Teleradiologie – Update 2014

Tablets as an Option for Telemedicine-Evaluation of Diagnostic Performance and Efficiency in Intracranial Arterial Aneurysm Detection

Purpose: To evaluate a commercially available mobile device for the highly specialized task of detection of intracranial arterial aneurysm in telemedicine. Methods: Six radiologists with three different levels of experience retrospectively interpreted 60 computed tomography (CT) angiographies for the presence of intracranial arterial aneurysm, among them 30 cases with confirmed positive findings. Each radiologist reviewed the angiography datasets twice: once on a dedicated medical-grade workstation and on a commercially available mobile consumer-grade tablet with an interval of 3 months. Diagnostic performance, reading efficiency and subjective scorings including diagnostic confidence were analyzed and compared. Results: Diagnostic performance was comparable on both devices regardless of readers’ experience, and no significant differences in sensitivity (66–87.5%) and specificity (79.4–87%) were found. Results obtained with tablets and medical workstations were also comparable in terms of subjective assessment across all reader groups. Conclusions: There was no significant difference between tablet and workstation readings of angiography datasets for the presence of intracranial arterial aneurysm. Sensitivity, specificity, efficiency and subjective scorings were similar with the two devices for all three reader groups. While medical workstations are 10 times more expensive, tablets allow higher mobility especially for radiologists on call.

Obstacles and Solutions Driving the Development of a National Teleradiology Network

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.

Evaluation of diagnostic accuracy of intracranial aneurysm detection using medical-grade versus commercial consumer-grade displays and different image reconstructions against the background of process optimization for telemedicine

BACKGROUND

Process optimization in computed tomography (CT) and telemedicine.

PURPOSE

To compare image quality and objective diagnostic accuracy of medical-grade and consumer-grade digital displays/computer terminals for detection of intracranial aneurysms.

MATERIAL AND METHODS

Four radiologists with different levels of experience retrospectively read a total of 60 patients including 30 cases of proven therapy-naïve intracranial aneurysm detectable on a medical-grade grayscale calibrated display. They had 5 min per case reading the first 20 datasets using only axial slices, the next 20 patients using axial slices and multiplanar reconstructions (MPRs), and the last 20 patients using axial slices, MPRs, and maximum intensity projections (MIPs). Three months after the first reading session on a medical-grade display, they read all datasets again under the same standardized conditions but on a consumer-grade display. Diagnostic performance, subjective diagnostic confidence, and reading speed were analyzed and compared. Readers rated image quality on a five-point Likert scale.

RESULTS

Diagnostic accuracy did not differ significantly with areas under the curve of 0.717-0.809 for all readers on both display devices. Sensitivity and specificity did not increase significantly when adding MPRs and/or MIPs. Reading speed was similar with both devices. There were no significant differences in subjective image quality scores, and overall inter-reader variability of all subjective parameters correlated positively between the two devices (P <0.001-0.011).

CONCLUSION

Diagnostic accuracy and readers' diagnostic confidence in detecting and ruling out intracranial aneurysm were similar on commercial-grade and medical-grade displays. Additional reconstructions did not increase sensitivity/specificity or reduce the time needed for diagnosis.

The compliance with and knowledge about radiation protection in operating room personnel: a cross-sectional study with a questionnaire

INTRODUCTION

Radiation protection is becoming more important with an ongoing increase in radiation exposure due to the use of X-rays in minimally invasive procedures in orthopaedic and trauma surgeries. However, sufficient education in medical physics and radiation protection can often be improved.

MATERIALS AND METHODS

A questionnaire consisting of four questions about personal data and ten questions about radiation protection was distributed to lead consultants, consultants, residents, medical students, and medical technical assistants at two institutions, a level 1 trauma center and a children's hospital.

RESULTS

This study consisted of 83 participants. The compliance with radiation protection, i.e., usage of a dosimetry, an apron, and a thyroid shield on a regular basis was only seen in 54 %. Participants from the trauma center wore a dosimeter and thyroid shield significantly more often. The regular use of a thyroid shield differed significantly between job positions. It was observed in 80 % of students, but only 15 % of technical assistants. Only 65 % of all knowledge questions were answered correctly. There was a discrepancy between incorrectly answered knowledge questions (35 %) and those marked as uncertain (20 %). Different job positions did not have an impact on the answers to the questions in most instances.

CONCLUSIONS

The compliance with and the knowledge about radiation protection seems to be unnecessarily low in trauma physicians and technical assistants. The discrepancy in falsely answered questions and those marked as uncertain may suggest that participants may overestimate their knowledge about radiation protection, which is potentially harmful due to the increased radiation exposure. Therefore, we advocate a quick and valuable training of trauma surgeons and medical staff addressing the important preventive measures, some of which are illustrated in the present study. These consist of wearing dosimetry and protection devices, reduction in X-ray duration, preferably antero-posterior C-arm positioning with the image intensifier close to the patient and the surgeon, maximal distance, collimation, and increased voltage. Furthermore, the use of visual feedback on complex and potentially hazardous radiation facts may be useful for training purposes.

STUDY DESIGN

Cross-sectional study with a questionnaire.