Clinical value of real-time tertiary fetal ultrasound consultation by telemedicine: Preliminary evaluation

Congenital fetal abnormalities are major causes of perinatal mortality and morbidity. The performance of ultrasound in the diagnosis and assessment of fetal anomalies varies enormously between tertiary referral centers and ge neral units. Telemedicine offers a chance for tertiary realtime ultrasound consultations using standard telephone lines for remote sites. Preliminary investigations by our group have shown that real-time transmission of fetal ultrasound images over long distances via telephone (integrated systems di gital network [ISDN]) lines is technically feasible. A live link of up to 2 Mb/s was established between Mater Mothers Hospital in Brisbane and Kirwan Hospital for Women in Townsville, which are 1,500 km apart. The objective of the current study was to evaluate the clinical value of a tertiary teleu ltrasound consultation service. Patients requiring tertiary ultrasound cons ultations were recruited from North Queensland. Clinicians from the referra l site established an initial diagnosis and management plan. Using standard ISDN lines, the real-time ultrasound images were transmitted to the matern al fetal medicine subspecialists in Brisbane. The ultrasound examination wa s completed under the direction of the subspecialist. The subspecialist exp lained the findings to the patient at the end of the session, and discussed the diagnosis and management plans with the clinicians involved. Any diagn osis and management variations were classified into minor and major upon ag reement by the two teams of clinicians involved. The clinicians and patient s in Townsville rated the value of the consultation, and the subspecialists rated the confidence of their diagnoses on five-point scales. Pregnancy ou tcomes were obtained and the data analyzed. Over a 3-month period, 24 teleu ltrasound consultations were carried out. The indications for referral were : assessment of growth restriction/fetal wellbeing in the third trimester ( 6); detailed assessment for high-risk patients (5); evaluation of markers f or anomalies (5); isolated fetal anomalies (1); and complex fetal problems such as twin/twin transfusion, multiple anomalies, etc. (7). Overall, the c onsultations resulted in some modifications to the clinical diagnosis in 45 .8% of the cases, and modifications to the management plan in 33.3% of the cases (about half of which were minor variations). The clinicians rated the teleconsultations highly (mean rating 4.7, SD 0.44). The patients also rat ed the consultations highly, and were comfortable that their privacy and co nfidentiality were maintained during the consultation. The subspecialists w ere confident in making their diagnoses by telemedicine (mean score for con fidence 4.2, SD 0.43). Al the pregnancies have now been completed, with all antenatal diagnoses confirmed to be correct postnatally. Tertiary real-tim e ultrasound consultation by telemedicine is not only technically feasible, it is welcomed by the clinicians and patients involved. It also contribute s to diagnostic and management differences. Larger scale clinical trials ar e needed to evaluate the true benefits and costs involved. The social benef its in bridging the healthcare gap between the country and the city, and in enabling patients in remote areas to stay close to their family under time s of stress is well recognized by all involved.