MAKING GLOBAL TELEMEDICINE PRACTICAL AND AFFORDABLE - DEMONSTRATIONS FROM THE MIDDLE-EAST

(OBJECTIVE. The purpose of this study was to demonstrate the first use of voice-grade telephone lines for the international transmission of both high-resolution digital images (radiology and pathology) and vide o in near real-time. MATERIALS AND METHODS. Eight live demonstrations were performed from the United Arab Emirates and the Kingdom of Saudi Arabia at the invitation of the respective ministries of health. Thirt y radiologic studies (CT, MR, and radiographs) were digitized, compres sed, and transmitted to Cambridge, MA, where they were interpreted on diagnostic workstations (1792 x 2252 display matrix) by a team of subs pecialist radiologists. Near real-time image transmission was achieved by combining wavelet-based image compression (average compression rat io of 23:1) and multiplexing technology that used four phone lines sim ultaneously During each demonstration, one pathology image was transmi tted from Cambridge to the demonstration site, where it was interprete d by a visiting pathologist. Videoconferencing was implemented with a drl-kilobits-per-sec leased line from the United Arab Emirates and wit h four multiplexed telephone lines from Saudi Arabia. RESULTS. For tel eradiology and telepathology, transmission times ranged from 2-5 min p er image. Image fidelity was judged to be of diagnostic quality in all transmitted cases. The video link to the United Arab Emirates was hig hly reliable. Bandwidth for videoconferencing from Saudi Arabia was ma rginal on four voice-grade telephone lines, resulting in some downtime (10-20%). Live consultations provided by subspecialists in Cambridge assisted in the management of patients at both venues. The system was well received by both the referring physicians in the Middle East and the participants in the United States. CONCLUSION. Image compression a nd multiplexing technologies enabled high-resolution teleradiology and telepathology as well as real-time video consultations over internati onal telephone lines. While telecommunications systems are advancing r apidly in many parts of the world, those areas most in need of telemed icine services are likely to be the last to upgrade their telecommunic ations infrastructures. This ''proof of concept'' article outlines a p ractical and affordable approach that makes telemedicine more accessib le to underserved areas worldwide.