Low-cost devices make telemedicine more feasible

Several forms of low-cost tele-mammography readers showed high inter-device agreement on BI-RADS assessment categories in an article published in the Journal of the American College of Radiology. The study suggests that the use of these less expensive devices can be used to bring mammography to underserved or remote populations.

Disparities between mammography screening in rural versus urban populations are well documented, as many demographic factors common to rural women are correlated with low screening mammography levels: lack of health insurance, low income and low education. Efforts to bring telemedicine to these areas have been hampered by the cost of equipment, but this Colombian study shows no substantial difference when reading mammograms on film, two different digital displays and a Lumix digital camera.

Researchers used the BI-RADS staging system to measure concordance among the seven radiologists participating in the study and used images from 70 patients totaling nearly 2,000 mammograms.

The results were encouraging; authors reported very high agreement between devices on malignancy classification and agreement on BI-RADS category was slightly lower, although this was expected due to previous research on the BI-RADS grouping categories.

However, authors were careful to note that BI-RADS category 3 showed the lowest agreement between devices, as the category lies on the border between an imaging or a biopsy follow-up—the difference between conservative or aggressive management of the abnormality. Selecting category 3 prematurely can lead to unnecessary follow-up of benign lesions, a common criticism of large-scale screening mammography. On the other hand, dismissing concerns about a category 3 classification can lead to delayed diagnosis of malignant tumors and more difficult treatment.

Low-cost telemedicine can drastically change the treatment outlook for underserved populations, especially with preventable disease. This provides substantial quality of life benefits, as both diagnoses and treatments happen faster. In addition, telemedicine can bring fiscal  perks, including cheaper care and the economic boon from a healthier populace.