Accuracy and reliability of store-and-forward teledermatology: preliminary results from the St George Teledermatology Project.

Teledermatology is the practice of dermatology across distances (and time) and involves the transfer of electronic information. To be effective and safe, the teledermatology process needs to demonstrate an acceptable level of accuracy and reliability. Accuracy is reflected by the degree of concordance (agreement) between the teledermatology and face-to-face diagnoses. Reliability is dependent on how consistently a set of results can be reproduced across different operators. Mean concordance (primary diagnoses) achieved by four dermatologists studying 53 store-and-forward diagnostic cases, originating from 49 referred patients, was 79% (range 73-85%). When the differential diagnoses were taken into account, the variation across individual dermatologists narrowed further, with a mean of 86% (range 83-89%). In contrast, the mean general practitioner (GP; n=11) concordance (GP face-to-face vs reference dermatologist store-and-forward diagnoses) was 49%. An interim review of all 49 teledermatology patients showed no adverse outcome at the end of 3 months. The ability to request face-to-face visits by dermatologists, combined with GPs maintaining primary care of the referred patient, serve as additional safeguards for patients using a telemedicine system. Our results indicate that teledermatology management of referred skin complaints is both accurate and reliable.

Australian teledermatology: the patient, the doctor and their government.

Telemedicine is an emerging technology within Australia. We review the historical development of telemedicine and discuss the clinical and non-clinical issues surrounding its practice in this country. Teledermatology is one application of telemedicine. We discuss the potential impact of teledermatology on patients, doctors and third parties such as government. So far, teledermatology has received little attention from Australian dermatologists. By contrast, the Government and other organizations are showing keen interest in establishing infrastructure within this country. We believe it is time for dermatologists to become more involved in the practice and politics of telemedicine within Australia.

Experimental test of harmonic contribution to the thermal index for soft tissue.

Experimental data were gathered for the heating effect of an ultrasound beam propagating in water and incident on a thermal test object containing artificial tissue in which a fine-wire thermocouple was embedded close to the beam entrance. The extent of temperature elevations in the artificial tissue was limited by using a constant low value for spatial peak temporal average ultrasound intensity so that the medium did not denature. The adjusted (for continuous wave conditions) maximum temperatures reached in a fixed exposure time initially increased linearly with increase in the spatial peak pulse average ultrasound intensity, but, for the higher values of this parameter, exceeded that expected from a linear relationship. In addition to the fundamental frequency, significant higher frequencies were present in the beam at high intensities, which caused additional enhancement of the ultrasound heating. Calculations of W(DEG) for evaluation of the thermal index should include the evaluation of the heating contributions from all frequencies present in the beam.