Emergence of teleradiology, PACS, and other radiology IT solutions in Acta Radiologica.

For this historical review, we searched a database containing all the articles published in Acta Radiologica during its 100-year history to find those on the use of information technology (IT) in radiology. After reading the full texts, we selected the presented articles according to major radiology IT domains such as teleradiology, picture archiving and communication systems, image processing, image analysis, and computer-aided diagnostics in order to describe the development as it appeared in the journal. Publications generally follow IT megatrends, but because the contents of Acta Radiologica are mainly clinically oriented, some technology achievements appear later than they do in journals discussing mainly imaging informatics topics.

[Assessment of teleradiology patients in a major regional hospital]. / Charakterisierung teleradiologisch untersuchter Patienten an einem Krankenhaus der Schwerpunktversorgung.

PURPOSE: To evaluate teleradiology examinations regarding the most frequently requested exams and examined body regions. Additionally, the frequency of pathological changes depending on the examined region and clinical situation as well as the time profile for requesting teleradiology (daytime, day of the week) were analyzed. MATERIALS AND METHODS: A retrospective analysis of all consecutive teleradiology exams in 2018 that were reported in the radiology department of a major regional hospital and scanned in three referring primary health care institutions regarding clinical history, working diagnosis and requested body region was performed. Additionally, the date and time of the examination were analyzed. RESULTS: A total of 1207 CT (computer tomography) scans that were reported as part of the teleradiology agreement were included. The most frequently requested examination was a cranial CT (77.9%) with 14.6% pathological findings, followed by abdominal CT (14%) with 63.9% pathological changes, spine/extremities (8.8%) with 50% pathological changes and CT of the chest (7.9%) with 53.7% abnormal scans. Most teleradiology requests were referred on weekends between 8 am and 4 pm, followed by 4 pm to 6 pm on weekdays. The smallest number of scans was requested between 2 am and 4 am. CONCLUSION: Most teleradiology CT requests focus on brain examinations, followed by abdominal CT, CT of the spine and extremities and CT chest. Most cranial CTs do not show an acute pathology, while abdominal CTs had the highest rate of pathological findings.

Results of an Italian survey on teleradiology.

OBJECTIVES: The aim of this study is to present the results of the Italian survey on teleradiology (TR). METHODS: Two radiologists created an online electronic survey using the Survey Monkey web-based tool. The questionnaire was then improved by suggestions from a multidisciplinary group of experts. In its final form, the survey consisted of 19 multiple-choice questions. Space was left below each question for participants to add their personal comments. Members of Italian Society of Medical Radiology (SIRM) were given 2 weeks to perform the survey. RESULTS: A total of 1599 radiologists, corresponding to 17 % of all SIRM radiologists, participated into the online survey. As a result, 62 % of participants have a positive opinion on teleradiology, while 80 % including 18 % with a negative opinion believe that teleradiology will have a future. 55 % of responders (n = 874) use teleradiology in their clinical practice. The majority of users adopt intra-mural teleradiology for coverage of emergencies (47 %), of night and weekend shifts (37 %) or to even out distribution workload (33 %). Most responders still show concern on the use of teleradiology. In particular, they think that teleradiology is too impersonal (40 %), and that it is responsible for insufficient communication with the referring clinician (39 %). CONCLUSIONS: The majority of Italian radiologists are favorable to teleradiology. However, they have concerns that teleradiology may further reduce communication with the referring clinician ad patient.

Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre: follow-up study.

