Teleradiology continues to struggle with disparate systems, data

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SEATTLE—While the field of teleradiology continues to grow, many technological and communicative problems still need to be addressed, according to a presentation Friday by Raymond Geis, MD, of the Advanced Medical Imaging Consultants, at the 2008 Society of Imaging Informatics in Medicine (SIIM) annual meeting.

If radiologists at numerous, distinct settings read exams from disparate sites, virtual radiology group in imaging DMZ, workload balancing and subspecialty coverage must be taken into consideration, according to Geis. However, he said that teleradiology provides value-added interpretation and images to help clinician make decisions.

In working with central imaging informatics systems, “you must verify data, which is a huge issue when you first start doing this because it is hard to keep track of data coming in from all different areas. You should provide business support and advanced post processing, local archives and data demographic clinical images,” Geis said.

With teleradiology, the problem is that “everything is disparate, including cultures; imaging equipment; exam descriptors; protocols/contrast; security and firewalls; networks; and demographics, especially across different states, or the VA vs. private hospitals,” he said.

To combat these complications, he suggested that the radiologists create “some kind of personal thesaurus, so you can decipher the differences, in order to ensure standardization and consistency.”

For hardware, “there is no single point of failure.” To ensure efficiency, Geis made several recommendations to his fellow radiologists:

  • Try to duplicate everything, “so you can access it from two different places. Archive at originating and central sites;”
  • Network: More than one way to get from modality to radiology;
  • Archive: Think about it as “save everything, forever;”
  • Security: “You are taking data offsite, and therefore, it is easier for someone to hack into it. At least audit your workflow.”

With regard to teleradiology software, Geis stressed the need to purchase a thin-client, web-based solution. “This is the most important aspect, a necessity for teleradiology,” he said. Also for software usage, he suggested to archive with DICOM part 10, but “at least one copy should not be proprietary.” He also highlighted the importance of unified communication, especially with other radiologists, and suggested IM with colleagues.

Another “major unresolved issue” is access relevant patient medical history, especially relevant demographic data, which he described as “often hard to access.”

Geis also noted that face time with clinicians is rare, so the teleradiologist’s notes must be much more informative. Value-added extras are: key images, “for more information, go to…” and tailor the report to the audience. On this last point, he said that “many of the smaller hospitals want more direction in the report, while many of the bigger institutions do not want recommendations included in the report.” He noted that multiple dispersed radiologists should not equate to variation in interpretation.

Geis consistently stressed the importance of communication, in order to effectively provide radiology 24/7.