Implementation of an international teleradiology staffing model

Digital transformation of career landscapes in radiology: personal and professional implications

Millennial radiology is marked by technical disruptions. Advances in internet, digital communications and computing technology, paved way for digitalized workflow orchestration of busy radiology departments. The COVID pandemic brought teleradiology to the forefront, highlighting its importance in maintaining continuity of radiological services, making it an integral component of the radiology practice. Increasing computing power and integrated multimodal data are driving incorporation of artificial intelligence at various stages of the radiology image and reporting cycle. These have and will continue to transform the career landscape in radiology, with more options for radiologists with varied interests and career goals. The ability to work from anywhere and anytime needs to be balanced with other aspects of life. Robust communication, internal and external collaboration, self-discipline, and self-motivation are key to achieving the desired balance while practicing radiology the unconventional way.

Emergency Teleradiology-Past, Present, and, Is There a Future?

Emergency radiology has evolved into a distinct radiology subspecialty requiring a specialized skillset to make a timely and accurate diagnosis of acutely and critically ill or traumatized patients. The need for emergency and odd hour radiology coverage fuelled the growth of internal and external teleradiology and the "nighthawk" services to meet the increasing demands from all stakeholders and support the changing trends in emergency medicine and trauma surgery inclined toward increased reliance on imaging. However, the basic issues of increased imaging workload, radiologist demand-supply mismatch, complex imaging protocols are only partially addressed by teleradiology with the promise of workload balancing by operations to scale. Incorporation of artificially intelligent tools helps scale manifold by the promise of streamlining the workflow, improved detection and quantification as well as prediction. The future of emergency teleradiologists and teleradiology groups is entwined with their ability to incorporate such tools at scale and adapt to newer workflows and different roles. This agility to adopt and adapt would determine their future.

Pediatric Emergency Imaging Studies in Academic Radiology Departments: A Nationwide Survey of Staffing Practices

OBJECTIVE

Particularly for pediatric patients presenting with acute conditions or challenging diagnoses, identifying variation in emergency radiology staffing models is essential in establishing a standard of care. We conducted a cross-sectional survey among radiology departments at academic pediatric hospitals to evaluate staffing models for providing imaging interpretation for emergency department imaging requests.

METHODS

We conducted an anonymous telephone survey of academic pediatric hospitals affiliated with an accredited radiology residency program across the United States. We queried the timing, location, and experience of reporting radiologists for initial and final interpretations of emergency department imaging studies, during weekday, overnight, and weekend hours. We compared weekday with overnight, and weekday with weekend, using Fisher's exact test and an α of 0.05.

RESULTS

Surveying 42 of 47 freestanding academic pediatric hospitals (89%), we found statistically significant differences for initial reporting radiologist, final reporting radiologist, and final report timing between weekday and overnight. We found statistically significant differences for initial reporting radiologist and final report timing between weekday and weekend. Attending radiologist involvement in initial reports was 100% during daytime, but only 33.3% and 69.0% during overnight and weekends. For initial interpretation during overnight and weekend, 38.1% and 28.6% use resident radiologists without attending radiologists, and 28.6% and 2.4% use teleradiology. All finalized reports as soon as possible during weekdays, but only 52.4% and 78.6% during overnight and weekend.

DISCUSSION

A minority of hospitals use 24-hour in-house radiology attending radiologist coverage. During overnight periods, the majority of academic pediatric emergency departments rely on resident radiologists without attending radiologist supervision or outside teleradiology services to provide initial reports. During weekend periods, over a quarter rely on resident radiologists without attending radiologist supervision for initial reporting. This demonstrates significant variation in staffing practices at academic pediatric hospitals. Future studies should look to determine whether this variation has any impact on standard of care.

