Teleradiology fills rural niche in High Plains imaging

The chronic shortage of radiologists and the difficulty of attracting radiologists to country hospitals have made teleradiology a vital service for rural clinics.

"Without radiology services, rural hospitals will tell you they cannot keep their doors open," said Steven Mecklenburg, telehealth coordinator for Poudre Valley Health System in Fort Collins, CO.

PVH's telehealth system relieves much of this anxiety by providing interactive video and teleradiology (diagnostic-quality digital radiology) to several outlying hospitals in the High Plains region of Colorado and Nebraska.

The teleradiology program, which began in 1998, is currently utilized by four rural hospitals:
? Haxtun Hospital District in Haxtun, CO
? Memorial Health Center in Sidney, NE
? Kimball Community Hospital in Kimball, NE
? Morrill County Hospital in Bridgeport, NE

Haxtun digitizes plain film only, while Sidney has CT, mobile MRI, ultrasound, and digitized plain-film capacity. Kimball has mobile MRI and digitized plain film, and Bridgeport has digitized plain film. Current utilization is for emergent consultations only, with over 5000 patient studies transmitted.

Radiologists do travel and read images onsite three times a week in Sidney and once a week in Colorado, although the program is now gearing up for continuous image transfer of all patient images. Images are transferred by leased T1 lines.

"In a few locations, we tried VPNs (virtual private networks) through local, rural ISPs and had little success," Mecklenburg said.

Response times and transfer times were high. Transfer of a 20-Mb chest film with Q factor of 90 takes 20 seconds on a T1. It takes three minutes on a T1 shared to an ISP, which impedes the communication process, he said.

Reports are either dictated to the rural site's dictation service or at PVH and charged back to the rural hospital.

"Radiologists found the dictation systems were different enough between hospitals, and when errors occurred, they encouraged the remote facilities to use PVH," Mecklenburg said.

Another issue is plain-film image quality.

In the computer business, GIGO (garbage in, garbage out) is the rule. This is also true with film.

"We tell them to throw away the hot light because it gives them a false sense of confidence," Mecklenburg said. "Every film sent to us must be excellent."

PVH has a standing offer that remote RTs can come in and work with PVH techs to polish their skills at no charge.