Abstract
4th World Congress on Teledermatology
Tbilisi, Georgia, 4–6 October 2012
The 4th World Congress of Teledermatology was held from 4–6 October 2012 at Tbilisi, Georgia. George Galdava from the Tbilisi State University, Tbilisi, Georgia and Oleg Kvlividze from the Institute of Dermatology and Venereology, Tbilisi, Georgia, were the Congress President and Secretary, respectively. The Congress theme of ‘dermatology conquering distance’ was exemplified by the speaker delegates from across the globe. Stella Atkins from the University of British Columbia, Canada, started the scientific session with her sterling talk on ‘Automated melanoma diagnosis using a dermoscope attached to a smart phone’. The role of NGOs in the establishing and promotion of telemedicine network today was stressed by Olga Litusi, from Ukraine. Saul Halpern of the British Teledermatology Society expressed that dermatologists in the UK appear to be gradually accepting Teledermatology. The American Academy of Dermatology, African Teledermatology Project was reviewed by Karen Mckoy Lahey Clinic, VT, USA. The concept of virtual hospital was elaborated by Leonard Witkamp from KSYOS TeleMedical Centre, the first virtual hospital in The Netherlands. In his presentation, he concluded that health management practice has been applied in the development, research and large scale implementation of teledermatology. The Indian delegates Jayakar Thomas from the Sree Balaji Medical College and Hospital (Chromepet, Chennai, India), Parimalam Kumar, Head of Dermatology (Thanjavur, India) and Dinesh Kumar from the KK CHILDS Trust Hospital (Nungambakkam, India) discussed the current status and the future directions of Teledermatology in India.
Stella Atkins from the University of British Columbia, Canada, started the scientific sessions with her sterling talk on ‘Automated melanoma diagnosis using a dermoscope attached to a smart phone’. She introduced the presentation stating that nonautomatic systems for remote melanoma diagnosis depend on an expert to perform the diagnosis by visual inspection of the remotely acquired image of a lesion. Current automated systems for remote melanoma diagnosis usually compare a lesion against a database of melanomas and non-melanomas, returning advice to a medical practitioner, she added. Furthermore, some systems use expensive imaging devices such as a multispectral digital dermoscope with a specialized imaging probe and software to assist with differentiation between early melanoma and other skin lesions. With a goal to develop a low cost, automated method to be used in screening tools for early diagnosis of melanoma, especially suitable for use in teledermatology, she and her colleagues worked to develop a smart phone application in conjunction with a dermoscope attached to a smart phone camera. Their approach was to first segment the lesion from the skin image, which can be acquired using a dermoscope attached to a smart phone camera. They then located clinically useful atypical dermoscopic structures such as pigment networks and streaks. The images were then transferred to a server for processing, or used with a local smart phone application, to visualize any atypical features overlaid on the acquired image. The method for identifying pigment networks identifies the holes, and the nets surrounding the holes, and then calculates the regularity of the nets to determine the atypicality. They used an image processing method based on techniques developed for fingerprint analysis. For both these dermoscopic structures, they first used machine learning methods on a database of images acquired with any dermoscope to identify the best values of the parameters to use on a new image. Multiscale techniques were used to deal with the situation of images acquired at different magnifications. The results on 500 dermoscopic images from an atlas showed an accuracy of 82% on classification of the images as pigment network absent, typical or atypical. On 300 images, a two-way classification accuracy of 85% was found for streaks absent or present. On an even larger image dataset of 945 images, an accuracy of 77% for classifying lesions was achieved. Atkins claimed that their results are very robust to the values of the parameters chosen, so that new images acquired with new dermoscopes can be readily analyzed without changes to the algorithms or the parameters. Atkins further stated that the fully automated method for imaging and extracting important features from dermoscopic images allows classifications and excellent visualizations, which are important for melanoma diagnosis using teledermoscopy.
The role of NGOs in the establishing and promotion of telemedicine network is undeniable today. This was exemplified by Litusi, from Ukraine. The Euro-Asian Association of Dermatologists are currently continuing the dialogue in creating a telemedicine framework among the members so that a newly founded NGO unites dermatologists by expanding training programs, supporting access to modern technologies, stimulating research and inducing crosscountry partnership programs. Among other programs are developing of standards, licensure, reimbursement, security of personal data and low costs for implementation of telemedicine services in the rural areas. It is proposed to form an international longstanding partnership between the Euro-Asian Association of Dermatologists and the International Society of Teledermatology.
There are changes in the use and attitudes towards teledermatology in the UK. Discussing the results of two national surveys, Saul Halpern of the British Teledermatology Society (Kent, UK) and the British Association of Dermatologists (London, UK) expressed that dermatologists in the UK appear to be gradually accepting teledermatology as an adjunct in service provision and, while controversy remains, the British Association of Dermatologists are supportive of Teledermatology where it is part of an integrated service run by local dermatologists.
Karen McKoy from the Department of Dermatology, Lahey Clinic, VT, USA, reviewed the American Academy of Dermatology African Teledermatology Project. In her review, McKoy discussed that the project aids local healthcare providers, who work with dermatologists in the USA and Austria, in managing skin diseases. In addition, US dermatology residents work year round in Botswana through a grant program administered by the American Academy of Dermatology, providing care and teaching, as well as contributing to the teledermatology project.
The concept of virtual hospital was elaborated by Leonard Witkamp, Director KSYOS TeleMedical Centre, The Netherlands. Speaking on the critical steps in the large-scale implementation of teledermatology, Witkamp explained that there is a paradigm shift in the ideas of daily health care in the Western world. While on the one hand traditional methods do not appear to find solutions, on the other hand, the newer initiatives are led by this paradigm shift. Elaborating further, Witkamp expressed the delicate balance among innovative techniques, different working models, preventive methodology and education systems. Health management practice gets choked in striking a balance amongst these domains, said Witkamp. However, there is an earnest attempt by using a four-phase research model: development, usability studies, efficiency research and postmarketing surveillance. Although all groups in society invest in health management practice, the principal contribution and direction is in the hands of those people who are interested directly, and these include experts (primarily medical specialists) and customers (primarily patients). Witkamp emphasized that in the end, health management practice may make a substantial contribution to a fundamentally different interpretation of healthcare services. Health management practice has been applied in the development, research and large-scale implementation of teledermatology.
The Indian experience was revealing! Presenting an audit, Jayakar Thomas (Sree Balaji Medical College and Hospital, Chromepet, Chennai, India) described that various feasibility studies are performed to determine the diagnostic accuracy of a teledermatology tool. Diagnostic accuracy has been the outcome measure used to determine the feasibility of this tool. Surveys have determined and provide systematic information about the willingness and satisfaction from both patient and healthcare providers. Regular teledermatology practice, tertiary teledermatology and subspecialty such as pediatric teledermatology and resident training/medical education are being performed. The teledermatology tool, when applied in the field of dermatosurgery with suitable modifications, will be able to meet up with the increasing demand in this new field. According to Dinesh Kumar (KK CHILDS Trust Hospital, Nungambakkam, India), another dermatosurgeon will be able to perform surgery from thier own office on a patient in a remote locality with the help of a qualified and trained assistant. The Indian scenario was wrapped up with Parimalam Kumar (Head of Dermatology, Thanjavur, India) emphasized that acceptance of this is dependent on awareness of this technology. Awareness should spread to the grassroots level and the common man should be made conscious of this technology, and should know that this is available to him. The patient should realize and understand that living in a remote location does not prevent them from getting help from specialists in the country at only a fraction of the cost.
Financial & competing interests disclosure
The author has no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
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