Departamento de Teoría de la Señal y Comunicaciones, Universidad Rey Juan Carlos and Fundacion EHAS, Camino del Molino S/N, Fuenlabrada, 28943, Spain.
Biomed Eng Online. 2012 Aug 23;11:57. doi: 10.1186/1475-925X-11-57.
Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians) may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respiratory sounds from a remote auscultation, as well as video images showing where the technician is placing the stethoscope on the patient's body.
A real-time wireless stethoscopy system was designed. The initial requirements were: 1) The system must send audio and video synchronously over IP networks, not requiring an Internet connection; 2) It must preserve the quality of cardiorespiratory sounds, allowing to adapt the binaural pieces and the chestpiece of standard stethoscopes, and; 3) Cardiorespiratory sounds should be recordable at both sides of the communication. In order to verify the diagnostic capacity of the system, a clinical validation with eight specialists has been designed. In a preliminary test, twelve patients have been auscultated by all the physicians using the tele-stethoscopy system, versus a local auscultation using traditional stethoscope. The system must allow listen the cardiac (systolic and diastolic murmurs, gallop sound, arrhythmias) and respiratory (rhonchi, rales and crepitations, wheeze, diminished and bronchial breath sounds, pleural friction rub) sounds.
The design, development and initial validation of the real-time wireless tele-stethoscopy system are described in detail. The system was conceived from scratch as open-source, low-cost and designed in such a way that many universities and small local companies in developing countries may manufacture it. Only free open-source software has been used in order to minimize manufacturing costs and look for alliances to support its improvement and adaptation. The microcontroller firmware code, the computer software code and the PCB schematics are available for free download in a subversion repository hosted in SourceForge.
It has been shown that real-time tele-stethoscopy, together with a videoconference system that allows a remote specialist to oversee the auscultation, may be a very helpful tool in rural areas of developing countries.
急性呼吸道感染是儿童死亡的主要原因。发展中国家农村地区缺乏医生，使得他们难以正确诊断和治疗。农村卫生机构的工作人员（医疗技术人员）可能没有能力通过听诊来区分呼吸疾病。出于这个原因，这个项目的目标是开发一种远程听诊系统，使医生能够从远程实时接收心肺声音，并显示技术员在患者身体上放置听诊器的视频图像。
设计了一个实时无线听诊系统。最初的要求是：1）系统必须通过 IP 网络同步发送音频和视频，而不需要互联网连接；2）它必须保持心肺声音的质量，允许适应标准听诊器的双耳塞和胸件，并且；3）心肺声音应该可以在通信的两侧记录。为了验证系统的诊断能力，已经设计了一个由 8 名专家参与的临床验证。在初步测试中，所有医生都使用远程听诊系统对 12 名患者进行了听诊，而传统听诊器则进行了局部听诊。该系统必须允许听诊心脏（收缩期和舒张期杂音、奔马律、心律失常）和呼吸音（喘鸣、啰音和爆裂音、哮鸣、减弱和支气管呼吸音、胸膜摩擦音）。
详细描述了实时无线远程听诊系统的设计、开发和初步验证。该系统是从头开始作为开源、低成本设计的，以便发展中国家的许多大学和小型本地公司都可以制造它。为了最大限度地降低制造成本并寻求联盟以支持其改进和适应，仅使用了免费的开源软件。微控制器固件代码、计算机软件代码和 PCB 原理图可在 SourceForge 托管的版本控制系统中免费下载。
事实证明，实时远程听诊，加上允许远程专家监督听诊的视频会议系统，可能是发展中国家农村地区非常有用的工具。
