High-def teleconferencing aids doc-to-doc consultation

It might have been just another example of teleradiology, but the exceptional image quality of the PET/CT scans and live consult made it much more.

In a two-way consultation spanning the 325 miles between two California hospitals, 17 radiologists and oncologists discussed the details of a 78-year old man battling recurrent colorectal cancer, the picture of physicians in one window, PET/CT images in another.

If the images had been examined on a less sensitive system, the patient might have been deemed inoperable. But, given the clarity of the transmitted PET/CT images, experts at the City of Hope Medical Center in Culver City, CA, which has been designated by the National Cancer Institute as a comprehensive cancer research center, suggested a surgical strategy that could excise all the lesions displayed on the high-definition screen.

BIG DIFFERENCE

Making the difference was the Sony Ipela system, which is able to display five times more data per unit of time than conventional teleconferencing systems.

The line density was twice that available on conventional systems, according to Mike Sekiguchi, general manager of the Ipela business unit at Sony. The system can display more than 1000 lines on the high-definition color monitor at the City of Hope Medical Center. The 1280 x 720 pixel images were refreshed 60 times per second, four times faster than conventional systems.

The effect on image quality was dramatic, said Dr. Shyamali Singhal, medical director of the cancer center at El Camino Hospital, a 395-bed nonprofit community hospital in Mountain View, CA. Diagnostic images transmitted during earlier efforts to adopt teleconferencing technology had come through so badly degraded that examining them was like trying to see through fog, she said. No such problems arise with high-definition transmission and reception.

The additional resolution proved useful when the two tumor boards examined the case. El Camino's radiology director, Dr. Volney F. Van Dalsem, had earlier compiled PET and CT images covering the patient's clinical history. The images were loaded into a Microsoft PowerPoint presentation on a laptop computer connected to the Ipela system. As Van Dalsem described the case, the images were transmitted to the City of Hope Medical Center.

SHARP IMAGES, SUBTLE LESIONS

The clear crisp pictures translated into a confident clinical evaluation, said Dr. Lawrence Wagman, chairman emeritus of City of Hope's division of surgery. His group could see what Singhal and her colleagues at El Camino were talking about when they referred to subtle 0.5 cm lesions.

"If you didn't have good definition and resolution, you wouldn't be able to see it when it was projected to the other site," Wagman said. "The whole interaction felt like it was real-time. There was less of that drag we usually get with teleconferencing."