University-Based Teleradiology in the United States

A teleradiology network for the improvement of healthcare and patient management in the developing countries of the African continent

INTRODUCTION

Africa is the second-largest continent on Earth in terms of both size and population. However, inaccessibility and shortfall of trained radiologists impede the delivery of adequate healthcare to such a large population. Teleradiology holds considerable potential in improving patient outcomes and healthcare delivery in African nations by furnishing timely interpretation of radiological examinations, particularly in those areas where there is a particular scarcity of radiologists. The aim of the present study was to assess the impact of teleradiology in the improvement of healthcare and patient management in the developing countries of the African continent.

METHODS

In this retrospective study, from January 2017 and December 2022, the scans of a cohort of patients from eight African countries were uploaded to the teleradiology cloud server and interpreted by board certified radiologists empanelled by a teleradiology service provider.

RESULTS

The telehealth model proposed in the study was seen to provide timely and quality reporting of 58,223 scans of 39,513 patients with a mean turn-around-time (TAT) of 2.46 h 95 % CI (2.44-2.48).

DISCUSSION

A dedicated teleradiology model designed in this study allowed the interpretation and analysis of the scans of the cohort of patients from hospitals in African countries by teleradiologists via high quality DICOM-image transfer over a cloud-based platform. The outcomes of our investigation reflect that teleradiology provides an effective solution for early diagnosis/interpretation of examinations performed in Africa. Further, the currently proposed teleradiology model may be used for other developing countries across the world to improve quality of care.

Night Radiology Coverage for Trauma: Residents, Teleradiology, or Both?

BACKGROUND

Overnight radiology coverage for trauma patients is often addressed with a combination of on-call radiology residents (RR) and a teleradiology service; however, the accuracy of these 2 readers has not been studied for trauma. We aimed to compare the accuracy of RR versus teleradiologist interpretations of CT scans for trauma patients.

STUDY DESIGN

A retrospective analysis (March 2019 through May 2020) of trauma patients presenting to a single American College of Surgeons Level I trauma center was performed. Patients whose CT scans were performed between 10 pm to 8 am were included, because their scans were interpreted by both a RR and teleradiologist. Interpretations were compared with the final attending faculty radiologist's interpretation and graded for accuracy based on the RADPEER scoring system. Discrepancies were characterized as traumatic injury or incidental findings and missed findings or overcalls. Turnaround time was also compared.

RESULTS

A total of 1,053 patients and 8,226 interpretations were included. Compared with teleradiologists, RR had a lower discrepancy (7.7% vs 9.0%, p = 0.026) and major discrepancy rate (3.8% vs 5.2%, p = 0.003). Among major discrepancies, RR had a lower rate of traumatic injury discrepancies (3.2% vs 4.4%, p = 0.004) and missed findings (3.4% vs 5.1%, p < 0.001), but a higher rate of overcalls (0.5% vs 0.1%, p < 0.001) compared with teleradiologists. The mean turnaround time was shorter for RR (51.3 vs 78.8 minutes, p < 0.001). The combination of both RR and teleradiologist interpretations had a lower overall discrepancy rate than RR (5.0% vs 7.7%, p < 0.001).

CONCLUSIONS

This study identified lower discrepancy rates and a faster turnaround time by RR compared with teleradiologists for trauma CT studies. The combination of both interpreters had an even lower discrepancy rate, suggesting this combination is optimal when an in-house attending radiologist is not available.

Emerging Challenges and Opportunities in the Evolution of Teleradiology

OBJECTIVE. In recent decades, teleradiology has expanded considerably, and many radiology practices now engage in intraorganizational or extraorganizational teleradiology. In this era of patient primacy, optimizing patient care and care delivery is paramount. This article provides an update on recent changes, current challenges, and future opportunities centered around the ability of teleradiology to improve temporal and geographic imaging access. We review licensing and regulations and discuss teleradiology in providing services to rural areas and assisting with disaster response, including the response to the coronavirus disease (COVID-19) pandemic. CONCLUSION. Teleradiology can help increase imaging efficiency and mitigate both geographic and temporal discrepancies in imaging care. Technologic limitations and regulatory hurdles hinder the optimal practice of teleradiology, and future attention to these issues may help ensure broader patient access to high-quality imaging across the United States.

