Teleradiology Mark Foltz Transitioning to Teleradiology Telemedicine is most commonly viewed as the ability of healthcare providers (or organizations) to engage or consult with other, perhaps distant, healthcare professionals via audiovisual interactive means facilitated by the electronic transfer of medical information and imagery. Given such a capability, stipulating appropriate institutional credentialing and privileges of respective providers, the capability of healthcare providers to deliver a higher, more efficient level of patient care in a more time and cost- efficient manner cannot be understated.

Telemedicine is not restricted, or constrained, as presented above and is extended to include remote physical examinations and robotic surgeries through ever-evolving and superior technologies. However, for the purpose of this report, the intent is to drill-down within telemedicine and take a closer, basic look at the teleradiology (TR) component of telemedicine in healthcare; today TR makes up 60% of telemedicine field (Kumar, 2008). In order to better understand the benefits that TR brings to our healthcare system today and for the future, a review of conventional radiology (CR) is helpful.

Conventional Radiology CR consists of exposing patients (and technicians) to a degree of radiation when a radiograph (XRAY) was taken. The XRAY film is then developed so it can be read by the radiologist; film development requires a technician in a special room with specific equipment and chemicals. The developed film is then physically delivered to, and read by, a radiologist. Reading the XRAY film generally means the radiologist is on-site (within the hospital, clinic or office). If a radiologist is not on-site, i. e. fter hours or weekends, he/she is called in to do the reading. Once the XRAY is read, the radiologist prepares a report (written or verbal for transcription) to be delivered to the ordering physician and filed in the patient chart. In the case of an immediate need, or STAT order, the radiologist contacts the ordering physician and relays his/her findings personally. After necessary treatment is accomplished the XRAY needs to be logged, filed and maintained for a period specific to pertinent state law – thus creating another (and ever-growing) need for additional space.

In the event the XRAY needs to be retrieved at a later date, the mechanical evolution for such includes identifying file location, going to the location and pulling the file, distributing the file the requestor. When the requestor has completed use of the XRAY film subsequent retrieval, re-logging and re-filing of the film is accomplished. Such a CR process “worked” for many years. Obviously there are inherit problems and opportunities for improvement in process that seemingly jump off of the paper given the advances in communication and information technology that we enjoy today.

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Teleradiology Basic TR has long been the pioneer when it comes to coupling communication and information technology with the practice of medicine. With TR, radiology has moved from the film to image, the improvements and opportunities that have followed are numerous and to continue to grow. To impress the changes in lay terms we look at TR, using the same process framework as discussed above in CR. With the introduction of TR, the patient (and technician) exposure to radiation is lessened. Once the “image” is taken it is immediately saved in a digital (or 3-D) format.

The image, along with pertinent patient data, is (immediately) electronically routed to the radiologist for reading [further discussion of this process is forthcoming]. If no radiologist is onboard, the image can be routed to his/her home or as in many cases today to a distant site where it can be read by a contracted radiologist (Thrall, 2007). The radiologist reads the image (which can be enhanced with technology if necessary); while reading, the radiologist is making a verbal report (using voice-recognition technology) that is being transcribed as the reading is ongoing.

Once the reading is completed, the transcribed report is presented on the radiologist’s computer screen and reviewed by the radiologist who can make necessary changes before signing off on, and submitting, the final report. Once the report is acceptable to the radiologist, the image and the report are electronically returned to the requesting physician for review and subsequent necessary treatment; another copy is sent to the patients chart, and yet another copy (image and report) is sent to main server where it stored and can be retrieved with ease for future review.

Teleradiology Advanced The previous sections presented a rather simplistic review of CR and TR; however TR has a bit more than such broad brush. TR architecture and workflow integration are components that make its past transition from CR (Englemann, Munch, & Stroter, 2007), and its current application and future progression somewhat more intriguing and challenging to work with. Architecture In the classical architectural approach of TR (as seen above) the image (or data), once obtained, is transmitted or “pushed” from the “sender” or originating site to the “receiver” or distant site.

Once the image is read, the completed report is attached and returned to the sender. Minimally, this push-model involves two workstations connected via TCP-IP; the stations directly transmit between each other and security protocols are built-in addressing privacy concerns. Beyond the push model, is what is referred to as the “pull- model”. With the pull-model, the sender drops the image into a dedicated server, the receiver pulls, or accesses, the image for review and then return drops a report with the image once it has been read.

Internet access is necessary when using the pull-model; the use of a dedicated server is required and allows for the vast quantities of date to be manipulated as well as to avoid delays in transmission. Addition builds to pull-model software include “drop-box” checks on a time or event submission (Englemann, 2007). Integration Early on, TR was a very isolated element of a hospitals IT department; today, in many cases, it has become the driver of clinical IT and often demands its own stand-alone department.

The bottom line is however, to integrate each individual patient’s image and report to the patient and then provide optimum access to the data. Thank goodness for the communications and information technology professionals because it seems that all one needs to do is ask (Kumar, 2008). In order to integrate the data, an outgrowth of the server approach used in the pull-model known as a “web portal” is employed. The web portal provides the opportunity to blend, or integrate, images and associated reports located on the server into a hospital clinical workflow system. The image and report are linked to the patient, when a hysician or other authorized member of the hospital staff access the patients “folder” the image and associated data (report) are electronically and immediately available. Conclusion Movement from CR to TR has improved patient and technician safety with less radiation exposure, improved the XRAY image from a single dimension film to a digital or 3-D representation; TR has bettered the quality and timeliness of care that may be delivered through more precise and quicker diagnoses, it has decreased space requirements for film processing and future storage, and enhanced expediency of review and reporting capabilities.

Certainly this is not done without significant monetary cost relative to computer architecture, workflow integration, hardware and software requirements and needs. However, given the vast deployment of such systems the benefits to society as a whole are well worth the investment in the technology to provide a quality and timely element within the healthcare system. References Englemann, U. , Munch, H. , & Stroter, A. M. (2007). The last 10 years in teleradiology.

International Journal of Computer Assisted radiology and Surgery , pp. S315-S316. Acessed on June 4, 2011: http://www. chili-radiology. com/Papers/P13-07. pdf Kumar, S. (2008). Introduction to teleradiology. Berlin Heidleberg: Springer-Verlag. Accessed on June 4, 2011: http://www. medicalcentury. com/download/Teleradiology_Springer2008. pdf#page=30 Thrall, J. (2007, June). Radiology. 613-617. Accessed on June 4, 2011: http://radiology. rsna. org/content/243/3/613. full


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