cardiology Center, Kielce, Poland), Jacek Kołcz (Department of Pediatric Cardiosugery, Polish-American Pediatric Institute, Krakow, Poland), Wiktoria Wojciechowska (Ist Department of Cardiology and Arterial Hypertension, Krakow, Poland), Adam Koprowski (IT Department, Institute of Cardiology, Warsaw, Poland)

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Authors and Affiliations

  1. Department of Coronary Disease, Institute of Cardiology, Jagiellonian University, Pradnicka 80, 31-202, Kraków, Poland

    Andrzej Gackowski & Anton Chrustowicz

  2. John Paul II Hospital, Krakow, Poland

    Andrzej Gackowski, Anton Chrustowicz, Jerzy Sadowski, Piotr Podolec & Mieczysław Pasowicz

  3. Department of Computer Science, AGH University of Science and Technology, Krakow, Poland

    Łukasz Czekierda, Jacek Cała, Michał Nowak & Krzysztof Zieliński

  4. Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University, Krakow, Poland

    Jerzy Sadowski

  5. Department of Cardiovascular Disease, Institute of Cardiology, Jagiellonian University, Krakow, Poland

    Piotr Podolec

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  1. Andrzej Gackowski
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  2. Łukasz Czekierda
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Correspondence to Andrzej Gackowski.

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Gackowski, A., Czekierda, Ł., Chrustowicz, A. et al. Development, Implementation, and Multicenter Clinical Validation of the TeleDICOM—Advanced, Interactive Teleconsultation System. J Digit Imaging 24, 541–551 (2011). https://doi.org/10.1007/s10278-010-9303-8

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