INTRODUCTION: The optimal management strategy for patients with head injury admitted to a non-specialist hospital is uncertain. The aim of this study was to evaluate the outcomes of victims of head injury requiring hospitalisation but initially admitted to a rural level II trauma centre without a neurosurgical facility but with a system for neurosurgical consultation via teleradiology. METHODS: Patients admitted for head injury during 2006-2011 were included. Late transfer of patients initially hospitalised in the level II trauma centre was evaluated for treatment failure, defined as clinical or radiological deterioration. RESULTS: Five hundred and sixty-two patients were initially hospitalised in the level II trauma centre. Evaluation of late transfers showed that only 23 (4.1%) represented real treatment failures due to clinical or radiological deterioration. The clinical course was altered by primary intent to hospitalise patients in the level II trauma centre in only one patient. CONCLUSIONS: Selected patients with head trauma who have a pathological CT scan may be safely managed in level II trauma centres following neurosurgical consultation using teleradiology. Review of treatment failures is necessary to ensure proper ongoing management of a system in which neurosurgical patients are selectively transferred to trauma centres with neurosurgical capacity.

A Feasibility Study of Real-Time Remote CT Reading for Suspected Acute Appendicitis Using an iPhone.

We aimed to evaluate the feasibility of an iPhone-based remote control system as a real-time remote computed tomography (CT) reading tool for suspected appendicitis using a third-generation (3G) network under suboptimal illumination. One hundred twenty abdominal CT scans were selected; 60 had no signs of appendicitis, whereas the remaining 60 had signs of appendicitis. The 16 raters reviewed the images using the liquid crystal display (LCD) monitor of a picture archiving and communication system (PACS) workstation, as well as using an iPhone connected to the PACS workstation via a remote control system. We graded the probability of the presence of acute appendicitis for each examination using a five-point Likert scale. The overall sensitivity and specificity for the diagnosis of suspected appendicitis using the iPhone and the LCD monitor were high, and they were not significantly different (sensitivity P = 1.00, specificity P = 0.14). The average areas under the receiver operating characteristic curves for all CT readings with the iPhone and LCD monitor were 0.978 (confidence interval 0.965-0.991) and 0.974 (0.960-0.988), respectively, and the two devices did not have significantly different diagnostic performances (P = 0.55). The inter-rater agreement for both devices was very good; the kappa value for the iPhone was 0.809 (0.793-0.826), and that for the LCD monitor was 0.817 (0.801-0.834). Each rater had moderate-to-very good intra-observer agreement between the two devices. We verified the feasibility of an iPhone-based remote control system as a real-time remote CT reading tool for identifying suspected appendicitis using a 3G network and suboptimal illumination.

[Teleradiology: case series and experience acquired in the military field]. / La teleradiologia: casistica ed esperienza acquisita in ambito militare.

PURPOSE: Our aim was to evaluate the peculiarities of military teleradiology on the basis of the large case series collected between January 2006 and December 2010. MATERIALS AND METHODS: We analysed all radiological teleconsultations/telediagnoses requested by theatres of operations: Kosovo, Iraq, Chad, warships Etna (Indian Ocean) and Cavour (earthquake in Haiti), for a total of 1,132 cases. As part of the case series collected in Kosovo (n=827), we evaluated the entire sample of patients transferred to the Celio Military Hospital in Rome following a teleradiological diagnosis (27 examinations analysed). RESULTS: A total of 1,132 radiological examinations were requested (704 military and 428 civilians). Comparison between teleradiology diagnoses and diagnoses made after patient transfer showed almost perfect concordance based on Cohen's Kappa (κ) statistic (92.59% identical diagnoses), with only a small minority of false positive results (two cases, 7.4%). CONCLUSIONS: The use of teleradiology by the Military Medical Corps helped attain an accurate diagnosis in almost all cases, significantly reducing diagnostic errors and limiting transfers from theatres of operation to cases genuinely necessitating transfer.

The performance of outside readings by radiology practices.

