Video networking of cardiac catheterisation laboratories

Background The purpose of this study was to assess the feasibility and accu racy of a video telecommunication network to transmit coronary images to pr ovide on-line interaction between personnel in a cardiac catheterization la boratory and a remote core laboratory. Methods A telecommunication system was installed in the cardiac catheteriza tion laboratory at Kaiser Hospital, lasAngeles, and the core laboratory at the University of California, Irvine, approximately 40 miles away. Cineangi ograms, live fluoroscopy, intravascular ultrasound studies and images of th e catheterization laboratory were transmitted in real time over a dedicated T1 line at 768 kilobytes/second at 15 frames/second. These cases were perf ormed during a clinical study of angiographic guidance versus intravascular ultrasound (IVUS) guidance of stent deployment. During the cases the core laboratory performed quantitative analysis of the angiograms and ultrasound images. Selected images were then annotated and transmitted back to the ca theterization laboratory to facilitate discussion during the procedure. Results A successful communication hookup was obtained in 39 (98%) of 40 ca ses. Measurements of angiographic parameters were very close between the or iginal cinefilm and the transmitted images. Quantitative analysis of the ul trasound images showed no significant difference in any of the diameter or cross-sectional area measurements between the original ultrasound tape and the transmitted images. The telecommunication link during the interventiona l procedures had a significant impact in 23 (58%) of 40 cases affecting the area to be treated, the size of the inflation balloon, recognition of sten t underdeployment or the existence of disease in other areas that was not n oted on the original studies. Conclusions Current video telecommunication systems provide high-quality im ages on-line with accurate representation of cineangiograms and intravascul ar ultrasound images. This system had a significant impact on 58% of the ca ses in this small clinical trial. Telecommunication networks between hospit als and a central core laboratory may facilitate physician training and imp rove technical skills and judgement during interventional procedures. This project has implications for how multicenter clinical trials could be opera ted through telecommunication networks to ensure conformity with the protoc ol.