[How certain is teleradiological telediagnosis for the tomographic procedure?]. / Wie sicher ist die teleradiologische Ferndiagnose für Schnittbildverfahren?

PURPOSE: To define the value of teleradiographic studies, a comparison was carried out between digitised copies of CT examinations of the skull with the original images. Differences in image quality obtained from a digital scanner and a camera were quantified. MATERIAL AND METHOD: 56 CT examinations of the skull, 28 of which had discrete abnormalities, were chosen for ROC analysis. The original films were digitised with a Vidar VXR-12 scanner and Panasonic WV-160 and WV-BP 500 cameras. The images were evaluated by five radiologists after image transfer with Video Conference software to a personal computer. RESULTS: For the analysis of the films the area under the ROC curve was 0.91 +/- 0.04, for the digital scanner it was 0.85 +/- 0.04, for camera WV-BP 500 0.89 +/- 0.06 and for camera WE-160 0.87 +/- 0.09. Comparison with the film findings showed. a minimal p-value of 0.17 which indicated that there was no significant reduction in diagnostic value following digitization. CONCLUSION: The probable reason for the slight deterioration using the digital scanner was the reduction to 75 dpi compared with 134 dpi on the CT films. The cameras produce image noise comparable to CT with low window settings and reduced local resolution. We expect similar results for CT with soft tissue windows or for MRT of the skull. Conventional radiographs containing high local resolution, wide grey scale and low image noise would presumably make higher demands on methods of digitization.

["Second opinion" in online radiology via Internet: report on implementation and analysis of reliability of findings in sectional images]. / Die "Zweite Meinung" in der Radiologie Online über das Internet: Bericht über die Implementierung und Analyse der Befundungssicherheit von Schnittbildern.

Numerous medical on-line services have already been established in the world-wide internet. In connection with the Information service TELESCAN, sponsored by the EU, a pilot project has been initiated which offers a radiological "second opinion" via the transmission of radiological findings and images that have been previously rendered anonymous. In addition to a description of the basic implementation, tests of the diagnostic certainty of the transmitted cranial computed tomographs have been performed. The CT images were digitized with a document camera, transmitted over the Internet, and then evaluated on the receiver's monitor. Both the transfer of originally generated digital image files (in ACR-NEMA or DICOM) as well as graphic files after digitization of X-ray films, for example by a document camera, is possible via electronic post (e-mail). Visualization by the receiver requires the use of current proprietary software for special medical image formats, while standard graphic formats such as GIFF or JPEG can be visualized with the usual Internet software. In an ROC analysis, 56 individual images of cranial computed tomographs, half with pathological findings such as space-occupying lesions, infarcts, or brain edema, were tested with regard to the diagnostic certainty after digitization and transmission. In comparison with the original film findings, there was a slight but statistically not significant reduction in diagnostic certainty of the images evaluated on screen after transfer via the Internet. We believe that this result is due to the low local resolution, low dynamic range, the high image noise and of CT arising from the window technique. The same parameters are probably valid for MRI. The result cannot be applied to conventional radiography including mammography because, in comparison to the mentioned image techniques, their local resolution is high and image noise is considerably lower.

[Teleradiology: use of multimedia PC for access to electronic patient records and teleconsultation]. / Teleradiologie: Einsatz eines Multimedia-PC für den Zugriff auf elektronische Patientenakten und Telekonsultationen.

A PC-platform is presented using internet technology on Ethernet (local) or ISDN (external) for access to digital hospital infrastructures comprising electronic multimedia patient records integrating information systems of all clinical departments. In addition, a videoconferencing system is implemented for teleconsulting, and a document camera allows transmission of analogue data. In combination with the multimedia-PC. Ethernet as well as ISDN offer satisfying performance for transmission of medical data including images. In 20 cases, visualisation of the electronic patient record, an average CT with report and 58 GIFF Images', or transfer of an ACR-NEMA file from CT, took seconds (Ethernet) or up to 3.5 minutes (ISDN - 58 CT images and report).

