Implementation of a 24-Hour Teleradiology Service for Cruise Ships: A Pilot Study.

OBJECTIVE. The purpose of this study was to introduce a 24-hour teleradiology service for cruise ships as a novel concept in maritime telemedicine. SUBJECTS AND METHODS. One cruise ship equipped with a mobile radiography unit and digital storage imaging plates was involved in this pilot study. Radiographs were transmitted via satellite internet to a tertiary hospital on shore for image interpretation by expert radiologists. Use of a virtual private network (VPN) enabled secure data transfer. Radiographs and patient data were automatically integrated into the PACS and radiology information system of the radiology department at the hospital. Images were analyzed by the staff radiologist at the hospital, and reports were immediately returned via e-mail through the VPN tunnel. RESULTS. Seventy-five radiographs of 47 patients were obtained on board within 2 months. All datasets were successfully transmitted. Most of the examinations (35 [≈ 75%]) were skeletal radiographs; the other 12 (≈ 25%) were chest radiographs. The turnaround time for the radiology reports was within 30 minutes in 43 cases (≈ 92%). In four cases (≈ 8%), delay was due to technical and organizational issues at the tertiary hospital. CONCLUSION. With the objective of supporting ship physicians with expert analyses of radiographs, a secure and stable method of image and radiology report transmission between an onboard hospital and a land-based radiology department was established.

Telerreumatología en tiempos de crisis durante la pandemia por COVID-19 / Tele-rheumatology during the COVID-19 pandemic

INTRODUCCIÓN: Durante la pandemia por COVID-19 las necesidades de prevención de transmisión de la infección viral nos obligaron a potenciar las consultas virtuales. OBJETIVO: El objetivo de estudio es describir los resultados obtenidos con la anterior estrategia y definir el perfil de paciente más idóneo para aplicarla. MATERIAL Y MÉTODOS: Durante el período comprendido entre el 16 de marzo y y el 10 de mayo del 2020 todas las consultas sucesivas de nuestro servicio fueron realizadas en formato de teleconsulta reumatológica (TCR). Se recogieron las características sociodemográficas, geofuncionales y clínicas de los pacientes; se evalúo mediante escala numérica verbal (0-10, donde 0 = muy insatisfecho hasta 10 = completamente satisfecho) el grado de satisfacción del paciente/médico con la TC. RESULTADOS: La mayoría de los pacientes atendidos en las 469 TCR realizadas fueron mujeres, con una edad media de 60,83 años. Solo el 16% había realizado estudios universitarios. La distancia media recorrida para acudir a una consulta presencial era de 33km, con una inversión de tiempo total promedio de 2 h. La mayoría de los sujetos estaban diagnosticados de artrosis/reumatismos de partes blandas u osteoporosis; el 21% eran presentaban artritis reumatoide. La duración media de la TCR fue de 9,64 min. Encontramos una mayor satisfacción con la TCR por parte del paciente, cuando el nivel de estudios era más alto (OR = 4,33) y por parte del médico cuando el individuo manejaba mejor Internet (OR = 3,22). CONCLUSIÓN: Es posible transferir actividad asistencial reumatológica hacia la TCR con un grado importante de satisfacción para el paciente y el médico

INTRODUCTION: During the COVID-19 pandemic strategies to prevent transmission of the viral infection obliged our hospital to promote virtual consultations. OBJECTIVE: The objective of this study is to describe the results obtained with the previous strategy of transferring activity to teleconsultation during the period of maximum impact of the pandemic. MATERIAL AND METHODS: Between 16/03 and 10/05/2020 all successive consultations in our unit were performed in virtual rheumatology teleconference (RTC) format. The socio-demographic, geo-functional and clinical characteristics of all patients were collected; a numeric verbal scale (NVS) (where 0=very dissatisfied to 10=fully satisfied) was applied to assess the degree of satisfaction of the doctor/patient with the RTC. RESULTS: 469 TC were included. Most patients seen by RTC were women, mean age: 60,83 years. Only 16% had university education. The mean distance travelled for face-to face consultation is 33 Km with a mean total time of 2hours. Most individuals were diagnosed with osteoarthritis/soft tissue rheumatic diseases and/or osteoporosis; 21% had rheumatoid arthritis. The mean length of the TC was 9.64minutes. We find more patient satisfaction with the TC when their level of education is higher (OR=4.12); doctor satisfaction was higher when the individual was better able to manage the Internet (OR=3.01). CONCLUSION: It is possible to transfer rheumatological care activity to TC with a considerable degree of satisfaction for both the patient and the doctor

Integration of Real-Time Electronic Health Records and Wireless Technology in a Mobile Stroke Unit.

