TechnologyMultimedia Messaging Service teleradiology in the provision of emergency neurosurgery services
Introduction
Neurosurgical emergencies form a significant proportion of a tertiary neurosurgical service. The potentially life-threatening conditions encountered mandate prompt and accurate diagnosis and rapid institution of definitive therapy to reduce neurological mortality and morbidity.
Most neurosurgical units are operated on a 2-tier system after standard working hours. The in-house service is normally run by a middle-level staff. The middle-level staff is conventionally a neurosurgeon-in-training (registrar or resident), and the senior staff (consultant or attending) is normally consulted on issues via telephone consults.
Brain imaging is integral to definitively diagnose neurosurgical pathology. The intricacy of neuroanatomy and unfamiliarity with interpretation of CT or MR images may potentially result in erroneous or missed diagnosis. This can obviously lead to devastating adverse effects as appropriate therapy may be delayed.
As middle-level doctors may not be fully conversant with the interpretation of emergency brain scans, teleradiology of the scans to an experienced doctor can potentially result in more accurate scan interpretation and institution of prompt and appropriate treatment.
Multimedia Messaging Service mobile phone technology offers a simple, cheap, quick, and effective solution to the problem of scan interpretation. An MMS takes only a few minutes to send and receive and allows senior doctors to view important images and make important clinical decisions to enhance patient management in an emergency situation. The technology is already in widespread use and can be seamlessly and rapidly implemented in the clinical arena.
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Material and methods
A mobile phone (with VGA camera and MMS capabilities) was provided to the neurosurgery registrar on call. The on-call mobile phone is passed on to the corresponding registrar on-call the next day. All consultants had personal mobile phones that are MMS-enabled.
Relevant representative CT/MRI images can be taken directly from the mobile phone from the PACS off the computer screen (Fig. 1). When only hard copies are available, the images can be taken off the light box. On average, 3 to 4 images
Results
The total number of respondents was 12. This consisted of 7 senior staff (consultant) and 5 middle-level staff (registrar).
The following is a summary of the results of the survey.1. How frequently do you use MMS when you are on-call? • <25% (3) • 25%-50% (2) • 51%-75% (2) • >75% (0) 2. Did the use of MMS improve your level of confidence in clinical decision making? • No difference (0) • Slight difference (2) • Moderate difference (1) • Significant difference (4)
Discussion
Emergency neurosurgery services are provided on a 24-hour basis. However, after standard working hours, the provision of emergency services is traditionally provided in a 2-tiered fashion with the in-house staff manned by middle-level doctors (usually neurosurgeons-in-training) who will consult the senior doctors on more complex clinical problems via telephone consults. Referrals via the telephone have been shown to have inherent deficiencies in the quality of the information provided, which
Conclusion
Accurate scan interpretation and prompt institution of appropriate therapy are critical to reduce the mortality and morbidity associated with emergent neurosurgical pathologies.
The MMS mobile phone system is an existing technology in mainstream use and offers a simple, cheap, quick, and effective solution to the problem of scan interpretation.
The implementation of this technology can complement existing emergency neurosurgery services in most neurosurgical units and improve patient care.
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2012, World NeurosurgeryCitation Excerpt :Besides the clinical details such as age and level of consciousness, scan interpretation is critical in making a definitive diagnosis and formulating the management plan. With the advent of Multimedia Messaging Service (MMS) technology, the National Neuroscience Institute in Singapore has been utilizing MMS since 2006 (5), mainly for communication between neurosurgical specialist residents and the attending neurosurgeon. Relevant representative scan images are taken directly from the mobile phone from the Picture Archiving and Communications System off the computer screen using a dedicated mobile phone (with VGA camera and MMS capabilities) and transmitted to the attending neurosurgeon, followed by a telephone consultation to provide relevant clinical details.