Day 2 :
- Track-2 Role of electronics and communication technology in Telemedicine
Track-4 Preventive eHealth Systems
Track-6 Biomedical Technologies in Telemedicine
Track-7 Challenges in Implementing Telemedicine
Session Introduction
Philippe Arbeille
Medecine Hopital Trousseau, France
Title: Tele-Operated Echograph and Probe Transducer Through Internet for Tele-Operating Echography and Doppler Examination Remotely on Isolated Subjects
Time : 9:00AM – 10:00AM
Biography:
Ph Arbeille is the Director of UMPS, Space Medicine and Physiology Research Unit, at University Hospital Trousseau, France. His area of research is Human adaptation and deconditioning in extreme environment (microgravity, bed rest, confinement...), and Tele-echography (Robotic arm, motorized transducer, 3D capture, remote echograph) for ground and space application.
Abstract:
Objective: The objective was to design an integrated echograph and motorized probe unit which could be fully controlled from away by an expert. Method: The function (Gain, depth, freeze, PW colour Doppler, 3D capture and measures.) of a commercial echograph were controlled via internet. Two engines inside a probe allowed tilting and rotating the transducer from away according to the movement of expert hand on a dummy probe. A non-sonographer person by the side of the patient located the motorized probe (400 g, 240 cm3) on the patient, on top of the acoustic window of the organ as indicated by the expert by visio conference. Then the expert controlled the orientation of the transducer, until he got the appropriate view of the organ. He also adjusted the image display (Gain, depth.) and activated at his convenience the different function (PW or Colour Doppler, TM, 3D and measures) using a conventional PC keyboard. At last he captured images or video directly on his computer. Results: The system was successfully tested through terrestrial and satellite network on 100 patients with abdominal, vascular and small parts pathologies and pregnancies in small medical centre away from the university hospital. The right diagnostic was found in 90% of the cases. Conclusion: The ergonomy of the tele-operated echograph and probe unit was found particularly well adapted for investigating patient in isolated places was no sonographer was available. It is now schedule to be used for investigating human in extreme environment like space or hostile and restricted places.
Junji Kamogawa
Shiraishi Hospital, Japan
Title: Using 3D MRI/CT Fusion Image to Reveal the Pathway and Pathology of the spinal Nerve Root in Patients with Irritable Radicular Pain
Time : 10:00AM – 10:45AM
Biography:
Junji Kamogawa (Birth: 1969, PhD; Pathology of autoimmune arthritis: 2000, University of Ehime) is a chief Director of Spine & Sport Center in Shiraishi Hospital, a spinal surgeon, an expert for radiculopathy treatment. His clinical and research interests include spinal pain, microscopic-spinal surgery, spinal imaging, pathology, sport medicine and therapeutic stretching (Awards: Ehime medical 2002, Spine radiology 2013). For future task, he is researching for new image of both sympathetic nerve and epi-dural circulatory dynamics. He wants to get new ideas from experts in other fields such as angiography, MRI physics, and anatomy.
Abstract:
Background: There have been several imaging studies of cervical/lumbar radiculopathy but no three-dimensional (3D) images have shown the position, its running pathway and pathological changes of the nerve roots and spinal root ganglion relative to the bony structure. Moreover, the spinal roots are small and soft and can change shape during motion. Characteristic anatomical features of the nerve roots include curved running, no merkmal and no enhancement with contrast media. The objective of this presentation is to introduce a technique that enables the virtual pathology of the nerve root to be assessed using 3D magnetic resonance (MR)/computed tomography (CT) fusion images that show the compression of the nerve root by the herniated disc, yellow ligament and the bony spur in patients with degenerative cervical/lumbar radiculopathy. Methods: 3D MR images were placed onto 3D CT images using a computer workstation. Results: The entire nerve root could be visualized in 3D with or without the vertebrae. The most important characteristic evident on the images was flattening of the nerve root by a bony spur or hard disc. The affected root was constricted at a pre-ganglion site. In cases of severe deformity, the flattened portion of the root seemed to change the angle of its path resulting in tortuosity. Conclusions: The 3D MR/CT fusion imaging technique enhances visualization of pathoanatomy in lateral spinal hidden area that is composed of the root and inter-vertebral foramen. This technique provides two distinct advantages for diagnosis of radiculopathy. First, the isolation of individual vertebra clarifies the deformities of the whole shape for root groove. Second, the tortuous or twisted condition of a compressed root can be visualized. 3D-MRI/CT fusion imaging is very useful for all clinicians treating irritable radicular pain. In addition, this technique can also be used as educational material for all hospital staff (new doctors, nurses, radiological technicians, therapists, medical students) and for patients and patients’ families who provide informed consent for treatments. Virtual images have thus enabled the visualization of previously inaccessible anatomical locations and depicting conditions clearly at a glance without the need for hard-to-understand medical terminology.
Amir Khoshvaghti
AJA University of Medical Sciences, Iran
Title: Telemedicine as the best solution for cardiac emergencies in air travels
Time : 11:00AM - 11:45AM
Biography:
Amir Khoshvaghti has completed his PhD of Anatomical Sciences from Shahid Beheshti University of Medical Sciences. He is the Assistant Professor and Head of Department (Basic Sciences of Aerospace and Sub aquatic Medicine Faculty) in Iran. He has published more than 10 papers in reputed journals (English and Farsi). He has also presented more than 30 oral presentations or posters in national and international congresses.
