腹部超音波檢查之互動式遠距會診系統：147例之初步報告

Interactive Tele－consultation in Abdominal Sonography: Preliminary Report Based on 147 Cases

遠距會診的目的在於幫助偏遠地區民眾在當地就醫之時，可以得到專家會診，以減少不必要之轉診，並提高基層醫療機構的醫療照顧水準。利用遠距會診進行同步雙向腹部超音波會診，在文獻上未曾報告。本研究乃架構於兩地相距約46公里之台大醫院與台北縣金山鄉衛生所間，由ATM(asynchronous transfer mode)網路聯結之互動式遠距會診系統上，共包含了147例腹部超音波之遠距會診。本研究之目的，在於使用互動式遠距會診系統，同時傳送腹部超音波檢查之影像，並進行轉診或會診醫師之線上語音交談，以達到腹部超音波檢查診斷之目的。並利用問卷調查轉診及會診醫師對此遠距會診之意見。在轉診醫師意見，認為會診結果滿意(100%)，並且罕有誤解的發生(1.4%)。會診醫師則認為會診結果滿意(95.8%)，並且認為會診中很少有誤解發生(3.5%)。本研究並在初次檢查後6至12個月追蹤其中59例(40%)，發現90%病例(53/59)診斷維持不變，在追蹤病例中之診斷再現率(reproducibility)為93%。本研究認為腹部超音波檢查的互動式遠距會診的確可以幫助轉診醫師做診斷及處置病患，減少不必要之病患轉診，減少醫療費用之支出，並可達到遠距教學及繼續醫學教育之目的。

The purpose of teleconsultation is to improve medical care in rural areas. Using teleconsultaton, improvements in patient care and management are expected. Unnecessary patient transferal may also be avoided. To our knowledge, there have been few reports about interactive teleconsultation in abdominal ultrasound to our knowledge. The framework of this pioneering study using interactive teleconsultation was based on the ATM network between the Chin-Shan group practice center and National Taiwan University Hospital. In this study, interactive tele-consultation with consulting radiologists was used to both instruct referring physicians and help them in interpreting abdominal ultrasound images. The diagnosis was made after completing whole abdominal examination and on-line discussion. There were 147 cases included in this study. The satisfaction of both referring physicians and consultant radiologists were recorded. The results showed a high degree of satisfaction of both referring physicians (100%) and consultant radiologists (95.8%). The percentages of misunderstanding reported by referring physicians and consultant radiologists were low (1.4% and 3.5% respectively). Follow-up abdominal ultrasound with interactive consultation was also performed in 59 cases (40%) 6 to 12 months after the initial examination. In 53 of 59 follow-up cases (90%), the diagnoses remained the same. Disease progression was found in 2 cases. The overall diagnostic reproducibility was 93% (55/59). We conclude that interactive abdominal ultrasound consultation is useful not only to improve medical care but also to contribute to continuous medical education.