Colombo Jamie N, Seckeler Michael D, Barber Brent J, Krupinski Elizabeth A, Weinstein Ronald S, Sisk David, Lax Daniela
1 Department of Pediatrics, The University of Arizona , Tucson, Arizona.
2 Section of Pediatric Cardiology, The University of Arizona , Tucson, Arizona.
Telemed J E Health. 2016 May;22(5):429-33. doi: 10.1089/tmj.2015.0114. Epub 2015 Sep 28.
Telemedicine is used with increasing frequency to improve patient care in remote areas. The interpretation of medical imaging on iPad(®) (Apple, Cupertino, CA) tablets has been reported to be accurate. There are no studies on the use of iPads for interpretation of pediatric echocardiograms. We compared the quality of echo images, diagnostic accuracy, and review time using three different modalities: remote access on an iPad Air (iPad), remote access via a computer (Remote), and direct access on a computer linked through Ethernet to the server, the "gold standard" (Direct).
Fifty consecutive archived pediatric echocardiograms were interpreted using the three modalities. Studies were analyzed blindly by three pediatric cardiologists; review time, diagnostic accuracy, and image quality were documented. Diagnostic accuracy was assessed by comparing the study diagnoses with the official diagnosis in the patient's chart. Discrepancies between diagnoses were graded as major (more than one grade difference) or minor (one grade difference in severity of lesion).
There were no significant differences in accuracy among the three modalities. There was one major discrepancy (size of patent ductus arteriosus); all others were minor, hemodynamically insignificant. Image quality ratings were better for iPad than Remote; Direct had the highest ratings. Review times (mean [standard deviation] minutes) were longest for iPad (5.89 [3.87]) and then Remote (4.72 [2.69]), with Direct having the shortest times (3.52 [1.42]) (p < 0.0001).
Pediatric echocardiograms can be interpreted using convenient, portable devices while preserving accuracy and quality with slightly longer review times (1-2 min). These findings are important in the current era of increasing need for mobile health.
远程医疗在偏远地区改善患者护理方面的使用频率日益增加。据报道，在iPad（®）（苹果公司，加利福尼亚州库比蒂诺）平板电脑上对医学影像进行解读是准确的。目前尚无关于使用iPad解读儿科超声心动图的研究。我们使用三种不同方式比较了超声心动图图像质量、诊断准确性和查看时间：在iPad Air（iPad）上远程访问、通过计算机远程访问（远程）以及通过以太网连接到服务器的计算机直接访问，即“金标准”（直接）。
使用这三种方式对连续50份存档的儿科超声心动图进行解读。由三位儿科心脏病专家对研究进行盲法分析；记录查看时间、诊断准确性和图像质量。通过将研究诊断结果与患者病历中的官方诊断进行比较来评估诊断准确性。诊断差异分为主要差异（超过一个分级差异）或次要差异（病变严重程度相差一个分级）。
三种方式在准确性方面无显著差异。存在一处主要差异（动脉导管未闭大小）；其他所有差异均为次要差异，对血流动力学无显著影响。iPad的图像质量评分优于远程；直接访问的评分最高。查看时间（平均[标准差]分钟）以iPad最长（5.89[3.87]），其次是远程（4.72[2.69]），直接访问时间最短（3.52[1.42]）（p<0.0001）。
儿科超声心动图可以使用方便、便携的设备进行解读，同时保持准确性和质量，只是查看时间稍长（1 - 2分钟）。这些发现对于当前对移动健康需求不断增加的时代具有重要意义。
