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Goelz L, Arndt H, Hausmann J, Madeja C, Mutze S. Obstacles and Solutions Driving the Development of a National Teleradiology Network. Healthcare (Basel) 2021; 9:healthcare9121684. [PMID: 34946410 PMCID: PMC8701208 DOI: 10.3390/healthcare9121684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/03/2021] [Accepted: 12/04/2021] [Indexed: 02/07/2023] Open
Abstract
Background: Teleradiology has the potential to link medical experts and specialties despite geographical separation. In a project report about hospital-based teleradiology, the significance of technical and human factors during the implementation and growth of a teleradiology network are explored. Evaluation: The article identifies major obstacles during the implementation and growth of the teleradiology network of the Berlin Trauma Hospital (BG Unfallkrankenhaus Berlin) between 2004 and 2020 in semi-structured interviews with senior staff members. Quantitative analysis of examination numbers, patient numbers, and profits relates the efforts of the staff members to the monetary benefits and success of the network. Identification of qualitative and quantitative factors for success: Soft and hard facilitators and solutions driving the development of the national teleradiology network are identified. Obstacles were often solved by technical innovations, but the time span between required personal efforts, endurance, and flexibility of local and external team members. The article describes innovations driven by teleradiology and hints at the impact of teleradiology on modern medical care by relating the expansion of the teleradiology network to patient transfers and profits. Conclusion: In addition to technical improvements, interpersonal collaborations were key to the success of the teleradiology network of the Berlin Trauma Hospital and remained a unique feature and selling point of this teleradiology network.
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Affiliation(s)
- Leonie Goelz
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany; (H.A.); (J.H.); (C.M.); (S.M.)
- Correspondence: ; Tel.: +49-30-56813829; Fax: +49-30-56813803
| | - Holger Arndt
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany; (H.A.); (J.H.); (C.M.); (S.M.)
| | - Jens Hausmann
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany; (H.A.); (J.H.); (C.M.); (S.M.)
| | - Christian Madeja
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany; (H.A.); (J.H.); (C.M.); (S.M.)
| | - Sven Mutze
- Department of Radiology and Neuroradiology, BG Klinikum Unfallkrankenhaus Berlin, Warener Straße 7, 12683 Berlin, Germany; (H.A.); (J.H.); (C.M.); (S.M.)
- Institute for Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany
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Abstract
This update of Turkish Society of Radiology's (TSR) guidelines for the practice of teleradiology is intended to provide a reference framework for all parties involved in delivering imaging services away from the immediate vicinity of the patient. It includes relevant definitions and general principles, features organizational modes and qualifications of the practicing parties, lists technical issues, and addresses such management and legal aspects as archiving and documentation, security and privacy, reliability, responsibilities, quality inspection and improvement, reimbursement and accountability.