OBJECTIVE: The purpose of our study was to determine how many radiology practices perform outside readings, what characteristics affect the prevalence and volume of outside readings, and how practices are paid for outside readings. MATERIALS AND METHODS: We analyzed data from the American College of Radiology's 2007 Survey of Radiologists, a stratified random sample e-mail and telephone survey. A total of 480 survey responses were evaluated; responses were weighted to make them representative of all U.S. radiology practices. We provide descriptive statistics and multivariable regression analysis results. RESULTS: Overall, 40% of radiology practices in the United States performed outside readings in 2007. Outside readings constituted an average of 11% of the workload of these practices and 4% of the total workload of radiologists in the United States. Other practice characteristics being equal, academic practices, government practices, radiology units of multispecialty groups, and small practices had particularly low odds of performing outside readings. If they did perform outside readings, then, other practice characteristics being equal, small practices, solo practices, radiology units of multispecialty groups, practices in the main cities of large metropolitan areas, and those in nonmetropolitan areas had, on average, a relatively large portion of their workload consisting of outside readings. By far, the most common methods of payment were directly billing for the professional component or receiving a flat fee per study. CONCLUSION: Outside readings were a common activity among radiology practices in 2007. There was substantial variability among practice types, sizes, and locations in whether practices performed outside readings and, if so, how much outside reading they did.

Teleradiology interpretations of emergency department computed tomography scans.

BACKGROUND: Teleradiologist interpretation of radiographic studies during after-hours Emergency Department (ED) care has the potential to influence patient management. STUDY OBJECTIVES: We sought to characterize frequencies of discrepancies between teleradiology and in-house radiology interpretations for computed tomography (CT) scans. METHODS: We conducted a prospective observational study comparing teleradiologist and in-house radiologist interpretations of CT scans obtained between 7:00 p.m. and 7:00 a.m. from the ED at a Level I trauma center. For each scan, discrepancies were characterized as major, minor, or no discrepancy. Follow-up data were used to characterize major discrepancies. RESULTS: Of 787 studies sent to teleradiology, 550 were scans of the head, cervical spine, chest, or abdomen and pelvis. Major discrepancies were identified in 32 of 550 studies (5.8%; 95% confidence interval 4.1%-8.1%), including 7 of 160 head CT scans, 1 of 29 cervical spine CT scans, 3 of 64 chest CT scans, and 21 of 297 abdominopelvic CT scans. We attributed 8 of the 32 major discrepancies to a teleradiology misinterpretation, with one case leading to an adverse event. CONCLUSIONS: We identified major discrepancies due to teleradiologist misinterpretation in 8 of 550 studies, with one patient suffering an adverse event. Our findings support the cautious use of teleradiology interpretations.

Work-style reform and use of information and communication technology among diagnostic radiologists in Japan: results of the 2018 JRS/JCR joint survey.

PURPOSE: The purpose of this study was to investigate recent trends in work-style reform and the use of information and communication technology (ICT) among board-certified diagnostic radiologists in Japan. MATERIALS AND METHODS: We conducted online questionnaire surveys of board-certified radiologists of the Japan Radiological Society (JRS) and registered training institutions. Completed surveys were obtained from 1192 radiologists and 275 training institutions (response rates of 25.5% and 38.1%, respectively). Respondents were assured of confidentiality. RESULTS: 13.5% (134/991) of full-time radiologists and 56.7% (89/157) of part-time radiologists had shifted some of their work to teleradiology at home. In addition, 52.9% (83/157) of part-time radiologists and 27.3% (12/44) of board-certified individuals who had stopped working as radiologists responded that they would consider starting full-time work in hospitals, if teleradiology at home was permitted as part of full-time work. Furthermore, 16.7% of training institutions (46/275) had introduced teleradiology systems for radiologists, and 47.2% (108/229) of the remaining training institutions wanted to introduce teleradiology systems in the future. CONCLUSION: Teleradiology using ICT is already a part of Japanese radiologists' workload. Work-style reform may progress with the use of ICT, such as part-time radiologists, and board-certified individuals who stop working as radiologists, becoming full-time radiologists.

Radiology practices' use of external off-hours teleradiology services in 2007 and changes since 2003.