BACKGROUND: UCHealth's Mobile Stroke Unit (MSU) at University of Colorado Hospital is an ambulance equipped with a computed tomography (CT) scanner and tele-stroke capabilities that began clinical operation in Aurora, Colorado January 2016. As one of the first MSU's in the United States, it was necessary to design unique and dynamic information technology infrastructure. This includes high-speed cellular connectivity, Health Insurance Portability and Accountability Act compliance, cloud-based and remote access to electronic medical records (EMR), and reliable and rapid image transfer. Here we describe novel technologies incorporated into the MSU. Technological data-handling aspects of the MSU were reviewed. Functions evaluated include wireless connectivity while in transit, EMR access and manipulation in the field, CT with image transfer from the MSU to the hospital's Picture Archiving Communication System (PACS), and video and audio communication for neurological assessment. METHODS/RESULTS: The MSU wireless system was designed with redundancy to avoid dropped signals during data transfer. Two separate Internet Protocol destinations with split-tunnel architecture are assigned, for videoconferencing and for EMR data transfer. Brain images acquired in the ambulance CT scanner are transferred initially to an onboard laptop, then via Citrix Receiver to the hospital-based PACS server where they can be viewed in PACS or EMR by the stroke neurologist, neuroradiologist, and other providers. PACS and Radiology Information System are 2 of the XenApps utilized by CT technologists on board the MSU. DISCUSSION/CONCLUSIONS: These technologies will serve as a blueprint for development of similar units elsewhere, and as a framework for improvement in this technology.

One-year experience of a regional service model of teleconsultation for planning and treatment of complex thoracoabdominal aortic disease.

OBJECTIVE: The objective of this study was to report the methodology and 1-year experience of a regional service model of teleconsultation for planning and treatment of complex thoracoabdominal aortic disease (TAAD). METHODS: Complex TAADs without a feasible conventional surgical repair were prospectively evaluated by vascular surgeons of the same public health service (National Health System) located in a huge area of 22,994 km2 with 3.7 million inhabitants and 11 tertiary hospitals. Surgeons evaluated computed tomography scans and clinical details that were placed on a web platform (Google Drive; Google, Mountain View, Calif) and shared by all surgeons. Patients gave informed consent for the teleconsultation. The surgeon who submits a case discusses in detail his or her case and proposes a possible therapeutic strategy. The other surgeons suggest other solutions and options in terms of grafts, techniques, or access to be used. Computed tomography angiography, angiography, and clinical outcomes of cases are then presented at the following telemeetings, and a final agreement of the operative strategy is evaluated. Teleconsultation is performed using a web conference service (WebConference.com; Avaya Inc, Basking Ridge, NJ) every month. An inter-rater agreement statistic was calculated, and the κ value was interpreted according to Altman's criteria for computed tomography angiography measurements. RESULTS: The rate of participation was constant (mean number of surgeons, 11; range, 9-15). Twenty-four complex TAAD cases were discussed for planning and operation during the study period. The interobserver reliability recorded was moderate (κ = 0.41-0.60) to good (κ = 0.61-0.80) for measurements of proximal and distal sealing and very good (κ = 0.81-1) for detection of any target vessel angulation >60 degrees, significant calcification (circumferential), and thrombus presence (>50%). The concordance for planning and therapeutic strategy among all participants was complete in 16 cases. In one case, the consultation was decisive for creating an innovative therapeutic strategy; in the remaining seven cases, the strategy proposed by the patient's surgeon was changed completely after the discussion. Technical success was the same (100%) if concordance in planning was present initially or not. Overall 6-month mortality was 4%, 0% for those patients with initial concordance in planning vs 12% for those without initial concordance (P = .33). Surgery was always performed in a tertiary hospital by local surgeons, and in two cases (8%) external surgeons joined the local surgical team. CONCLUSIONS: Such a regional service of teleconsultation may be of value in standardizing the treatment and derived costs of complex TAADs in a huge region under the same health provider. The shared decision-making strategy may be of medical-legal value as well.

Implementation of Image-Guided Cochlear Implant Programming at a Distant Site.

