Evaluation of a training and diagnostic ultrasound service for general practitioners using narrowband ISDN

We carried out a four-month pilot study of telemedicine for the delivery of training and diagnostic ultrasound services for general practitioners (GPs ). Two health centres and a district general hospital were linked using ISD N (128 kbit/s) and PC-based videoconferencing units. Sixteen videoconferenc ing sessions were conducted, with 64 patients scanned over the ISDN link fo r a range of clinical conditions. Nine cases of pathology were demonstrated and confirmed by a consultant radiologist. A total of 229 images were tran smitted using the store-and-forward facility, of which 194 (85%) images wer e of diagnostic quality and 35 (15%) were regarded as non-diagnostic. Allow ing for sampling error, we would expect 79-89% of stored images to provide diagnostic information at a 95% confidence level. A total of 115 store-and- forward images (SAFI) were randomly selected and compared with hard-copy im ages (HCl) for technical quality. There was a significant difference in the quality of images. The results show that SAFI are far superior to HCl, tra ditionally used by clinicians for making primary diagnosis and that the sup erior quality of the SAFI improved diagnostic accuracy. This pilot study sh owed a high degree of confidence in videoconferencing for training GPs to c arry out ultrasound clinics, enhancing their ability to make accurate diagn oses, and providing them with immediate access to second and higher opinion .