Radiology teeters on the brink of integrated healthcare

No radiology department is an island. So it's time to bid farewell to point-to-point teleradiology systems and self-contained filmless imaging departments.

The future of digital imaging rests with seamless information transfer between different hospital departments, external healthcare providers, and remote workers, according to speakers at last week's meeting of the International Society for Strategic Studies in Radiology. Leading academics and top industry representatives, gathered at the three-day "hot house" meeting in Paris, outlined a vision for 21st century radiology services built on enterprise-wide networks, smart data extraction systems, and mobile technology.

"For 30 years, we have been working toward the historic goal of the all-digital department of radiology. A lot of us thought that was the goal," said Dr. James Thrall, chair of radiology at Massachusetts General Hospital. "But if all we do now is convert what we used to do into a digital form, then we have fallen short of the mark."

Radiologists need to transform their all-digital department into part of an all-digital healthcare enterprise, Thrall said. This requires adoption of the "electronic round-trip," in which patient data are only inputted once and can be accessed wherever and whenever required.

The notion of classic teleradiology, involving case-by-case transmission of images and notes, should also be rehashed, he said. Remote workers should instead have full access to their department's RIS and PACS under wide area or global networking schemes, such as that set up between MGH and radiologists in Bangalore, India.

Thrall's vision for radically reshaping digital imaging services extends to the use of information. MGH radiologists have devised a data mining tool to retrieve thumbnail images and report summaries of past cases from the department's RIS and/or PACS. A single click then brings up detailed information on disease characteristics and suggested hotlinks for further information. Practitioners are also committed to maximizing the value of information acquired from each diagnostic exam.

"Michaelangelo famously said that it is the artist's function to release thought imprisoned in matter," Thrall said. "It is now the radiologist who must learn to release the information imprisoned in the enormous blocks on image data we routinely obtain."

Dr. Jarmo Reponen, project manager for telemedicine and the electronic patient record at Oulu University Hospital in Finland, outlined a similar picture of digital radiology solutions subsumed into electronic healthcare programs. A pocket-sized terminal capable of displaying diagnostic-quality images, for instance, has been received enthusiastically by neurosurgeons working at Oulu, he said.

"Do clinicians care about teleradiology? No. What they care about is an integrated electronic patient record. They are interested to see the radiologist's report and images wherever they are working," he said. "The bottom line when developing imaging processing and telemedicine systems is how they translate to patient care."