Teleradiology : changing radiological service processes from local to regional, international and mobile environment

Abstract

<div lang="en" class="abs"><p class="abs_header">Abstract</p><p>The possibilities of teleradiology to modify the radiological service process in a regional, international and mobile setting were investigated by building new types of technical connections and then by evaluating their feasibility.</p><p>First a teleradiology link based on low-end technology was built for primary care and hospital settings. On evaluation, the total diagnostic agreement between the transmitted images and the original films was 98%.</p><p>Then, a work practice-oriented approach was used to gain an understanding of the relationship between the emerging teleradiology work practice and the newly implemented technology. Ethnographically informed fieldwork and cooperative workshops were utilized. According to findings, articulation work that supports the key tasks is mostly conducted at the receiving site, and radiologists have to rely on much less information in image interpretation. The decisions made at the sending site influence the outcome.</p><p>To study the idea of consultations between different countries, a connection utilizing the Internet was built between university hospitals in Oulu, Reykjavik and Tromsø. After 131 images, a suitable image compression ratio was selected. Image quality and transfer time of the 80 clinical case readings were found to be adequate for teleradiology.</p><p>A wireless image consultation system for radiological sub-specialist consultations based on a portable computer and a mobile phone with secure access to the hospital network was set up and tested. The transmitted images of 68 patients were acceptable for final diagnosis in 72% of the cases. The wireless link saved the senior radiologist a hospital visit in 24% of the cases.</p><p>A smartphone was then used to communicate computed tomography scans in a feasibility study of 21 patient cases of brain attacks. All transmitted image series were suitable for giving a preliminary consultation to the clinic, and in one case even a final report could be made. In a real life clinical setting of the study with neuroradiological and neurosurgical emergencies, two different smartphone platforms with electronic patient record integration were built in European research projects and evaluated with sets of 115 and 150 patient cases. They were good for final diagnosis in 38% and 40% of the cases, respectively. The concept was found to be ready for clinical use.</p><p>Finally a survey was made showing the status and trends of the usage of eHealth applications in Finland. The results from all the public health care providers and a representative sample of private providers showed that in 2005, teleradiology services were used by 18/21 hospital districts and the usage of all eHealth applications has progressed throughout the entire health care delivery system. Teleradiology services have become an integrated part of eHealth.</p></div>