The role of teleradiology during COVID-19 outbreak: Saudi radiologists' perspectives.

OBJECTIVES: To evaluate the role of teleradiology during the COVID-19 pandemic from Saudi radiologists' perspectives to improve the radiology quality service. METHODS: A cross-sectional study was carried out in Saudi Arabia among radiologists working at local hospitals from October to November 2021. It contains 21 questions involved demographic information; general information on teleradiology services; and the impact of teleradiology during COVID-19. One-way ANOVA was used to compare demographic groups. Chi-square test was used to compare demographic groups regarding their distribution of responses. All tests were carried out <0.05 level of significance. RESULTS: A total of 102 radiologists participated in this study (56% males, 44% females), 58.8% of them were sub-specialized in chest radiology. Regarding the general status of teleradiology, 69.6% of participants believed that teleradiology is a helpful tool for imaging interpretation. However, 44% of them were uncertain on the impact of teleradiology on patients' confidentiality. Approximately 87% of participants agreed that there is a positive contribution of teleradiology during COVID-19, which enables decreasing risk of infection and workload. There was a significant difference between professional degrees and overall participant responses (p<0.05). Academicians agreed that it enhances radiology departments' work (mean=17.78, SD=1.86). CONCLUSION: Concerns raised on complicated cases that require physical presence of patients, cannot be performed by teleradiology. Additionally, it might provide insufficient communication with other professionals to discuss images.

Mitigation Tactics Discovered During COVID-19 with Long-Term Report Turnaround Time and Burnout Reduction Benefits.

RATIONALES AND OBJECTIVES: The purpose is to describe a hybrid teleradiology solution utilized in an academic medical center and its outcomes on radiology report turnaround time (RTAT) and physician wellness. MATERIALS AND METHODS: During coronavirus disease 2019, we utilized an alternating teleradiology solution with procedural and education attendings working in the hospital and other faculty remote to keep the worklist clean. RTAT data was collected for remote vs. in house emergency department (ED) and inpatient cases over a 6-month period. Pre and post implementation burnout surveys were administered. RESULTS: RTAT significantly improved for ED and inpatient MR and CT, and inpatient US and radiographs when interpreted remotely compared to in-hospital. Physician wellness scores improved and open-ended comments reflected positive feedback about the hybrid work solution. 74% enjoyed the autonomy and flexibility, and 51% said the solution positively influences my desire to remain in my current institution and improves their clinical and/or academic productivity. CONCLUSION: Hybrid work from home solutions allow faculty autonomy and flexibility with work-life balance, improving wellness. It is important to alternate the at-home faculty to maintain interdepartmental relations, particularly for junior faculty, and prevent isolation. The hybrid solution also demonstrated improved patient care metrics, possibly due to decreased distractions at home compared to the reading room.

Teleradiology in India during the COVID-19 pandemic: merits, pitfalls and future perspectives.

The field of teleradiology has been of interest for almost 55 years and its potential prospects for healthcare have been constantly assessed and investigated. In view of the global preventive measures, such as social distancing and hand hygiene, the ongoing COVID-19 pandemic has further accentuated the necessity for telemedicine and teleradiology. In a country as densely populated as India wherein radiology services are often fragmented, teleradiology can prove to be a lifesaving technology and aid dampen the repercussions stemming from the highly skewed doctor to patient ratio. Although innovative, the effective adoption of teleradiology faces several obstacles in India, such as inadequate technological infrastructure, a lack of knowledge among most medical practitioners, urban-rural disparities and a lack of financing. Similar challenges continue to also be faced by several other developing countries across the globe. This article therefore aims to elaborate on the most important facets of implementation of teleradiology observed in the Indian context to help provide salient pointers for the readership of relevant jurisdictions who may be embracing comparable teleradiology challenges. Despite the hurdles, the future of teleradiology seems promising. The respective governments, policymakers and all relevant stakeholders must continue to take decisive action to ensure that this potential is fully exploited by allocation of necessary funds, strengthening of information technology and its related fields, involvement of human resources with adequate technical and administrative expertise as well as taking continued action to improve existing telemedicine and teleradiology services.

