remote Brazilian states and international centers of excellence. The average of synchronously connected points per video con- ference was 20. On average there were 46 by web conferencing, with an average of 480 participants per event. The map of inter- national coverage of all the participants is illustrated in Figure 1. All the telesessions were recorded and are made available in a vir- tual learning environment. The program has the accredited by the Brazilian College of Radiology and is supported by the Telehealth Center of the State University of Rio de Janeiro (UERJ).
THE VIRTUAL LEARNING ENVIRONMENT Since 2008, a virtual learning environment using open-source
FigUre 2. The UERJ Telehealth Center virtual learning environment.
MXP Codec integrator provides all the necessary components for simple custom integration. Customer access is via a H.323 protocol (a standard for codification and decoding of a flow of audio and video data). In order to make use of a virtual room at the MCU, a minimum speed of 2GB is requested. The endpoints are registered in a gatekeeper, which controls admission and also authorizes incoming calls. At the center of the Telehealth system at the University Hospital Pedro Ernesto in the State University of Rio de Janeiro, the endpoint is linked to a work station with a web server that transmits the videoconference audio and video to remote points with minimum demanded speed requested of 256 Kbps. The management web software is Adobe Connect Pro installed in a Dell server with Windows Server 2008, Intel Xeon Processor E5450, 3GHz, and RAM memory of 4GB. The combination of both audio and video is done by the cap- ture of the audio (using a sound board) and the codec video (using a capture card) which are then sent to a work station and distributed to the points connected to the web conference. Remote access to the web conference is made through a Web browser and an add-in which needs to be installed prior to the first access to a virtual room of the web conference. In the vid- eoconference, all participants can interact orally face-to-face. Via web conferencing remote participants can send questions and comments using a “chat” system. Most presentations use Microsoft Office PowerPoint but others use simply a speaker talking to the group. The use of videos and animation is not enabled in the two technologies [8]. In this way, the participants can always interact with the speaker by webconference, and with each other, either orally, by videoconference or via chat. This allows all users to feel truly included in the sessions.
COVERAGE OF RADPED PROGRAM
Since 2007, a total of 72 teleconferences have been held, includ- ing 29 anatomical-clinical radiological sessions. There have been 40 lectures, of which 9 were taught by foreign teachers in Canada (2), the United States of America (3), Germany (1), Chile (1); Panama (1), Argentina (1). There were three thematic virtual symposia, lasting on average 3.5 hours. Participants included various Brazilian institutions, municipalities in several
APRIL/MAY 2012
software (Moodle; Martins Dougiamas, Perth, Australia) has been implemented [Figure 2]. Since then, all the telesessions and virtual symposia have been recorded and posted on the Internet. This allows asynchronous integration between the participants and free re-use of all the education content pro- vided by the teleconferences. Accessibility to the virtual learn- ing environment is available at the UERJ Telehealth Center’s site (
www.telessauderj.uerj.br/ava/) [9]. In addition to being able to reuse content, a big advantage of the association of an asynchronous virtual learning environment with recorded teleconferences is the possibility of obtaining a second opinion by a specialist pediatric radiology team for dif- ficult cases. The virtual learning platform has a dedicated space for the sending of data and images of difficulty cases. At this moment, 640 undergraduate medical students and 1346 doctors are registered in the virtual learning environment. The average time spent per visit in the RADPED program is 45 min.
FUTURE DEVELOPMENTS
A worldwide network in telemedicine has been created, enabling people to be connected around the globe, so they may share information, exchange experience and learn from each other and allowing professional training and specialized support, espe- cially for doctors in remote areas. As a distance education tool, telehealth is progressively enabling changes in attitude in several health disciplines. The aim of the RADPED program remains the creation of a strong network for the provision of online support to medical teams and making available content relevant for the optimal care and radiological protection of children.
REFERENCES 1. McLoud TC. .AJR 2000; 174: 3. 2. Tello R et al. AJR Am J Roentgenol 2000;174:1519. 3. Chumley-Jones HS et al. Acad Med 2002;77:S86. 4. Merewitz L & Sunshine JH. AJR 2006; 186:12. 5. Goske MJ et al AJR 2008;190(2):273.
6. What is the Telemedicine University Network. Telemedicine University Network. Available on
http://rute.rnp.br/arute http://rute.rnp.br/arute/
7. Brazilian National E-health Program. E–health Brazil–Ministry of Health. Available at
www.telessaudebrasil.org.br/php/index.php.
8. Monteiro AMV et al Telemed J E Health 2011 17(10):753. 9. Sparacia G et al. RadioGraphics 2007; 27: 573. 10. Stahl JN et al RadioGraphics 2000; 20: 1495. 11. Gold RH et al. AJR 1993;160:1309. 12. Della Mea V et al. J Telemed Telecare. 2003; 9: 95. 13. Kimball AM et al. J Telemed Telecare. 2009;15: 368. 14. Cook A et al.J Urol. 2005;174:1958.
DI EUROPE 49
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56