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At least 19 recordsLinked to original sources
PubMed1993

Personal computer teleradiology: comparing image quality of lateral cervical spine radiographs with conventional teleradiology.

Teleradiology images of 14 cervical spine x-rays were studied by radiologists to compare radiological diagnostic interpretations and image quality with an inexpensive personal computer (PC) teleradiology system adapted to personal computers. Image quality ratings were similar for the conventional teleradiology images, PC teleradiology images, and the original cervical spine films. Interpretations of images showed some variation between PC and conventional teleradiology. Lesions in poorly contrasted films were visible with difficulty, using PC teleradiology. Lesions in well-contrasted films were identified easily with all three image types. Inexpensive teleradiology can be achieved using PC devices already on the market for $650 to $2000 compared with $30,000 for conventional teleradiology. Standardization of image and modem transmission parameters may facilitate the development of interhospital image transfers to optimize patient transfers and to assist in long-distance patient consultations. PC teleradiology deserves further study.

Cervical Vertebrae↗
PubMed2003

Guidelines for teleradiology practice: results of the Tyrolean teleradiology pilot project.

The Tyrolean telemedicine pilot project linked the University Clinic of Innsbruck and the district hospital in Reutte. Five medical specialties were investigated: teleradiology, telepathology, teledermatology, tele-ophthalmology and tele-oncology. A Tyrolean 'four-column model of quality management in telemedicine' was introduced to ensure a global view of the project and to avoid mistakes. In teleradiology, a 12-step workflow was developed, which described the medical responsibilities at each stage. We found that the defined teleradiology workflow and the technical equipment for data security and data exchange worked without problems in over 79% of a total of 424 cases. To ensure continuous quality assurance, the whole teleradiology workflow was ISO 9001:2000 certified.

Austria↗
PubMed2002

[Teleradiology--blessing or curse? 4 years routine in the North Hessia teleradiology data network].

Several hospitals in northern Hessen, not having their own radiology departments, want to run CT-scanners with the goal of improving medical quality. They requested co-operation from the Radiological Institute in the Hardtwaldklinik I in Bad Zwesten. Therefore a teleradiological network was developed, which enables the exchange of radiological-images and -reports between 19 hospitals today. An elementary requirement for this co-operation is an efficient and functional computer infrastructure and verified co-operation contracts. The conception, structure and development of the program, as well as associated difficulties are presented and discussed from different perspectives in the light of the controversy among experts. The results, experiences and benefits gained in four years, in which the teleradiological network of northern Hessen has been in place, demonstrate the importance and possibilities of teleradiology as an element of telemedicine. Teleradiology/telediagnostics improves the quality of patient care in smaller hospitals located in less-populated areas and present possibilities to optimize and integrate health care structures, taking economic considerations into account.

Computer Communication Networks↗
PubMed2002

[The future of teleradiology: results of Teleradiology Expert Meeting of the Health Network Congress 2001].

Legal prerequisites have substantial influence on the development of teleradiology. At an expert meeting (Mannheim, 8.6.2001) a proposal for a teleradiology article in the new German x-ray ordinance has been set up. An exception of the demand for a doctor trained in radiation protection at the point of examination shall be established for emergency cases. To realize the intended improvement of patient care measurements for quality assurance concerning the medical personnel and processes are necessary. Along with other current developments the basis of secure regional teleradiology networks is now built up.

Forecasting↗
PubMed2003

[Teleradiology for emergency cranial computed tomography].

PURPOSE: We report our experience with the teleradiologic service provided by a center hospital (CH) for emergency cranial computed tomography (CCT) in two regional hospitals (RH) during a 12-month period. The clinical and economic impact of teleradiology will be discussed as well as the acceptance by the clinicians of the regional hospitals. MATERIAL AND METHODS: In 2001, 213 CT-scans in 202 patients were performed and reported using teleradiology. Teleradiologic and final medical diagnosis were analysed by the medical reports. The transfer of the patients to a CH and their further treatment were checked. The referring physicians in the RH were asked to complete a questionnaire about the teleradiological support. RESULTS: 18 (9 %) patients had to be urgently transferred to a CH based on the CT findings in the teleradiological reports. 24 patients (11 %) were transferred to a center hospital during further treatment. 80 % of patients were treated in the RH. CONCLUSION: CT data transfer is reliable and efficient. Teleradiology reduces costs by avoiding unnecessary transport of patients for diagnostic procedures. Teleradiology improves patient management by reducing time from admittance to decide about further treatment. Teleradiology enables rapid selection of the best-equipped center hospital for the management of the patient's disease. Teleradiology is well accepted by the physicians in the RH. In the RH, teleradiology has become an indispensable standard procedure in the emergency diagnostic workup of cerebral trauma patients and in patients with acute unclear neurological symptoms.

