The Initial Development of Integrated Add-On Tele-Ultrasonography for Monitoring the Health of Pregnant Women and Fetuses in the Community Health Centers in Indonesia
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Maternal health and fetal growth in rural areas require special attention due to limited access to adequate healthcare systems. Early detection of fetal health conditions can be achieved using B-mode ultrasonography (USG). However, expectant mothers in these regions often lack regular to regular check-up, even when healthcare facilities are available there may not be trained professionals available to analyze the B-mode images obtained in the Community Health Centres. To address this gap, a tele-USG system was developed that allows healthcare workers in remote areas to operate basic USG equipment and transmit real-time images to specialist doctors at higher-level healthcare facilities. During system development, a general-purpose USG phantom was used to test parameters: penetration depth, geometric accuracy, focal zone, and axial and lateral resolution. Testing confirmed that both USG and laptop used for streaming produce reliable and accurate results. A slight geometric representation differences of 2.74% (approximately 1 cm per target) was observed, attributed to dimensional distortion between devices with different monitor sizes. In geometric accuracy tests, five out of eight vertical and six out of seven horizontal targets were successfully detected. The smallest variation of 0.028 mm occurred at 5 MHz frequency, demonstrated high precision focal zone measurements. The axial resolution ranged between 0.25-0.5 mm, while lateral resolution ranged from 1.0-2.0 mm, indicating strong capability for fine-detail imaging. Overall, the system exhibited high sensitivity and excellent imaging performance, offering a promising solution to enhance maternal and fetal healthcare challenges faced by rural communities in Indonesia through accessible real-time diagnostic support
AIUM. (2021). AIUM Practice Parameter for the Performance of Detailed Diagnostic Obstetric Ultrasound Examinations Between 12 Weeks 0 Days and 13 Weeks 6 Days. Journal of Ultrasound in Medicine, 40(5), E1–E16. https://doi.org/10.1002/jum.15477
Alsaadi, M., Alomaireenie, S., Abd Al-Sattar, T., Alshaibani, M., & Alfuraih, A. (2025). Accuracy assessment of PACS workstation monitor measurements compared to real-time ultrasound imaging of abdominal organs. Egyptian Journal of Radiology and Nuclear Medicine, 56(114), 1-8. https://doi.org/10.1186/s43055-025-01537-7
Bahner, D. P., Adkins, E. J., Nagel, R., Way, D., Werman, H. A., & Royall, N. A. (2011). Brightness Mode Quality Ultrasound Imaging Examination Technique (B-QUIET) Quantifying Quality in Ultrasound Imaging from the Departments of Emergency Medicine (D. 1649–1655. www.aium.org
Buijtendijk, M. F. J., Bet, B. B., Leeflang, M. M. G., Shah, H., Reuvekamp, T., Goring, T., Docter, D., Timmerman, M. G. M. M., Dawood, Y., Lugthart, M. A., Berends, B., Limpens, J., Pajkrt, E., van den Hoff, M. J. B., & de Bakker, B. S. (2021). Diagnostic accuracy of ultrasound screening for fetal structural abnormalities during the first and second trimester of pregnancy in low-risk and unselected populations. Cochrane Database of Systematic Reviews, 8, 1–30. https://doi.org/10.1002/14651858.CD014715.pub2
Cengiz, S., Hamdi, I., & Yaqub, M. (2022). Automatic Quality Assessment of First Trimester Crown-Rump-Length Ultrasound Images. Lecture Notes in Computer Science (Including Subseries Lecture Notes in Artificial Intelligence and Lecture Notes in Bioinformatics), 13565 LNCS, 172–182. https://doi.org/10.1007/978-3-031-16902-1_17
Coordinating Ministry for Human Development and Culture. (2019). National Strategy for Accelerating the Prevention of Stunting in Children (Strategi Nasional Percepatan Pencegahan Anak Kerdil (Stunting)).
Crawford, I., McBeth, P. B., Mitchelson, M., Ferguson, J., Tiruta, C., & Kirkpatrick, A. W. (2012). How to set up a low cost Tele-ultrasound capable videoconferencing system with wide applicability. Critical Ultrasound Journal, 4(13), 1-7. https://doi.org/10.1186/2036-7902-4-13
Doubilet, P. M. (2014). Ultrasound evaluation of the first trimester. Radiologic Clinics of North America, 52(6), 1191–1199. https://doi.org/10.1016/j.rcl.2014.07.004
Dowdy, D. L., & Harris, R. D. (2024). Tele-Ultrasound: Meeting Global Imaging Challenges. Applied Radiology, 53(1), 38–41. https://doi.org/10.37549/ar2949
Enriquez, J. L., & Wu, T. S. (2014). An Introduction to Ultrasound Equipment and Knobology. In Ultrasound Equipment and Knobology 30(1), 25-45, Elsevier Inc. https://doi.org/10.1016/j.ccc.2013.08.006
Graham, G. M. (2010). Ultrasound Evaluation of Pregnancy in the First Ultrasound Evaluation of Pregnancy in the First Trimester. Donald School Journal of Ultrasound in Obstetrics and Gynecology, 4(1), 17–28.
