Nuclear medicine teleradiology in regional and rural centres of Western Australia

Telemedicine consultation for patients with upper extremity disorders is reliable

Telemedicine is a valuable resource for the delivery of health care to patients in underserved areas. The purpose of this study was to assess the reliability of asynchronous teleconsultation in the diagnosis and establishment of treatment plans for patients with disorders of the upper extremity. One hundred patients with disorders of the upper extremity were prospectively evaluated. Initial patient evaluations, done by an independent evaluator, involved a medical history, physical examination, digital images of the patient, and digitized radiographic studies. This patient information was presented electronically to two hand surgeons 6 months after one surgeon independently evaluated the patients in the outpatient clinic. The physicians formulated diagnosis and treatment plans for the patients based on the blinded electronic information. These findings then were compared with the treatment plans made by the physicians at the time of the patients' visits. Telemedicine consultation resulted in excellent agreement within observers (kappa = .92) and between observers (kappa = .86). Telemedicine consultation seems to be a reliable method for diagnosis and establishment of treatment plans in the management of upper extremity disorders.

LEVEL OF EVIDENCE

Diagnostic study, Level I-1 (testing of previously developed diagnostic criteria in series of consecutive patients--with universally applied reference gold standard). See the Guidelines for Authors for a complete description of levels of evidence.

The effect of nuclear medicine telediagnosis on diagnostic pathways and management in rural and remote regions of Western Australia

Limited accessibility to certain medical imaging services in regional and rural centres has led to the use of alternative modalities, which may not be best practice or which require patients to travel considerable distances for diagnosis. Data collected over three years were examined to determine the clinical effect of nuclear medicine teleradiology (NMT) and its effect on diagnostic patterns for the investigation of cardiovascular disease, radio-occult musculoskeletal injury and oncology. In comparison with two other rural, non-NMT areas of similar demographic profile, there was a significant shift in the delivery of care in terms of diagnostic work-up. NMT input led to the detection of disease and a change to therapeutic management in 122 cases and eliminated the need to transfer patients to another facility for unnecessary and expensive examinations in 38 cases. While NMT is more costly than conventional nuclear medicine services, it permits faster access to specialist consultation, provides for better management and is likely to reduce overall health costs by reducing the volume of inappropriate tests and treatment practice.

Teleradiology in orthopaedic surgery: impact on clinical decision making for acute fracture management

OBJECTIVE

To determine whether teleradiology improved clinical decision making for the treatment of patients with acute fractures.

DESIGN

Prospective cohort.

SETTING

Level 1 trauma center.

PATIENTS

One-hundred eight consecutive patients with 123 acute fractures who visited our Level 1 trauma center, when the first author was the attending orthopedic surgeon on call, and had orthopaedic consultations were included.

MAIN OUTCOME MEASURES

In each case, an orthopaedic junior resident performed the emergency department consultation. Radiographs were digitized and electronically transmitted to the attending orthopaedist. Treatment plans were formulated and recorded by the attending surgeon at three different times. The original plan was defined after traditional verbal communication of physical and radiographic findings. A revised plan was defined after the radiographic images were reviewed by the attending surgeon, and the final plan was defined after review of the original radiographs. Two different types of deviations from the original plan were distinguished. Changes in the acute management were defined as any emergency department procedures, emergent operative procedures, or dispositions that were not part of the original plan. Changes in the ultimate management were defined as changes to the original plan that did not affect emergency department treatment, emergent operative procedures, or the disposition of the patient.

RESULTS

In twenty-six of the 123 fractures (21 percent), the additional information provided by viewing electronically transmitted images of radiographs changed the acute management or the ultimate management. In none of the 123 cases did subsequent review of original radiographs result in any further changes to the treatment plan.

CONCLUSIONS

The routine use of electronically transmitted digitized radiographic images has the potential to improve clinical decision making for the care of patients with acute fractures.