Medical College of Georgia

Three GSTP Facilities Participate in Colposcopy Feasibility Study

by Toni Baker

Whether colposcopy — an examination of the cervix for signs of cancer after a positive Pap smear — can effectively be performed via telemedicine is being determined by researchers at the Medical College of Georgia.

Dr. Daron Ferris, family medicine physician, colposcopist and principal investigator on the project, wants to know if a colposcopist examining a woman in person and one viewing her cervix via telemedicine see the same thing.

"Does the technology make a difference?" Dr. Ferris said. If the answer is "no," telemedicine could be used to improve access to this procedure, particularly for women with complicated problems who may travel several hours to centers such as MCG for care. "It may be we can save some of these women a trip, let them stay with their own health care provider and reduce excess costs," he said.

He along with Drs. Michael S. Macfee and Laverne Mensah, both colposcopists and gynecologic oncologists at MCG, are taking turns seeing patients at the Ware County Health Department in Waycross, Ga., and Tri-County Health Systems, Inc., an outpatient facility serving Warren, Glascock and Taliaferro Counties.

While one of the doctors is in Waycross or Warrenton with the patient, another will be in Augusta at the MCG Telemedicine Center. That way each patient is examined by doctors at both locations and their findings can be compared. Later a third physician views a videotape of the telemedicine consult and the computer image and gives an interpretation as well.

The $500,000 study of 240 women, funded by the National Institutes of Health’s Agency for Health Care and Policy Research and the National Cancer Institute, also is looking at whether a computer and modem — something found in essentially every doctor’s office — can transmit still images suitable for making a diagnosis.

There’s a sizeable potential patient population for colposcopy, and the availability of the procedure varies widely across the state, Dr. Ferris said. Each month in Ware County alone, about 40 women who come to the health department, have a positive Pap smear and many need a

follow-up colposcopy, said nurse practitioner Diane Watson. Ms. Watson typically performs the examination, does the biopsy and three local gynecologists volunteer to look at biopsy results later. As part of the study, she now has one colposcopist at her side while she performs the colposcopy and another viewing the cervix via telemedicine as well as the images transmitted via the computer system.

During colposcopy, the cervix is examined for cancerous or pre-cancerous lesions using a magnifying device coupled with an intense illumination source, Dr. Ferris said. For the purposes of the study, the scope has a fine-resolution micro-camera attached that transmits the images via the telemedicine network to MCG. With the computer study, a compatible micro-camera captures a couple of still images and digitizes the images, which are transmitted by a modem to a computer in Augusta.

The Georgia Statewide Telemedicine Program enables real-time, television-quality video and allows health care professionals at both ends to interact. The computer system only makes several still images available for examination at the remote location, Dr. Ferris said. But if it’s found that the computer images are sufficient for proper diagnosis, a health care professional anywhere could transmit the images to a colposcopist anywhere else for assessment, he said.

Part of the study also is looking at the women’s comfort with the additional technology. Dr. Priscilla Gilman, MCG psychiatrist, is helping determine this through surveys the women complete before and after colposcopy.

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Medical College of Georgia Telemedicine Center