July 18, 2022

How do we facilitate Tele-radiologists?

Kovey Kovalan

Tele-radiology is making rapid strides in the world of healthcare. In the coming years, its impact is going to be felt in a more profound manner. But what processes does it include? It involves the electronic transfer of data across locations for diagnostic purposes. To put it in simple words, it is a process which breaks the limitations of the traditional on-site services provided by a radiologist. With the increase in the number of diagnostic images in the past few years, there is a remarkable increase in the demand for radiologists. In its infancy, tele-radiology is seen as an overnight service to fill in the gap of conventional radiologists. To-day, however, its scope has widened. As we stare at a shortage of radiologists it is hoped that tele-radiologists would fill in the vacuum. The option also allows radiologists to strike a better work-life balance and decrease the on-job pressure, both of which ultimately lead to better results. In addition, it lets patients from even the most remote corners of the world make use of the services of top-class radiologists.

Tele-radiology grew at a faster pace since last decade. Advanced technology is the main driver of tele-radiology, but now the medical imaging become digital and high-speed internet allowed technologists to upload images from the modality to any RIS PACS system in the world, the concept of tele-radiology took off. With the help of EMRs and cloud sharing made it easier for the radiologists to retrieve complete case studies. For this reasons, now tele-radiologists can provide not only preliminary but also full final reads. Tele-radiologists are driven by more than technology, today it is the consolidation and the competition of those who re-main in the healthcare. But there are a number of issues which have to be ad-dressed. As with every other field in medicine and healthcare, the technology employed, and its reliability becomes critical. Our tele-radiologists need to be provided with the best infrastructure and technology. How do we get that done?

We have to increase the practice of tele-radiologists not only in the emergency night hours but also during the daytime. As the volume of neuro studies at a particular site increases, they need half a neuroradiologist. Its very difficult to hire half a neuroradiologist but we can supply easily in a cost-effective way, pay-per-study model. Similarly, as many groups are coming together, increasing in numbers, and broaden their services, it becomes very important to access sub-specialized teleradiology services, permissive to continue their growth. Increase in the number of urgent growth centers, standalone emergency department, increases the demand for the tele-radiologists. Health care systems are trying to establish centers of excellence, specialized in foot and ankle orthopedic centers. These centers require specialists and radiologists, who can examine and read these specialized reports.

Integration, Interoperability and latency sensitivity

Medical imaging data is complex and requires powerful technology to enable its sharing. Incompatibility in the applications used by institutions can be a major hindrance to tele-radiologists. Integrating PACS from different vendors with hospital management systems (HIS) is a continuous struggle. Sharing images be-tween various third party EHR’s are common problems faced by radiologists. Integrating PACS with RIS, billing, voice recognition are also a struggle. The integration problem becomes worse, due to lack of inter-vendor device and IT integration. Readability of images while they are being shared is essential for tele-radiology. Here again, the onus is on powerful technology.

Integration problems are hardware, integrating advanced image reconstruction from digitizing PRE-DICOM modalities. DICOM converter can be used to add value from older CT and fluoroscopy systems. Radiologists and PACS administrators would like to see simple and better integration between PACS and advanced visualization systems including a shared image archive. They want to enable RIS PACS workstations to display thicker CT section using thin section data to avoid the need to save both thin and thick slices. The main challenge remains managing the hardware between different vendors. Additional software integration required for new devices with new vendor contracts.

In medical imaging industry, latency sensitive issues are critical and that is still not properly addressed by many big giants in the market. The speed of data generation in medical imaging technology is important as it interprets a typical workflow related to diagnostic medical procedure. Medical imaging technologies are latency sensitive applications which must respond faster on specific events failed to do so can end up in deadly consequences with regard to these applications. Latency sensitive medical image processing applications are typically having 0.5 to 3 seconds latency. However, it is important to achieve 0,01 seconds latency for high FPS.