Feasibility, outcomes, and safety of tele-hepatology services during the COVID-19 pandemic

Coronavirus disease 2019 (COVID‐19) has hampered health care delivery globally. We evaluated the feasibility, outcomes, and safety of telehepatology in delivering quality care amid the pandemic. A telemedicine setup using smartphones by hepatologists was organized at our tertiary‐care center after pilot testing. Consecutive patients availing telehepatology services were recruited between March and July 2020. An adapted model for assessment of telemedicine was used after validity and reliability testing, to evaluate services 7‐21 days after index teleconsultation. Of the 1,419 registrations, 1,281 (90.3%) consultations were completed. From 245 randomly surveyed patients, 210 (85.7%) responded (age [years, interquartile range]: 46 [35‐56]; 32.3% females). Seventy percent of patients belonged to the middle or lower socio‐economic class, whereas 61% were from rural areas. Modes of teleconsultation were audio (54.3%) or hybrid video call (45.7%). Teleconsultation alone was deemed suitable in 88.6% of patients. Diagnosis and compliance rates were 94% and 82.4%, respectively. Patients’ convenience rate, satisfaction rate, improvement rate, success rate, and net promoter scores were 99.0%, 85.2%, 49.5%, 46.2% and 70, respectively. Physical and mental quality of life improved in 67.1% and 82.8% of patients, respectively, following index teleconsultation. Person‐hours and money spent by patients were significantly lower with teleconsultation (P < 0.001); however, person‐hours spent by hospital per teleconsultation were higher than in physical outpatient services (P < 0.001). Dissatisfied patients were more likely to have lower diagnosis rate, unsuitability for teleconsultation, noncompliance, poorer understanding, and uncomfortable conversation during teleconsultation. Connectivity issues (22.9%) were the most common barrier. Three patients, all of whom were advised emergency care during teleconsultation, succumbed to their illness. Conclusion: Telehepatology is a feasible and reasonably effective tool for rendering health care services using smartphones during the COVID‐19 pandemic. Systematic implementation, possible integration into routine health care delivery, and formal cost‐effectiveness of telehepatology services need further exploration.

Ethics Certification of Health Information Professionals

OBJECTIVES

 To provide a model for ensuring the ethical acceptability of the provisions that characterize the interjurisdictional use of eHealth, telemedicine, and associated modalities of health care deliveiy that are currently in place.

METHODS

 Following the approach initiated in their Global Protection of Health Data project within the Security in Health Information Systems (SiHIS) working group of the International Medical Informatics Association (IMIA), the authors analyze and evaluate relevant privacy and security approaches that are intended to stem the erosion of patients' trustworthiness in the handling of their sensitive information by health care and informatics professionals in the international context.

RESULTS

 The authors found that while the majority of guidelines and ethical codes essentially focus on the role and functioning of the institutions that use EHRs and information technologies, little if any attention has been paid to the qualifications of the health informatics professionals (HIPs) who actualize and operate information systems to deal with or address relevant ethical issues.

CONCLUSION

 The apparent failure to address this matter indicates that the ethical qualification of HIPs remains an important security issue and that the Global Protection of Health Data project initiated by the SiHIS working group in 2015 should be expanded to develop into an internationally viable method of certification. An initial model to this effect is sketched and discussed.

Utility of contemporaneous dual read in the setting of emergency teleradiology reporting

PURPOSE

Emergency radiology requires rapid and accurate interpretation of imaging examinations. Missed findings may lead to adverse outcomes. Double reporting may be used to minimize errors. Limited contemporaneous double reporting may be most efficient and cost-effective, but no data exists. This study is intended to examine the benefits of double reading and identify examinations where this would be most useful.

METHODS

In this study, dual reporting was conducted in a parallel reading environment in a teleradiology practice for 3779 radiological procedures performed at two radiology centers in the USA over a period of 4 months. Discrepancies between reads were scored using the ACR peer review scoring system and grouped by modality and body part. Errors were tabulated across the study types, followed by identification of statistically significant differences. The interaction between image number and odds of an error was ascertained.

RESULTS

In 145 instances (3.8%; 95 % CI, 3.2-4.4%), double reporting identified errors, leading to report modification. Study type was significantly related to error frequency (p = 0.0001), with higher than average frequencies of error seen for CT abdomen and pelvis and MRI head or spine, but lower than average for CT head, CT spine, and ultrasound. Image number was positively associated with error odds, but was not independently significant in a joint logistic regression model that included study type.

CONCLUSION

Dual reporting identifies missed findings in about 1 of 25 emergency studies. This benefit varies substantially across study types and limited double reporting, merits further investigation as a cost-effective practice improvement strategy.