OBJECTIVE: Our objective is to report patterns of utilization of external off-hours teleradiology services (EOTSs) in 2007 and changes since 2003. MATERIALS AND METHODS: We analyzed non-individually identified data from the American College of Radiology's 2007 Survey of Member Radiologists and its 2003 Survey of Radiologists. Responses were weighted to be nationally representative of individual radiologists and radiology practices. We present descriptive statistics and multivariable regression analysis results on the use of EOTSs in 2007 and comparisons with 2003. RESULTS: Overall, 44% of all radiology practices in the United States reported using EOTSs in 2007. These practices included 45% of all U.S. radiologists. Out-of-practice teleradiology had been used by 15% of practices in 2003. Regression analysis indicates that, other practice characteristics being equal, in 2007, primarily academic practices had lower odds of using EOTSs than private radiology practices. Also, large practices (>or= 30 radiologists) had lower odds of using EOTSs than practices with 15-29 radiologists. Small practices (1-10 radiologists) had high odds, but nonmetropolitan practices did not. There were no significant differences by geographic region of the United States. CONCLUSION: Use of EOTSs was widespread by 2007, and it had been increasing rapidly in the preceding few years. Patterns of use were generally as might be expected except that nonmetropolitan practices did not have high odds of using EOTSs.

Media messaging in diagnosis of acute CXR pathology: an interobserver study among residents.

The objectives of the study were to determine whether diagnostic accuracy and reliability by on-call teams is affected by communicating chest radiograph (CXR) images via instant messaging on smartphones in comparison to viewing on a workstation. 12 residents viewed 100 CXR images each with a 24% positive rate for significant or acute findings sent to their phones via a popular instant messaging application and reported their findings if any. After an interval of 42 days they viewed the original DICOM images on personal computers and again reported their findings. There were no statistically significant differences in accuracy, agreement, sensitivity, specificity, positive predictive value or negative predictive value between desktop workstation viewed images and images sent via the mobile application. Media messaging is a useful adjunct for quick second opinions on radiological images, without significant decay in diagnostic accuracy. If technical, ethical and legal issues are addressed, it could be incorporated into practice as a useful adjunct.

The state of teleradiology in 2003 and changes since 1999.

OBJECTIVE: The purpose of our study is to describe in detail the use of teleradiology in 2003 and to report on changes since 1999 in this rapidly evolving field. MATERIALS AND METHODS: We analyze non-individually identified data from the American College of Radiology's 2003 Survey of Radiologists, a stratified random sample mail survey that achieved a response rate of 63%, and data from the American College of Radiology's 1999 Survey of Practices. Responses were weighted to represent the distribution of individual radiologists and radiology practices nationwide. We present descriptive statistics and multivariable regression analysis results on the prevalence and uses of teleradiology in 2003 and comparisons with 1999. RESULTS: Overall, 67% of all radiology practices in the United States, which included 78% of all U.S. radiologists, reported using teleradiology. A significant increase (p < 0.05) was seen in the prevalence of teleradiology or PACS, from 58% of practices in 1999 to 73% in 2003. Regression results indicate that, other practice characteristics being equal, in 2003, primarily academic practices were less likely to use teleradiology than private radiology practices, and medium-sized practices (5-14 radiologists) were more likely to have teleradiology than larger ones. In practices using teleradiology, home was the most frequent receiving site in both 1999 (81%) and 2003 (75%), the percentages being not significantly different. CONCLUSION: Already a fixture of radiology practice in 1999, teleradiology increased in prevalence substantially by 2003. The primary use of teleradiology, transmission of images to home, did not change, suggesting that easing the burden of call remains the main use of teleradiology.

Referring physicians' attitudes toward international interpretation of teleradiology images.

