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- Teleradiology

Teleradiology Arrives at Rural Hospitals -- Part II

In the January/February issue of Telemedicine an overview of the definitive teleradiology project in place at Mercy Hospital Medical Center and its affiliate hospitals was presented. In this issue, our attention turns to North Iowa Mercy Health Center and its affiliate's preliminary diagnosis and supplemental teleradiology project. As noted in the last issue, each teleradiology system meets specific functionality requirements set by the reviewing facility.

North Iowa Mercy in Mason City and Franklin General Hospital in Hampton were the first locations in the MRTC network to deploy the technology, primarily to assist in radiology coverage. Like so many rural hospitals today, the low volume of radiology cases does not support the need for a full-time radiologist.

Barb Bell, a radiology technologist at Franklin General commented, "All of the cases that we've sent to North Iowa Mercy have been conducted during non-coverage times (off hours or no visiting radiologist on site). Our particular system allows us to send the images to the Radiology Department at North Iowa Mercy, or directly to the home of the on-call radiologist."

The teleradiology system utilized by Franklin General is an EMED Lumiscan system. It is comprised of a PC-Windows platform, an on-board modem and a 512 kbs by 512 kbs resolution scanner. The system uses existing Plain Old Telephone Service (POTS), unlike the system at Mercy Hospital in Des Moines, which utilizes a 1/4 bandwith of the ISDN PRI-circuit.

"Transmitting a case is quite simple," says Bell. "A patient is brought into our radiology department for x-rays and the films are developed. Using the communications program on the teleIeradiology system, I create a facsimile coversheet with the patient's demographics and brief case history. After the patient's films have been developed, it is scanned it into the computer, reviewed for clarity and sent."

"The Radiology Department at North Iowa Mercy is notified when the images are sent, and whether or not the case is urgent. In most cases, a telephone call from the reviewing radiologist is received within 20 to 45 minutes," says Bell. Because Franklin General only receives a preliminary diagnosis via teleradiology, every case (films and report) is then sent to the reviewing radiologist in Mason City for a definitive and final report.

The teleradiology system at North Iowa Mercy and Franklin General Hospital has been in operation for a year. The system has been used to diagnose cases ranging from child pneumonia to second opinions on chest exams. However, up to this point, teleradiology has not been utilized to its full capacity. Causes linked to the low volume of cases maybe a lack of protocols (which has since been resolved) and unfamiliarity with the technology at both locations by both physicians and technologists.

Trine S. Bergmo of the Department of Telemedicine at the University Hospital of Tromso, Norway, recently presented a case study named An economic analysis of teleradiology versus a visiting radiologist service in the Journal of Telemedicine and Telecare [Volume 2, No. 3 - 96]. Bergmo's study indicates a radiology department at a tertiary hospital can save $422,000 per year by using teleradiology services at a rural hospital, rather than having a "circuit rider" radiologist visit that rural site -- assuming that 6000 patients (or 8000 examinations) were seen per year (an average of 25 patients per day).

Another study Teleradiology services for a rural hospital: a case study was also featured in the same issue of the Journal of Telemedicine and Telecare. This study, compiled by E.A. Franken, Jr., and W. L. Smith at the University of Iowa, and P. Whitten at the University of Kansas Medical Center, revealed "approximately one-half of all US hospitals have fewer than 100 beds, and each of these hospitals performs an average of about 7000 radiographic examinations annually. This constitutes about 12% of all radiographic examinations performed in the USA."

With radiographic technology and telecommunications constantly fusing together, it will be the progressive organizations small and large who will profit from harnessing its awesome potentials.

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