Imaging Informatics Telemedicine & Teledentistry Dr Ebtissam Al-Madi

Biomedical imaging informatics Is the study of methods for generating, manipulating, managing, and integrating images in many biomedical applications

Tasks of imaging informatics Image generation Process of generating images and converting them to digital form Image manipulation Uses preprocessing and post processing methods to enhance, visualize, or analyze the images. Image management Includes methods of storing, transmitting, displaying, retrieving, and organizing images. Image integration The combination of images with other information needed for interpretation, management, and other tasks.

Basic concepts Digital images Represented in a computer by a 2 dimensional array of numbers (a bit map). Each element of the array represents the intensity of a small square area of the picture called a pixel. Once pictures are in digital form , they can be handled (transmitted, stored, displayed and manipulated) like any data.

Basic concepts Imaging Parameters: Spatial resolution It is a measure of how well the imaging modality can distinguish points on the object that are close together. Is related to the sharpness of the image. It is the number of pixels per image. Contrast resolution It is a measure of the ability to distinguish small differences in intensity. It is related to the difference in measurable parameters such as xray attenuation. It is the number of bits per pixel. Temporal resolution It is the measure of the time needed to create an image. It can be real-time if the images are created concurrent with the physical process (30 images a second).

Applications of medical imaging Structural imaging Two- dimensional images Three dimensional images Functional imaging Image based functional mapping Non-image based functional mapping

Areas of development for structural imaging Energy Source: Light X-rays Ultrasound Nuclear Magnetic resonance Reconstruction Methods Higher Dimensionality Contrast agents New structural imaging methods

Roles for imaging in biomedicine Detection and diagnosis Assessment and planning Guidance of procedures Communication Education and training Research

Assess clinical problem Assess quality/monitor performance Communicate results and recommendations Request/ schedule exam Educate/train, provide feedback Analyze/ interpret findings Perform exam The Radiologic process

Image Management and Display Image acquisition Storage Requirements Image Transmission Standardization of formats Display Capabilities Cost

PACS: Picture Archiving and communication systems

telehealth

TeleHealth Telehealth is the delivery of health-related services and information via telecommunications technologies. Telehealth delivery could be as simple as two health professionals discussing a case over the telephone, or as sophisticated as using videoconferencing between providers at facilities in two countries, or even as complex as robotic technology.

Tele health Direct access to health information resources by consumers Consumer health related messaging Remote monitoring Remote interpretation Video based telehealth

Types of Telehealth Telehealth: Telemedicine: Telecardiology refer to clinical and non-clinical services such as medical education, administration, and research Telemedicine: telemedicine often refers only to the provision of clinical services Telecardiology ECG or electrocardiograph can be transmitted using telephone and wireless Teleradiology; is the ability to send radiographic images (xrays, CT, MR, PET/CT, SPECT/CT, MG, US...) from one location to another Telepsychiatry: Allows anonymity of patient and less social stigma, physical examinations are not important. Correctional telehealth: Telehealth for prisoners in correctional facilities Teledentistry: is the use of information technology and telecommunications for dental care, consultation, education, and public awareness

Connections EHR Nurse Surgeon Video conferencing- telephone- messaging Family, friends other patients Patient Peer support networks Consumer health resources Tel Home Care Tele presences, remote surgery Video conferencing- telephone- messaging Imaging EHR Patient Images Health Related websites Specialist General information websites Primary care provider Nurse Surgeon

Benefits of telemedicine Provides care for those living in remote areas Provides consultation, education and back up for specialists in remote areas Decreases costs Better care in remote monitoring for patients Reduce visits to hospital and reduce congestion in hospitals Provide help for patients in areas not able to be reached conventionally

Types of Telemedicine Store-and-forward telemedicine involves acquiring medical data (like medical images, biosignals etc) and then transmitting this data to a doctor or medical specialist at a convenient time for assessment offline Remote monitoring: also known as self-monitoring/testing, enables medical professionals to monitor a patient remotely using various technological devices. Interactive telemedicine: provide real-time interactions between patient and provider, to include phone conversations and online communication.

Teledentistry using the Internet to consult with an expert. This consultation could be: direct (between the patient and the expert) indirect (between the patient’s doctor and the expert).

Evolution of teledentistry Phone call to expert Fax charts and records Internet: scanned image, digital image, and audio transfer of requests

Uses of teledentistry Conditions that only visual inspection or history is needed for interpretation Oral medicine Chronic Facial Pain Assisting patients with concerns: Trauma Finding a dentist Specific organizations with urban and rural centers: MOH, KFSH, MOD, ect

Challenges and future directions Quality of information and content credentialing Ensuring provision of care Licensure of providers Reimbursement of providers Emerging roles of health professionals Robotics utilization

InteractiveMD is a telehealth company that connects patients with doctors via real-time videoconferencing, phone, and secure email, MDLiveCare is an on-demand telehealth company that provides patients with remote access via video, phone, and secure email to board certified doctors and licensed therapists. Recently, the company partnered with Google Health to allow their users to sync the data shared during telehealth consultations with their online health records.

Virtual healthcare http://www.ahfmr.ab.ca/researchnews/2010/spring/virtualhealthcare/ IPhones deliver medical scans to MDs http://www.cbc.ca/canada/calgary/story/2010/04/20/calgary-iphone-mitchell-application-scan-mri.html?ref=rss Teledentistry in Use: http://www.urmc.rochester.edu/news/story/index.cfm?id=1774

This weeks assignments Log on to http://faculty.ksu.edu.sa/ealmadi/182DEN/default.aspx View this lecture online for review. Article this week: suggested reading only Participate in discussion: If you are assigned to become a dentist in a MOH clinic in a small remote village in Saudi arabia, how will you propose that utilization of teledentistry will help you. Defend your proposal to the ministry. Discuss View Read