Healthcare Supported by Data Mule Networks in Remote Communities of the Amazon Region

This paper investigates the feasibility of using boats as data mule nodes, carrying medical ultrasound videos from remote and isolated communities in the Amazon region in Brazil, to the main city of that area. The videos will be used by physicians to perform remote analysis and follow-up routine of prenatal examinations of pregnant women. Two open source simulators (the ONE and NS-2) were used to evaluate the results obtained utilizing a CoDPON (continuous displacement plan oriented network). The simulations took into account the connection times between the network nodes (boats) and the number of nodes on each boat route.

Telemedicine across borders: a systematic review of factors that hinder or support implementation

PURPOSE

Innovative technologies to deliver health care across borders have attracted both evangelists and sceptics. Our aim was to systematically identify factors that hinder or support implementation of cross-border telemedicine services worldwide in the last two decades.

METHODS

Two reviewers independently searched ten databases including MEDLINE and EMBASE, in June 2011 including citations from 1990 onwards when at least an abstract was available in English. We also searched ELDIS and INTUTE databases and Internet search engines to identify grey literature. We included studies which (a) described the use of telemedicine to deliver cross-border healthcare and, or (b) described the factors that hinder or support implementation of cross-border telemedicine services. All study designs were included. Two reviewers independently assessed titles and abstracts of articles identified. Papers were allocated to one of four reviewers who extracted relevant data and validated it. We took a qualitative approach to the analysis, conducting a narrative synthesis of the evidence.

RESULTS

6026 records were identified of which 5806 were excluded following screening of titles and abstracts. We assessed 227 full text articles, excluding 133 because they were fatally flawed or did not meet the inclusion criteria, producing a final sample of 94. They involved 76 countries worldwide, most involving collaborations between high and low or middle income countries. Most described services delivering a combination of types of telemedicine but specialties most represented were telepathology, telesurgery, Emergency and trauma telemedicine and teleradiology. Most link health professionals, with only a few linking professionals directly to patients. A main driver for the development of cross-border telemedicine is the need to improve access to specialist services in low and middle income countries and in underserved rural areas in high income countries. Factors that hinder or support implementation clustered into four main themes: (1) legal factors; (2) sustainability factors; (3) cultural factors; and (4) contextual factors.

CONCLUSIONS

National telemedicine programmes may build infrastructure and change mindsets, laying the foundations for successful engagement in cross-border services. Regional networks can also help with sharing of expertise and innovative ways of overcoming barriers to the implementation of services. Strong team leadership, training, flexible and locally responsive services delivered at low cost, using simple technologies, and within a clear legal and regulatory framework, are all important factors for the successful implementation of cross-border telemedicine services.

Developed-developing country partnerships: benefits to developed countries?

Developing countries can generate effective solutions for today's global health challenges. This paper reviews relevant literature to construct the case for international cooperation, and in particular, developed-developing country partnerships. Standard database and web-based searches were conducted for publications in English between 1990 and 2010. Studies containing full or partial data relating to international cooperation between developed and developing countries were retained for further analysis. Of 227 articles retained through initial screening, 65 were included in the final analysis. The results were two-fold: some articles pointed to intangible benefits accrued by developed country partners, but the majority of information pointed to developing country innovations that can potentially inform health systems in developed countries. This information spanned all six WHO health system components. Ten key health areas where developed countries have the most to learn from the developing world were identified and include, rural health service delivery; skills substitution; decentralisation of management; creative problem-solving; education in communicable disease control; innovation in mobile phone use; low technology simulation training; local product manufacture; health financing; and social entrepreneurship. While there are no guarantees that innovations from developing country experiences can effectively transfer to developed countries, combined developed-developing country learning processes can potentially generate effective solutions for global health systems. However, the global pool of knowledge in this area is virgin and further work needs to be undertaken to advance understanding of health innovation diffusion. Even more urgently, a standardized method for reporting partnership benefits is needed--this is perhaps the single most immediate need in planning for, and realizing, the full potential of international cooperation between developed and developing countries.

