A protocol for the assessment of diagnostic accuracy in tele-echocardiography imaging

Tele-echocardiography could be a useful means for investigating heart pathologies on remotely-located patients. At present, the main drawback with tele-echocardiography is the lack of a thorough protocol for the assessment of the diagnostic accuracy of the transmitted images. Diagnostic accuracy in tele-echocardiography is not only a function of quantitative parameters but also of the subjective decision of the operator depending on his/her a priori knowledge based on complex internal models. In the framework of three Italian projects, we defined and validated a wide-ranging protocol that considers not only the most common quantitative parameters in medical imaging, but also the use of a dynamic phantom, and subjective/partially subjective evaluations. The validation of tele-echocardiography systems chosen from those evaluated in the projects showed that the protocol was feasible. It permitted access to the degradation of the transmitted images and correlate quantitative and subjective analyses. The protocol was found suitable for tele-echocardiography systems but also for other tele-imaging applications, where medical decision making is based on dynamic images.