LifeVoxel a cure to all the woes

LifeVoxel has been working in medical imaging field for more than 3 decades, investing a great deal of time and capital to raise standards in tele-radiology solutions. Today it is the only platform which can address all the above issues which can affect the efficiency of tele-radiologists. The 12 international patents that it holds for its technology is ample evidence for this.

It is the only platform which provides a rendering of images from the server-side and gives a platform which can perform using low bandwidth and no latency, something that is extremely essential when it comes to tele-radiology. LifeVoxel has utilized the readily available supercomputing processing capabilities that Graphics Processing Unit (GPU) possess and have innovatively integrated into its robust cloud technology. GPUs are the ideal fit executing artificial intelligence algorithms in real-time. The use of Machine Learning through AI algorithms is provided clinicians with decision support and other analytics which drastically reduces the turnaround time and incidence of error.

Traditional cloud service providers are unable to handle the complex medical data that radiologists have to work with. Companies like LifeVoxel which have specialized in bringing this data on to the cloud can address all the needs of tele-radiologists. The data shared via the platform is compatible across applications. Server rendering ensures premier visualization capabilities and AI technology helps the tele-radiologists get a head start along with greater convenience.

A Cloud-based system provides a software platform for RIS PACS, remote image review software (teleradiology), advanced 3D workstation software which is a thin client (all you need is a browser), and billing software, and this is actively accessed by end users remotely by using computers or tablets over the Internet. This makes imaging truly virtual. Radiologists need not maintain many IT products like software and hardware, but simply have a single central processing unit. This system allows radiologists to focus on their practice and not how or where the service is processed, hosted, or routed. This will also allow the state to have a centralized pool of specialist radiologists who can access the images from any-where with an internet connectivity and improve patient care and health out-comes.

As we stare at a radiologist crisis today, the field of tele-radiology is eyed as a possible solution to fill in the gap and the market has responded with open arms. But this would require ensuring that our tele-radiologists have access to top-notch technology which can address the issues of interoperability, image quality and latency. With the right technology, tele-radiology can become a panacea to many woes.

According to a Franklin and Seidelmann Sub-specialty Radiology (F&S) 2006 study, 23.4 percent of radiology practice respondents stated that sub-specialty coverage is a problem in their practices, reporting that current coverage levels for specialized interpretations are not at “appropriate” levels to support their clinician referrers’ needs.

“The shortage of skilled radiologists has lead to a significant shortage of subspecialized or fellowship-trained radiologists,” said Greg Rose, M.D., Ph.D, presi-dent and CEO of NightRays. “It is too much to ask one radiologist to be an ex-pert on MSK, neuro, CTA, mammo, peds and nuclear imaging. Now that sub-specialization is available by teleradiology, general radiologists can focus on bread and butter radiology and get support from an expert readily online. This eases the already increasing burden of the on-site radiologist and allows subspecialization to reach the patients in remote areas that cannot support a full-time specialist,” he explained. [1]

The lack of availability of timely diagnostic services causes great problems for clinicians during emergencies and during the night hours. Moreover, the Health Care Financing Administration (HCFA) in the US mandates round-the-clock services in every hospital. By outsourcing radiology reporting to places such as Australia, Europe, and some Asian countries (including India) hospitals in the USA, UK, and Singapore can be assured of competent and timely professional help. The immediate availability of diagnostic services, which is extremely important during medical emergencies, is a big advantage that outsourcing offers. Outsourcing of ‘on-call’ night reporting is popularly called ‘nighthawking.’

Another reason for the growth of tele-radiology is that most parts of rural India do not have good radiological services and personnel. With tele-radiology, this deficiency can be overcome by using the help of more experienced personnel in the larger centers in the cities. Also, even in the cities, not all imaging centers have subspecialty expertise; difficult cases in specific areas of radiology can be sent to experts for their opinion. [2]


1 https://www.itnonline.com/article/redefining-teleradiology

2 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2747412/

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