Evaluating paediatric orthopaedic teleradiology services at a tertiary care centre.

Telehealth services are innovative healthcare strategies that utilize communication technologies to improve healthcare access for patients. Teleradiology is a form of telehealth service that involves the transmission of radiological images, such as x-rays, CTs and MRIs, from one location to another to share patient information with other physicians. The purpose of this study was to assess teleradiology consultations for orthopaedic patients at a paediatric tertiary care centre. A retrospective review was conducted of patients who received teleradiology consultations with a single orthopaedic surgeon from 2015 to 2018 through the paediatric orthopaedic hip clinic at our institution. Teleradiology consultations involved follow-up radiographic imaging at a local community facility for patients who initially received healthcare services at our institution, followed by a telephone consultation to review imaging results and communicate next steps in care. Data collected included patient demographics, imaging type, facility location and distance from our institution. Eighty patients (F = 66, M = 14) who received teleradiology services were reviewed. Mean age was 3.5 years [95% confidence interval (CI): 2.5-4.4] at time of imaging. The average distance from community facilities to our institution was 1167 km (95% confidence interval: 920-1414), a measure of the total distance saved in travel for each patient in a single direction. The travel distance saved was substantial. Paediatric orthopaedic teleradiology services provide families specialized consultations and care continuity without costly travel. With increased implementation of teleradiology services, more patients and families can remain in their home communities while receiving the same quality of care.

The digital doctor: telemedicine in facial plastic surgery.

PURPOSE OF REVIEW: In the setting of the COVID-19 global pandemic, the demand for and use of telemedicine has surged in facial plastic and reconstructive surgery. This review aims to objectively review and summarize the existing evidence for the use of telemedicine within facial plastic surgery. RECENT FINDINGS: Telemedicine has been successfully implemented among subsets of facial plastic surgery patients, with high patient and provider satisfaction. Although the technology to facilitate telemedicine exists and preliminary studies demonstrate promise, multiple technological, financial, and medical barriers may persist in the postpandemic era. SUMMARY: Telemedicine will likely continue to grow and expand within facial plastic surgery moving forward, and we should continue to critically evaluate patient selection, access to care, and strategies for effective implementation to enhance current clinical practices.

Practical clinical and radiological models to diagnose COVID-19 based on a multicentric teleradiological emergency chest CT cohort.

Our aim was to develop practical models built with simple clinical and radiological features to help diagnosing Coronavirus disease 2019 [COVID-19] in a real-life emergency cohort. To do so, 513 consecutive adult patients suspected of having COVID-19 from 15 emergency departments from 2020-03-13 to 2020-04-14 were included as long as chest CT-scans and real-time polymerase chain reaction (RT-PCR) results were available (244 [47.6%] with a positive RT-PCR). Immediately after their acquisition, the chest CTs were prospectively interpreted by on-call teleradiologists (OCTRs) and systematically reviewed within one week by another senior teleradiologist. Each OCTR reading was concluded using a 5-point scale: normal, non-infectious, infectious non-COVID-19, indeterminate and highly suspicious of COVID-19. The senior reading reported the lesions' semiology, distribution, extent and differential diagnoses. After pre-filtering clinical and radiological features through univariate Chi-2, Fisher or Student t-tests (as appropriate), multivariate stepwise logistic regression (Step-LR) and classification tree (CART) models to predict a positive RT-PCR were trained on 412 patients, validated on an independent cohort of 101 patients and compared with the OCTR performances (295 and 71 with available clinical data, respectively) through area under the receiver operating characteristics curves (AUC). Regarding models elaborated on radiological variables alone, best performances were reached with the CART model (i.e., AUC = 0.92 [versus 0.88 for OCTR], sensitivity = 0.77, specificity = 0.94) while step-LR provided the highest AUC with clinical-radiological variables (AUC = 0.93 [versus 0.86 for OCTR], sensitivity = 0.82, specificity = 0.91). Hence, these two simple models, depending on the availability of clinical data, provided high performances to diagnose positive RT-PCR and could be used by any radiologist to support, modulate and communicate their conclusion in case of COVID-19 suspicion. Practically, using clinical and radiological variables (GGO, fever, presence of fibrotic bands, presence of diffuse lesions, predominant peripheral distribution) can accurately predict RT-PCR status.