Adolescent↗
PubMed2005

Swiss teleradiology survey: present situation and future trends.

The purpose of this study was to obtain a survey about the present situation including the usage pattern, technical characteristics and the anticipated future of teleradiology in Switzerland. An internet-based questionnaire was made available to all members of the Swiss Society of Radiology. Questions concerning current teleradiology usage, the type of transmitted modalities, the technology employed, security, billing issues and the anticipated future of teleradiology were addressed. One hundred and two (22.67%) of 450 radiologists responded to the survey. Of the total, 41.2% (42) were teleradiology users, 35.3% (36) planned to use teleradiology in the near future and 24.5% (25) did not use or plan to use teleradiology. The mean number of examinations transmitted per month was 198 (range 1-2,000) and the mean distance was 33 km (range 1,250 km). An emergency service was considered the most important purpose (mean score 6.90; minimum 1, maximum 10) for the use of teleradiology, followed by image distribution (mean 6.74) and expert consultation (mean 6.61). The most commonly transmitted modality was computed tomography (mean 8.80), followed by conventional X-rays (8.40) and magnetic resonance imaging (8.32). The most commonly transmitted format was Digital Imaging and Communications in Medicine (DICOM) (66.7%), followed by bitmap/Joint Photographic Experts Group (jpg) (38.1%), using the DICOM send/receive protocol (52.4%), followed by the hypertext transfer protocol (26.2%) and e-mail (21.4%). For security a secure connection (54.8%) followed by encryption (14.3%) and anonymization (9.5%) was used. For the future, image distribution was rated the most important aspect of teleradiology (7.88), followed by emergency (7.22) and expert consultation (6.53). Development of legal regulations is considered most important (8.17), followed by data security guidelines (8.15). Most radiologists believe that insurance companies should pay for the costs of teleradiology (37.3%), followed by the radiologist (33.3%). In conclusion, in Switzerland a wide spectrum of teleradiology applications and technologies is in use. Guidelines and reimbursement issues remain to be solved.

Humans↗
PubMed1998

Effect of real-time teleradiology on the practice of the emergency department physician in a rural setting: initial experience.

RATIONALE AND OBJECTIVES: The authors' goal was to determine the feasibility and usefulness of online teleradiology consultation for emergency department physicians at a rural hospital. MATERIALS AND METHODS: Electronic linkage between the emergency department of Chatham County Regional Hospital (remote site) and the University of North Carolina Hospitals (host site) was established via a fiberoptic network. From October 1995 through September 1996, teleradiology consultation was initiated by an emergency department physician at the remote site and was provided online by host-site radiologists using a commercially available teleradiology system and a high-resolution digitizer. The turnaround time for each teleradiology consultation was calculated, and the effect of the consultation on diagnosis and treatment was assessed. The emergency department physicians scored their satisfaction and comfort levels with the system by using a scale of 1-7, with 7 representing the highest and 1 representing the lowest satisfaction and comfort. The online soft-copy interpretation was compared with a later interpretation of the original hard copy. RESULTS: A total of 123 separate studies comprising 460 radiographs were successfully transmitted in 90 discrete teleradiology events. The mean turnaround time for a teleradiology consultation was 1.3 hours. The teleradiology consultations led to changes in the emergency department physician's initial diagnosis in 27 of 90 cases (30%) and resulted in treatment changes in 23 of 90 cases (26%). The emergency department physicians reported an average satisfaction score of 5.4 and a comfort level of 5.6 with the teleradiology system. No major discrepancy between soft- and hard-copy interpretations was noted. CONCLUSION: Online real-time teleradiology consultation is feasible with available technology.

Adolescent↗
PubMed1991

High-resolution digital teleradiology: a perspective.