Abstract:
Introduction: Inflight, medical and cardiac emergencies always occur and air travels are increasing every year. There are not so many researches about the problem. Physicians have limited experience because of lack of formal medical education. Cardiac emergencies are not recorded as a standard format by airlines. Telemedicine is considered to provide health care at a distance. Methods: The systematic study has been done for Pub Med articles from 2000-2015. Results: Every year, 17000 in-flight medical emergencies occur in America. It has been shown that there are potential stresses in air travel. Commercial airplanes are pressurized but if pressure reduction happens, there would be a serious problem; hypoxia. Cardiac and respiratory patients (symptomatic coronary disease, uncompensated heart failure, heart congenital and valvular disorders, sickle cell anemia and sleep apnea) will suffer from lack of oxygen. Chest pain and cardiovascular emergencies have been diverted flights in most instances as reported. Discussion & Conclusion: Telemedicine seems as the best solution for the problem especially with supervision of an aerospace medicine specialist. The following suggestions are proposed by aerospace medicine: Travelers screening, educational programs for travelers, education of aircrew, founding a central standard recording system, designing proper medical kits for airplanes and considering telemedicine as the basic necessity for emergencies in air travel.
Anandhi V Dhukaram
University of Cambridge, United Kingdom
Title: Supporting Everyday Cardiovascular Disease Self-Care Decision Making: Are we there yet?
Time : 11:45AM - 12:30PM
Biography:
Anandhi Dhukaram is passionate about combining multidisciplinary design approach, technology and cognitive engineering to create a state of the art solution. Her PhD at the University of Birmingham is funded by the European Union project titled \"Pervasive Technology for Cardiac care\". She has been a speaker and presented in various conferences. Her recent work is published in the Journal of Medical Informatics. Before entering academia, she had a distinguished career for more than a decade working for various clients including Accenture, Barclays, and ACNielsen across the globe: India, Australia, Canada, USA and UK.
Abstract:
Although some of the severe consequences of cardiovascular disease (CVD) can be minimized through vital signs monitoring and treatment adherence tools, the magnitude of CVD continues to accelerate globally, with high rates of mortality and hospitalization. The aim of this talk is two-folds: first to present various self-care decisions patients make in everyday life and second to explore the support available for everyday decision making. Focus group studies with CVD patients show that self-care can get quite complicated due to everyday decisions that range from routine ill-structured problems, e.g., “What to eat?†to uncertain symptoms-related decisions, e.g., “Is this pain related to heart burn or heart attack?†to time-constraint treatment-related decisions, e.g., “Do I go to the doctor or wait and see?†Patients should be able to address such ambiguities through the use of appropriate self-management systems by considering the cognitive and behavioural process involved in the choice of behaviours to maintain physiological stability including symptoms monitoring, treatment adherence, and response to symptoms. Literature shows that the current tools available for supporting self-care are based on clearly defined rules and procedures similar to supporting patients in an episodic or acute condition. As CVD is a long-term condition involving multiple patient attributes (knowledge, experience, situation recognition) and treatment attributes, patients need to understand the impact of their decision or of the symptoms in relation to their health condition for deciding an appropriate course of action rather than a rule-based solution to a problem.
Esther Arrieta-Cerdán
Hospital Universitario de Burgos, Spain
Title: Applications of Telemedicine
Time : 13:30PM - 13:45PM
Biography:
Esther Arrieta-Cerdán has completed her Medical Degree from Valladolid University and Master in Public Health and Preventive Medicine from Alcalá University. She is a Public Health and Preventive Medicine resident physician in Burgos Universitary Hospital
Abstract:
Telemedicine is a remote medical attention that could be practiced in most medical specialties. Focusing on rural and mountain medicine, there are two examples of projects carried out in the Pyrenees: SUP and STIPP. SUP (Safety and Emergencies in the Pyrenees) had as objective to improve emergency management in different scenarios like mountains, hostile areas and isolated villages. They used portable equipment and specifically worked with ECG in twelve derivations, heart rate, blood pressure, respiratory frequency and O2 saturation in real time. It transmits data by Internet and a specialist physician at hospital helps the rescue team or GP make decisions. The SUP project has improved quality of life in rural areas, optimized limited resources management and enhanced safety and quality in Pyrenees tourism. STIPP (Transfrontier Information System for Prevention in the Pyrenees) objectives are to improve people’s safety in critical situations in cross-border mountains until specialized assistance arrival and to improve risk prevention in Pyrenees by the creation of a transfrontier information system. It gives an instant distribution of information on acts of nature in the mountains, weather information and geo-location by satellite alert system. They have a telemedicine “go†bag placed in mountain shelters and a computer submersible up to 1m, humidity, cold and knock resistant with an anti-glare touch screen. To sum up, telemedicine is a new way of organizing and planning human and material resources, an excellent tool in extra-hospital assistance and guarantees care access and continuity for all patients.