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Affiliation(s)
- Mustafa Nasuh Özmen
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
| | - Oğuz Dicle
- Department of Radiology, Dokuz Eylül University School of Medicine, İzmir, Turkey
| | - Utku Şenol
- Department of Radiology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Üstün Aydıngöz
- Department of Radiology, Hacettepe University School of Medicine, Ankara, Turkey
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Johnston K, Smith D, Preston R, Evans R, Carlisle K, Lengren J, Naess H, Phillips E, Shephard G, Lydiard L, Lattimore D, Larkins S. "From the technology came the idea": safe implementation and operation of a high quality teleradiology model increasing access to timely breast cancer assessment services for women in rural Australia. BMC Health Serv Res 2020; 20:1103. [PMID: 33256724 PMCID: PMC7708244 DOI: 10.1186/s12913-020-05922-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 11/13/2020] [Indexed: 12/18/2022] Open
Abstract
Breast cancer is the most commonly diagnosed cancer in Australian women. Providing timely diagnostic assessment services for screen-detected abnormalities is a core quality indicator of the population-based screening program provided by BreastScreen Australia. However, a shortage of local and locum radiologists with availability and appropriate experience in breast work to attend onsite assessment clinics, limits capacity of services to offer assessment appointments to women in some regional centres. In response to identified need, local service staff developed the remote radiology assessment model for service delivery. This study investigated important factors for establishing the model, the challenges and enablers of successful implementation and operation of the model, and factors important in the provision of a model considered safe and acceptable by service providers. METHODS Semi-structured interviews were conducted with service providers at four assessment services, across three jurisdictions in Australia. Service providers involved in implementation and operation of the model at the service and jurisdictional level were invited to participate. A social constructivist approach informed the analysis. Deductive analysis was initially undertaken, using the interview questions as a classifying framework. Subsequently, inductive thematic analysis was employed by the research team. Together, the coding team aggregated the codes into overarching themes. RESULTS 55 service providers participated in interviews. Consistently reported enablers for the safe implementation and operation of a remote radiology assessment clinic included: clinical governance support; ability to adapt; strong teamwork, trust and communication; and, adequate technical support and equipment. Challenges mostly related to technology and internet (speed/bandwidth), and maintenance of relationships within the group. CONCLUSIONS Understanding the key factors for supporting innovation, and implementing new and safe models of service delivery that incorporate telemedicine, will become increasingly important as technology evolves and becomes more accessible. It is possible to take proposed telemedicine solutions initiated by frontline workers and operationalise them safely and successfully: (i) through strong collaborative relationships that are inclusive of key experts; (ii) with clear guidance from overarching bodies with some flexibility for adapting to local contexts; (iii) through establishment of robust teamwork, trust and communication; and, (iv) with appropriate equipment and technical support.
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Affiliation(s)
- Karen Johnston
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia.
| | - Deborah Smith
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Robyn Preston
- School of Health, Medical and Applied Sciences, CQUniversity, QLD, Townsville, 4810, Australia
| | - Rebecca Evans
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Karen Carlisle
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
| | - Janet Lengren
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Helen Naess
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Elizabeth Phillips
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | - Greg Shephard
- BreastScreen Queensland, PO Box 2368, Fortitude Valley BC, Qld, 4006, Australia
| | | | | | - Sarah Larkins
- College of Medicine and Dentistry, James Cook University, QLD, Douglas, 4814, Australia
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Weikert T, Sommer G, Tamm M, Haegler P, Cyriac J, Sauter AW, Hostettler K, Bremerich J. Centralized expert HRCT Reading in suspected idiopathic pulmonary fibrosis: Experience from an Eurasian teleradiology program. Eur J Radiol 2019; 121:108719. [PMID: 31706232 DOI: 10.1016/j.ejrad.2019.108719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/08/2019] [Accepted: 10/19/2019] [Indexed: 11/17/2022]
Abstract
PURPOSE To share experience from a large, ongoing expert reading teleradiology program in Europe and Asia aiming at supporting referring centers to interpret high-resolution computed tomography (HRCT) with respect to presence of Usual Interstitial Pneumonia (UIP)-pattern in patients with suspected Idiopathic Pulmonary Fibrosis (IPF). METHOD We analyzed data from 01/2014 to 05/2019, including HRCTs from 239 medical centers in 12 European and Asian countries that were transmitted to our Picture Archiving and Communication System (PACS) via a secured internet connection. Structured reports were generated in consensus by a radiologist with over 20 years of experience in thoracic imaging and a pulmonologist with specific expertise in interstitial lung disease according to current guidelines on IPF. Reports were sent to referring physicians. We evaluated patient characteristics, technical issues, report turnaround times and frequency of diagnoses. We also conducted a survey to collect feedback from referring physicians. RESULTS HRCT image data from 703 patients were transmitted (53.5% male). Mean age was 63.7 years (SD:17). In 35.1% of all cases diagnosis was "UIP"/"Typical UIP". The mean report turnaround time was 1.7 days (SD:2.9). Data transmission errors occurred in 7.1%. Overall satisfaction rate among referring physicians was high (8.4 out of 10; SD:3.2). CONCLUSIONS This Eurasian teleradiology program demonstrates the feasibility of cross-border teleradiology for the provision of state-of-the-art reporting despite heterogeneity of referring medical centers and challenges like data transmission errors and language barriers. We also point out important factors for success like the usage of structured reporting templates.
