Economic analysis of teleradiology applications with KAMEDIN.

The teleradiology system KAMEDIN (German Telekom), installed on HP-Unix- and NT-Workstations, was evaluated in different scenarios and a cost-benefit-analysis was performed. CT examinations were transferred from a PACS workstation (GE) to KAMEDIN using DICOM-3 protocol. Teleconferences were realized with an intensive care unit by LAN, with a radiology department at 5 km. distance by ISDN, and with an on duty radiologist 22 km. away by ISDN. On average, 36 CT slices per patient were transferred. Overall costs (costs for hardware, software, support, ISDN-fees, and staff) were compared to possible cost reduction, mainly concerning transportation and films. These three scenarios could be realized during daily routine work. Differing in their amount of transportation cost reduction, two applications (intensive care unit, radiologist on duty) showed a break-even at 1817, respectively 528 teleconferences/year. Improvement of cost-effectiveness can be obtained on the conditions that existing hardware will be used and that the automatic data transfer will be improved. Combining all optimisation factors, the break-even decreased to a minimum of 167, respectively 77 teleconferences/year. The optimisation of patient management is an additional--but in this study, not yet counted--advantage of teleradiology.

[Radiologic medical desktop conferences--clinical evaluation of the KAMEDIN teleradiology system in routine practice of a radiologic institute]. / Radiologisch-medizinische Desktop-Konferenzen--Klinische Evaluation des Teleradiologiesystems KAMEDIN im Routinebetrieb eines radiologischen Instituts.

KAMEDIN is a teleradiology project of "Deutsche Telekom". ISDN based image transfer, visualisation and online-presentation of digital radiological images is performed. In this study the suitability of the KAMEDIN-system has been tested in a clinical environment. The software has been adapted to the requirements of radiological image visualisation. During 6 months over 50 conferences took place with an average of 36 CT-slices per patient. The amount of time was approximately 10 min for conference preparation, 20 min for image transfer and 8 min for conferencing. Software problems occurred and were solved. Image quality on the monitor as well as online presentation including "simultaneous cursors" showed high performance and achieved high acceptance by the clinicians. Thus KAMEDIN is a useful teleradiology system, especially if the system is adapted to the requirements of radiology departments.

[Excentric rotation irradiation in ORL tumors]. / Exzentrische Rotationsbestrahlungen bei HNO-Tumoren.

A risk of dose insufficiency in the regions situated laterally to the spine and diagonally behind the spine is shown for the irradiation schemes applied hitherto in ORL tumors. In every case the fields are arranged in such a way that the myelon is not exposed to radiation. The excentric rotation technique presented guarantees that the exposition of the myelon doses not exceed 50% of the maximum dose. The axis lays within the myelon itself, and the central rays show an excentric deviation of 3 to 4 degrees. Thus a homogeneous dose distribution is achieved for the complete head and neck section.

[Combined therapy with high-dosage cisplatin and radiation in advanced ENT tumors (a phase-II study)]. / Kombinierte Therapie von hochdosiertem Cis-Platin und Bestrahlung bei fortgeschrittenen HNO-Tumoren (Phase-II-Studie).

The most promising method to obtain at least a palliative effect in advanced ORL tumors seems to be a combination of chemotherapy and radiotherapy. We made an attempt to reach a higher remission rate (n = 28) by means of an extraordinary high dose of cis-platinum and the usual maximum radiation dose of 60 Gy: The method had to be abandoned because the rates of success (CR and PR) decreased from 79% to 46% in eight months, the side effects, however, were beyond a tolerable degree. We are of the opinion that the same results can be obtained by less radical methods, too.

[Analysis of the recurrence pattern in Hodgkin's disease]. / Analyse des Rückfallmusters beim Morbus Hodgkin.

The data published about the healing chances of Hodgkin's disease cannot reflect reality since the evaluation includes also the technically preventable marginal recurrences. The analysis of 63 own cases furnishes the same result as far as only one true recurrence was found in the irradiated regions. Only in two patients we have seen a progression of the disease in lymph nodes beyond the extended field. The evaluation of our recurrences shows a clear pattern: in the individual cases, progression during radiotherapy and recurrences are very probably due to an understaging or to a problem concerning the dose.

[Computer tomographic diagnosis of lung abscess and pleural empyema]. / Computertomographische Diagnostik von Lungenabszessen und Pleuraempyemen.

Lung abscesses are characterised by irregular air spaces with non-homogeneous necrosis. Pleural empyemas often assume a sickle shape up against the thoracic wall and tend to be homogeneous. Problems in differential diagnosis may occur if the process is not confined to an exact anatomic position. A peripheral perforating abscess is isolated from the tracheobronchial system by thickened pleura and by its capsule; even if computer tomography does not show clear-cut findings, operative intervention is indicated.

[The role of computer tomography in staging of carcinomas of the bladder (author's transl)]. / Die Rolle der Computeromographie beim Staging von Harnblasenkarzinomen.

Carcinomas of the bladder can be demonstrated in various ways, such as examination with contrast medium before and after micturition, and filling with CO2 as suggested by Seidelmann. The procedure should be chosen depending on one's aim. We examined patients who had already been diagnosed when the bladder was full of urine, in order to confirm doubtful findings, and after micturition in order to demonstrate the smallest volume to which radiotherapy can be given. Computer tomography has proved valuable; in 33% of 54 patients staging had to be revised upwards.

[Computer tomographic staging of prostatic carcinomas (author's transl)]. / Computertomographisches Staging des Prostatakarzinoms.

The diagnosis of carcinoma of the prostate depends on well proven urological methods. Computer tomography provides valuable additional information, such as tumour spread beyond the prostate, to lymph nodes and to the skeleton. It is an important requirement for proper radiotherapy and can be used to control treatment. In 14% out of 62 patients is use resulted in a change in staging. These patients, who had originally been asigned to local radiotherapy, were treated by an extended field technique or hormone therapy as a result of the information provided by CT.

[Treatment procrastination time in breast cancer and personality structure]. / Verschleppungszeit beim Mammakarzinom und Persönlichkeitsstruktur.

Sixty patients with mammary cancer were studied in order to determine whether a connection between the tendency to delay medical treatment and a neurotic personality structure exists. The results are based on different personality factors that were investigated by means of the 16-PF test by Cattell. It could be shown that for patients who had delayed treatment (D2) the personality traits "limited inner tension" and "slightly inhibited" were present. On the other hand patients who had not delayed treatment (K1) displayed the personality traits "higher inner tension" and "free of inhibitions".

[Determination of normal values by means of various statistical methods derived from radioiodine tests (author's transl)]. / Ermittlung von Normalbereichen mit verschiedenen statistischen Verfahren beim Radiojod-Test

Normal values derived from 361 euthyroid patients were calculated by means of five different statistical methods and compared. Borderline values were also obtained from 61 patients with hyperthyroidism, nine with hypothyroidism and ten with autonomous adenomas. The following individuals data were collected: 131 I-PBI after 48 hours, thyroid uptake after two, 24 and 48 hours.