Telepathology for effective healthcare in developing nations

Telepathology has grown immensely due to rapid advances in information and technology. It has a wide variety of applications especially in the developing world, namely for remote primary diagnosis, specialist referrals, secondary opinions, remote teachings and in research. Basic infrastructure and skilled and experienced staff are the prerequisites for its successful implementation.Socio-economic differences in developing nations result in a chaotic scenario so that, the advanced areas have expertise, while rural and remote areas remain deprived. Telepathology has the potential to bridge this gap.This article discusses how successful use of the internet for telepathology is bridging this gap in developing nations and thereby contributing positively to effective healthcare. Possible constraints to telepathology and some solutions to overcome them are also discussed.

Telemedicine and pediatric radiology: a new environment for training, learning, and interactive discussions

OBJECTIVE

To report the experience of the Brazilian Program of Pediatric Teleradiology in combining teleconferencing and a virtual learning environment for services integration, collaborative research, and continuing education in pediatric radiology.

MATERIALS AND METHODS

We performed virtual meetings from March 2005 to October 2010 on pediatric radiology-related themes, using a combination of videoconferences and Web conferences, which were recorded and made available in an open-source software (Moodle) for reuse.

RESULTS

We performed 58 virtual sessions: 29 anatomical-clinical-radiological sessions, 28 on upgrading themes, and 1 virtual symposium. The average of connected points was 12 by videoconference and 39 by Web conference, and of 450 participants per event. At the time of this writing, 318 physicians and students are registered in the virtual learning environment, with a total of 14,678 accesses.

CONCLUSIONS

Telemedicine is being included in pediatric radiology practice, as a means for distance education, training, and continuing integration between groups.

The impact of an early-morning radiologist work shift on the timeliness of communicating urgent imaging findings on portable chest radiography

PURPOSE

The aim of this study was to assess the potential impact of staggered radiologist work shifts on the timeliness of communicating urgent imaging findings that are detected on portable overnight chest radiography of hospitalized patients.

METHODS

The authors conducted a retrospective study that compared the interval between the acquisition and communication of urgent findings on portable overnight critical care chest radiography detected by an early-morning shift for radiologists (3 am to 11 am) with historical experience with a standard daytime shift (8 am to 5 pm) in the detection and communication of urgent findings in a similar patient population a year earlier.

RESULTS

During a 4-month period, 6,448 portable chest radiographic studies were interpreted on the early-morning radiologist shift. Urgent findings requiring immediate communication were detected in 308 (4.8%) studies. The early-morning shift of radiologists, on average, communicated these findings 2 hours earlier compared with the historical control group (P < .001).

CONCLUSION

Staggered radiologist work shifts that include an early-morning shift can improve the timeliness of reporting urgent findings on overnight portable chest radiography of hospitalized patients.

Ethical and legal challenges for health telematics in a global world: telehealth and the technological imperative

Telehealth is one of the more recent applications of ICT to health care. It promises to be both cost-effective and efficient. However, there lies a danger that focusing mainly on pragmatic considerations will ignore fundamental ethical issues with legal implications that could undermine its success. Implicated here are, among others, changes in the nature of the health care professional patient relationship and informed consent, etc. The position of health informatics professionals as well as hard- and software providers is also affected. A further complicating factor is outsourcing. This paper identifies relevant issues and outlines some of their implications.

User interface of a teleradiology system for the MR assessment of multiple sclerosis

The aim of this study was to assess the image display of a web-based teleradiology system that uses a common web browser and has no need of proprietary applets, plug-ins, or dedicated software for DICOM display. The teleradiology system (TS) is connected to the Internet by ADSL and to radiological modalities using the DICOM standard with TCP/IP. Images were displayed on a PC through Internet connection with the remote TS using a common web browser. MS lesion number and volume in T1- and T2-weighted images (T1w and T2w, respectively) of 30 brain MR studies were quantified using both the TS and a conventional software. Wilcoxon signed ranks test and intraclass correlation coefficient (ICC) were used to assess the variability and concordance between intra- and inter-observer and TS and conventional DICOM viewer, setting significance at p < 0.05. No significant differences in T1w and T2w volumes between the TS and the conventional software were found by either operator. The ICC results showed a high level of inter-operator agreement in volume estimation in T1w and T2w images using the two systems. Quantitative assessment of MS lesion volumes in T1w and T2w images with a user interface of a teleradiology system that allows the consultation by means of a common web browser, without the need for proprietary plug-ins, applets, or dedicated software for DICOM display showed no significant differences from, and almost complete agreement with, conventional DICOM viewers.

