Is image selection a useful strategy to decrease the transmission time in teleradiology? A study using 100 emergency cranial CTs

Abstract

This study examines the suitability of working with a selection of images in a teleradiology consulting system in neurological or neurosurgical emergency situations. The teleradiology system was based on IBM-compatible personal computers, video digitization for data acquisition, and data transmission by Integrated System Digital Network. Forty normal and 60 abnormal emergency cranial computed tomograms were shown to a radiologist on call who presented all cases he regarded as pathologic to a neuroradiologic expert by teleradiology. To reduce transmission time, only a selection of images from the CT study was presented (up to four images per case). For each case the on-call radiologist's diagnosis (D(on-call)), the expert's diagnosis on the teleradiology screen (D(monitor)), and the expert's diagnosis on the original film (D(original)) was documented, together with an estimation of the agreement between those diagnoses. There was clinically relevant disagreement between the on-call radiologist's diagnosis and the neuroradiologist's diagnosis based on the image selection on the teleradiology monitor in 23% of cases. A clinically important discrepancy between the neuroradiologist's diagnosis based on the image selection and his diagnosis using the original films was found in 30% of cases. This was due to the presence of clinically relevant information on images not transferred by the on-call radiologist. Image quality of the transferred images was sufficient in all cases. Drastic selection of images from a complete CT study leads to a high rate of incorrect diagnoses and is not appropriate to reduce transmission time in teleradiology.

Preliminary clinical evaluation of a multi-site telemammography system in a screening mammography environment

“…In remote or underserved clinics in may be necessary to evaluate personnel qualifications in regards to deciding if teleradiology is appropriate and the necessary radiographic procedures. [1][2][3] Many teleradiology systems employ image processing techniques to manage the digital image data in terms of data acquistion, 4-9 transmission time (e.g., compression, 4,10,11,12 cropping, 13 image selection 14 ), and image display. 7,8,10,11,13,14,15 The effects of data management techniques on diagnostic image quality are application specific.…”

Teleconferencing Using Multimedia Messaging Service (MMS) for Long-Range Consultation of Patients With Neurosurgical Problems in an Acute Situation

“…Differences in opinion on digitally transmitted images on how a scan may be interpreted between a generalist and an expert often exist. 9,10 In images of patients with acute neurosurgical problem the disagreement is usually small as these lesions are obvious. Most of the abnormality involves acute hemorrhage that because of its hyperdense characteristics on a computed tomographic scan gives a good contrast to the surrounding brain.…”

Telemedicine and neurosciences

“…132,133 In a study involving 100 emergency cranial CT scans, Ludwig discusses whether image selection is a useful strategy to decrease the transmission time in teleradiology. 134 The internet 135 and the WWW play a major role in making available the services of the limited number of specialists in neurosciences to a global audience. Publications dealing with applications of the WWW to neurosurgical practice [135][136][137] and the use of electronic forums 138,139 emphasise this.…”