OBJECTIVE: We evaluated referring physician attitudes toward the international interpretation of radiologic images. MATERIALS AND METHODS: A five-question, scenario-based survey describing features of a hypothetic local radiology firm compared with those of its hypothetic overseas counterpart, international radiology, was sent by mail to 350 physicians from a broad range of medical and surgical specialties. One hundred nineteen physicians responded, for a response rate of 34%. Referring physicians were asked to indicate their preference for local versus international interpretation in each scenario using a 5-point Likert scale, with a score of -2 indicating a strong preference for international services, 0 indicating no preference, and 2 indicating a strong preference for local services. RESULTS: When all variables are held to be equal, referring physicians strongly prefer local services (mean score, 1.77; SD, 0.77). When international teleradiology provides either a 2-day faster turnaround time for reports or a 30 dollars lower out-of-pocket cost to the patient, referring physicians still prefer local services, although less than they did with all variables held equal (mean score, 0.42-0.44; SD, 1.30-1.40). When international teleradiology provides both a 2-day faster turnaround time and a 30 dollars lower out-of-pocket cost to the patient, referring physicians preferred international teleradiology, albeit only slightly (mean, -0.25; SD, 1.50). Finally, when the credentials of the international radiologists are perceived to be less than those of the local radiologists, even in the face of faster turnaround time and 30 dollars lower cost to the patient, referring physicians overall strongly prefer local services (mean, 1.51; SD, 0.86). CONCLUSION: Referring physicians prefer local interpretation of radiologic images to international interpretation when all things are equal. However, the timeliness of image interpretation and the cost to the patient are important factors in this decision.

Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre.

OBJECTIVE: To assess the effect of teleradiology upon the need for transfer of head injured victims requiring hospitalisation but referred initially to a rural level 2 trauma centre without neurosurgical capacity. METHODS: Head injured patients requiring hospitalisation, admitted to a rural level 2 trauma centre between August 2003 and August 2005, were identified. A digitalised copy of the computed tomographic (CT) scan was transferred to the neurosurgical referral centre via teleradiology and was available for review by the neurosurgeon on-call, who then, together with the trauma surgeon in the rural level 2 trauma centre, decided whether to transfer the patient to the neurosurgical referral centre. RESULTS: Of 209 trauma victims with neurosurgical pathology in need of hospitalisation, 126 (60.2%) were immediately transferred while 83 (39.7%) of the patients were hospitalised in the rural level 2 trauma centre for observation. Two (2.4%) failed the intent to treat locally. One patient, suffering from multi-trauma, was stabilised after damage control laparotomy only to succumb to an enlarging epidural haematoma. Another patient was transferred 2 days after admission because of difficulty in clinical evaluation due to a previously existing neurological disorder, but no active treatment was necessary. All other 81 patients recovered uneventfully. CONCLUSIONS: Selective head injured patients with pathological CT scan may be safely managed in level 2 trauma centres. A committed trauma team in the rural trauma centre, neurosurgical consultation and availability of a teleradiology system are requisites. Currently existing transfer criteria should be carefully re-evaluated.

Adaptive threshold-based block classification in medical image compression for teleradiology.

Telemedicine, among other things, involves storage and transmission of medical images, popularly known as teleradiology. Due to constraints on bandwidth and storage capacity, a medical image may be needed to be compressed before transmission/storage. Among various compression techniques, transform-based techniques that convert an image in spatial domain into the data in spectral domain are very effective. Discrete cosine transform (DCT) is possibly the most popular transform used in compression of images in standards like Joint Photographic Experts Group (JPEG). In DCT-based compression the image is split into smaller blocks for computational simplicity. The blocks are classified on the basis of information content to maximize compression ratio without sacrificing diagnostic information. The present paper presents a technique along with computational algorithm for classification of blocks on the basis of an adaptive threshold value of variance. The adaptive approach makes the classification technique applicable across the board to all medical images. Its efficacy is demonstrated by applying it to CT, X-ray and ultrasound images and by comparing the results against the JPEG in terms of various objective quality indices.

Consultation times in emergency telemedicine using realtime videoconferencing.