The reasons that many radiology practices don't use off-hours services

PURPOSE

To compare radiology practices that use external, internal, and no off-hours services.

METHODS

From August 2005 to June 2006, 300 nonspecialty hospitals randomly selected from the AHA Guide 2005 Edition were contacted by telephone, e-mail, and mail, with attempts made to speak to the chiefs of radiology. A total of 115 responses were obtained (a 38.3% response rate), with 64 from radiology practices that used external off-hours services, 13 from practices with internal services, and 38 from practices with no services. The demographics of the practices in the 3 categories were compared, and answers to category-specific survey questions were tabulated. Responses were analyzed using descriptive statistics.

RESULTS

Radiology practices using internal off-hours services were significantly larger (mean size, 19.9 full-time radiologists) than those using external off-hours services (mean size, 8.2 full-time radiologists) and those not using any off-hours service (mean size, 10.7 full-time radiologists). A sufficient number of radiologists or residents covering nights had the highest reported importance in the decision not to adopt an external service. Cost and quality concerns were also cited. The consistency of interpreting radiologists known to a practice had the highest importance in the decision to use an internal rather than an external off-hours service. Frequent reasons cited for radiologists to take regular internal off-hours employment were financial incentives provided and a preference for off-hours shifts.

CONCLUSIONS

As long as there are sufficient numbers of radiologists and residents to handle the volume of interpretations, many practices will not use external off-hours services. Such services could help increase their adoption by offering lower cost and proven quality.

A survey of radiology practices' use of after-hours radiology services

PURPOSE

The study's purpose was to identify the characteristics of and the motives behind radiologists' use of after-hours services.

METHODS

From August of 2005 to June of 2006, 300 nonspecialty hospitals randomly selected from the 2005 American Hospital Association Directory of Hospitals were contacted by phone, e-mail, and mail, with an attempt made to speak to the chiefs of radiology. We obtained 115 responses, a 38.3% response rate, including 64 from practices that used an external after-hours service. These 64 are the subject of this study. Responses were analyzed using descriptive statistical analyses.

RESULTS

Practices gave convenience as the most important reason they use after-hours services, with value for recruiting ranked second and shortage of radiologists for off-hours coverage ranked third. Three-fourths of practices said they receive 5% or less of their reads from these services. Two-thirds of practices paid the service approximately as much as they collected or more. Approximately 40% of respondents used an after-hours service located internationally. Of these, 56% said that the radiologists reading internationally were either all Americans or mostly Americans and 40% did not know the proportion of foreigners. Regardless, in-state licensure of all interpreting teleradiologists is essentially universal.

CONCLUSION

Most radiology groups using after-hours services do so for convenience rather than shortage of staff to provide coverage. Most practices send a small percentage of their studies to the services. Although overseas-located services are commonly used, there is little evidence of other than American radiologists or American-trained radiologists at these services.

Basics of imaging informatics: part 2

Part 1 of this review on the basics of imaging informatics discussed the elements that make up a picture archiving and communication system (PACS), as well as some of the useful software that can be used to enhance PACS performance. Part 2 will focus on the impact of informatics in the radiology reading room and on recent technologies that may be unfamiliar to residents and practicing radiologists outside the informatics community.

Outsourced teleradiology imaging services: an analysis of discordant interpretation in 124,870 cases

PURPOSE

Outsourcing after-hours radiology coverage to a teleradiology coverage company has become common in recent years. However, concerns have been raised over the quality of these types of coverage and the implications on patient care. This study details the quality assurance program of a teleradiology company that provides after-hours coverage to 64 California hospitals.

METHOD

The records of all examinations interpreted by 10 radiologists during 2003 were reviewed. Interpretations were compared with the final interpretations of the host practices and evaluated for timeliness.

