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

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

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.

MeSH terms

  • Cost-Benefit Analysis
  • Crowdsourcing
  • Cystoscopy* / methods
  • Humans
  • Rural Health Services / organization & administration
  • Telemedicine / instrumentation
  • Telemedicine / methods
  • Telemedicine / organization & administration*
  • Urinary Bladder Neoplasms / surgery
  • Videoconferencing / instrumentation
  • Videoconferencing / organization & administration
  • Videoconferencing / standards