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\begin{document}

\title{The need for a new style of tele-fetal diagnosis with cloud storage in
the post-COVID-19 era}



\author[1]{Yuto Maeda}%
\author[2]{Akihiko Ozaki}%
\author[3]{Tetsuya Tanimoto}%
\author[3]{Yasuteru Shimamura}%
\author[4]{Takahiro Nobuzane}%
\author[4]{Takafumi Katsuki}%
\author[3]{Naoyuki Kitamura}%
\affil[1]{National Center for Child Health and Development}%
\affil[2]{ Jyoban Hospital of Tokiwa Foundation}%
\affil[3]{MNES Inc.}%
\affil[4]{Katsuki Ladies Clinic Hiroshima Chuo-dori}%


\vspace{-1em}



  
  \date{May 18, 2024}


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\textbf{Title: The need for a new style of tele-fetal diagnosis with
cloud storage in the post-COVID-19 era}

\textbf{Authors} :

Yuto Maeda, MD

2-12-13-201, Takanawa, Minato-Ku, Tokyo 108-0074

Medical Governance Research Institute, Tokyo, Japan

Akihiko Ozaki, MD, PhD

57 Kaminodai, Kamiyunagaya-cho, Jyoban, Iwaki city, Fukushima, Japan

Department of Breast Surgery, Jyoban Hospital of Tokiwa Foundation,
Iwaki, Fukushima, Japan

Tetsuya Tanimoto, MD

1-2-27, Shinonome-honmachi, Minami-ku, Hiroshima-shi, Hiroshima, Japan

MNES Inc., Hiroshima, Japan

Yasuteru Shimamura, MD, PhD

1-2-27, Shinonome-honmachi, Minami-ku, Hiroshima-shi, Hiroshima, Japan

MNES Inc., Hiroshima, Japan

Takahiro Nobuzane, MD, PhD

7-1, Mikawa-cho, Naka-ku, Hiroshima-shi, Hiroshima, Japan

Katsuki Ladies Clinic Hiroshima Chuo-dori, Hirosima, Japan

Takahumi Katsuki, MD, PhD

7-1, Mikawa-cho, Naka-ku, Hiroshima-shi, Hiroshima, Japan

Katsuki Ladies Clinic Hiroshima Chuo-dori, Hirosima, Japan

Naoyuki Kitamura, MD, PhD

1-2-27, Shinonome-honmachi, Minami-ku, Hiroshima-shi, Hiroshima, Japan

MNES Inc., Hiroshima, Japan

\textbf{Corresponding Author:}

Yuto Maeda, MD

2-12-13-201, Takanawa, Minato-Ku, Tokyo 108-0074

Medical Governance Research Institute, Tokyo, Japan

Phone Number: 81-3-3441-7505

E-mail: ymaeda1636@gmail.com

\textbf{Short running Title: A new style of tele-fetal diagnosis with
cloud storage}

\textbf{Main text}

Congenital anomalies are one of the important causes of infant and
childhood death, chronic disabilities. Since congenital anomalies are
complicated with 3-5\% of all births (Mai CT, et al. National
population-based estimates for major birth defects, 2010-2014. Birth
Defects Res. 2019;111(18):1420-35.), screening fetal echography for
major anomaly should be routinely offered even for low-risk pregnant
women in most of the high-income countries. However, the ongoing
coronavirus disease (COVID-19) pandemic has jeopardized access to
various types of maternal and neonatal care for fear of contracting
COVID-19. As such, in the post-COVID-19 era, there is a growing trend of
incorporating telemedicine in neonatology.

Historically, fetal tele-echography was first developed as a synchronous
video visit with the spread of Internet technology since the 1990s.
(Landwehr JB, et al. Telemedicine and fetal ultrasonography: assessment
of technical performance and clinical feasibility. Am J Obstet Gynecol.
1997;177(4):846-8.) This has enabled doctors working in remote islands
or rural areas to consult ultrasound specialists. (Soong B, et al. The
fetal tele-ultrasound project in Queensland. Aust Health Rev.
2002;25(3):67-73.) The advantage of a synchronous video visit is that
specialists can give a real-time guide for obstetrical sonographers
through a complete evaluation. On the other hand, the disadvantage is
that the capacity of specialists for consultation is limited because of
the necessity for a secure and reliable tele-connection. (Bidmead E, et
al. Service user and staff acceptance of fetal ultrasound telemedicine.
Digit Health. 2020;6:2055207620925929.) Because of this disadvantage, it
is difficult to apply it in low- or middle-income countries, where
telemedicine is the most necessary since the equalization of perinatal
medicine fall behind other countries. Therefore, increased needs in
telemedicine would require a new style of tele-fetal diagnosis system
instead of real-time synchronous connection regardless of the income
level of countries.

One of the solutions to make tele-fetal diagnosis easily utilizable is
to adopt the way of thinking in other fields of telemedicine, such as
tele-radiology and tele-pathology. In these fields, images sent from
other medical institutions at various time points can be accessed on
demand by radiation and pathology specialists working remotely. In that
respect, a way of storing movies from ultrasound on cloud and sharing
them with other doctors or facilities could alleviate the
above-mentioned problems.

In this context, we have constructed a novel system, called ``LOOKREC'',
with which doctors and mothers could see ultrasound data on cloud both
in still image and video format. LOOKREC can store Digital Imaging and
Communications in Medicine (DICOM) format images on Google cloud and is
available to all the facilities using Picture Archiving and
Communication Systems (PACS), one of the most common systems storing
images worldwide. Thus, LOOKREC enables doctors to review ultrasound
images and make diagnoses with various devices, such as PC, tablet, or
smartphone, and regardless of time and place with affordable cost.
Naturally, this would increase capacity and opportunities of
tele-consultation in neonatology so that a safer pregnancy of a larger
number of fetuses can be guaranteed globally. Actually, we have already
utilized this system with patients who hope to share ultrasound images
with their family since August 2020. Use of this system has steadily
increased during the COVID-19 pandemic in Japan since family visits with
pregnant women in prenatal check-up have been limited. (Figure) Thus, to
meet the increased demands of tele-fetal diagnosis during the
post-COVID-19 pandemic era, establishing a new system for tele-fetal
diagnosis with cloud storage like ours is warranted.

\textbf{Acknowledgement:}

None declared.

\textbf{Disclosure of interests:}

YM, AO, TT, YS and NK receives personal fee from MNES Inc, inside the
scope of the study.

TN and TK declare no competing interests.

\textbf{Contribution to Authorship:}

YM has drafted the work, and other authors have revised the draft
critically for important intellectual content. TN and TK have
contributed to the acquisition of the data.

\textbf{Funding:}

None declared.

\textbf{Hosted file}

\verb`MNES_BJOG_Figure.docx`  available at \url{https://authorea.com/users/470355/articles/562569-the-need-for-a-new-style-of-tele-fetal-diagnosis-with-cloud-storage-in-the-post-covid-19-era}

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