[Technique and economics of first worldwide roentgen conference via public phone lines with the Medical Desktop-Conference and Integrated Services Digital Network]. / Technik und Okonomie der weltweit ersten Röntgenbesprechung über das öffentliche Fernsprechnetz mittels medizinischer Desktop-Konferenz und ISDN.

The introduction of the world's first Medical Desktop-Conference via public phone lines (ISDN-S2M) in spring 1994 for the weekly discussion of radiological findings with 25 orthopedic surgeons has proved the effectiveness of this system developed by the project BERMED. The use of standard hard- and software as well as ISDN are the most important factors to keep the system costs low. Technical advantages can be seen in the immediate, loss-free transmission of image and other patient-related data and in the integration of digital archives. Medical advantages are the 24-hour-availability of the radiologist and quality-control of the radiologists work. Practitioners and external hospitals can be tied closely to radiological service centers by using ISDNetwork.

Telemedicine in rural areas. Experience with medical desktop-conferencing via satellite.

Cooperation between physicians in hospitals in rural areas can be assisted by desktop-conferencing using a satellite link. For six weeks, medical desktop-conferencing was tested during daily clinical conferences between the Virchow-Klinikum, Berlin, and the Medical Academy, Wroclaw. The communications link was provided by the German Telekom satellite system MCS, which allowed temporary connections to be established on demand by manual dialling. Standard hardware and software were used for videoconferencing, as well as software for medical communication developed in the BERMED project. Digital data, such as computed tomography or magnetic resonance images, were transmitted by a digital data channel in parallel to the transmission of analogue video and audio signals. For conferences involving large groups of people, hardware modifications were required. These included the installation of a video projector, adaptation of the audio system with improved echo cancellation, and installation of extra microphones. Learning to use an unfamiliar communication medium proved to be uncomplicated for the participating physicians.

[Communication and integration of medical documents for the teleconference use. An outcome of the BERMED project]. / Kommunikation und Integration medizinischer Dokumente für Telekonferenz-Anwendungen: Ein Ergebnis aus dem Projekt BERMED.

The collaboration between physicians is supported in the BERMED project by implementing the remote access to distributed patient data and the realisation of computer-based medical conferencing. This requires the integration of the multimedia data in form of a meta-patient record for our medical application systems. These applications are supported by a distributed information management promoting access to different information systems, imaging modalities and digital archival storage systems. The features of image processing are concerned with quantification, segmentation and 3-D-visualisation to obtain additional information. This paper gives an overview of the actual state of the teleconferencing system in radiology.

Characterization of a pigment-dispersing hormone in eyestalks of the fiddler crab Uca pugilator.

A pigment-dispersing hormone (PDH) from eyestalks of the fiddler crab Uca pugilator has been purified by gel filtration, ion-exchange chromatography, partition chromatography, and reversed-phase liquid chromatography. Based on automated gas-phase sequencing and subsequent identification of carboxyl-terminal amide, we have assigned the primary structure of this peptide as Asn-Ser-Glu-Leu-Ile-Asn-Ser-Ile-Leu-Gly-Leu-Pro-Lys-Val-Met-Asn-Asp-Ala-NH (2). We have confirmed the sequence by synthesizing this peptide and demonstrating that the synthetic PDH and the native PDH display identical chromatographic behavior and biological activity. This hormone is a member of a family of invertebrate neuropeptides that includes a light-adapting/pigment-dispersing octadecapeptide hormone from the prawn Pandalus borealis. In assays for melanophore pigment dispersion in destalked fiddler crabs, Uca PDH was 21-fold more potent than Pandalus PDH. These two hormones share a hexapeptide core sequence (residues 5-10: -Ile-Asn-Ser-Ile-Leu-Gly-) as well as the amino- and carboxyl-terminal residues but differ at positions 3, 4, 11, 13, 16, and 17. These results point to speciesrelated or group-specific structural differences among crustacean PDHs.