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What's New in Teleradiology?

Teleradiology has been around for quite a while and is rather established and quite widespread. So what could possibly be new? Surprisingly there is a lot of research still be conducted in teleradiology and at the recent RSNA (Radiological Society of North America) some interesting studies were presented.

First – a bit about RSNA for those who have never attended. It is the largest radiology meeting in the world and is approaching its 100th annual meeting! It is always held the week after Thanksgiving and always in Chicago at the McCormick Center – and it fills the entire building ! This year there were over 54,000 attendees from all over the world (130 countries), with 40% from outside the US. 5207 attendees were trainees – residents for the most part but a few medical and graduate students as well. There were 662 exhibitors (105 first time vendors) utilizing 43,675 square feet of space! If you have never been it is an amazing experience – it can take the whole week just to visit all the vendors. Bring your sneakers!

A relatively new option for those who cannot attend is the Virtual Meeting. There are two lecture rooms set aside with dedicated broadcasting equipment and a variety of lecture topics are presented (CME available too!) throughout the meeting. This year 5690 people from around the globe participated virtually! 46% of the Case of the Day diagnoses were submitted virtually! The program itself had 238 refresher courses, 89 collaborative multi-session courses, 2,775 scientific sessions and 2,223 education exhibits (both electronic and traditional hardcopy.

So what was new in teleradiology? Going mobile! There were a number of studies assessing the feasibility of using tablets and SmartPhones for diagnosing images. For example, Seong et al. “Is the teleradiology consultation using a smartphone with mobile PACS helpful when an on-call radiology resifdent is not confident about the presence of appendicitis?” compared CT scans read by an in-house abdominal radiologist, an on-call radiologist (both using a commercial mobile PACS) and 2 off-site abdominal radiologists using iPhones. The iPhone readers actually performed better than the on-call radiologist! Mahmood et al. “How good is the iPad for detection of pneumothorax on chest x-ray? Diagnostic performance of radiologists and emergency medicine physicians” found that accuracy was 95% for detecting pneumothoraces with the iPad vs 97.4% for the PACS monitor (p = 0.03) and radiologists did better than ER physicians. The differences were mostly due to poorer detection of small pneumothoraces. So – still some limitations.

An interesting study by Yun et al. “The use of mobile devices for specimen mammography interpretation: feasibility study” compared analyses of specimen radiographs (images of tissue removed during surgical removal of cancer to determine if all the margins are clear) and found that diagnoses made with a Nexus10, Galaxy Note and iPad were comparable to those made with a 5 Mpixel display! This suggests that interpretation of these images could be done much faster reducing time in surgery for patients.

What else was talked about? Quality and security – which are very common telemedicine issues were common topics. Eigles et al. “Enhancing turn-around-time (TAT) on stroke protocol head CT reports via continuous quality improvement (CQI) methodology in a busy teleradiology practice reduced the number of delayed cases by implementing CQI to no more than 1 per month (delayed = > 15 minutes TAT). David Hirschorn organized a Radiology Informatics Series on Mobile Computing Devices and covered such important topics as platforms & security, global market analyses, how to develop & create mobile apps, bandwidth & integration for apps, security systems, and display quality.

Finally, globalization of teleradiology was often discussed attesting to the reach of technology and mobile devices around the world. Rehani et al. developed a survey (“Making imaging around the world better: global survey of radiologists in 10 countries”) to assess imaging needs and local opinions about how to effectively improve imaging in developing countries. The survey can help radiologists wanting to initiate humanitarian efforts to improve imaging services. Obviously there are lots of new directions and options for teleradiology today.

Stay tuned for updates after the 2014 RSNA meeting!

About the Author

Elizabeth Krupinski, Ph.D. is a Professor at Emory University in the Department of Radiology & Imaging Sciences and is Vice-chair of Research.. She is Associate Director of Evaluation for the Arizona Telemedicine Program and Director of the SWTRC. She has published extensively in these areas, and has presented at conferences nationally and internationally. She is Past Chair of the SPIE Medical Imaging Conference, Past President of the American Telemedicine Association, President of the Medical Image Perception Society, and Past Chair of the Society for Imaging Informatics in Medicine. She serves on a number of editorial boards for both radiology and telemedicine journals and is the Co-Editor of the Journal of Telemedicine & Telecare.

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