The ABCs of Teleradiology Quality Control

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The basics of teleradiology QC include speed, security and accuracy. How do you get the images - often data-intensive multislice CT studies - from here to there and back fast, securely and accurately? And while technical issues are a top priority, credentialing and customer service need to be considered in the QC equation, too.

The teleradiology business is booming. "Within the last few years, we've seen all teleradiology companies double their operations every six months with no signs of business slowing down," says Brent Backhaus, chief technology officer for Virtual Radiologic Consultants (VRC of Minneapolis).

Why the boom? For starters, teleradiology can aid the bottom line. Take Deaconess Billing Clinic (Billings, Mont.). The hospital pays Nighthawk Radiology (headquartered in Coeur d' Alene, Idaho, with remote reading in Sydney, Australia) about $20,000 a month for overnight reading services. PACS Specialists Laurie Walter points out, "That's a lot less expensive than a night radiologist."

The surge is not limited to nighthawk services. Both nighthawk providers and anytime-anywhere reading by staff radiologists can improve patient care by providing access to subspecialists. And let's not forget the radiologist shortage. Teleradiology can keep radiologists happy by shouldering (or at least easing) the night-reading
burden, and it can be used to fill gaps by providing a part-time FTE radiologist.

Sites that develop and adhere to a solid QC plan will reap the benefits of efficient and effective teleradiology. But a missing ingredient can frustrate clinicians, compromise patient care, violate HIPAA or chip away at the bottom line. Fortunately,
getting it right is fairly straightforward.

MEETING THE NEED FOR SPEED

Getting the images where they need to be means high-speed internet connections these days. "Faster [internet connections] are always better, but cost more," VRC's Backhaus explains. Options include business class DSL or cable modems, T1 lines, DS3 (essentially 3 T1 lines bunched together) and corporate intranets. Typically, a high-speed cable modem ensures a download speed in the range of 6 to 9 megabits per second. Backhaus says sites with a slower bandwidth connection might install an image compression gateway device to facilitate faster data transfer with the teleradiology vendor.

Most hospitals encounter some tradeoffs as far as speed, image compression and image quality. VRC's Backhaus says it typically takes about 13.5 minutes to transmit 100 CT slices from a hospital to VRC servers if the hospital has a T1, business-class DSL or business-class cable internet connection without any image compression in use. With an image compression device in place, diagnostic quality images can be transmitted from one side of the United States to the other at the rate of 100 CT slices in 57 seconds. The tradeoff that the hospital must evaluate involves the cost of the internet connection, the cost of an image compression device, the potential for over-compression leading to unacceptable image quality and the desire to transmit data as quickly as possible.

Next Generation Radiology (Great Neck, N.Y.) relies on eMed's (Burlington, Mass.) eMed.net Enterprise to enable real-time remote radiology services. eMed Matrix serves as the practice's PACS solution. The practice's four imaging locations communicate with a central server and archive, with eight remote reading stations that query the server. Next Generation provides web access for referring physicians and outsources some work to university centers. David Katz, MD, president of Next Generation, admits, "It requires a real dedication to IT." The practice relies on a pair of fused T1 lines, a.k.a. "a fat pipe," to provide the bandwidth of two T1 lines and enable radiologists to download and read images within minutes of study completion.

Deaconess Billings Clinics uses a Radworks 6.1 sending station coupled with a T1 connection and high-speed VPN to transfer images from Montana to Sydney; the set-up transfers a head CT in two to three minutes.

MacNeal Health Network (Berwyn, Ill.) is close to a teleradiology pioneer; the health system has relied on Images on Call (IOC of Dallas) tools to enable radiologists to complete night readings at home for about a decade. IOC's ViewStation Software, DICOM Gateway, Video DigitizerStation and Sockets Internet facilitate the teleradiology process. The hospital is equipped with a DSL line, and radiologists' home workstations are connected