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. 2016 Oct;22(7):397-404.
doi: 10.1177/1357633X15610040. Epub 2015 Oct 20.

Optimizing and validating the technical infrastructure of a novel tele-cystoscopy system

Helen Y Hougen  1 , Jennifer M Lobo  2 , Thomas Corey  3 , Randy Jones  4 , Karen Rheuban  3 , Noah S Schenkman  1 , Tracey L Krupski  5
Affiliations

Optimizing and validating the technical infrastructure of a novel tele-cystoscopy system

Helen Y Hougen et al. J Telemed Telecare. 2016 Oct.

Abstract

Introduction: Bladder cancer is the most costly malignancy to manage per capita due to the technical nature and intensity of follow-up. There are few urologists in rural areas, often necessitating that patients travel hours to receive follow-up care multiple times per year. We plan to train registered nurses and allied health professionals to perform cystoscopies which are monitored and interpreted in real-time by board-certified urologists. The key is to ensure optimal picture resolution to guarantee this technology is not inferior to traditional cystoscopy. Our objective was to develop the technical infrastructure needed for a tele-cystoscopy system through assessment of the transmitted video quality using expert reviewers and crowd-sourcing.

Methods: All combinations of the tele-cystoscopy system were systematically tested using a single Thiel cadaver. The videos were reviewed by expert urologists and general reviewers using a crowd-sourcing website. The video quality responses were assessed to determine concordance between each set of reviewers, and to determine the optimal equipment that should be selected for the tele-cystoscopy system.

Results: Of eight equipment combinations, only two were of high enough quality to be appropriate for medical use. We found there to be strong concordance of responses between the expert and crowd-sourced responses. The trade-offs between cost and tele-cystoscopy system component quality were compared with efficiency frontiers to elucidate the optimal system.

Discussion: We created and tested the feasibility of a tele-cystoscopy system that was deemed suitable for medical diagnosis by a group of experts. We further validated tele-cystoscopy video quality using both experts and recently validated crowd-sourcing.

Keywords: Cost benefits; crowd-sourcing; tele-oncology; telesurgery.

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Conflict of interest statement

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Tele-pack: components needed for tele-cystoscopy. HDMI: High-definition multimedia interface; CCD: Charge-coupled device; DVI: Digital visual interface.
Figure 2.
Figure 2.
Screenshot of the cystoscopy. Coincidentally, the cadaver had an exophytic bladder tumor that served as a landmark for the cystoscopy.
Figure 3.
Figure 3.
Screenshot of a video link with two associated questions that were in the human intelligence task (HIT) posted on Amazon Mechanical Turk (AMT). Each HIT includes eight cystoscopy videos and one negative control video.
Figure 4.
Figure 4.
Scatterplots depicting the trade-off between ratings and costs for each set of components. (a) presents the ratings for the experts, and (b) represents the ratings for the Amazon Mechanical Turk (AMT) workers. The efficiency frontiers for the slow Internet settings are shown with the dotted lines, and the efficiency frontiers for the fast Internet settings are shown with the solid lines. CCD: Charge-coupled device.
Figure 5.
Figure 5.
Flowchart of equipment optimization process.
See this image and copyright information in PMC

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MeSH terms