Underserved areas ring up for long-distance ultrasound interpretation

War-torn countries can improve their diagnostic imaging capabilities by simply dialing the phone.

Researchers in Serbia have successfully transmitted ultrasound images to the U.S. for interpretation over standard phone lines. The U.S. sonologists also used the phone to guide their Serbian counterparts, according to a study presented at the American Roentgen Ray Society meeting.

Studies have proven that ultrasound images can be transmitted from remote locations under the sea and outer space using high-bandwidth or satellite communications systems. But no one has attempted transmission over ISDN lines at 30 to 60 kbps, said Dr. Robert Harris, director of ultrasound at Dartmouth Medical School's Hitchcock Medical Center.

Harris and principal investigator Veljko Popov, a Dartmouth med student from Zrenjanin, a small city near Belgrade, brought a portable ultrasound unit to the local hospital to examine hundreds of patients. While Harris and Popov were in Serbia, scans got interpreted. Once they left, however, the facility lacked staff to read the images.

The researchers figured out how to transmit ultrasound scans through standard phone connections to Dartmouth radiologists back in New Hampshire. Albeit slowly, they were able to transmit images in real-time. They also managed to use the connection to have the U.S. sonologists impart instructions on how to get the best views, Harris said.

Investigators transmitted 50 thyroid, abdominal, pelvic, and transvaginal ultrasound scans to two attending radiologists, one radiology resident, and a medical student. They compressed the images to expedite the transmission but also sent the original uncompressed files for comparison.

The readers could not tell the difference between compressed and uncompressed images in 64% of the cases. They also ranked 67% of the compressed files as either adequate or better than adequate for diagnostic purposes.

Harris and his colleagues want to offer ultrasound imaging and interpretation to remote sites in undeveloped countries that lack sonologists and even sonographers. Their pilot experience proved that these villages or towns could resort to basic ultrasound technology and ad hoc sonographers to operate it.

They could have the images beamed up to a satellite and on to a tertiary or large medical center with subspecialty radiologists either in their own country or abroad for rapid diagnosis and treatment planning, Harris said.

"I have been frustrated at the lack of opportunity for international humanitarian work for radiologists, and know many would like to get involved," he said. "This project could afford radiologists the opportunity."

The study's next stage will test satellite broadcasting in an effort to expand bandwidth and speed filter transfer, he said.

For more information from the Diagnostic Imaging archives:

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