[Teleradiologic follow up of patients treated with aortic stent grafting]. / Teleradiologisk oppfølging av pasienter behandlet med stentgraft i aorta.

BACKGROUND: A study has confirmed the possibility of follow up in the local hospital of patients who have undergone endovascular repair. We present a cost analysis of such a regimen compared to follow up at a university hospital. MATERIAL AND METHODS: By using discharge data from the Norwegian Patient Register we identified a group of patients which could have been followed up at their local hospital for their stent-grafted abdominal aortic aneurysm and estimated the cost effects of performing follow ups locally. RESULTS: The cost analysis showed a potential for cost savings from local follow ups, especially from moving from inpatient care at the university hospital to outpatient care locally. The result of this cost analysis differs from other Norwegian studies of teleradiology by identifying a possibility for more cost-effective treatment. INTERPRETATION: Using teleradiology to follow up these patients will free up capacity in the university hospital. Most probably, other groups of patients can also be followed up by teleradiology. The university hospitals can use this freed-up capacity for new patients. Teleradiology could lead to more efficient use of health care facilities, which should be in the interest of the health authorities.

Three-dimensional teleradiology for surveillance following endovascular aortic aneurysm repair: a feasibility study.

PURPOSE: To study the feasibility of 3-dimensional (3D) teleradiology in surveillance of patients treated with stent-grafts for abdominal aortic aneurysm (AAA). METHODS: Between April 2002 and November 2003, 8 AAA patients (7 men; median age 73 years, range 62-84) with stent-grafts had follow-up computed tomograms (CT) performed at their local hospital and transmitted without loss across a broadband connection to the university hospital. On both monitors, the radiologists were presented with the complete CT axial dataset, sagittal and coronal reformatted slices, and a 3D volume-rendered reconstruction. The two radiologists were then able to simultaneously perform measurements and real-time manipulations of the axial and 3D pictures, which were discussed over the telephone or using a videoconferencing unit. Patient satisfaction, the radiologists' evaluation of the method, and the potential cost savings were explored. RESULTS: Twelve follow-up CT scans were performed on the 8 patients. The time for transmission over the teleradiological network averaged 5 minutes, and the evaluation required 15 minutes at the university hospital. The overall technical quality of the images was rated as good by the university radiologist. In 11 studies, the stent-grafts were satisfactory, but a type III endoleak was detected in one 5.5-year-old stent-graft. Neither radiologist had a problem identifying the endoleak. Patients had confidence that the examination at the local hospital was of good quality; they all felt that they received good care and were pleased with avoiding travel to the university hospital. From the economic analysis, an annual savings of 40,000 Euros (USD 52,304) was projected, mostly due to avoiding hospital stays and outpatient consultations at the university hospital. CONCLUSIONS: The experiences from this study are encouraging, but a larger series will be necessary for a thorough evaluation of 3D teleradiology as a surveillance method for aortic stent-graft patients.