Teleradiology liberates Air Force from radiologist shortage

Teleradiology has come to the rescue of the U.S. Air Force, which is facing a severe shortage of radiologists, according to a paper presented this morning at the RSNA meeting.

"The Air Force had 147 radiologists in 1999 and expects to have as few as 48 by 2004," said Lt. Col. Edward Callaway, a radiologist at Travis Air Force Base in California. "The number of military radiologists is expected to be only 50% of what is needed in USAF medical facilities by the summer of 2003."

The problem is simple economics: The Air Force and other service branches can't compete with pay structures in civilian practice.

Earlier this year, the radiology department at Travis' David Grant Medical Center (DGMC), a tertiary-care 300-bed military teaching hospital, was mandated to begin using teleradiology by last August. As a result, the Air Force quickly ramped up a teleradiology network for primary diagnosis ithat involved 10 military bases scattered around the country.

"We established a working group with members from radiology, administration, resource, information management, and communications from each site," Callaway said.

Two PACS broker configurations were installed. Four sites used one broker at DGMC, and four sites had a local broker. DGMC connected medical facilities across the U.S., including Minot AFB in South Dakota, Seymour Johnson AFB in North Carolina, and Barksdale AFB in Louisiana.

The Air Force teleradiology network will initially handle about 35,000 imaging studies annually. The system uses the Internet, not dedicated T1 lines, to transmit images, although every transmission is fully compliant with the Health Insurance Portability and Accountability Act, Callaway said.

A number of political, functional, and technical challenges surfaced during the implementation, including conversion of some smaller military medical facilities from film to digital imaging.

Security was a significant problem. Military hospitals are forbidden by the Rules of Armed Conflict to encrypt communications that originate within their walls. Encryption of any transmission at a hospital, even diagnostic images, nullifies the neutral status hospitals may claim during a war. Images moving over the teleradiology network therefore must stop first at the base communications lab, where message encryption occurs before transmission over the Internet.