What Is the Best Way for Patients to Take Photographs of Medical Images (Radiographs, CT, and MRI) Using a Smartphone?

BACKGROUND: Teleradiology has become one of the most important approaches to virtual clinical diagnosis; its importance has only grown during the coronavirus 2019 pandemic. In developing countries, asking patients to take photographs of their images using a smartphone can facilitate the process and help keep its costs down. However, the images taken by patients with smartphones often are of poor quality, and there is no regulation or standard instruction about how to use smartphones to take photographs of medical examination images effectively. These problems limit the use of smartphones in remote diagnosis and treatment. QUESTIONS/PURPOSES: To formulate a set of guidelines for the most appropriate and effective use of smartphones to capture images (radiographs, CT images, and MR images), and to determine whether these guidelines are more effectively adopted by patients of differing ages and genders. METHODS: In this prospective study, a set of step-by-step instructions was created with the goal of helping patients take better smartphone photographs of orthopaedic diagnostic images for transfer to telemedicine services. Following the advice of surgeons, experts in smartphone technology, imaging experts, and suggestions from patients, the instructions were modified based on clinical experience and finalized with the goals of simplicity, clarity, and convenience. Potentially eligible patients were older than 18 years, had no cognitive impairment, and used smart phones. Based on that, 256 participants (patients or their relatives and friends) who visited the orthopaedic department of our hospital from June to October 2020 potentially qualified for this study. A total of 11% (29) declined to participate, leaving 89% (227) for analysis here. Their mean age was 36 ± 11 years, 50% were women (113 of 227), and the patient himself/herself represented in 34% (78 of 227) of participants while relatives or friends of patients made up 66% (149 of 227) of the group. In this study, the diagnoses included spinal stenosis (47% [107 of 227]), disc herniation without spinal stenosis (31% [71 of 227]), vertebral fractures (14% [32 of 227]), and other (7% [17 of 227]). Each study participant first took photographs of their original medical images based on their own knowledge of how to use the smartphone camera function; each participant then took pictures of their original images again after receiving our instructional guidance. Three senior spine surgeons (YZ, TQL, TCM) in our hospital analyzed, in a blinded manner, the instructed and uninstructed imaging files based on image clarity (the content of the image is complete, the text information in the image is clearly visible, there is neither reflection nor shadow in the image) and image position (it is not tilted, curled, inverted, or reversed). If either of these conditions was not satisfied, the picture quality was deemed unacceptable; two of three judges' votes determined the outcome. Interobserver reliability with kappa values for the three judges were 0.89 (YZ versus TQL), 0.92 (YZ versus TCM), and 0.90 (TQL versus TCM). RESULTS: In this study, the overall proportion of smartphone medical images deemed satisfactory increased from 40% (91 of 227) for uninstructed participants to 86% (196 of 227) for instructed participants (risk ratio 2.15 [95% CI 1.82 to 2.55]; p<0.001). The proportion of acceptable-quality images in different age groups improved after instruction, except for in patients aged 51 years or older (3 of 17 uninstructed participants versus 8 of 17 instructed participants; RR 2.67 [95% CI 0.85 to 8.37]; p = 0.07). The proportion of acceptable-quality images in both genders improved after instruction, but there was no difference between the genders. CONCLUSION: We believe our guidelines for patients who wish to take smartphone photographs of their medical images will decrease image transmission cost and facilitate orthopaedic telemedicine consultations. However, it appears that patients older than 50 years are more likely to have difficulty with this approach, and if so, they may benefit from more hands-on assistance from clinic staff or younger relatives or friends. The degree to which our findings are culture-specific should be verified by other studies in other settings, but on the face of it, there is little reason to believe our findings would not generalize to a reasonable degree. Other studies in more heterogeneous populations should also evaluate factors related to levels of educational attainment and wealth differences, but in the meantime, our findings can give clinical teams an idea of which patients may need a little extra assistance. LEVEL OF EVIDENCE: Level II, therapeutic study.

