Real-Time, Remote, Interactive Internet Examination of Swallowing Function

 

This software makes possible real-time, remote, dynamic transmission of fluoroscopic medical imaging sessions.

Using standard MPEG video compression, a patient's medical images are transmitted in real time using a broadband Internet connection in a best-effort format. The transmitting computer, equipped with a video-encoding card and custom developed software is located in a remote hospital x-ray suite and is connected to a fluoroscope. This computer is fully controlled by a Control and Analysis Computer (CAC) which is located in the clinic or laboratory of a clinical specialist in the area of interest for diagnosis. The diagnostic specialist uses a speaker telephone and web camera to communicate with the x-ray suite.

While the best-effort format is transmitted in real time, the high quality images are simultaneously stored and later transferred offline to the CAC for accurate and detailed analysis. The CAC can support computers at any number of Internet-connected hospitals. Once the video images are transferred after the examination, the clinician at the central site can make measures of temporal events, bolus transport, and displacements of anatomical structures visible by fluoroscopy. The system is HIPAA compliant.

Using software, a video encoding card, and control algorithms, this technology makes possible real-time consultation with medical experts who are not in the same location as the patient. The diagnostic experts can direct the patient examination based on the dynamic images transmitted in real time, over the Internet. This allows the examination to be both time and cost savings, as well as healthier for patients. The software runs on two off-the-shelf computers. The first computer is connected to a local fluoroscope and uses a video encoding board. The computer transmits real-time dynamic images of the examination over the Internet via control by a diagnostic professional at the other computer located at a central location. The session is simultaneously recorded onto the hospital computer for transfer or play-back at another time. The real-time protocol streamlines transmission because it bypasses some frames in the diagnostic session, avoiding potentially time-consuming delays on the Internet. This loss in image quality does not impact the diagnostic process because the high quality images used for diagnosis are transferred after the session is completed.

This technology is flexible: Although it was originally designed for diagnosis of oropharyngeal swallowing disorders, its use is not limited to fluoroscopy. The technology can be used with any dynamic imaging equipment found in a hospital or clinic. This technology uses readily available components. It is based on a commonly used operating system in the US: Windows 2000/XP Professional. Because the developers designed the technology to be used by clinicians and not by computer specialists, it has been designed to be easy to set up and run on both the PC at the remote hospital site and the PC at the diagnostician's site. The technology has been developed so that the PC located at the remote hospital is completely controlled by the computer used by the diagnostic professional. The interface to the controlling computer is a graphical user interface (GUI) and has been continually enhanced during the usability study by clinicians. The control and analysis process is shown in steps with descriptive explanations.