Frequency, Recognition, and Potential Risk Factors of Incidental Findings on Trauma Computed Tomography Scans: A Cross-Sectional Study at an Urban Level One Trauma Center

Background

Computed tomography (CT) use in injured patients has continuously increased in the past decades. We designed and undertook this study to evaluate the frequency, and potential risks of incidental findings (IFs), and how they were processed in trauma patients receiving CT scans.

Methods

We retrospectively reviewed CT scans, official CT reports, and basic demographics in trauma patients who received CT scans at our emergency department in 2016. Scans with IFs prompted a detailed review of medical records to determine clinical significance and how they were processed. IFs were classified into three categories: category I (potentially severe condition, in-time management required), category II (not urgent, follow-up needed), and category III (of minor concern). Multivariable logistic regression models were fitted to determine patient characteristics associated with IFs.

Results

In the 4,092 scans enrolled, IFs were identified in 649 (15.9%). There were 13 (2.0%) category I, 306 (47.2%) category II, and 330 (50.8%) category III IFs. Patients with IFs were older than those without. No sex-based difference was found. Most (61.5%) of the scans were performed for the head; however, the abdomen had the highest IF prevalence (26.2%). Documentation about IFs was poor; 31% of category I, 91.9% of category II, and 97.0% of category III have no related record. Old age remains the risk predicting the presence of IFs, and every year of increasing age was independently associated with a higher prevalence of IFs (OR: 1.019; 95% CI: 1.015-1.024).

Conclusions

IFs are common in trauma CT scans; however, recognition and management remain poor. Abdomen and chest scans, and CT in older patients should remind us of increasing risks of IFs.

Centralized expert HRCT Reading in suspected idiopathic pulmonary fibrosis: Experience from an Eurasian teleradiology program

PURPOSE

To share experience from a large, ongoing expert reading teleradiology program in Europe and Asia aiming at supporting referring centers to interpret high-resolution computed tomography (HRCT) with respect to presence of Usual Interstitial Pneumonia (UIP)-pattern in patients with suspected Idiopathic Pulmonary Fibrosis (IPF).

METHOD

We analyzed data from 01/2014 to 05/2019, including HRCTs from 239 medical centers in 12 European and Asian countries that were transmitted to our Picture Archiving and Communication System (PACS) via a secured internet connection. Structured reports were generated in consensus by a radiologist with over 20 years of experience in thoracic imaging and a pulmonologist with specific expertise in interstitial lung disease according to current guidelines on IPF. Reports were sent to referring physicians. We evaluated patient characteristics, technical issues, report turnaround times and frequency of diagnoses. We also conducted a survey to collect feedback from referring physicians.

RESULTS

HRCT image data from 703 patients were transmitted (53.5% male). Mean age was 63.7 years (SD:17). In 35.1% of all cases diagnosis was "UIP"/"Typical UIP". The mean report turnaround time was 1.7 days (SD:2.9). Data transmission errors occurred in 7.1%. Overall satisfaction rate among referring physicians was high (8.4 out of 10; SD:3.2).

CONCLUSIONS

This Eurasian teleradiology program demonstrates the feasibility of cross-border teleradiology for the provision of state-of-the-art reporting despite heterogeneity of referring medical centers and challenges like data transmission errors and language barriers. We also point out important factors for success like the usage of structured reporting templates.

Telemedicine, Telehealth and m-Health: New Frontiers in Medical Practice

Telemedicine is changing the practice of medicine. It is part of the ever-growing use of communications technology in health care being used in prevention, disease management, home health care, long-term (chronic) care, emergency medicine, remote medical imaging, and many other applications. The pace at which telemedicine is being adopted and integrated into the healthcare enterprise is exponential and, for many (even those in the field!), it is often difficult to keep up with all of the changes occurring. Thus, it is useful periodically to stand back and summarize recent advances, to take stock, analyze where we have been, and project where we are headed. [...].