International teleradiology provides relief for weary radiologists

With fewer radiologists reading higher volumes of exams, the ability to offer work free of off-hour reading or night calls can be the ace up a department's sleeve when recruiting new radiologists. International teleradiology, by taking advantage of the difference in time zones, allows radiology departments to be more flexible in assigning work hours.

Dr. Orit Wimpfheimer, a clinical attending radiologist in Israel, answers questions about what it's like for an international radiologist reading images sent overseas from the U.S.

Q: How does your teleradiology setup work?

A: I consult for a radiology group in Philadelphia. I work in Israel out of my home, using home computers connected by ADSL. Currently, I'm connected to three hospitals. The group sends images (CT, nuclear images, ultrasound, etc.) to Israel. I have access to the hospital's server and can download cases that need to be read.

It takes about 2.5 minutes to download a head CT and anywhere from five to 10 minutes for abdominal CT, depending on the amount of images needed. Once I've got the images, I evaluate the case and call the referring physician to give the results of the study. Basically, I give the results within a half hour from the time I'm notified of a case.

I work 11 p.m. to 8 a.m. EST, which is from 6 a.m. to 3 p.m. here. This leads to one of the biggest night call, teleradiology benefits: When there's a need for someone to do an emergency read in the middle of the night in Philadelphia, I'm alert, awake, and waiting for the case. Instead of waking up a tired radiologist in the U.S., referring doctors and surgeons can call me and ask any emergency questions. Because they can ask me questions in the most dire emergencies, some of the biggest fans of this setup are ER doctors.

Q: What were the biggest surprises you encountered when beginning to do this type of radiology work?

A: Frankly, the biggest surprise was that I would like it. I only signed on for six months. I thought that sitting in my house could be boring. But since I work with a level 1 trauma center, the cases are quite interesting. I speak on the phone with doctors constantly and there is constant interaction back and forth between the referring physicians and myself.

Q: What are the biggest benefits/drawbacks to this type of setup?

Overcoming the fear of doing international teleradiology. There can be a lot of fears in the initial stages -- that the turnaround time will be too long, or that there will be too many technical and connection problems. In beginning, we did have some problems, but we were able to learn during the process and correct any difficulties we had. For instance, I use two different computers now with two different connections (ADSL and cable modem). That way if one connection is down, one is still up and running. We've learned to have a lot of backups in place.

Q: How does working internationally affect your reading of U.S. images?

I'm a U.S.-trained radiologist, so it's easy for me to cater to U.S. surgeons. The biggest benefit to doing international teleradiology is the difference in time zones. No one realized how critical this can be. In this type of setup, when you're an ER doctor or surgeon you can talk to alert, clear-eyed radiologists day or night.

Q: How difficult/easy is it to communicate questions or complications to your U.S. counterparts?

Communication is very easy. I talk to the CT technologists, the referring physicians, and ER doctors all of the time. When it's 3 p.m. my time and I have some final questions, it's pretty easy to find someone to communicate with on the East Coast, since it's 8 a.m. over there. We also use e-mail to communicate during those situations that can wait a bit longer. We've set up a system where there is a supervisor in Philadelphia who can get the information I send along and relay it to the pertinent clinical contacts. We discover issues as this implementation has been set up and solve them as they come along.

Q: How do you see this type of teleradiology setup helping with the radiologist shortage and the increasing demand of radiology services?

This type of teleradiology is the key to staying competitive. To get the best residents and fellows, you need to be able to provide good terms. This is pretty hard if you can only offer long hours and night calls. Practices need to be able to compete for the best candidates and can do this by offloading off-hour reads to an international teleradiology group.

Dr. Wimpfheimer works with Southeast Radiology in Upland, PA.