Mobile emergency teleradiology fleet takes on anthrax screening

A domestic teleradiology provider is arranging to purchase 50 direct digital radiography systems for installation in specially designed emergency vehicles. They will provide chest x-ray screening for anthrax or other pulmonary disease caused by biological or chemical agents.

The public health emergency fleet is being established by Digital Imaging Acquisition Networking Associates, better known as DIANAssociates, a Maryland telemedicine and teleradiology service provider. It will be wired with wideband telecommunications links to transmit digital images to a remote radiology reading center on demand by local, state, and federal government agencies.

Rapid, centralized reading in response to suspected biological and chemical terrorism is crucial so appropriate medical strategies and scarce resources can be allocated quickly and properly.

"If patients go off to 20 different emergency departments and clinics, it can take days or weeks to fully understand the nature and extent of the problem," said Dr. Philip A. Templeton, chair of diagnostic radiology and nuclear medicine at the University of Maryland and vice president of DIANA's telehealth services.

Imaging studies passing through the system's proprietary database will be coded to determine incidence and prevalence of positive results - all of which aids in faster epidemiology and health risk identification. Immediate, high-volume chest studies are critical when screening for anthrax and other respiratory infections, according to the Centers for Disease Control and Prevention.

In cases of suspected inhalation anthrax, the CDC recommends that radiologists look for a widened mediastinum, or enlargement of the lymph nodes behind the lungs and in front of the spine. The appearance of a widened mediastinum in a patient presenting with fever, myalgias, or dyspnea suggests a diagnosis of inhalation anthrax.

The emergency vehicles, each equipped with a Swissray ddRModulaire direct digital radiography system, will be capable of screening up to 50 people an hour - one every 72 seconds, or roughly three to four times the hourly capacity of conventional film-based x-ray.

Anthrax is only one of a number of biological and chemical threats the $15 million fleet could be used to combat. Dozens of agents like Legionella, irritant gases, and Mycobacterium tuberculosis could be weaponized, causing serious pulmonary disease, according to terrorism experts.

Plans call for the mobile anthrax screening system to resemble the existing nationwide teleradiology program already installed at several Immigration and Naturalization Service (INS) detention centers. Under the INS program, digital x-rays are obtained for detection of tuberculosis in immigrants detained at six U.S. border control stations. The images are then transmitted to a reading center at the University of Maryland where radiologists on duty 24/7 typically generate reports within an hour of receipt.