Teleradiology makes big splash in Pacific theater

Buoyed by the success of a prototype teleradiology solution outfitted aboard the carrier U.S.S. George Washington, the U.S. Navy is equipping other ships, as well as its Pacific Basin hospitals in Japan, Okinawa, and Diego Garcia.

Modern aircraft carriers may be mechanical wonders, but alone somewhere in the 70 million square miles of Pacific Ocean, they are medically more isolated than any remote village.

Results from the George Washington experiment offer abundant evidence of the value of teleradiology for the fleet. During a six-month cruise, medics aboard the George Washington initiated 60 clinical consults in 10 medical specialties, resulting in an avoidance of 20 medical evacuations at a cost savings of $150,000 and 565 worker-days, according to Cmdr. Richard Bakalar, an executive assistant to the Navy surgeon general and a staff nuclear medicine physician at the National Naval Medical Center in Bethesda, MD.

In all, 923 radiology studies (3500 images) were transmitted to specialists at Tripler Army Medical Center in Hawaii, with reports sent back to the ship via e-mail, usually within hours.

Problems of bandwidth and storage were addressed by a compression scheme. Without data compression, digital x-rays acquired and stored in matrices of more than 2K x 2K pixels require 4 to 8 MB per image and can take more than 35 minutes to transmit at 28.8 Kbps over a modest wide area network. Compression makes bandwidth a manageable problem with, however.

"We have demonstrated 100% data transmission using 20-30:1 wavelet data compression," Bakalar said.

Studies that once took two hours to transmit without compression are now sent in two to four minutes using 56 Kbps modems, an improvement embraced by carrier captains notoriously stingy about sharing bandwidth.

Another problem the Navy faced was equipment incompatibility. The Pentagon's patchwork approach to hardware acquisition over the years meant that some systems in use in the Pacific are not DICOM compliant. New Department of Defense-wide purchasing programs ensure future imaging systems will meet DICOM standards.