What is Teleradiology?
Teleradiology refers to the practice of a radiologist interpreting medical images while not physically present in the location where the images are generated. Hospitals, mobile imaging companies, urgent care facilities and even some private practices utilize teleradiology. The main idea behind the use of teleradiology is that it is expensive to have a radiologist on-site. Usually the cost starts at about $1,500 per day. On the other hand, using a teleradiology service enables you to pay on a per exam basis, and sometimes the cost is as low as $8 per exam. For facilities requiring 24/7 services, or those that have a small volume of radiology patients, it can provide a huge savings.
Patient care is improved by teleradiology by making it possible for radiologists to provide their services without needing to be in the same location as the patient. That is especially important whenever a sub-specialist like a musculoskeletal radiologist, pediatric radiologist, neuroradiologist or MRI radiologist is needed, given that usually these professionals work in large metropolitan areas during day hours. However, teleradiology makes it possible to have access to trained specialists on a 24/7 basis.
In order to define exactly what teleradiology is, a good place to start is defining the word radiology first. Radiology is a type of imaging technique that physicians use for taking images of the internal part of the body. This is usually done for either treatment or diagnosis. Ultrasounds, MRIs and x-rays are examples.
Now we can add the prefix “tele” onto radiology. Think about the word “telephone,” which refers to a device that allows you to call somebody who is in a different location. When applied to teleradiology, it means the images are sent to a different location. The images along with the studies performed on the images get sent to practitioners or doctors who are in a different location than where these images are taken.
Up until very recently, teleradiology was only used in emergencies. Of course, with the introduction of the internet, this practice started to spread very fast. It is as easy to send images as it is to send emails that have attachments. There are now computer programs that are dedicated specifically to the transmission of radiological images. These developments result in teleradiology turning into a significant medical practice, and it continues to grow in importance.
A doctor may want to use teleradiology in order to collaborate and consult with other doctors who are in other locations that he may not be able to without the technology. It helps with diagnosis, and frequently helps with getting a second opinion and assist with symptom control. Many times, it might be the first opinion since there might not be a radiologist available in the hospital.
One common scenario that often takes place is a patient coming into the emergency room. However, smaller hospitals may employ just one radiologist. Teleradiology makes it possible for the images that the ER teams takes to be examined by a radiologist located in a different location. This is particularly useful in rural areas.
What is really great about teleradiology is that a trained radiologist can read certain images and make life-saving discoveries. If an untrained eye views the images this isn’t always so. An ultrasound that shows a malignant growth might not mean anything to an untrained eye. However, it could indicate cancer to a trained radiologist. Teleradiology is the difference between a patient receiving the treatment the person needs, or leaving the hospital without getting a treatment plan.
This all sounds fine, and in some cases it could be life saving. However, like everything else, the practice can have some down sides to it. There is only so much a radiologist can do with images. Usually the doctor will follow up on procedures. With teleradiology, however, the radiologist only receives images and there isn’t a patient to perform any additional tests on. That means the doctor will need to relay his information to the doctors that are on-site. That can lead to miscommunication and confusion.
Another obvious drawback to teleradiology is that it is dependent on technology. Teleradiology is impossible to do without technology. For example, if the internet is down at the hospital, teleradiology will not be possible to use. This could result in a delay in diagnosis and treatment.
History of Teleradiology
Teleradiology has a history of almost a half a century at this point, and has been influential in forming the entire telemedicine industry. The idea of communicating through the use of wire transmission was first developed for the telephone almost 150 years ago. Since that time, the same technique has been applied and been instrumental in telemedicine’s evolution, which is the practice of using doctors that are not in the same place as the patient. During the 1930s, the ocean liner the Queen Mary used the marine radiotelephone on the ship for the purpose of medical consultation. A doctor on board would send information to external sources for consultation, and then serve as a consultant for individuals on other ships who needed medical attention.
During the 1960s and 1970s, there was extensive experimentation and research conducted to improve the techniques of broadcast television and closed circuit for sending medical images that had been captured by x-rays. Generally, the images pertained to pathology, dermatology and radiology. There was a new breakthrough when Dr. Kenneth Bird from Boston’s Massachusetts General Hospital was able to have an interactive television system installed that connected Logan Airport with the hospital and could be used for providing travelers with medical care.
There was a similar case at Walter Redd General Hospital located in Washington D.C. where a link was established between the emergency room and radiology department through a closed circuit television. In the early days, however, the transmission process was fairly tedious, since you could only share one image at a time, and the resolution and contrast was low quality, meaning that the system really was more an exhibit than it was a practical tool for the hospital. In these early years of telehealth, high maintenance and operation costs led most healthcare centers to reject teleradiology.
Teleradiology during the early 1980s existed primarily as physical film copies that were mailed to the radiologist. Then he would record a report on a cassette tape. This would then be mailed to the original facility so that it could be transcribed into the form of a paper report. These studies’ turnaround time would take days and sometimes even weeks. For routine studies that would work, but that timeframe won’t cut it in emergency situations.
Although some modalities (X-ray machines, MRIs, CTs) produced films or digital images that could be scanned into a digital image, displaying the digital copies on machines made by other manufacturers was very difficult. The National Electrical Manufacturers Association and American College of Radiology in 1983 joined forces and created an open standard for medical images to be digitally stored. The ACR/NEMA 300 standard did have some limitations and problems that didn’t lead to manufacturers adopting it broadly.
A second version of this standard got released in 1988. It is usually called ACR/NEMA V2.0. With this version, the images were transmitted through using a dedicated 2 cable (the EIA-485). The standard was accepted more widely, with the standard being support by companies like 3M, Vortech (which is now Kodak), Siemens Medical Systems, Merge Technologies, General Electric Medical Systems and DeJarnette Research Systems.
The third version of this standard got released in 1993, and was called DICOM. Standard network support got added with this edition, which finally made teleradiology really possible.
The American College of Radiology in 1994 published its first teleradiology standard. The ACR suggest that licensure should be maintained by radiologists who provided interpretations, at both receiving and initiating sites, and also have hospital credentials. An important step in the practice of teleradiology becoming legitimized was gaining ACR recognition.
During the late 1990s, there were several purely teleradiology companies that had been established and were becoming very successful. Radlinx, Nighthawk and vRad were some of the field’s early pioneers. Nighthawk is an especially interesting case since it was the first company that had radiologists in Australia and Europe to maximize on the time zone differences with the U.S. A doctor in Australia working in the afternoon could cover a graveyard shift in the U.S.
The next real change that took place in teleradiology interestingly enough came in 2010 when Nighthawk and vRad merged. The merger resulted in a number of radiologists needing to look for work. Some of them started working for different teleradiology companies. Others started their very own teleradiology companies by taking advantage of recent cloud computing advances. Some radiologists did both.
Radiologist as free agents made the market very interesting. A majority of teleradiologists do their work from home and work for several different teleradiology companies. Prices for the software needed for teleradiology services has dropped, which makes it more affordable for people.
Today’s teleradiology market has hundreds of companies that are in competition with one another for clients, as well as contractor radiologists for doing the readings for the patients. It could change your practice radically if you’ve lacked access to radiology services!
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