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Teleradiology in a post-Covid19 world

teleradiology

Last updated on June 28th, 2021

With the emergence of Covid-19, the adoption of Teleradiology has escalated among doctors and radiologists, who are playing a critical role in battling this fatal disease by imaging and predicting early diagnosis.

Teleradiology has the potential to alleviate some of the strains that healthcare providers are now enduring globally.

Fear of getting the infection, reduced mass transportation, and overcrowded health facilities were all factors that interrupted access to the healthcare system and radiology services and led to a tendency to delay services.

Reportedly, the usage of healthcare systems decreased over this time. Even delays in treatment for cardiovascular, neurovascular, and other serious illnesses have been observed.

In this situation, the adoption of Teleradiology was proven to be very useful. Therefore, this article will provide you with what is and could be the future of Teleradiology in a world where remote healthcare is slowly becoming the new normal.

History of teleradiology

Teleradiology refers to the imaging system to interpret and diagnose patients distantly. In the 1980s’ Teleradiology relied on the postal service. Physical copies of films were sent by email to a remote radiologist, and a paper report was then sent back.

Some drawbacks resided in the delay between imaging, diagnostics, and treatment. The turnaround time was days, even weeks. This process was efficient for routine analyses but could, of course, not be used for urgent care.

In 1983, the American College of Radiology (ACR) developed a standard for digital storage for medical imaging in partnership with the National Electrical Manufacturers Association, known as ACR/NEMA 300; this initiative was not widely adopted due to legal and technical restrictions.

Nevertheless, the ACR published the first standards for Teleradiology in 1994. They led to the use of Digital Imaging and Communications in Medicine standards (DICOM).

DICOM, an integral part of the patient’s Electronic Health Record (EHR), is used worldwide to send images and store them. In a nutshell, DICOM is for radiology, the equivalent of the jpeg format for pictures. Digital images are compressed and analyzed from anywhere using web-based picture archiving and communication systems (PACS).

The use of the DICOM format allows fast and secure transmission and analyses. In addition, contrary to X-rays, the brightness and contrast of the images can be fine-tuned.

The system also offers the ability to zoom on a specific part of the image to improve diagnostics. In a nutshell, the DICOM format provides the ease of using a standard picture for medical imaging.

The present use of teleradiology

In 2019, a survey published in the Journal of the American College of Radiology analyzed the current usage of Teleradiology practice.

Among the 936 radiologists who participated in the study, 85.6% reported using Teleradiology within the past ten years. 46.2% performed remote radiology services for rural areas and 37.2% for critical access hospitals.

The use of Teleradiology also seems to be linked to the size of the practice. For radiology groups with less than ten members, only 79.1% said they engaged in this new approach. The number jumped to 94.4% for practices or groups with more than 100 members.

In the Age of social distancing, remote interpretation of the images by radiologists located in different states, countries, or even at home is convenient for protecting both the patient and the personnel.

Teleradiology provides a range of advantages. Reducing turnaround time and providing real-time and around-the-clock analyses by relying on imaging centers located in different areas or countries were another set of advantages of this technology. As a result, teleradiology has already improved the quality of care.

The main perceived challenges for smooth teleradiology service were access to electronic health records (62.8%), quality assurance (53.8%), and technologist proximity (48.4%).

It misses out on the advantages of the physical presence of doctors, radiologists, and nurses. The team’s physical presence helps develop a more collaborative team and strengthens cooperation and connections, thus fostering the best treatment.

However, not sitting next to the radiologist during the images’ interpretation is not ideal for residents and fellows to ensure proper training.

On top of that, to receive images, the internet connection must be fast and secure enough to comply with HIPAA standards. This can be a real challenge for small rural hospitals.

Picture Archiving and Communication (PACS system) must also comply with the standards meaning continuous technical and IT personnel investment.

The Future of Teleradiology

Radiology is a complex medical specialty. In the United States, Rosenkrantz et al., in a study conducted in 2018, found that geographical disparities existed in radiologists’ subspecialization. A local community will be less likely to have a pediatric radiologist or an MRI radiologist than big urban centers.

The current years have seen an increase in radiologists’ subspecialization, especially toward breast imaging, abdominal imaging, and neuroradiology. The remote analysis is the only way to provide consistent quality care to patients independently of their location.

For interventional radiologists, pre-operative assessment can be performed remotely and relies on the benefits of Telehealth. Radiology practices can also see the use of remote imaging to protect both the patients and the clinicians.

The hybrid model with the on-site and off-site radiologist also needs to be considered. On-site physicians perform the needed procedures and maintain a direct relationship with the patients, while more specialized radiologists will conduct off-site analysis.

Many of the benefits of Telehealth appeared clearly during the pandemic and improved the speed and rate of adoption of these new technologies.

Once the investment in technologies has been completed, there will be no turning back. Therefore, teleradiology certainly has a bright future that will ultimately benefit the quality of care in the post-pandemic period.

To summarize: Benefits and Challenges of Teleradiology

Just like any new technology, pros and cons exist. However, the challenges need to be addressed quickly for teleradiology to become common practice and its many benefits to serving patients and physicians.

Benefits

  • Improves patient care and turnaround time for small rural or community hospitals,
  • It helps to get a second opinion quickly,
  • Teleradiology reduces the workload of on-site radiologists and lets them concentrate on operational procedures,
  • It can be used as an educational resource.

Challenges

  • Medicare and Medicaid do not allow reimbursement for services outsourced out of the U.S.,
  • It misses out on the advantages of the physical presence of doctors, radiologists, and nurses.
  • Emergency Room physicians do not know the remote radiologists. So, it can lead to miscommunication and lack of trust,
  • It poses incompatibilities between PACS systems,
  • Technical investment and maintenance are often challenging.

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