Trial of tele-medicine to promote the fetal diagnosis of congenital - PDF document

Motoyoshi Kawataki, Kanagawa Children’s Hospital Trial of tele-medicine to promote the fetal diagnosis of congenital heart disease (CHD) Motoyoshi Kawataki M.D. Depart. Of Neonatology, Kanagawa Children’s medical Center Yokohama, Japan Before Era of Telemedicine The 7th Asia Telemedicine Symposium, 2013 1

Motoyoshi Kawataki, Kanagawa Children’s Hospital Hypoplastic left heart Syndrome (HLHS) before Era of Telemedicine ductal shock pre-shock non-shock Fetal Diagnosis of significant CHDs Prenatal Diagnosis 70 Postnatal Diagnosis 60 50 40 30 20 10 0 93 94 95 96 97 98 99 The 7th Asia Telemedicine Symposium, 2013 2

Motoyoshi Kawataki, Kanagawa Children’s Hospital Detection rate of significant CHDs 100 90 80 70 60 50 40 30 20 10 0 93 94 95 96 97 98 99 Our trial of tele-medicime to promote the fetal screening 2006 ～ Tele-diagnosis of CHD 2009 ～ Tele-seminar of advanced fetal cardiology (SINET) 2013 ～ Tele-conference of fetal heart disease (Internet) The 7th Asia Telemedicine Symposium, 2013 3

Motoyoshi Kawataki, Kanagawa Children’s Hospital Tele-diagnosis More than 200 cases after 2006 clinic Our hospital Sent by CDROM Analysis and diagnosis by PC Collection of the volume data The 7th Asia Telemedicine Symposium, 2013 4

Motoyoshi Kawataki, Kanagawa Children’s Hospital 50 40 30 20 10 0 Kyuushuu Chuugoku Kinnki Kantou Shikoku Toukai Touhoku Hokkaidou Diagnosis ＣＨＤあり ＣＨＤなし The 7th Asia Telemedicine Symposium, 2013 5

Motoyoshi Kawataki, Kanagawa Children’s Hospital Transposition of Great Arteries (TGA) Total Anomalous Pulmonary Venous Return (TAPVR) The 7th Asia Telemedicine Symposium, 2013 6

Motoyoshi Kawataki, Kanagawa Children’s Hospital Tele ‐ diagnosis is useful for; • level 2 diagnosis not only in complexed CHD but also border line abnormalities • technical supports for obstetricians and sonographers • education and training of fetal heart screening Problems of tele-diagnosis 1.Accuracy of diagnosis 2.Time consuming for fetal cardiologists 3.Responsibility 4.Cost The 7th Asia Telemedicine Symposium, 2013 7

Motoyoshi Kawataki, Kanagawa Children’s Hospital Tele-medicime to promote the fetal screening 2006 ～ Tele-diagnosis by CD-ROM 2009 ～ Tele-seminar of advanced fetal cardiology ( SINET) 2013 ～ Tele-conference of fetal heart disease (Internet) Tele-seminar by SINET Nation ‐ wide remote seminar trials of fetal echocardiography in Japan (Kazuto Noguchi /Ehime Univ./Japan) The 7th Asia Telemedicine Symposium, 2013 8

Motoyoshi Kawataki, Kanagawa Children’s Hospital Tele-medicine to promote the fetal screening 2006 ～ Tele-diagnosis (CD-ROM) 2009 ～ Tele-seminar of advanced fetal cardiology (SINET) 2013 ～ Tele-conference of fetal heart disease (Internet) Hukuoka Yokohama The 7th Asia Telemedicine Symposium, 2013 9

Motoyoshi Kawataki, Kanagawa Children’s Hospital Shiga University Noda Clinic in Miyazaki The 7th Asia Telemedicine Symposium, 2013 10

Motoyoshi Kawataki, Kanagawa Children’s Hospital Miyagi Chirdren’s Hoapital Outcome of telemedicine The 7th Asia Telemedicine Symposium, 2013 11

Motoyoshi Kawataki, Kanagawa Children’s Hospital Significant CHDs diagnosed prenatally Tele-conference Tele-seminar pts Tele-diagnosis 160 140 120 100 80 60 40 20 0 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 year Detection rate of significant CHDs (%) 70 60 50 40 30 20 10 0 The 7th Asia Telemedicine Symposium, 2013 12

Motoyoshi Kawataki, Kanagawa Children’s Hospital Detection rate of HLHS 10 postnatal DX 9 prenatal DX 8 7 6 5 4 3 2 1 0 1993 95 97 99 1 3 5 7 9 11 Detection rate of TOF 20 Postnatal Dx 18 prenatal Dx 16 14 12 10 8 6 4 2 0 93 95 97 99 1 3 5 7 9 The 7th Asia Telemedicine Symposium, 2013 13

Motoyoshi Kawataki, Kanagawa Children’s Hospital Detection rate of TGA 14 neonatal DX prenatal DX 12 10 8 6 4 2 0 93 95 97 99 1 3 5 7 9 11 Detection rate of TAPVD 9 postnatal DX 8 prenatal DX 7 6 5 4 3 2 1 0 93 95 97 99 1 3 5 7 9 11 The 7th Asia Telemedicine Symposium, 2013 14

Motoyoshi Kawataki, Kanagawa Children’s Hospital Open heart surgery of Neonate ① (TGA) ② Annual Number Year Cooperation of fetal diagnosis to promote fetal screening Perinatal center (level 2) Clinics of OBGY(level 1) detailed screening examination cooperation telemedicine support support education education Sonographer Fetal cardiologist The 7th Asia Telemedicine Symposium, 2013 15

Motoyoshi Kawataki, Kanagawa Children’s Hospital Thank you . The 7th Asia Telemedicine Symposium, 2013 16