Editor's note: Over the past couple of months we've watched the evolving world of teleradiology and thought a way to capture some of its features would be a series of vignettes written by those most involved.

The writers of these vignettes, all of them commissioned before the acquisition of NightHawk by Virtual Radiologic, were asked to answer two questions: How has teleradiology changed over the past decade, and what impact has it had on the practice of radiology? Not all stuck precisely to the format, but all provided interesting answers that will give you a sense of how differently teleradiology is being viewed, even among its most active practitioners.

—John C. Hayes

TELERADIOLOGY HAS MOVED FROM ADJUNCT TO ESSENTIAL ELEMENT OF PRACTICE

Teleradiology has morphed over the last decade, from an adjunct to the practice of radiology to an essential practice- enhancing technology for groups large and small.

For large practices, it has facilitated the ability to provide subspecialty radiology coverage to a large geographic footprint. In addition to providing a higher quality subspecialty interpretation within a practice or group of practices, teleradiology has also supplied a tool to help hospitals and radiologists practice more efficiently, resulting in timelier subspecialty imaging coverage. For the small practice, teleradiology is now more than an adjunctive tool facilitating night call coverage; it is a tool to tap into a subspecialty resource whenever there is a need.

Teleradiology’s decade-long impact on the medical landscape is multifactorial. It has facilitated subspecialty coverage of radiology practice landscapes unachievable in an analog world. It has made subspecialty reads increasingly possible around the clock and has allowed radiologists to focus on the development of subspecialty expertise within a practice by delivering imaging studies regardless of the patient location. Most important, teleradiology has helped radiologists keep the patient first in delivering high-quality service to all patients under their care, at that moment, regardless of geographic location within a practice envelope.

Arl Van Moore, M.D., FACR
President, Charlotte Radiology,
Charlotte, NC

Teleradiology changes reflect technology, market shifts

The evolution of our teleradiology practice reflects changes for radiology practices in general. Advanced Medical Imaging Consultants (AMIC), the teleradiology group in which we are partners, has a unique twist on teleradiology. On the professional side, we offer a full-service, subspecialized radiology group to hospitals, imaging centers, and clinics in Colorado, Wyoming, and Nebraska. We also supply a smorgasbord of imaging IT services, from radiology IT consultation to PACS and image storage provider.

AMIC began this service over a decade ago in an effort to help sites which otherwise had trouble finding radiology coverage. Initial issues included expensive storage, low and costly bandwidth, last-mile connectivity, additional workstations, and DICOM conflicts. Reading was tightly centralized because of workstation cost and data transmission limitations. At the time, however, radiology was less specialized. A typical CT had fewer than 60 images and 50-MB digital mammograms weren’t even part of the discussion.

Data storage is now cheap and can be dispersed in a grid or a cloud, high-bandwidth and last-mile issues are less significant, and diagnostic workstations are inexpensive. These factors have allowed for dispersed reading, improved efficiency, and time shifting as options even for small groups. On the other hand, exams are significantly larger, more complex, and more numerous. As a result, advanced image processing and subspecialization have become the norm rather than the exception, and the number of stat exams as a percentage of overall volume continues to increase.

In the beginning, many sites simply appreciated consistent, high-quality coverage. Today, however, radiology is a commodity—with quality assumed—and clients focus almost entirely on cost and turnaround time. While these things are easy to quantify and certainly have some bearing, quality is more difficult to measure. A good teleradiology practice, though, will always obtain relevant priors and may spend hours on the phone discussing patients and their presentations. In today’s world of radiology, it’s attention to details such as these that makes the difference between a teleradiology company and your teleradiologist.

J. Raymond Geis, M.D.,
Medical Director, Imaging Informatics
Chris Fleener, M.D.,
Codirector, Outreach Imaging
Advanced Medical Imaging Consultants
Fort Collins, CO