RESULTS

A total of 124,870 radiologic studies were interpreted by 10 teleradiologists during 2003. Computed tomography (CT) comprised 74% of these examinations: CT head (35%) examinations were the most commonly transmitted examinations, and CT abdomen/pelvis examinations were the second most common studies (27%). The average turnaround time was 12.2 min; 93% of the examinations were reported within 30 min, and 99% were completed within 1 hour. The overall discordant rate for individual teleradiologists ranged from 0.70% to 1.41%, with an average of 1.09%. Of the most commonly ordered examinations, CT of the abdomen/pelvis had the highest rate of discordance, at 2.1%.

CONCLUSIONS

Outsourcing to a teleradiology program with an active quality-assurance program can be safe. An active quality-assurance program should be an integral component of any teleradiology program. Constant feedback improves the performance of the radiologists.

The diffusion of a medical innovation: where teleradiology is and where it is going

Teleradiology is one of the more successful applications of telemedicine as measured by a bibliometric analysis of teleradiology research publications. The organizational diffusion of innovation framework is helpful in understanding the diffusion of teleradiology. Teleradiology had become part of the practices of two-thirds of radiologists who responded to the American College of Radiology survey in 1999. It is clear that teleradiology has become routinized even though quantitative data are hard to find. Telecardiology may be the next successfully diffused form of telemedicine. The potential cloud on the horizon for telediagnostics is political pressure to avoid outsourcing to foreign countries, particularly those to which US information technology jobs have already been transferred. How the outsourcing issue is resolved will have a significant effect on teleradiology specifically, and, perhaps, telemedicine generally.

Referring Physicians' Attitudes Toward International Interpretation of Teleradiology Images

OBJECTIVE

We evaluated referring physician attitudes toward the international interpretation of radiologic images.

MATERIALS AND METHODS

A five-question, scenario-based survey describing features of a hypothetic local radiology firm compared with those of its hypothetic overseas counterpart, international radiology, was sent by mail to 350 physicians from a broad range of medical and surgical specialties. One hundred nineteen physicians responded, for a response rate of 34%. Referring physicians were asked to indicate their preference for local versus international interpretation in each scenario using a 5-point Likert scale, with a score of -2 indicating a strong preference for international services, 0 indicating no preference, and 2 indicating a strong preference for local services.

RESULTS

When all variables are held to be equal, referring physicians strongly prefer local services (mean score, 1.77; SD, 0.77). When international teleradiology provides either a 2-day faster turnaround time for reports or a 30 dollars lower out-of-pocket cost to the patient, referring physicians still prefer local services, although less than they did with all variables held equal (mean score, 0.42-0.44; SD, 1.30-1.40). When international teleradiology provides both a 2-day faster turnaround time and a 30 dollars lower out-of-pocket cost to the patient, referring physicians preferred international teleradiology, albeit only slightly (mean, -0.25; SD, 1.50). Finally, when the credentials of the international radiologists are perceived to be less than those of the local radiologists, even in the face of faster turnaround time and 30 dollars lower cost to the patient, referring physicians overall strongly prefer local services (mean, 1.51; SD, 0.86).

CONCLUSION

Referring physicians prefer local interpretation of radiologic images to international interpretation when all things are equal. However, the timeliness of image interpretation and the cost to the patient are important factors in this decision.

The Effect of International Teleradiology Attending Radiologist Coverage on Radiology Residents’ Perceptions of Night Call

PURPOSE

The purpose of this study was to determine the effects of international teleradiology attending radiologist coverage (ITARC) of emergency examinations on radiology residents' perceptions of night call.

METHODS

A survey was administered at 2 different radiology residency programs that have attending radiologists who cover the night shift via teleradiology from Israel 5 nights per week. The survey consisted of 12 questions concerning residents' education and anxiety during on-call shifts and the effects of ITARC on these aspects of residency training. The questions were answered on a scale ranging from 1 to 5, with 3 being neutral.

