Trials with telemedicine started with the advent of television in the 1930s. Now, 60 years later, high-quality videoconferences can be run on desktop computers, and in western Europe and North America, high-speed Integrated Services Digital Network (ISDN) telephony suitable for multimedia is gaining ground. The figure shows a prototype conference system combining video, audio, and stored magnetic resonance images for endoscopic consultation. However, as Grigsby points out, the medical profession is hesitant. He estimates that at the beginning of 1995 there were only about 25-30 active telemedicine programs in the USA excluding teleradiology, with an additional 40-50 systems in various stages of development. In western Europe, the corresponding figure is only slightly higher. To increase the use of telemedicine, many governments and funding bodies have initiated research programmes, and a notable event this year was the start of one such programme in Health Care (European Commission DG XIII; the 4th Framework Telematics Application Programme) to which the European Commission has allocated 135 MEcu for 1995-99. Quite a lot of this money will be spent on telemedicine. In contrast, teleradiology is widespread, and even a commercial success. Several private practices in the USA now offer teleradiology services, the largest being Teleradiology Associates with about 25 000 cases projected for 1995 (Forsberg D, personal communication). Teleradiology may proliferate even more as the quality of screen-reading catches up with that of film. Using the latest available computer-screen technology, researchers at the Johns Hopkins Medical Institutions recently found no significant difference between the accuracy of interpretation on film and on screen of radiographs of high diagnostic difficulty (Gitlin J). Comparison of emergency department cases; presented at the 1995 RSNA meeting). With image compression, teleradiology becomes even more accessible. Recent ROC studies indicate that, by use of the Joint Photographers Expert Group algorithm, an eight-fold compression (from 12 bits to 15 bits per pixel) has no influence on the diagnosis made by the radiologist (Wong). Teleradiology also profits from the widespread acceptance of the Digital Imaging and Communication in Medicine (DIDCOM) standard for data exchange (Houtchens). In a surprisingly short time, the Internet has profoundly influenced both remote medical education and the distribution of medical information in general. As of July, 1995, there were more than 6 million computers
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