European Teleradiology now and in the future: results of an online survey.

OBJECTIVES: To obtain an overview of teleradiology usage within Europe, to evaluate the current opinion and future vision about this technique. METHODS: A web-based survey targeted at active radiologists throughout Europe. RESULTS: A total of 368 radiology professionals participated in the survey. Among them 65 % currently use teleradiology. The main usages are in-house image distribution (71 %) and on-call readings from home (44 %). The major advantages are improved collaboration with other radiologists (46 %) and efficient distribution of workload (38 %). Outsourcing is performed by 35 % of the participants, among them 68 % use commercial services. The major advantages of outsourcing are availability of second opinions (82 %) and additional capacity for on-call services (71 %). The major disadvantages are insufficient integration of patient history and priors (69 %), and limited communication with clinicians (68 %). The majority expressed a positive opinion regarding the future of teleradiology (80 %) predicting a growing importance (46 %). Opportunities ought to be found in emergency reading services, flexible support of small practices and in collaborative platforms. CONCLUSIONS: A wide usage of teleradiology throughout Europe is perceived; however usage of commercial services is relatively limited. Regarding cross-border services, there is a great demand for a focused Pan-European legislation, an adapted price regulation and a quality assurance framework. MAIN MESSAGES: • A wide variety of teleradiology applications exist in Europe • Implementation mainly occurs in countries with a high concentration of networked PACS • Usage of commercial teleradiology services in Europe is relatively limited • Language is an unsolved issue and limiting factor for further deployment of services • There is a demand for a Pan-European legislation, price regulation and quality assurance framework.

Teleradiology: evolution and concepts.

Teleradiology has become a reality for several years now, but its existence still has not been freed from all controversies. From the beginning the military has been the driving force for teleradiology. Today teleradiology has many purposes worldwide ranging from services for expert or second opinions to international commercial diagnostic reading services. Ten years ago image quality, transmission speed and image compression were important issues of debate. Today the focus is on clinical governance, medico-legal issues and quality assessment. The increasing use of teleradiology reflects the changing world of clinical practice, service delivery and technology.

[Digitalization of radiological imaging information and consequences for patient care in the hospital ]. / Digitalisering van de radiologische beeldinformatie en consequenties voor de patiëntenzorg in het ziekenhuis.

Determining the rate at which radiology must be digitalised has been a controversial issue for many years. Much radiological information is still obtained from the film-screen combination (X-rays) with all of its known inherent restrictions. The importance of imaging information in the healthcare process continues to increase for both radiologists and referring physicians, and the ongoing developments in information technology means that it is possible to integrate imaging information and electronic patient files. The healthcare process can only become more effective and efficient when the appropriate information is in the right place at the right time, something that conventional methods, using photos that need to be physically moved, can scarcely satisfy. There is also a desire for integration with information obtained from nuclear medicine, pathology and endoscopy, and eventually of all stand-alone data systems with relevance for the individually oriented hospital healthcare. The transition from a conventional to a digital process is complex; it is accompanied by the transition from a data-oriented to a process-oriented system. Many years have already been invested in the integration of information systems and the development of digital systems within radiology, the current performance of which is such that many hospitals are considering the digitalisation process or are already implementing parts of it.

Socioeconomic trends in radiology.

For radiology the socioeconomic environment is a topic of increasing importance. In addition to the well-known important scientific developments in radiology such as interventional MRI, several other major trends can be recognized: (1) changes in the delivery of health care, in which all kinds of managed care are developing and will influence the practice of radiology, and (2) the process of computerization and digitization. The socioeconomic environment of radiology will be transformed by the developments in managed care, teleradiology and the integration of information systems. If radiologists want to manage future radiology departments they must have an understanding of the changes in the fields of economics and politics that are taking place and that will increasingly influence radiology. Some important and recognizable aspects of these changes will be described here.

Remote expert consultation for MRI procedures by means of teleradiology.

From April 1992 to January 1993, radiology expert opinion for MRI procedures was offered by means of teleradiology. The experiment was carried out in addition to an existing service of a mobile MRI unit. MRI images were sent by means of teleradiology via regular telephone lines from the mobile MRI unit to an academic hospital, which served as expert consultation centre. During this period, 43 requests for expert opinions were performed. This article describes the clinical effects of these expert opinions, and the technical and organisational requirements to perform teleradiology in daily clinical practice.

Required functionality of PACS from clinical point of view.

Concerning the required functionality of PACS from a clinical point of view this paper describes the functionality during the several phases of the imaging process. A list of general requirements is summarized. To get more information a period of prototype development and testing is needed. During this period the required functionality has to be investigated by questionnaires and automatic registration by the work stations.

Influence of CT on radiologic utilization in The Netherlands.

The authors studied the influence of computed tomography (CT) on radiologic utilization in The Netherlands. Twenty-six hospitals with a CT scanner were compared with 27 hospitals without on the basis of number of radiologic procedures per clinical patient from 1977 to 1984. Changes in average length of hospitalization were also considered. The number of procedures decreased in hospitals with CT scanners (-9%), in contrast to hospitals without (+10%). The influence of CT on average length of stay appeared minimal. Although this study was limited, the authors believe that use of CT influenced changes in radiologic utilization.

Diagnostic evaluation of a PACS subsystem using mammographs. An ROC analysis.

The objective of this study was to compare the diagnostic accuracy of digitized mammographs with the original conventional films. The criterion was the detectability of small calcifications in the female breast. Four skilled radiologists read 100 films, conventional as well as digitized. The results were analysed using ROC methodology, and showed much lower diagnostic accuracy of digitized images (average AUC 0.67) compared to conventional films (average AUC 0.89). One of the problems with digitized images was to recognize and ignore film artifacts, which were hard to discriminate from small calcifications. The experiment was prepared, carried out and analysed with the FEASIBLE software package.

A case of extraskeletal osteogenic sarcoma in the neck.

A patient with an extraskeletal osteogenic sarcoma in the neck is described. At the site of this extremely rare tumor a liposarcoma had been removed 7 and 14 years previously. The patient had never received radiotherapy. The presence and type of calcification and ossification serve to distinguish between the various conditions of the differential diagnosis.