Teleradiology

What is Teleradiology?

Teleradiology is a part of telemedicine in which radiological images are transferred using telecommunication services to other facilities for reports from qualified radiologists.

This method is used to transmit reports of imaging studies like:

• X-rays
• MRI
• Ultrasound
• CT scan
• Nuclear medical studies

This technological advancement aids in facilitating reports from radiologists in areas where there are no qualified radiologists.

How Did Teleradiology Evolve?

Teleradiology began in 1929 when dental x-rays were transmitted across health centers for consultations. Initially, patient pictures were captured using digital cameras and the images transferred to the computer, radiological images were likewise scanned and transferred to the computer. These files were then transmitted to the radiologist via the internet who in turn would assess the condition and provide a suitable report. However, the use of latest technologies involves telecommunication devices that are far superior and allow instant transfer of information.

In India, teleradiology started relatively late, only in 1996 by Jhankaria Imaging in Mumbai, which is a private imaging center. This center brought in teleradiology to facilitate immediate transfer of emergency CT scans to doctors. The first teleradiology company set up in India was in Bangalore called Teleradiology Solutions and where U.S. Board certified radiologists provided teleradiology services to people in the U.S, Singapore and India.

How Does Teleradiology Work?

• DICOM Compliant Radiological Equipment: Nearly all radiological equipment that are available today are Digital Imaging and Communication (DICOM) compliant. This allows all images to be stored in a DICOM work folder can be transferred. Identifying micro-calcifications require large mammogram file size, but these cannot be transferred by teleradiology as of now.
• Image Transfer: The time taken to transfer images depends largely on the software and the equipment available at the centers. The images may be transferred over the internet or can be connected directly with the equipment across centers. The images may be transferred or they can be streamed.

The DICOM system serves to integrate scanners, network, printers, servers that are manufactured by different manufacturers into a common system.

• Viewing The Images: The transferred images are then viewed on a high resolution screen by qualified radiologists who provide their report by dictating into a dictaphone.

What are the Benefits of Teleradiology?

There are many benefits associated with teleradiology.

• Connects with Qualified Radiologists: Teleradiology was initiated because there was a lack of qualified radiologists, though there were CT scanners and other required technologies available in various hospitals. Experts are consulted over teleradiology to facilitate better diagnosis. A study conducted in Japan by Masatoshi Matsumoto and colleagues titled " Geographic Distribution of Radiologists and Utilization of Teleradiology in Japan: A Longitudinal Analysis Based on National Census Data" highlighted the increasing gap in the shortage of radiologists in rural and urban areas. According to the study authors, teleradiology will help reduce this gap. This holds true even for India, where rural areas do not have sufficient qualified radiologists.

• Reduced Time and Effort: When second opinions are required concerning a certain diagnosis, teleradiology allows doctors in a hospital to consult with experts without having to travel to meet them.
• Transfer of Complex Data: With the advent of technology, transfer of complex diagnostic images is possible even from the most remote but technically compatible village if the relevant supporting equipment is available.
• Reduced Costs: The burden on the radiology department is reduced with the development of teleradiology and there is reduction in costs as experts are consulted based on the need.
• Round The Clock Services: Countries like U.S and U.K require round the clock diagnostic services to support emergencies that may occur during the night. Teleradiology allows doctors from Asian countries like India and Singapore to be reached at night, as it would be day in these countries.
• Patient Satisfaction: A technological advancement that satisfies patients is an important milestone in the quest to simplify lives. Jac J.W.M.Jacobs and colleagues from the Health Psychology Section, University Medical Centre Groningen, The Netherlands conducted a study titled "Patient satisfaction with a teleradiology service in general practice"(Feb 2016). The study found that patients were happy with:
• Technical quality
• Interpersonal skills of the doctor

Moreover,

• Elderly patients and patients who had trauma were more than the younger patients.
• 90% of the people included in the study were happy with the technology
• It allowed patients from remote places to access advanced medical opinion without having to travel far.

What are the Uses of Teleradiology?

Teleradiology can be used in a variety of settings and they include:

• Imaging Studies at Hospitals: This is the primary use of teleradiology where radiological images are scanned to qualified radiologists for opinion and directives.
• Research Studies: Research scientists working on various studies would require the services of radiologists to study and provide a report on scans and other radiological images. Teleradiology would ensure that the scientists do not have to leave their laboratory to get the required information.
• Night Hawking: Scans and other imaging systems are sent to board-certified radiologists in India for review and report. This is considered to be a promising sector; however, the lack of qualified radiologists could affect its growth potential.
• Teaching: Lectures and demonstrations of medical procedures can be used to teach and train student doctors.
• Second Opinion: Certain hospitals may have qualified radiologists, but teleradiology may be used to acquire a second opinion.

• Sub-specialist Reporting: Radiologists who are experts or qualified in various sub-specialties like musculoskeletal, neuroradiology, pediatrics, oncology imaging, cardiac angiography and emergency radiology can provide useful information.

References:

1. Teleradiology: The Indian perspective - (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747412/)
2. Results of an Italian survey on teleradiology - (https://www.ncbi.nlm.nih.gov/pubmed/27108418)
3. A statewide teleradiology system reduces radiation exposure and charges in transferred trauma patients - (https://www.ncbi.nlm.nih.gov/pubmed/27012476)
4. A Cloud Architecture for Teleradiology-as-a-Service - (https://www.ncbi.nlm.nih.gov/pubmed/26940635)
5. Patient satisfaction with a teleradiology service in general practice - (https://www.ncbi.nlm.nih.gov/pubmed/26864118)
6. Geographic Distribution of Radiologists and Utilization of Teleradiology in Japan: A Longitudinal Analysis Based on National Census Data - (https://www.ncbi.nlm.nih.gov/pubmed/26421721)
7. Teleradiology: The Importance of Communication - (http://journalofethics.ama-assn.org/2014/12/ecas1-1412.html)
8. Teleradiology Usage and User Satisfaction with the Telemedicine System Operated by M�decins Sans Fronti�res - (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4211542/)
9. The accuracy of mobile teleradiology in the evaluation of chest X-rays - (https://www.ncbi.nlm.nih.gov/pubmed/25322696)

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