Quality improvement through teleradiology: Opportunities and challenges

[Teleradiology: case series and experience acquired in the military field]

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.

"Initiate-build-operate-transfer"--a strategy for establishing sustainable telemedicine programs in developing countries: initial lessons from the balkans

Establishing sustainable telemedicine has become a goal of many developing countries around the world. Yet, despite initiatives from a select few individuals and on occasion from various governments, often these initiatives never mature to become sustainable programs. The introduction of telemedicine and e-learning in Kosova has been a pivotal step in advancing the quality and availability of medical services in a region whose infrastructure and resources have been decimated by wars, neglect, lack of funding, and poor management. The concept and establishment of the International Virtual e-Hospital (IVeH) has significantly impacted telemedicine and e-health services in the Balkans. The success of the IVeH in Kosova has led to the development of similar programs in other Balkan countries and other developing countries in the hope of modernizing and improving their healthcare infrastructure. A comprehensive, four-pronged strategy, "Initiate-Build-Operate-Transfer" (IBOT), may be a useful approach in establishing telemedicine and e-health educational services in developing countries. The development strategy, IBOT, used by the IVeH to establish and develop telemedicine programs, was discussed. IBOT includes assessment of healthcare needs of each country, the development of a curriculum and education program, the establishment of a nationwide telemedicine network, and the integration of the telemedicine program into the healthcare infrastructure. The endpoint is the transfer of a sustainable telehealth program to the nation involved. By applying IBOT, a sustainable telemedicine program of Kosova has been established as an effective prototype for telemedicine in the Balkans. Once fully matured, the program will be transitioned to the national Ministry of Health, which ensures the sustainability and ownership of the program. Similar programs are being established in Albania, Macedonia, and other countries around the world. The IBOT model has been effective in creating sustainable telemedicine and e-health integrated programs in the Balkans and may be a good model for establishing such programs in developing countries.

The changing face of radiology: from local practice to global network

Rapid advances in communications and computing technology have opened up new opportunities for clinical teleradiology. The quality of teleradiology reporting, when carried out properly, is on par with onsite reporting, and offers the potential for increased accuracy and improved patient outcomes. Local and international industry organisations and professional bodies are creating standards, policies and protocols for every aspect of teleradiology in response to concerns about the use of this technology. The key factor for the long-term success of teleradiology has been identified as a commitment to ensuring duty of care to patients (encompassing high-quality service and patient safety) is the first priority. Evidence indicates that increased use of teleradiology will be a step forward if managed well, but requires a commitment to excellence, patience and perseverance.

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.

Clinical-oriented collaboration over the Web during interventional radiology procedures

Multidisciplinary collaboration is a key requirement in several contemporary interventional radiology procedures (IRPs). We proposed a hybrid system (NetAngio) to enable "on the fly" heterogeneous collaboration to support IRP providing intraoperating essential services, and investigate its feasibility and effectiveness in a referral medical center. We have developed a Web-based, cost-effective structure, able to support real-time mentoring, image manipulation, and education services beyond the boundaries of the single institution and potentially allow sub specialists to participate in opinion and decision making in more complex cases. Supported services based on a Motion Joint Photographic Experts Group (MJPEG) coder/decoder (CODEC) can be easily accessible by authorized collaborators, within a user-friendly interface by using a typical Web-browser. Ten interventional radiologists, two vascular surgeons and two medical physicists participated in 33 "fully collaborative" cases during a 13-month period from January 2004 to February 2005. In addition, fifteen 90-minute open seminars and finally, 75 expert's module activations, and 255 learner's module activations were performed during the evaluation period. Collaborative procedures are able to enhance outcomes performance especially in more complex cases where the simultaneous presence of a remote expert interventionist and a medical physicist or a surgeon is required. Further research is needed to promote integration of additional data sources and services.

Structural brain imaging in patients with cognitive impairment in the year 2015

Cognitive impairment, especially in its early stages, is associated with very mild signs and symptoms that are difficult to detect by clinical and neuropsychological assessment. Advanced imaging analysis techniques applied to magnetic resonance images allow the detection of cerebral structural changes in vivo in mildly affected patients, and might be a useful supporting tool in the early diagnosis and treatment of patients with cognitive impairment. The increasing importance of computer science in cognitive neuroscience has led to the dissemination of a new discipline, neuroinformatics, which is crucial for the introduction of research findings into clinical practice. This review describes some advanced imaging analysis techniques aimed at studying brain structural images and how these techniques might benefit clinical practice through image data sharing and remote analysis in order to increase the accuracy of diagnosis in patients with cognitive impairment.