Culture acts as main obstacle to radiotherapy via teleradiology

The experience at a Norwegian hospital suggests that psychological issues are more important than technological ones for successfully implementing a teleradiological radiotherapy network.

Researchers at Norwegian Radium Hospital in Oslo recently reported lessons learned after six years of distributing radiotherapy services to two satellite hospitals hundreds of kilometers apart via a teleradiology network (Stud Health Technol Inform 2008;134:209-216).

"The main lesson learned is that the most serious obstacles are not technological but sociopsychological challenges," said Dr. Albrecht Reith of the hospital's pathology department.

Successful implementation of distributed teleradiological radiation therapy requires more focus on educating and motivating the staff in using the technology for changing work practice, according to Reith.

"This requires an altered mindset," he said.

It was achieved at NRH through weekly educational sessions with staff at the satellite units and the main clinic.

Until recent efforts typified by the pioneering work at NRH, teleradiology has rarely been used in radiation therapy. Reith expects that to change.

"Based on the nature of radiation therapy, with the vast amount of digital information characteristic of the therapeutic process, one can expect that telemedicine in radiation therapy will become important in improving the quality of these procedures," he said.

The most evident role for teleradiology can be found in treatment planning and simulation in individual patients. Here, remote consultation may be of clinical importance in identifying and delineating cancerous tissue from CT, MR, ultrasound, and PET images, Reith said.

At smaller radiation therapy clinics, the required expertise may not be available, in which case teleradiology may be a helpful tool.

"Ideally, with real-time telemedicine and teleradiology service, identification and delineation, treatment options, and treatment plan evaluation can be discussed jointly among the clinical team, even though remotely located," Reith said.

NRH opened its first radiation therapy satellite unit in 2001 at Kristianasand, followed in 2002 by a second facility at Gjøvik. Both units were established to provide decentralized radiation therapy, primarily for palliative cancer care and standard curative breast cancer radiation.

Both satellite units and the main clinic are equipped with identical software solutions for maximum connectivity, communication, and data transfer, Reith said.

"Dedicated radiation therapy DICOM databases are installed at both satellite units and the main Oslo clinic, and transfer of all radiation therapy data from satellite units to the main clinic is performed daily," he said.