Diagnostic performance of teleradiology in cervical spine fracture detection.

This study was done to assess the diagnostic accuracy of high-resolution (5 lp/mm) teleradiology for detecting cervical spine fractures. Single radiographs from 25 patients with and 25 patients without cervical spine fractures were transmitted between two units of our teleradiology system (Dupont DTR 2000) located 5 miles apart. Each image was examined by four readers. Fracture detection accuracy was assessed by generating receiver operating characteristic (ROC) curves and comparing the areas under each reader's curves for original and transmitted images. Two readers had statistically significant better fracture detection using nontransmitted images, whereas two had no significant differences in accuracy. The authors conclude that high resolution in and of itself is not adequate for fracture detection, and that issues concerning image contrast manipulation also will have to be addressed before teleradiology systems can be used for clinical cervical spine fracture screening.     

Strategic uses of teleradiology.

The most frequently cited benefits of image communications systems (teleradiology) are: (1) a reduction in the travel time of radiologists, and (2) an improvement in access to services, especially in rural areas. The benefits of teleradiology services for hospitals are, however, potentially much greater. Teleradiology services could alter the competitive positions of organizations in the market for imaging services and change the nature of the competition. In this article we examine how a small community hospital and a large referral hospital might each use teleradiology strategically to improve their respective competitive positions.     

Radiogenomics: Creating a link between molecular diagnostics and diagnostic imaging

Studies employing high-throughput biological techniques have recently contributed to an improved characterization of human cancers, allowing for novel sub-classification, better diagnostic accuracy, and more precise prognostication. However, requirement of surgical procurement of tissue among other things limits the clinical application of such methods in everyday patient care. Radiographic imaging is routine in clinical practice but is currently histopathology based. The use of routine radiographic imaging provides a potential platform for linking specific imaging traits with specific gene expression patterns that inform the underlying cellular pathophysiology; imaging features could then serve as molecular surrogates that contribute to the diagnosis, prognosis, and likely gene-expression-associated treatment response of various forms of human cancer. This review focuses on high-throughput methods such as microarray analysis of gene expression, their role in cancer research, and in particular, on novel methods of associating gene expression patterns with radiographic imaging phenotypes, known as “radiogenomics.” These findings underline a potential future role of both diagnostic and interventional radiologists in genetic assessment of cancer patients with radiographic imaging studies.     

Basics of German teleradiology

The methods and techniques of teleradiology are used in numerous clinical specialties. Several teleradiology projects have been state-aided in Germany over the last 10 years. Using the teleradiology standard proposed by the German Radiology Society, some of these systems are also interoperable. Several techniques are available for realizing teleradiology connections, including Web servers, virtual private networks (VPNs), and e-mail-based solutions. For the establishment of a new teleradiology connection, the needed applications must be analysed in order to find an adequate and cost-effective solution. Legal, financial, and data security aspects must also be taken into account. Legal regulations for the use of teleradiology-guided examinations in Germany demand a high technical and organisational standard for the set-up and the quality control of teleradiology installations.     

Legal aspects of teleradiology

Summary It is hoped that the implementation of teleradiology will improve the quality and economic effectiveness of health care in the future. The German federal government has submitted a bill for a legal statute, thereby creating the necessary framework to guarantee the essential “document security”. The responsibility of those involved with orderly data transmission as well as the limited responsibility for physicians' findings are both governed by general liability. General principles apply also with regard to professional discretion. Authorized utilization of external networks depends upon the quality of data security. Networks with unlimited public access may not be used without explicit consent from those concerned.      

Quantifying diagnostic performance: The log odds method as a practical option

PurposeTo investigate the most practical option available when statistically analysing small sample size studies.MethodThe log odds ratio was applied to a study which took a retrospective approach and involved 50 patients who had undergone a ventilation and perfusion scan in the period between 01 January 2002 and 31 December 2002. Radiology reports and the patients' medical records were obtained, so that the clinical indications for the examination and the patients' medical history could be transferred onto the report form. Four radiographers who are routinely rotated into the Nuclear Medicine Department independently reported the same 50 ventilations and perfusion scans under identical conditions to the reporting radiologist.ResultsTaking the radiologist reports as the gold standard the radiographers had an accuracy rate of 78%. The radiographers recorded an average sensitivity value of 94% and specificity value of 63%, with an A_z reading of 0.71.ConclusionAs the sample size was too small for a receiver operating characteristic (ROC) curve to be drawn, the log odds ratio provided a value, which represents an area under the receiver operating characteristic (ROC) curve, which in turn ensured the results were statistically reliable. The log odds ratio enables researchers to carry out small-scale research without harbouring the data collected by unreliable analysis.     

Clinical evaluation of a teleradiology system utilizing personal computers and public telephone line.

