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After testing the extended multimedia interface (EMMI) product which is an asynchronous transmission mode (ATM) user to network interface (UNI) of AT&T at the Society for Computer Applications in Radiology conference in Winston-Salem, the Department of Radiology together with AT&T are implementing a tele-ultrasound system to combine real- time ultrasound with the static imaging features of more traditional digital ultrasound systems. Our current ultrasound system archives digital images to an optical disk system. Static images are sent using our digital radiology systems. This could be transferring images from one digital imaging and communications (DICOM)-compliant machine to another, or the current image transfer methodologies. The prototype of a live ultrasound system using the EMMI demonstrated the feasibility of doing live ultrasound. We now are developing the scenarios using a mix of the two methodologies. Utilizing EMMI technology, radiologists at the BGSM review at a workstation both static images and real-time scanning done by a technologist on patients at a remote site in order to render on-line primary diagnosis. Our goal is to test the feasibility of operating an ultrasound laboratory at a remote site utilizing a trained technologist without the necessity of having a full-time radiologist at that site. Initial plans are for a radiologist to review an initial set of static images on a patient taken by the technologist. If further scanning is required, the EMMI is used to transmit real-time imaging and audio using the audio input of a standard microphone system and the National Television Standards Committee (NTSC) output of the ultrasound equipment from the remote site to the radiologist in the department review station. The EMMI digitally encodes this data and places it in an ATM format. This ATM data stream goes to the GCNS2000 and then to the other EMMI where the ATM data stream is decoded into the live studies and voice communication which are then received on a television and audio monitor. We also test live transmission of pediatric echocardiograms using the EMMI from a remote hospital to the Bowman Gray School of Medicine (BGSM) via a GCNS2000 ATM switch. This replaces the current method of having these studies transferred to a VHS tape and then mailed overnight to our pediatric cardiologist for review. This test should provide valuable insight into the staffing and operational requirements of a tele-ultrasound unit with pediatric echocardiogram capabilities. The EMMI thus provides a means for the radiologist to be in constant communication with the technologist to guide the scanning of areas in question and enable general problem solving. Live scans are sent from one EMMI at the remote site to the other EMMI at the review station in the radiology department via the GCNS2000 switch. This arrangement allows us to test the use of public ATM services for this application as this switch is a wide area, central office ATM switch. Static images are sent using the DICOM standard when available, otherwise the established institutional digital radiology methods are used.
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