Teleradiology has come a long way, from analog transmission systems using slow-scan television over standard telephone lines, to present-day, commercially available, microcomputer-based, low-resolution teleradiology systems. However, there exists a need to address the high-resolution end of the medical imaging categories, namely chest radiographs and mammograms, to firmly establish teleradiology. The availability of high-resolution image digitizers, display units, and digital hard copiers has made high-resolution digital teleradiology a feasible concept. Although the use of satellite channels can speed up the transmission of radiographic image data, with widespread acceptance of high-resolution teleradiology systems in the foreseeable future, the sheer amount of data involved in this field will give rise to problems of data transmission and storage. Data compression schemes can bring down the amount of data handled and can have a great economic impact on future teleradiology systems. We have developed a number of compression techniques for reversible compression of medical images. Our experiments have shown that lossless compression of the order of 4:1 is possible for a class of high-resolution medical images. Use of pattern recognition techniques offers the potential to bring down these data rates even further. We plan to use these techniques in a prototype high-resolution teleradiology system being developed. In this paper, we trace some of the developments in teleradiology and image data compression, and present a perspective for teleradiology in the 1990s.

Radiographic Image Enhancement↗
PubMed2006

Teleradiology applications with DICOM-e-mail.

For the connection of several partners to a Dicom-e-mail based teleradiology network concepts were developed to allow the integration of different teleradiology applications. The organisational and technical needs for such an integration were analysed. More than 60 institutions including 23 hospitals in the Rhein-Neckar-Region, Germany were connected. The needed functionality was grouped in six teleradiology applications (emergency consultation, tele-guided examinations, expert consultations, cooperative work, scientific cooperations and homework with on call services) and their technical and organisational needs according to availability, speed of transfer, workflow definitions and data security needs was analysed. For the local integration of teleradiology services the setup and workflow is presented for a standalone teleradiology workstation and a server based teleradiology gateway. The line type needed for different groups of applications and users is defined. The security concept and fallback strategies are laid out, potential security problems and sources of errors are discussed. The specialties for the emergency teleradiology application are presented. The DICOM-e-mail protocol is a flexible and powerful protocol that can be used for a variety of teleradiology applications. It can meet the conditions for emergency applications but is limited if synchronous applications like teleconferences are needed.

Computer Security↗
PubMed1999

The diagnostic performance of a PC-based teleradiology link.

AIM: Evaluation of the diagnostic performance of a personal computer based teleradiology link. MATERIALS AND METHODS: Two experienced radiologists assessed 100 cases, all based on chest and skeletal films using teleradiology for 50. These assessments were compared with the consensus of a panel of three independent radiologists. RESULTS: Diagnostic performance of teleradiology and conventional film was similar (sensitivity 88 vs. 90%; specificity 96 vs. 90%; accuracy 91 vs. 90%; not significant). However, the quality of teleradiology images was rated poorer, and the confidence in diagnosis was lower with teleradiology. ROC curve analysis, taking into account diagnostic confidence, showed significantly poorer performance for teleradiology at all thresholds when chest X-rays only were considered. There was no significant difference for skeletal images, although the two smooth curves crossed, suggesting teleradiology might be better when the specificity is high. CONCLUSION: These findings suggest that when this type of teleradiology system is used, the value of rapid reporting must be balanced against poorer image quality, particularly for chest X-rays.

Bone and Bones↗
PubMed2005

[Teleradiology: economic research analysis of CT investigations in a small hospital].

PURPOSE: To evaluate, discuss and compare economic aspects of teleradiological applications in CT examinations in a small hospital. Scenario (1): CT examination by an extern institution including transport of a patient. Szenario (2): External consultation of an internal CT examination (teleradiology according to ROV). Scenario (3): Complete in-house radiology department. To evaluate economic aspects of teleradiology service providers. MATERIALS AND METHODS: Costs have been separated into fixed and variable costs in a model. Total costs of 500 CT examinations per year have been calculated for the three scenarios. A break-even analysis has been performed to determine the necessary/minimal number of CTs per year for economical advantages. The number of CT consultations for teleradiology service providers to make profit has been calculated. RESULTS: Scenario (1): This is the most cost-effective scenario for 500 CTs per year, but most time-consuming. Beyond 548 CTs per year using a single slice CT and 965 CTs per year using a multislice CT the teleradiology scenario [scenario (2)] is most cost-effective. Beyond 1065 CTs per year an in-house radiology department [scenario (3)] is economically reasonable. On the basis of 30 Euros per CT consultation a teleradiology service providing system will be profitable starting from 322 CT consultations per year. CONCLUSION: Teleradiology applications are economically reasonable in a wide range in small hospitals. CT teleradiology services can also be provided on a cost-effective basis at a reachable number of consultations.

Cost-Benefit Analysis↗
PubMed1997

Teleradiology for remote diagnosis: a prospective multi-year evaluation.