Practical usefulness of a teleradiology system using CCD camera, personal computer and telephone line was evaluated in a daily clinical practice. Image quality of this system is diagnostic for the majority of abnormalities on radiological images including plain radiographs. Radiological consultation between hospitals in the same city as well as between distant cities using this moderately priced system was thought to be useful in 90% of cases. Teleradiology using compact systems like ours is expected to be useful in the urban clinical environment as well as in distant areas.     

Legal aspects of cross-border teleradiology

The growth of cross-border teleradiology has created legal challenges that are insufficiently addressed by nation health laws. New legislation is currently under development at the European level. This article will look at the details of the existing and proposed legislation and the still unsettled issues and will discuss the implications for international teleradiology.     

The successful development of a women's diagnostic center.

Health care organizations must meet new demands for prompt, quality service or be left behind, maintains Mr. Kilmartin. He describes several innovative programs in women's health care developed at his institution and discusses issues such as market research, pricing and facility design.     

Toward the appropriate use of teleradiology

Teleradiology involves much more than merely transmitting images and information between two points: teleradiology consists of sharing knowledge and working together in a network. It facilitates rapid access to radiological reports and second opinions, remote consulting among physicians, improved patient care, access to complex tools for postprocessing and computer-aided diagnosis, support for research and training projects, ties between isolated healthcare providers and busier or more experienced providers, 24-hour coverage, and competition among radiology departments. A close relation with the radiologist leads to better care. However, teleradiology should not have negative effects on the efficacy of the clinical radiology service that is closest to the patient. This article focuses on the legal requirements of teleradiology services and on the clinical problems that can arise in teleradiology settings, with the ultimate aim of ensuring the appropriate use of teleradiology to improve healthcare.     

The use of teleradiology in an emergency setting with speculation on the near future.

None of these models will automatically come to pass but all are possible today. Radiologists have to realize that the teleimaging era for emergency patients is here to stay. Successful utilization for good and gain may no longer be accomplished by a reliance on old or outmoded practice assumptions. The virtual turf, prepared by the rapidity of the remote transmission of electronically generated pictures, is a real phenomenon for which radiology has and will play a major role. The practice opportunities may not be vast in scope, but on a regional basis the imaging landscape is still green and up for grabs.     

Virtual MRI: a PC-based simulation of a clinical MR scanner

RATIONALE AND OBJECTIVE: The aim of this project was to simulate the features and functions of a clinical or real-world MR scanner on a personal computer by means of a computer program. The users should be able to change all relevant settings of the virtual scanner and adapt them to the expected pathology. MATERIALS AND METHODS: The algorithms of the simulation are based on parameter images of the three physical basic properties T1, T2, and proton density. From this, the synthetic images are calculated pixel by pixel on the basis of the well-known formulas of the pulse sequences chosen and modified by the user. The graphical user interface is oriented to a real-world MR scanner. The software is programmed in pure Java and is freely available under the GPL license. RESULTS: Besides spin echo pulse sequence, 6 other pulse sequence classes are implemented. Parameters like repetition time and echo time can be adjusted. The choice of parameters like matrix size, slice-thickness, and number of acquisitions has an impact on the signal-to-noise ratio of the images. In a first step, the simulation calculates the signal intensity in k-space. Wraparound and motion artifacts are simulated by modifying the data of k-space. In a last step, a 2D-Fourier transform of k-space data is performed. As the image calculation takes only a few seconds, an interactive manner of working is possible. CONCLUSION: The simulation has been used in the education of medical students and interns for more than 1 year and has gained widespread acceptance.     

The German teleradiology system MEDICUS system description and experiences in a German field test

MEDICUS is a teleradiology system which has been developed in a joint project of the German Cancer Research Center (Deutsches Krebsforschungszentrum) and the Transfer Center Medical Informatics (Steinbeis-Transferzentrum Medizinische Informatik) in Heidelberg, Germany. The system is designed to work on ISDN lines as well as in a local area network. Special attention has been given to the design of the user interface and data security, integrity, and authentication. The software is in use in 13 radiology departments in university clinics, small hospitals, private practices, and research institutes. More than 25 thousand images have been processed in 6 months. The system is in use in six different application scenarios. MEDICUS is running under the UNIX operating system. The connection of the modalities could in most cases not be realized with the DICOM protocol as older machines were not equipped with this standard protocol. Clinical experiences show that the MEDICUS system provides a very high degree of functionality. The system has an efficient and user friendly graphical user interface. The result of a comparison with other systems shows that MEDICUS is currently the best known teleradiology system. Cost reductions are already obvious, but additional research has to be performed in this field. An even more powerful commercial successor is currently under construction at the Steinbeis-Transferzentrum Medizinische Informatik in Heidelberg.