Here lies teleradiology: rest in peace

The continuing evolution of new information networks, combined with a continuing demand for radiology services, could doom teleradiology as we know it, a new research paper argues. What could emerge to replace it are large networks that accomplish in geographic regions what a PACS does within a hospital today.

The old model of teleradiology - in which an order is faxed, an image is transmitted over a point-to-point link, and a report is faxed back the next day - will likely become increasingly unacceptable, said Kevin M. McNeill, Ph.D., a research scientist in the Radiology Research Laboratory at the University of Arizona.

Instead, the next-generation network (NGN), which combines greater volume capacities with linked services such as voice and data, represents the coming technology wave. It could be spurred by the need for faster and better radiology services, he said.

"The traditional approach to teleradiology is prone to failure, errors, lost reports, and the potential unauthorized release of patient information," McNeill said.

In addition, quality of care concerns are driving service level agreements (SLAs), in which radiology service providers guarantee minimum turnaround times. Stat reports for a trauma case, for example, must be returned in 30 minutes or less to avoid the potential expense of a helicopter evacuation from a rural hospital to a trauma center.

If the bandwidth available does not support reliable transmission of a cervical spine CT exam in less than 10 minutes, there is little chance of meeting strict SLAs.

"We want NGN available at rural hospitals to support unification of teleradiology and radiology into simply digital radiology," McNeill said.

When the communications infrastructure is no longer an issue, PACS moves into the realm of a very large-scale software system.

"As the capabilities of modalities (especially multidetector CT) to generate very large quantities of data grow, the network traffic load will demand NGN types of services," McNeill said.

His comments came in a paper (J Digit Imaging, 2004 Feb 19, Epub ahead of print) addressing the issue of medical applications that will drive, and benefit from, NGN. It detailed research developments in the networking community that promise to enable the creation of highly distributed digital radiology systems able to operate across the country with performance the same as existing PACS operating across the hall.

A key factor in NGN is the ubiquitous high-volume bread-and-butter nature of radiology. This is especially true in remote areas where demand is unsatisfied for technical and economic reasons.

"The network-centric nature of radiology and the success of DICOM standardization make radiology a strong candidate to achieve killer app status," McNeill said. "The data volume and performance aspects of radiology far exceed those of other specialties."

The key obstacle to killer app status for radiology is whether it will spur an economic driving factor for the deployment of NGN, especially to remote areas, according to McNeill.

"Killer app status is not just about technical requirements," he said. "It usually carries an economic factor that drives Internet service providers and telephone companies to invest in new technology."