Clinical Validation of Digital Image Compression Levels for Fetal Echocardiograms for Telemedicine

BACKGROUND: Digital telephone transmission of dynamic fetal echocardiographic sequences requires wide bandwidths. To reduce the transmission of nonessential information present in echocardiographic images, compression algorithms have been used and validated for adult echocardiography. The level of compression that retains all diagnostic clinical information must be determined and validated for fetal echocardiographic studies. The purpose of this study was to validate levels of image compression that are diagnostic for fetal echocardiography. METHODS: Twenty previously recorded fetal echocardiograms representing two normal and 18 congenitally abnormal hearts were looped, digitized, and compressed at differing ratios. Images were reviewed in a blinded manner by four experts. Images were scored for diagnosis, diagnostic quality, and technical quality. RESULTS: Forty-four images were viewed. Experts correctly diagnosed 87% of images. There were no images of unacceptable diagnostic quality at a compression ratio of 300 (0%) and 2% at compression ratio of 600:1. CONCLUSIONS: Digital image compression of 300:1 was diagnostic for fetal congenital heart diseases with a variety of defects using cine-looped images. These data support the use of compressed fetal images for telephone transmission with a low bandwidth.