We reviewed 2135 consecutive emergency teleconsultations, which were received at an academic emergency department from state correctional facilities. During the 52-week study period, an average of 5.8 video-consultations per day were performed. A total of 1522 consultations (71%) had complete start and end consultation times, and were included in the analysis. Of these, 923 were managed primarily by emergency medicine residents and physician assistants, while the remaining 599 were managed by attending physicians alone. Following consultation, the disposition of the patients included 940 who were transported to the emergency department, 351 who were discharged to the general facility population and 193 who were admitted to the local infirmary. Overall, 38% of patients avoided a journey to the emergency department. The average consultation time was 17 min (95% confidence interval [CI], 10-24). The average consultation time for residents and physician assistants was 16 min (95% CI, 8-24) and it was 19 min (95% CI, 11-27) for attending physicians. Consultation time for patients not transported to the emergency room was 21 min (95% CI, 13-29), while for patients transferred to an emergency department, consultation time was 15 min (95% CI, 9-21). These results may assist in planning the workforce requirements for emergency department-based telemedicine services.

A novel approach to optimize workflow in grid-based teleradiology applications.

BACKGROUND AND OBJECTIVE: This study proposes an infrastructure with a reporting workflow optimization algorithm (RWOA) in order to interconnect facilities, reporting units and radiologists on a single access interface, to increase the efficiency of the reporting process by decreasing the medical report turnaround time and to increase the quality of medical reports by determining the optimum match between the inspection and radiologist in terms of subspecialty, workload and response time. METHODS: Workflow centric network architecture with an enhanced caching, querying and retrieving mechanism is implemented by seamlessly integrating Grid Agent and Grid Manager to conventional digital radiology systems. The inspection and radiologist attributes are modelled using a hierarchical ontology structure. Attribute preferences rated by radiologists and technical experts are formed into reciprocal matrixes and weights for entities are calculated utilizing Analytic Hierarchy Process (AHP). The assignment alternatives are processed by relation-based semantic matching (RBSM) and Integer Linear Programming (ILP). RESULTS: The results are evaluated based on both real case applications and simulated process data in terms of subspecialty, response time and workload success rates. Results obtained using simulated data are compared with the outcomes obtained by applying Round Robin, Shortest Queue and Random distribution policies. The proposed algorithm is also applied to a real case teleradiology application process data where medical reporting workflow was performed based on manual assignments by the chief radiologist for 6225 inspections. CONCLUSIONS: RBSM gives the highest subspecialty success rate and integrating ILP with RBSM ratings as RWOA provides a better response time and workload distribution success rate. RWOA based image delivery also prevents bandwidth, storage or hardware related stuck and latencies. When compared with a real case teleradiology application where inspection assignments were performed manually, the proposed solution was found to increase the experience success rate by 13.25%, workload success rate by 63.76% and response time success rate by 120%. The total response time in the real case application data was improved by 22.39%.

The Effects of Real-Time Interactive Multimedia Teleradiology System.

This study describes the design of a real-time interactive multimedia teleradiology system and assesses how the system is used by referring physicians in point-of-care situations and supports or hinders aspects of physician-radiologist interaction. We developed a real-time multimedia teleradiology management system that automates the transfer of images and radiologists' reports and surveyed physicians to triangulate the findings and to verify the realism and results of the experiment. The web-based survey was delivered to 150 physicians from a range of specialties. The survey was completed by 72% of physicians. Data showed a correlation between rich interactivity, satisfaction, and effectiveness. The results of our experiments suggest that real-time multimedia teleradiology systems are valued by referring physicians and may have the potential for enhancing their practice and improving patient care and highlight the critical role of multimedia technologies to provide real-time multimode interactivity in current medical care.

[Teleradiology: economic research analysis of CT investigations in a small hospital]. / Teleradiologie: Betriebswirtschaftliche Analyse von CT-Untersuchungen eines kleineren Krankenhauses.

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.