Our objective was to prospectively evaluate implementation of a new cochlear implant (CI) mapping technique, image-guided cochlear implant programming (IGCIP), at a site distant to the site of development. IGCIP consists of identifying the geometric relationship between CI electrodes and the modiolus and deactivating electrodes that interfere with neighboring electrodes. IGCIP maps for 17 ears of 15 adult CI patients were developed at a central image-processing center, Vanderbilt, and implemented at a distant tertiary care center, House Ear Institute. Before IGCIP and again 4 weeks after, qualitative and quantitative measures were made. While there were no statistically significant groupwise differences detected between baseline and IGCIP qualitative or quantitative measures, 11 of the 17 (64.7%) elected to keep the IGCIP map. Computed tomography (CT) image quality appears to be crucial for successful IGCIP, with 100% of those with high-resolution CT scans keeping their maps compared to 53.8% without.

The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence.

INTRODUCTION: Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. METHODS: A selective review of the credible literature during the past decade (2005-2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. FINDINGS: The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.

First Automated Stroke Imaging Evaluation via Electronic Alberta Stroke Program Early CT Score in a Mobile Stroke Unit.

BACKGROUND: Recently, a mobile stroke unit (MSU) was shown to facilitate acute stroke treatment directly at the emergency site. The neuroradiological expertise of the MSU is improved by its ability to detect early ischemic damage via automatic electronic (e) evaluation of CT scans using a novel software program that calculates the electronic Alberta Stroke Program Early CT Score (e-ASPECTS). METHODS: The feasibility of integrating e-ASPECTS into an ambulance was examined, and the clinical integration and utility of the software in 15 consecutive cases evaluated. RESULTS: Implementation of e-ASPECTS onto the MSU and into the prehospital stroke management was feasible. The values of e-ASPECTS matched with the results of conventional neuroradiologic analysis by the MSU team. The potential benefits of e-ASPECTS were illustrated by three cases. In case 1, excluding early infarct signs supported the decision to directly perform prehospital thrombolysis. In case 2, in which stroke was caused by large-vessel occlusion, the high e-ASPECTS value supported the decision to initiate intra-arterial treatment and triage the patient to a comprehensive stroke center. In case 3, the e-ASPECTS value was 10, indicating the absence of early infarct signs despite pre-existing cerebral microangiopathy and macroangiopathy, a finding indicating the program's robustness against artefacts. CONCLUSIONS: This study on the integration of e-ASPECTS into the prehospital stroke management via a MSU showed for the first time that such integration is feasible, and aids both decision regarding the treatment option and the triage regarding the most appropriate target hospital.

MEDXVIEWER: PROVIDING A WEB-ENABLED WORKSTATION ENVIRONMENT FOR COLLABORATIVE AND REMOTE MEDICAL IMAGING VIEWING, PERCEPTION STUDIES AND READER TRAINING.

MedXViewer (Medical eXtensible Viewer) has been developed to address the need for workstation-independent, picture archiving and communication system (PACS)-less viewing and interaction with anonymised medical images. The aim of this paper is to describe the design and features of MedXViewer as well as to introduce the new features available in the latest release (version 1.2). MedXViewer currently supports digital mammography and tomosynthesis. The flexible software design used to develop MedXViewer allows it to be easily extended to support other imaging modalities. Regions of interest can be drawn by a user, and any associated information about a mark, an image or a study can be added. The questions and settings can be easily configured depending on the need of the research allowing both ROC and FROC studies to be performed. Complex tree-like questions can be asked where a given answer presents the user to new questions. The hanging protocol can be specified for each study. Panning, windowing, zooming and moving through slices are all available while modality-specific features can be easily enabled, e.g. quadrant zooming in digital mammography and tomosynthesis studies. MedXViewer can integrate with a web-based image database OPTIMAM Medical Image Database allowing results and images to be stored centrally. The software can, alternatively, run without a network connection where the images and results can be encrypted and stored locally on a machine or external drive. MedXViewer has been used for running remote paper-less observer studies and is capable of providing a training infrastructure and coordinating remote collaborative viewing sessions.

[Telemedicine in Switzerland]. / Telemedizin in der Schweiz.

