| BackgroundUltrasound echocardiography（UCG）can intuitively,accurately and comprehensively visualize the structure,geometric morphology,spatial relationship,motion and blood flow status of the cardiac chambers[1].As the spatial and temporal resolution of UCG are improving,UCG has become the routine method for the diagnosis,treatment and prognostic evaluation of cardiovascular diseases[2].However,image collection and diagnostic process with UCG are different from other imaging technologies,which rely on ultrasound doctors.It is required that the ultrasound doctors not only master the basic theories and knowledge about UCG and heart diseases,but also the operational skills with UCG in collecting standard images from multiple angles and on multiple planes[3].That is why ECG-based diagnosis is still challenging for ultrasound doctors at the grassroots hospitals[4].As a medical service discipline integrating modern communication,electronic technology,computer network and medicine,telemedicine expands the scope of patients’access to medical services by overcoming geographical barriers,and provides clinical support for patients to improve their health status[5].It includes remote clinical case consultation,remote imaging,remote ECG,remote pathology,and remote ultrasound consultation and diagnosis.China has a vast territory and a large number of personnel.In order to solve the problem that the technical level of different medical institutions is uneven and the medical technology level of remote areas is still low,China has introduced a series of policies to help,and telemedicine is an major solution for the construction of hierarchical diagnosis and treatment system[4].ObjectiveTo explore the feasibility,clinical significance and promotion value of three-synchronousdouble-real-timeinteractiveremotetransthoracic echocardiography consultation based on the current Internet cloud service technology.MethodsBased on the current Internet cloud service technology,applying unique dynamic image encoding and decoding and synchronization technology,integrating multi-dimensional voice,text,pictures and other communication information,Henan Provincial People’s Hospital and three county-level primary hospitals 300 kilometers away（Fanxian People’s Hospital of Puyang City,Zhenping People’s Hospital of Nanyang City and Xincai People’s Hospital of Zhumadian City）have established three Synchronous dual real-time interactive remote transthoracic echocardiography consultation platform.Remote consultations were conducted under 4G and 5G networks successively,and basic information such as patient age,gender,current medical history,preliminary diagnosis results,remote consultation results and network speed were recorded.After the consultation,an electronic report was submitted for reference by the superior hospital.At the same time,three off-site experts were required to use a Likert five-point scale to rate the transmission image quality of 4G and 5G networks respectively.We use Windows SPSS 18.0K（SPSS Inc.,Illinois,USA）for statistical analysis.The measurement data is expressed byx±s.Counting data is expressed in the form of composition ratio（percentage%）.ResultsA total of 115 patients were included,among which 77 patients were consulted under the 4G network and 38 patients were consulted under the 5G network.The mean age of patients was 63±16 years.The total consultation time was 1426 minutes,and the average consultation time for each patient was 12.4±5.8 minutes.Among all patients,14 patients were finally diagnosed with congenital heart disease,93 patients with acquired heart disease,and 8 patients without obvious cardiac abnormalities.Compared with the preliminary diagnosis results of primary hospitals,17 cases of abnormal lesions were found by remote consultation experts,accounting for 15%of the total consultation cases.8 abnormal cases were excluded,accounting for 7%of the total number of consultation cases.The expert opinions of the other 90 consultation cases were basically consistent with the initial consultation in grassroots hospitals,accounting for 78%of the total consultation cases.According to statistics,among 115 cases of echocardiographic consultation results,there are 18 main diagnostic results（each patient may have one or more main diagnostic results）.There are 14 cases of congenital heart abnormalities,including 5cases of atrial septal defect,2 cases of patent ductus arteriosus,4 cases of ventricular septal defect,and 3 cases of complex congenital heart（including double outlet of right ventricle+ventricular septal defect+transposition of great arteries,etc.）.Left ventricular systolic dysfunction is the most common in acquired heart disease,with28 cases,accounting for 24%;followed by segmental movement of the left ventricular wall and pulmonary hypertension,21 cases each,accounting for 18%;mitral valve prolapse with There are 12 cases of incomplete closure,accounting for10%.In addition,there are 6 types of secondary diagnosis,namely:mild valvular regurgitation,large and left ventricular relaxation dysfunction,a small amount of pericardial effusion,mitral valve leaflet calcification and large left ventricle.The average download speed of 4G and 5G networks is 92.43Mbps and480.24Mbps,respectively.The upload speed is 12.26Mbps and 92.43Mbps.The image quality scores of 4G and 5G networks calculated by Likert five-point scale are both greater than 4 points,indicating high image quality.Conclusions1.Based on the current network technology,the three-synchronous double-real-time interactive remote transthoracic echocardiography consultation has the advantages of simple equipment,clear image quality,smooth consultation and high feasibility.2.Remote transthoracic echocardiographic consultation not only reduces the transfer rate of primary hospitals,but also reduces unnecessary costs and time wastage for patients.At the same time,it provides better guidance to primary doctors and is a good platform for improving their technical knowledge.It has good clinical significance and promotion value. |
PDF Full Text Request