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Affiliation(s)
- Thomas Weikert
- University Hospital Basel, University of Basel, Department of Radiology, Petersgraben 4, 4031 Basel, Switzerland.
| | - Gregor Sommer
- University Hospital Basel, University of Basel, Department of Radiology, Petersgraben 4, 4031 Basel, Switzerland.
| | - Michael Tamm
- University Hospital Basel, University of Basel, Clinics of Respiratory Medicine, Petersgraben 4, 4031 Basel, Switzerland.
| | - Patrizia Haegler
- Boehringer Ingelheim (Switzerland) GmbH, Hochbergerstrasse 60B, 4057 Basel, Switzerland.
| | - Joshy Cyriac
- University Hospital Basel, University of Basel, Department of Radiology, Petersgraben 4, 4031 Basel, Switzerland.
| | - Alexander W Sauter
- University Hospital Basel, University of Basel, Department of Radiology, Petersgraben 4, 4031 Basel, Switzerland.
| | - Katrin Hostettler
- University Hospital Basel, University of Basel, Clinics of Respiratory Medicine, Petersgraben 4, 4031 Basel, Switzerland.
| | - Jens Bremerich
- University Hospital Basel, University of Basel, Department of Radiology, Petersgraben 4, 4031 Basel, Switzerland.
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Bashshur RL, Krupinski EA, Thrall JH, Bashshur N. The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence. Telemed J E Health 2016; 22:868-898. [PMID: 27585301 PMCID: PMC5107673 DOI: 10.1089/tmj.2016.0149] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/10/2016] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. METHODS A selective review of the credible literature during the past decade (2005-2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. FINDINGS The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.
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Affiliation(s)
| | | | - James H. Thrall
- Department of Radiology, Massachusetts General Hospital, Harvard, Boston, Massachusetts
| | - Noura Bashshur
- University of Michigan Health System, Ann Arbor, Michigan
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Abstract
The science and applications of informatics in medical imaging have advanced dramatically in the past 25 years. This article provides a selective overview of key developments in medical imaging informatics. Advances in standards and technologies for compression and transmission of digital images have enabled Picture Archiving and Communications Systems (PACS) and teleradiology. Research in speech recognition, structured reporting, ontologies, and natural language processing has improved the ability to generate and analyze the reports of imaging procedures. Informatics has provided tools to address workflow and ergonomic issues engendered by the growing volume of medical image information. Research in computeraided detection and diagnosis of abnormalities in medical images has opened new avenues to improve patient care. The growing number of medical-imaging examinations and their large volumes of information create a natural platform for "big data" analytics, particularly when joined with high-dimensional genomic data. Radiogenomics investigates relationships between a disease's genetic and gene-expression characteristics and its imaging phenotype; this emerging field promises to help us better understand disease biology, prognosis, and treatment options. The next 25 years offer remarkable opportunities for informatics and medical imaging together to lead to further advances in both disciplines and to improve health.
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Affiliation(s)
| | | | - C E Kahn
- Charles E. Kahn, Jr., Department of Radiology, 3400 Spruce Street, 1 Silverstein, Philadelphia, PA 19104, USA, E-mail:
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Coppola F, Bibbolino C, Grassi R, Pierotti L, Silverio R, Lassandro F, Neri E, Regge D. Results of an Italian survey on teleradiology. Radiol Med 2016; 121:652-9. [PMID: 27108418 DOI: 10.1007/s11547-016-0640-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2016] [Accepted: 04/05/2016] [Indexed: 10/21/2022]
Abstract
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.
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