Telemedicine always was at the edge in adapting newest information and communication technologies. Since medicine occurred, telemedica/ activity was undertaken with the aim to overcome a distance. Telemedicine is defined as an interaction between one or several health professionals, within the context of a medical process, but at a distance, without direct physical contact. Classical fields of telemedicine or Teleradiology, Telepathology, are mainly related to medical specialties and hospital centres,in Switzerland as well. In parallel, Swiss Telemedicine did undertake a specific evolution, by developing sophisticated telemedical consultation centres focused on primary health and with highly trained multiprofessional staff They contribute to the development of decentralized and population based integrated health and care services. In turn, this enables development of new interprofessional health professionals' roles and activities. As progression of patient-citizens' mobility and spreading out of mobile devices take place simultaneously, this opens the opportunity to overcome structural change of the Swiss healthcare system by creating new and innovative healthcare services.

Diagnostic Imaging Integrated Network: A Teleradiology Pilot in Public Hospitals in Uruguay.

A network of health care centers allows radiologists to share diagnostic images in different areas of Uruguay. This solution is based on an informatics multicenter application for center management, enabling the creation, storage and distribution of images and reports from different imaging modalities according to outsourcing agreements. The solution improves health care territorial equity and reduces asymmetry in resources distribution.

Client-side Medical Image Colorization in a Collaborative Environment.

The paper presents an application related to collaborative medicine using a browser based medical visualization system with focus on the medical image colorization process and the underlying open source web development technologies involved. Browser based systems allow physicians to share medical data with their remotely located counterparts or medical students, assisting them during patient diagnosis, treatment monitoring, surgery planning or for educational purposes. This approach brings forth the advantage of ubiquity. The system can be accessed from a any device, in order to process the images, assuring the independence towards having a specific proprietary operating system. The current work starts with processing of DICOM (Digital Imaging and Communications in Medicine) files and ends with the rendering of the resulting bitmap images on a HTML5 (fifth revision of the HyperText Markup Language) canvas element. The application improves the image visualization emphasizing different tissue densities.

[Teleradiological report turnaround times: An internal efficiency and quality control analysis]. / Teleradiologische Prozess- und Untersuchungszeiten: Eine institutsinterne Effizienz- und Qualitätsanalyse.

AIMS: The teleradiological examinations performed at the Charité were analyzed for the purpose of internal quality and efficiency control. Data included the type and number of examinations performed, the time of day and week the examination was performed and the differences in teleradiologist report turnaround times. MATERIAL AND METHODS: A retrospective analysis of the radiology information system (RIS) database of all teleradiological computed tomography examinations performed at the Charité from 2011 through 2013 was carried out. The search retrieved 10,200 teleradiological examinations which were included in the analysis. The records were analyzed for the time of the day and week the examination was performed, the interval between examination and time of reporting, the type of teleradiological examination and the campus in which they were performed. RESULTS: The number of teleradiological examinations performed increased continuously during the observation period. Computed tomography of the head was the most frequently performed type of examination with 86%. Taking all forms of examination into consideration it took an average of 34 min until a report was written. Over the 3-year observation period the times remained virtually unaltered. CONCLUSION: During the 3-year observation period nearly constant report times could be observed in spite of the increased numbers of examinations. This indicates an efficiency enhancement and rational integration of teleradiology into the radiological workflow.

Addressing requests for emergency ultrasonographic examinations when implementing teleradiology services.

PURPOSE: To prospectively assess how to address requests for ultrasonographic examinations when setting up an on-call teleradiology service. MATERIALS AND METHODS: An analytical prospective study was performed from January 2012 to December 2012 inclusively. All requests received for after-hours ultrasonographic examinations during this period were analyzed. Ultrasound requests were classified as being postponable until working hours, replaceable by an alternate cross-sectional imaging modality, or urgent and needing to be performed after hours. RESULTS: A total of 176 requests for ultrasonographic examinations were analyzed. They predominantly included requests for abdominal and pelvic ultrasonographic examinations (63%). Thirty-nine requests (22.2%) were considered as postponable, 49 (27.8%) as replaceable and 64 (36.4%) as both postponable and replaceable. Twenty-four requests (13.6%) were considered as urgent; they consisted of 10 requests for venous duplex Doppler ultrasonographic examinations of the lower limbs, eight requests for testicular ultrasonographic examinations, five for pelvic ultrasonographic examinations and one for soft-tissue ultrasonographic examination. In these urgent cases, realistic options were either to transfer the patient to another institution or to train emergency department physicians in ultrasonography for local handling. CONCLUSION: Although the need for addressing requests for ultrasonographic examinations should be taken into account when setting up an on-call teleradiology service, it should not impede such plans.