RESULTS

The radiology residents felt that ITARC improved the on-call learning experience (score = 3.7; 1 = much worse, 5 = much improved). The residents felt neutral about the statements "Review of cases with the attending radiologist over the telephone is comparable educationally to having the attending radiologist in person at the workstation" (score = 3.0) and "Having an attending radiologist easily available diminishes the need for me to commit to a diagnosis on my own and is therefore detrimental to my education" (score = 2.9; 1 = strongly disagree, 5 = strongly agree). The residents' stress levels on call were high without ITARC (score = 1.8; 1 = very high, 5 = very low) and moderate with ITARC (score = 2.7). The residents' anxiety levels before a night on call were moderate without ITARC (score = 2.9; 1 = very high, 5 = very low) and low with ITARC (score = 3.7).

CONCLUSIONS

Radiology residents felt that ITARC improved their educational experience. International teleradiology attending radiologist coverage also decreased radiology residents' stress and anxiety related to on-call shifts.

Teleradiology in Singapore – Taking Stock and Looking Ahead

Teleradiology will have a significant impact on the delivery of healthcare and the practice of medicine. In order to ensure a positive outcome, the expected benefits, limitations and potential pitfalls of teleradiology must be carefully considered. For Singapore, teleradiology can be used to facilitate a quantum leap in the standards of radiological services. This can be achieved through the development of an integrated, nationwide, high-speed radiology network which will allow patients to have access to high-quality and responsive subspecialty radiology expertise located throughout the country. If judiciously implemented, teleradiology has the potential to propel Singapore radiology to an unprecedented level of professional quality and service delivery, and will provide the framework for sustainable radiological insourcing from other countries.

Structural brain imaging in patients with cognitive impairment in the year 2015

Cognitive impairment, especially in its early stages, is associated with very mild signs and symptoms that are difficult to detect by clinical and neuropsychological assessment. Advanced imaging analysis techniques applied to magnetic resonance images allow the detection of cerebral structural changes in vivo in mildly affected patients, and might be a useful supporting tool in the early diagnosis and treatment of patients with cognitive impairment. The increasing importance of computer science in cognitive neuroscience has led to the dissemination of a new discipline, neuroinformatics, which is crucial for the introduction of research findings into clinical practice. This review describes some advanced imaging analysis techniques aimed at studying brain structural images and how these techniques might benefit clinical practice through image data sharing and remote analysis in order to increase the accuracy of diagnosis in patients with cognitive impairment.

Swiss teleradiology survey: present situation and future trends

The purpose of this study was to obtain a survey about the present situation including the usage pattern, technical characteristics and the anticipated future of teleradiology in Switzerland. An internet-based questionnaire was made available to all members of the Swiss Society of Radiology. Questions concerning current teleradiology usage, the type of transmitted modalities, the technology employed, security, billing issues and the anticipated future of teleradiology were addressed. One hundred and two (22.67%) of 450 radiologists responded to the survey. Of the total, 41.2% (42) were teleradiology users, 35.3% (36) planned to use teleradiology in the near future and 24.5% (25) did not use or plan to use teleradiology. The mean number of examinations transmitted per month was 198 (range 1-2,000) and the mean distance was 33 km (range 1,250 km). An emergency service was considered the most important purpose (mean score 6.90; minimum 1, maximum 10) for the use of teleradiology, followed by image distribution (mean 6.74) and expert consultation (mean 6.61). The most commonly transmitted modality was computed tomography (mean 8.80), followed by conventional X-rays (8.40) and magnetic resonance imaging (8.32). The most commonly transmitted format was Digital Imaging and Communications in Medicine (DICOM) (66.7%), followed by bitmap/Joint Photographic Experts Group (jpg) (38.1%), using the DICOM send/receive protocol (52.4%), followed by the hypertext transfer protocol (26.2%) and e-mail (21.4%). For security a secure connection (54.8%) followed by encryption (14.3%) and anonymization (9.5%) was used. For the future, image distribution was rated the most important aspect of teleradiology (7.88), followed by emergency (7.22) and expert consultation (6.53). Development of legal regulations is considered most important (8.17), followed by data security guidelines (8.15). Most radiologists believe that insurance companies should pay for the costs of teleradiology (37.3%), followed by the radiologist (33.3%). In conclusion, in Switzerland a wide spectrum of teleradiology applications and technologies is in use. Guidelines and reimbursement issues remain to be solved.