Tele-expertise and video transmission in fetal ultrasound: A few elements to do it yourself

Following the restriction of accompanying persons within the framework of Covid-19, the Cabinet SF du Parc has set up a system of tele-expertise in foetal ultrasound allowing the co-parent to follow live the ultrasound of their spouse via the Internet.

This live transmission is now easy to access and is based on the combination of two widespread tools : a video capture box and a videoconference software.

However, the capture and retransmission of medical imaging remains a processing of sensitive personal data. Therefore, it is important to think carefully about the implementation as well as the tools used upstream to ensure the highest security and confidentiality of this data. We will try here to give you some keys for reflection.

The principle of the acquisition box

A video acquisition box to capture the signal from a camera in order to transmit it to the central memory of a computer through an interface. This technology is very widespread today and is used by Streamers to be able to retransmit live parts of video games or broadcasts as on Twitch.

On this, little needs to be checked; the technical characteristics can be important for the quality of the video. However, it is important to make sure that the data that will be collected will not be transmitted to the box manufacturer.

The data should remain locally and only be redirected to your computer directly.

As far as SFDUPARC is concerned, the choice went to standard models for a question of affordability and simplicity: no interface from the manufacturer, therefore no data transmission to a third party.

The acquisition unit is installed at the ultrasound scanner output and is connected to a computer on which a videoconferencing software will be installed.

If the principle of the acquisition unit is simple and does not, a priori, pose any problem in terms of data protection, the same cannot be said of the videoconferencing software, for which it will be necessary to be more exhaustive.

Which video conferencing software to choose?

In theory, a simple Skype call or a live broadcast on Twitch could make it possible to broadcast a live ultrasound. However, a certain amount of personal data would be collected, and, above all, data security could not be guaranteed.

When it comes to transferring medical data outside of his controlled environment, any health professional must be extremely vigilant and ensure at least 3 essential elements:

• The data is sufficiently protected during the transfer (encryption of the transfer)
• The data is transmitted to the right person and only to the right person (Recipient authentication and one-time transfer)
• The data carrier cannot 'peek' at the data (end-to-end encryption).

In order to guide you in your choice of system, the Dutch Data Protection Authority has carried out a comparison of the privacy protections of the largest market players.

This study revealed two particularly protective systems: Jitsi and NextCloud, which are also the only two self-hosted systems. This is why SFDUPARC has chosen to use (for the moment) Jitsi for several reasons:

• We host locally the videoconferencing server, which allows us to keep total control of the data.
• The personal data collected is minimized and erased after each call
• We can ascertain the identity of individuals on a case-by-case basis.

In addition to transmission security, it is also essential to ensure that transmissions are not backed up.

This is best done locally, or in a space that is sufficiently protected and capable of storing medical data. In France, the HDS: Health Data Hosting certification ensures a sufficient and appropriate level of security. A list of certified organizations can be found here.

Beyond the technological challenge, it was important for the Midwives team to be able to continue to preserve the parental couple in full construction and to allow the spouse to attend key ultrasound examinations.

In partnership with SAMSUNG and the BOULANGER Foundation, we have developed an assistance solution allowing ultrasound technicians who would like to do so to equip themselves.