Teleworking beyond teleradiology: managing radiology departments during the COVID-19 outbreak.

Teleradiology solutions are playing an essential role during the COVID-19 outbreak. Activity at radiology departments must be maintained and adapted to this new situation beyond teleradiology. Teleworking should be extended to the rest of non-medical radiology department areas. A comprehensive perspective based on our own experience during the COVID-19 outbreak has been performed highlighting the value of teleworking for almost all areas implied in the workflow of radiology departments beyond radiologists. Personal and technical requirements for successfully adapting to this new scenario are discussed including the opportunities that this unprecedent situation is bringing for reorganizing workflow and developing new projects. KEY POINTS: • Teleradiology solutions are playing an essential role during the COVID-19 outbreak. • Teleworking should be extended to the rest of non-medical radiology department areas whenever possible.

Emerging Challenges and Opportunities in the Evolution of Teleradiology.

OBJECTIVE. In recent decades, teleradiology has expanded considerably, and many radiology practices now engage in intraorganizational or extraorganizational teleradiology. In this era of patient primacy, optimizing patient care and care delivery is paramount. This article provides an update on recent changes, current challenges, and future opportunities centered around the ability of teleradiology to improve temporal and geographic imaging access. We review licensing and regulations and discuss teleradiology in providing services to rural areas and assisting with disaster response, including the response to the coronavirus disease (COVID-19) pandemic. CONCLUSION. Teleradiology can help increase imaging efficiency and mitigate both geographic and temporal discrepancies in imaging care. Technologic limitations and regulatory hurdles hinder the optimal practice of teleradiology, and future attention to these issues may help ensure broader patient access to high-quality imaging across the United States.

The challenge of environmental sustainability in radiology training and potential solutions.

The environmental impact of training has been poorly recognised for many years. With the emergence of high-profile climate activists and a wider appreciation of the need for sustainable healthcare, training within radiology can no longer be excused from its responsibility to consider the environment in its actions. In this paper, we aim to evaluate the environmental impact of the travel undertaken by trainees within the Peninsula training programme, with the aim of developing practices and providing suggestions (evidence-based where possible) on how to improve the impact on the environment of trainee travel. We envisage that many of the lessons and suggestions may be transferrable to other training schemes in the UK and further afield. During the early months of 2020, in addition to the environmental crisis, COVID-19 escalated to a pandemic resulting in the alteration of working practices across the UK (and the rest of the world). This led to many environmentally beneficial working practices being adopted in Radiology in the South West Peninsula Deanery, and throughout this paper we have evaluated these changes and used our collective experience of these to inform our suggestions on how to improve the environmental sustainability of Medical and Radiological training.

Response to the COVID-19 Pandemic: Practical Guide to Rapidly Deploying Home Workstations to Guarantee Radiology Services During Quarantine, Social Distancing, and Stay Home Orders.

OBJECTIVE. The purpose of this article is to share an experience in the rapid deployment of home workstations that illustrates a creative solution that transcended typical administrative barriers. CONCLUSION. In response to the global coronavirus disease (COVID-19) pandemic, radiology departments need to rapidly deploy home PACS workstations to facilitate physical distancing and to guarantee radiologic expertise despite possible home quarantining or stay home, work safe orders.

Remote reporting in the COVID-19 era: from pilot study to practice.

AIM: To assess the benefits and challenges of remote reporting using an intra-departmental teleradiology system. MATERIALS AND METHODS: A pilot of an in-hospital Trust radiologist reporting on in-hospital Trust patients via a remote login was undertaken. Reporting output, training impact, and quality improvement were measured. RESULTS: Reporting output increased by 140%. Trainee satisfaction was high in a qualitative survey, particularly for out-of-hours support and teaching. Clinicians found the service to be similar to the same service provided by a locally based radiologist. CONCLUSION: In the COVID-19 era, remote working has developed rapidly. This study shows that radiology departments can provide remote reporting that is equal in standard to reporting from within the hospital, and in addition, that there are advantages to output and training.