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Teleradiology: A Brief Overview

Teleradiology

Teleradiology is probably the most advanced part of telemedicine in the United States. For nearly a decade almost all radiologic exams have been digital. The film era of radiology passed into history around the turn of the century.

Since radiologists interpret digital images on a computer workstation using picture archiving and communications software (PACS), the radiologist’s location does not really matter as long as the digital images can be easily transmitted to his or her workstation and the formal radiologic report can be transmitted to the patient’s physicians or other healthcare providers. This transmission of images and reports is usually internal to a hospital or medical center, but it can be across town or across the country.

Teleradiology vs. Ordinary Radiology

Nowadays, the American College of Radiology (ACR) does not distinguish between teleradiology and “ordinary” radiology. The requirements for the digital image quality and the formal radiology report are the same, since all radiologic studies are in digital form and transmitted from their site of origin to the site of interpretation.

The only difference between teleradiology and ordinary, everyday radiology is the teleradiologist is at a location separate from where the imaging studies are performed.

The Early Days

Teleradiology became practical in the mid 1990’s when high-speed communications networks sprung up across the nation. At that time, digital image quality became sufficient to rival or supplant film-based radiology. 

In its earliest days, 10-15 years ago, teleradiology provided coverage of emergent or urgent after-hours studies by a radiologist who was not only physically remote from the patient’s location, but also did not have a professional association with the radiologists providing routine in-house coverage. 

“Nighthawks”

Those teleradiologists who provided such after-hours (nights, weekends, holidays) services came to be called “nighthawks” after birds that feed on the wing in the early evening or pre-dawn hours. As the practice of radiology has evolved, Nighthawk refers not only to teleradiologists working after-hours, but it also refers to private corporations that employ teleradiologists. 

Today, teleradiology is big business. A few months ago, a Wikipedia article claimed there were 500 teleradiology companies in the U.S. Whether this is true is unknown, however it is certain that teleradiology is a multi-million dollar industry. Nearly one-half of all radiology practices and radiologists use or provide teleradiology services. 

Teleradiologic studies cover the entire sweep of medical imaging studies from standard radiography (i.e., x-rays) to computed tomography (CT), ultrasound (US), magnetic resonance imaging (MRI), and nuclear medicine.

Limitations

Those radiologic procedures requiring the physical presence of a radiologist, such as a conventional “GI” barium study or an interventional radiologic study like an abscess drainage, are not ordinarily provided by teleradiology practices. This is a significant limitation of teleradiology. A few teleradiology providers will travel to a distant site to provide occasional in-house services, but this is uncommon and usually expensive.

Providers

Good teleradiologic practice requires a written report for every patient radiologic study. The report may be a final written interpretation, or it may be a preliminary interpretation with the final interpretation provided later, typically by an in-house radiologist at the same location where the patient had the study. 

Some of the larger private for-profit teleradiology providers offer daytime services for routine or subspecialty coverage. Some even seek to replace traditional in-house radiologists. This has caused considerable consternation and controversy in the radiologic community. 

It’s a tough world out there, and all radiologic practices, whether traditional, teleradiology, or university-based have to scramble for patients and contracts. The competition is intense, and the role of teleradiology in medical imaging practice constantly changes. Nevertheless, teleradiology is a very successful application of modern technology and modern telemedicine with considerable benefit for patients and their healthcare providers. 

About the Author

Tim Hunter's picture

Tim B. Hunter, MD, MSc, is the former head of the Department of Radiology (now known as the Department of Medical Imaging) at the University of Arizona College of Medicine and has been a faculty member for 39 years. Dr. Hunter received his medical degree from Northwestern University in 1968. After serving in the U.S. Navy from 1969 until 1971, he completed his residency in diagnostic radiology at the University of Michigan in 1974. He joined the faculty at UA in 1975 and now serves as a professor in both radiology and orthopedic surgery. His areas of special interest in radiology are musculoskeletal imaging and medical devices.


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