Grazhdani, H., David, E., Ventura Spagnolo, O., Buemi, F., Perri, A., Orsogna, N., Gigli, S., & Chimenz, R. (2018). Quality assurance of ultrasound systems: current status and review of literature. Journal of Ultrasound, 21(3), 173–182. https://doi.org/10.1007/s40477-018-0304-7
Hangiandreou, N. J., Stekel, S. F., Tradup, D. J., Gorny, K. R., & King, D. M. (2011). Four-Year Experience with a Clinical Ultrasound Quality Control Program. Ultrasound in Medicine and Biology, 37(8), 1350–1357. https://doi.org/10.1016/j.ultrasmedbio.2011.05.007
Henrichs, J., Verfaille, V., Jellema, P., Viester, L., Pajkrt, E., Wilschut, J., Van Der Horst, H. E., Franx, A., & De Jonge, A. (2019). Effectiveness of routine third trimester ultrasonography to reduce adverse perinatal outcomes in low risk pregnancy (the IRIS study): nationwide, pragmatic, multicentre, stepped wedge cluster randomised trial. The BMJ, 367:l5517. https://doi.org/10.1136/bmj.l5517
Hoskins, P., Martin, K., & Thrush, A. (2010). Diagnostic Ultrasound: Physics and Equipment. In Bedside Procedures for the Intensivist. https://doi.org/10.1007/978-0-387-79830-1_4
Indonesian Medical Council (KKI). (2020). Regulation of the Indonesian Medical Council (KKI) No. 74 of 2020 (Peraturan KKI no 74 Tahun 2020).
Jatmiko, W. (2023). Developing intelligent Tele-ECG systems and Tele-USG systems: progress and challenges. Procedia Computer Science, 216, 4. https://doi.org/10.1016/j.procs.2022.12.104
Khoirunnisa, D. (2024). Ultrasound Image Storage on Raspberry Pi as a Basic Data Transmission. Jurnal Teknokes, 17(4), 170–174. https://doi.org/10.35882/kzm0ms97
Kiserud, T., Piaggio, G., Carroli, G., Widmer, M., Carvalho, J., Neerup Jensen, L., Giordano, D., Cecatti, J. G., Abdel Aleem, H., Talegawkar, S. A., Benachi, A., Diemert, A., Tshefu Kitoto, A., Thinkhamrop, J., Lumbiganon, P., Tabor, A., Kriplani, A., Gonzalez Perez, R., Hecher, K., … Platt, L. D. (2017). The World Health Organization Fetal Growth Charts: A Multinational Longitudinal Study of Ultrasound Biometric Measurements and Estimated Fetal Weight. In PLoS Medicine, 14, 1-36. 14). https://doi.org/10.1371/journal.pmed.1002220
Kollmann, C., DeKorte, C., Dudley, N. J., Gritzmann, N., Martin, K., & Evans, D. H. (2012). Guideline for Technical Quality Assurance ( TQA ) of Ultrasound devices EFSUMB Technical Quality Assurance Group – US-TQA / B. Ultraschall in Der Medizin, 33(April), 544–549.
Mayo Clinic. (2025). Pregnancy Week by Week. Mayo Foundation for Medical Education and Research (MFMER). https://www.mayoclinic.org/healthy-lifestyle/pregnancy-week-by-week/in-depth/prenatal-care/ art-20045302
Mazaya, R. H., Dewantiningrum, J., Rahmadi, F. A., & Anantyo, D. T. (2023). In Utero Ultrasonography Parameters as a Children Growth Prediction at Age 2 – 3. Indonesian Journal of Obstetrics and Gynecology, 11(2), 99–104. https://doi.org/10.32771/inajog.v11i2.1791
Metcalfe, S. C., & Evans, J. A. (1992). A study of the relationship between routine ultrasound quality assurance parameters and subjective operator image assessment. British Journal of Radiology, 65(775), 570–575. https://doi.org/10.1259/0007-1285-65-775-570
Ministry of Health of the Republic of Indonesia. (2019). The Ministry of Health Regulation Number 20 of 2019. (Text in Indonesian)
Ministry of Health of the Republic of Indonesia. (2021a). Ministry of Health Performance Report 2020. (Text in Indonesian)
Ministry of Health of the Republic of Indonesia. (2021b). The Decree of the Minister of Health of the Republic of Indonesia on Guidelines for Healthcare Services through Telemedicine during the COVID-19 Pandemic. (Text in Indonesian)
Ministry of Health of the Republic of Indonesia. (2022). Ministry of Health meets the need for ultrasound and anthropometric equipment in all community health centres and integrated health posts. (Text in Indonesian). https://kemkes.go.id/id/kemenkes-penuhi-kebutuhan-usg-dan-antropometri-di-semua-puskesmas-dan-posyandu
Ministry of Health of the Republic of Indonesia. (2023). Minister of Health Regulation of the Republic of Indonesia No. 3 of 2023 on Health Service Tariff Standards in the Implementation of the Health Insurance Program ((Text in Indonesian)
Ministry of Health of the Republic of Indonesia. (2024). Minister of Health Regulation No. 6 (Permenkes no. 6). (Text in Indonesian)
Mulyadita, U., Sutanto, E., Fiqri, M., Setiawan, E., & Pattaik, A. (2025). Mapping Telemedicine in Indonesia : Evidence for Policy Action at a Critical Juncture. Technical Report, March, 1–34.
