Subspecialty Teleradiology: Expertise You Need, Now

Illustration: Veer/Matt FosterThe virtues of teleradiology have quickly grown beyond the simple definition of remote reading and interpretation of imaging studies, as support for overflow, or as back-up during nighttime hours. It’s now an effective way to revolutionize your practice. For example, if you are an upstart, it can level the playing field with larger facilities with their own full team of radiologists with expertise in various subspecialties. It can also save you a lot of money.

Getting a second look

Going with a teleradiology company allowed Augusta Cardiology Clinic, a cardiology group based in Augusta, Ga., to kill two radiological birds with one stone. By contracting with USTeleradiology, a group based out of Atlanta that is affiliated with Neurostar Solutions, they not only got the over-reads their cardiologists wanted for portions of cardiac computed tomography angiography (CTA) images they produce, but they also got a way to store images.

Augusta Cardiology Clinic operates in a pretty small niche, doing only calcium scoring and a variety of coronary CTAs. A majority of the work done with the CTAs is performed by their own cardiologists. They only send a portion of the image over to be over-read, so in a sense they use USTeleradiology as subspecialty teleradiology in reverse.

They use USTeleradiology “to evaluate the images for everything besides the angiography-related portions of the studies,” says Philip James, CT technologist for Augusta Cardiology Clinic. Beyond their own doctors, patients have benefited from extra pairs of eyes. “We’ve had several instances where the radiologists have found cysts in abdomens, or other masses in the abdomens. We’ve found a few things that we weren’t expecting to see.”

Otherwise, he adds, “we needed a way to store the data. We found that with a typical study we were eating up 2 to 3 discs. That’s a lot of discs if we do very many of these. So, we’re also using them for storage as well.”

USTeleradiology makes use of Neurostar’s HIPAA compliant, web-based teleradiology system to manage the images and data from its clients.
“Normally we get a report back in 24 hours. They will fax us a copy and then 48 hours later, we receive a copy in the mail,” says James. “When they find something unusual, they will call us and let us know the same day they do the study. And if we’ve got one that we’re really concerned about, they have been able to give us a call back within 30 to 45 minutes to give us a wet read on it, too.”

The clinic is only sending about three of these studies a week, and it costs about $60 to $65 each. But James says that going this route has saved them tens of thousands of dollars compared to other teleradiology and storage options they researched. It took about 4 to 6 weeks to install the whole process and equipment at their facility, including training, he says.

They have lifetime storage for the studies, and their physicians can retrieve the studies they send over via a web connection from anywhere.

Building your business with specificity

Despite all of its other benefits, the reason that Central Medical Imaging, a free-standing imaging center located 15 miles south of Detroit, went with subspecialty teleradiology is the ability of specialists to provide reporting with extreme detail.

When it comes to surgery “there is no such thing as too much detail,” says Jack Eastham, director of imaging, chief operating officer. So when a subspecialty radiologist is interpreting, you’re getting more detail than would be available from a general radiologist, he says, adding that after all “it’s a service industry. It is healthcare still, but it’s service and we provide a beautiful report.”

Rather than go with expensive in-house radiologists that they would have to keep on-site nearly around the clock, they inked a deal with subspecialty teleradiology provider Franklin & Seidelmann (F&S) for their service. They couldn’t be happier.

“Subspecialty radiology has grown my business because they offer expertise in each aspect of the anatomy. Because of subspecialty radiology, I’ve had a more broad scale of specialist referring physicians such as orthopedic surgeons, neurosurgeons” send patients, he says.

This is a big deal because they are an imaging center that is not affiliated with any hospital or health system in the Detroit area. Offering this type of service has leveled the playing field for them.

Eastham says that he now markets to specific groups of doctors such as ENT physicians, orthopedic surgeons, and oncologists, because they see the reporting, the quality of the image, and the service which “you can’t beat.” In fact, he’s confident enough in what they offer to turn the tables on physicians and ask, “’why aren’t you sending us your patients?’ I put it on their plate.”

Speed and quality assurance also have been benefits. The patient is scanned at their facility and within an hour the studies are placed in their RadWorks PACS and then transmitted over to F&S. Within 12 to 24 hours, the report is complete. The referring physicians do have access to the reports via the internet, but they provide a fax directly to their office as well.

As for quality, F&S assisted them in setting their imaging protocols, and because they see the images they are producing around the clock, they are the first to say that there is degradation in the image quality and they will work with their technologists to fix it, he says.


Teleradiology — whether it is used in the subspecialty realm or to increase flexibility and expertise — offers a way to greatly expand a hospital or imaging center’s own expertise. Essentially it makes expertise portable and easy to add, whether it is used for a very specific part of a specific image, or whether an entire business model is based around it. The end benefit, as with all positive industry developments, is better patient care and broader available to a wider range of studies for consumers.