Teleradiology has been used for nearly 3 years at our institution to provide urgent radiologic interpretations for two outpatient clinics and an affiliated hospital. The purpose of this study was to evaluate the clinical reliability of the existing system. Teleradiology images were interpreted using 1600 x 1200 pixel display stations. The original films from the same cases were subsequently interpreted, usually by another radiologist. The initial and final interpretations were compared. Discrepancies were rated and adjudicated by another senior radiologist. These data were compared to peer review interobserver discrepancy rates. Among the 2688 teleradiology examinations evaluated, there were major discrepancies in 31 (1.5%). In three instances teleradiology rather than film interpretation was considered correct. Abnormalities missed on teleradiology were apparent in all but two at adjudication. Among the 628 peer-review cases, there were 6 (0.96%) major discrepancies. Major teleradiology discrepancy rates are statistically similar to film-based peer review discrepancy rates. Teleradiology is suitable for providing radiologic services to remote medical facilities.

Evaluation Studies as Topic↗
PubMed2005

Standardization of teleradiology using Dicom e-mail: recommendations of the German Radiology Society.

Until recently there has been no standard for an interoperable and manufacturer-independent protocol for secure teleradiology connections. This was one of the main reasons for the limited use of teleradiology in Germany. Various teleradiology solutions have been developed in the past, but the vast majority have not been interoperable. Therefore an ad hoc teleradiology connection was impossible even between partners who were already equipped with teleradiology workstations. Based on the evaluation of vendor-independent protocols in recent years the IT Working Group (AGIT) of the German Radiology Society set up an initiative to standardize basic teleradiology. An e-mail based solution using the Dicom standard for e-mail attachments with additional encryption according to the OpenPGP standard was found to be the common denominator. This protocol is easy to implement and safe for personalized patient data and fulfills the legal requirements for teleradiology in Germany and other countries. The first version of the recommendation was presented at the 85th German Radiology Convention in 2004. Eight commercial and three open-source implementations of the protocol are currently available; the protocol is in daily use in over 50 hospitals and institutions.

Computer Communication Networks↗
PubMed2005

Teleradiology and emerging business models.

A number of new diagnostic radiology services have emerged which use teleradiology. The main themes include: (1) stand-alone teleradiology practice; (2) the "Nighthawk"/on-call coverage; (3) solo radiologist practice; (4) expert/second-opinion teleradiology; (5) a global virtual radiology service based on workload sharing and reallocation. More applications of teleradiology can be expected due to the continuing shortages and uneven distribution of radiologists, and the increasing use of radiological imaging for diagnosis. In a large enterprise, such as the US army, teleradiology will allow the creation of a global diagnostic organization where diagnostic images are distributed according to the availability of radiologists. Eventually the distinction between picture archiving and communication systems and teleradiology will be blurred and radiology will be provided by virtual organizations with distributed capabilities. As teleradiology services claim a bigger share of radiology practice, various legal and regulatory issues will need to be solved. Ultimately the successful business model will depend on the ability to produce the highest-quality product at the lowest cost.

Costs and Cost Analysis↗
PubMedDate not supplied

Borderless teleradiology with CHILI.

Teleradiology is one of the most evolved areas of telemedicine, but one of the basic problems which remains unsolved concerns system compatibility. The DICOM (Digital Imaging and Communications in Medicine) standard is a prerequisite, but it is not sufficient in all aspects. Examples of other currently open issues are security and cooperative work in synchronous teleconferences. Users without a DICOM radiological workstation would benefit from the ability to join a teleradiology network without any special tools. Drawbacks of many teleradiology systems are that they are monolithic in their software design and cannot be adapted to the actual user's environment. Existing radiological systems currently cannot be extended with additional software components. Consequently, every new application usually needs a new workstation with a different look and feel, which must be connected and integrated into the existing infrastructure. This paper introduces the second generation teleradiology system CHILI. The system has been designed to match both the teleradiology requirements of the American College of Radiology (ACR), and the functionality and usability needs of the users. The experiences of software developers and teleradiology users who participated in the first years of the clinical use of CHILI's predecessor MEDICUS have been integrated into a new design. The system has been designed as a component-based architecture. The most powerful communication protocol for data exchange and teleconferencing is the CHILI protocol, which includes a strong data security concept. The system offers, in addition to its own secure protocol, several different communication Methods: DICOM, classic e-mail, Remote Copy functions (RCP), File Transfer Protocol (FTP), the internet protocols HTTP (HyperText Transfer Protocol) and HTTPS (HyperText Transfer Protocol Secure),and CD-ROMs for off-line communication. These transfer METHODS allow the user to send images to nearly anyone with a computer and a network. The drawbacks of the non-CHILI protocols are that teleconferences are not possible, and that the user must take reasonable precautions for data privacy and security. The CHILI PlugIn mechanism enables the users or third parties to extend the system capabilities by adding powerful image postprocessing functions or interfaces to other information systems. Suitable PlugIns can be either existing programs, or dedicated applications programmed with interfaces to the CHILI components. The developer may freely choose programming languages and interface toolkits. The CHILI architecture is a powerful and flexible environment for Picture Archiving and Communications Systems (PACS)and teleradiology. More than 40 systems are currently running in clinical routine in Germany. More than 300,000 images have been distributed among the communication partners in the last two years. Feedback and suggestions from the users influenced the system architecture by a great extent. The proposed and implemented system has been optimized to be as platform independent, open, and secure as possible.