Passananti, E., Bevilacqua, E., di Marco, G., Felici, F., Trapani, M., Ciavarro, V., Di Ilio, C., Lanzone, A., & Familiari, A. (2024). Management and outcome of fetal abdominal cysts in first trimester: systematic review of the literature. Ultrasound in Obstetrics & Gynecology, November, 721–729. https://doi.org/10.1002/uog.27663
Recker, F., Höhne, E., Damjanovic, D., & Schäfer, V. S. (2022). Ultrasound in Telemedicine: A Brief Overview. In Applied Sciences (Switzerland) (Vol. 12, Issue 3). https://doi.org/10.3390/app12030958
Salomon, L. J., Alfirevic, Z., Berghella, V., Bilardo, C. M., Chalouhi, G. E., Da Silva Costa, F., Hernandez-Andrade, E., Malinger, G., Munoz, H., Paladini, D., Prefumo, F., Sotiriadis, A., Toi, A., & Lee, W. (2022). ISUOG Practice Guidelines (updated): performance of the routine mid-trimester fetal ultrasound scan. Ultrasound in Obstetrics and Gynecology, 59(6), 840–856. https://doi.org/10.1002/uog.24888
Salomon, L. J., Alfirevic, Z., Da Silva Costa, F., Deter, R. L., Figueras, F., Ghi, T., Glanc, P., Khalil, A., Lee, W., Napolitano, R., Papageorghiou, A., Sotiradis, A., Stirnemann, J., Toi, A., & Yeo, G. (2019). ISUOG Practice Guidelines: ultrasound assessment of fetal biometry and growth. Ultrasound in Obstetrics and Gynecology, 53(6), 715–723. https://doi.org/10.1002/uog.20272
Sargsyan, A. E., Hamilton, D. R., Jones, J. A., Melton, S., Whitson, P. A., Kirkpatrick, A. W., Martin, D., & Dulchavsky, S. A. (2005). FAST at MACH 20: Clinical ultrasound aboard the International Space Station. Journal of Trauma - Injury, Infection and Critical Care, 58(1), 35–39. https://doi.org/10.1097/01.TA.0000145083.47032.78
Smith, P., & Brebner, E. (2002). Tele-Ultrasound for Remote Areas. Journal of Telemedicine and Telecare, 8, 80–81. https://doi.org/10.1177/1357633X020080S237
Smith, Thomas, E., Snoswell, C. L., Haydon, H., Mehrotra, A., Clemensen, J., & Caffery, L. J. (2020). Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). Journal of Telemedicine and Telecare, 26(5), 309–313. https://doi.org/10.1177/1357633X20916567
Sovio, U., Murphy, H. R., & Smith, G. C. S. (2016). Accelerated fetal growth prior to diagnosis of gestational diabetes mellitus: A prospective cohort study of nulliparous women. Diabetes Care, 39(6), 982–987. https://doi.org/10.2337/dc16-0160
Wong, L., Paul, E., Murday, H. K., Fang, J., Lavender, I., Coombs, P. R., & Teoh, M. (2018). Biparietal diameter measurements using the outer‐to‐outer versus outer‐to‐inner measurement: A question of pedantry? Australasian Journal of Ultrasound in Medicine, 21(3), 161–168. https://doi.org/10.1002/ajum.12091
Zander, D., Hüske, S., Hoffmann, B., Cui, X. W., Dong, Y., Lim, A., Jenssen, C., Löwe, A., Koch, J. B. H., & Dietrich, C. F. (2020). Ultrasound Image Optimization (Knobology): B-Mode. Ultrasound International Open, 6(1), E14–E24. https://doi.org/10.1055/a-1223-1134
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