Effect of real-time teleradiology on the practice of the emergency department physician in a rural setting: initial experience.

RATIONALE AND OBJECTIVES: The authors' goal was to determine the feasibility and usefulness of online teleradiology consultation for emergency department physicians at a rural hospital. MATERIALS AND METHODS: Electronic linkage between the emergency department of Chatham County Regional Hospital (remote site) and the University of North Carolina Hospitals (host site) was established via a fiberoptic network. From October 1995 through September 1996, teleradiology consultation was initiated by an emergency department physician at the remote site and was provided online by host-site radiologists using a commercially available teleradiology system and a high-resolution digitizer. The turnaround time for each teleradiology consultation was calculated, and the effect of the consultation on diagnosis and treatment was assessed. The emergency department physicians scored their satisfaction and comfort levels with the system by using a scale of 1-7, with 7 representing the highest and 1 representing the lowest satisfaction and comfort. The online soft-copy interpretation was compared with a later interpretation of the original hard copy. RESULTS: A total of 123 separate studies comprising 460 radiographs were successfully transmitted in 90 discrete teleradiology events. The mean turnaround time for a teleradiology consultation was 1.3 hours. The teleradiology consultations led to changes in the emergency department physician's initial diagnosis in 27 of 90 cases (30%) and resulted in treatment changes in 23 of 90 cases (26%). The emergency department physicians reported an average satisfaction score of 5.4 and a comfort level of 5.6 with the teleradiology system. No major discrepancy between soft- and hard-copy interpretations was noted. CONCLUSION: Online real-time teleradiology consultation is feasible with available technology.

Differences in the kinetics of axonal transport for individual lipid classes in rat sciatic nerve.

Lipid precursors ([2-3H]glycerol for phospholipids and [3H]acetate for cholesterol) were injected into the L-5 dorsal root ganglion of adult rats. At various times, animals were killed, the ganglion and consecutive 5-mm segments of sciatic nerve were dissected, and lipids were extracted and analyzed by TLC. Individual lipid classes exhibited markedly different transport patterns. The crest of radioactive phosphatidylcholine moved as a sharply defined front at about 300 mm/day, with a relatively flat plateau behind the moving crest. Although some radioactive phosphatidylethanolamine also moved at the same rate, the crest was continually attenuated as it moved so that a gradient of radioactive phosphatidylethanolamine along the axon was maintained for several days. Transported diphosphatidylglycerol exhibited a defined crest, as did phosphatidylcholine, but moved at about half the rate. Labeled cholesterol was transported at a rapid rate similar to that for phosphatidylcholine and phosphatidylethanolamine, but like phosphatidylethanolamine, the initial moving crest of radioactivity was continually attenuated. Relative to the phospholipids, cholesterol showed a more prolonged period of accumulation in the axons and was more metabolically stable. We propose that most labeled phosphatidylcholine, phosphatidylethanolamine, and cholesterol is transported in similar (or the same) rapidly moving membranous particles. Once incorporated into these particles, molecules of phosphatidylcholine tend to maintain associated with them during transport. In contrast, molecules of phosphatidylethanolamine and cholesterol in these transported particles exchange extensively with unlabeled molecules in stationary axonal structures. Diphosphatidylglycerol, localized in a specialized organelle, the mitochondrion, is transported at a slower rate than other phospholipids, and does not exchange with other structures.