Radiology Information Systems↗
PubMed2005

A comprehensive portrait of teleradiology in radiology practices: results from the American College of Radiology's 1999 Survey.

OBJECTIVE: This article presents a comprehensive portrait of the characteristics of teleradiology systems of radiology practices as of 1999. Our purposes are to help profile a rapidly evolving area of radiology that has been underexamined to date and to provide a baseline with which future findings can be compared. MATERIALS AND METHODS: In 1999, the American College of Radiology surveyed 970 practices by mail. A response rate of 66% was achieved. Responses were weighted to represent all radiology practices in the United States. Data from nine questions specifically designed to profile the use of teleradiology were analyzed using descriptive statistical methods and multivariate regression analyses. RESULTS: Seventy-one percent of multiradiologist practices had teleradiology systems in place, using them to interpret 5% of their studies. For solo practices, corresponding statistics were 30% and 14%. Ninety-two percent of multiradiologist practices with teleradiology systems used them for preliminary on-call interpretation. Other major uses included consultation with other radiologists (20%) and primary interpretation of studies (18%). Ninety-five percent of multiradiologist practices with teleradiology systems used them to interpret CT, 84% used them for sonography, 69% for nuclear medicine, 47% for MRI, and 43% for conventional radiographs. CONCLUSION: Teleradiology had already become a fixture in most practices by 1999, though it was used for only a small fraction of image interpretations. Its widespread presence positioned teleradiology to become a key element of radiology practice nationwide.

Diagnostic Imaging↗
PubMed2003

[Questionnaire survey on teleradiology for radiological technologists: analyses by age group and facility type in Hokkaido].

A questionnaire survey was given to 1,951 radiological technologists in Hokkaido to examine their views on teleradiology. The questionnaire consisted of questions about their understanding of teleradiology and interest in it as well as examining the need for teleradiology and problems with it. A total of 1,275 radiological technologists responded to the survey, a response rate of 65.4%. The returned questionnaires were analyzed according to different groups categorized by age of the radiological technologists and type of medical facility. Almost all radiological technologists knew about teleradiology. Among the different age groups, the higher age groups showed greater recognition and understanding of teleradiology. About 60% of radiological technologists were interested in teleradiology (no significant differences among age groups). When it was assumed that a teleradiology system would be introduced, (1) the working load for radiological technologists was estimated to be about 17,820 (+/-24,233) yen per month. (2) Sixty percent of the respondents considered that the system should be used for the reading and diagnosis of difficult cases. (3) Fifty percent of them thought that the system should be managed and operated by radiological technologists. (4) Many radiological technologists pointed out problems concerning initial costs and the facility's management system.

Adult↗
PubMedDate not supplied

Rural teleradiology: a snapshot.

A national survey was conducted among rural hospitals active in teleradiology and their affiliated health care providers to delineate the current status of rural telemedicine. 109 telemedicine programs were identified that use teleradiology as well as other telemedicine applications, and 340 programs were identified that use only teleradiology. Programs that use only teleradiology have been in operation longer than programs that combine teleradiology with other telemedicine services. Most teleradiology facilities are adjacent to small metropolitan areas or in more rural counties with a population of at least 2500. Only 22% of the teleradiology-only facilities spend more than $60,000 on initial equipment, and annual transmission costs average less than $4,000 for most facilities. Ordinary copper telephone lines are the transmission medium most commonly used for transfer of radiology images. Radiographs and CT scans are the types of studies most commonly transmitted, followed by MRI and nuclear medicine studies.

Diffusion of Innovation↗