Teleradiology Benefits : Improved Communication Immediate accessibility to ER doctor/specialist Support for Technologist – protocols, rescans Radiologist Productivity, Efficiency, Lifestyle Cost benefit – economy of scale

1. Emergency Teleradiology
Arjun Kalyanpur MD, DABR
Chief Radiologist
Teleradiology Solutions

2. Outline
• Background
• Clinical Role and Benefits
• Technology and Operations
• Quality and Peer Review
• Regulation and Accreditation
• Challenges

3. Background
• Radiologist shortages – not getting better
– Emergencies (night shift) most affected
– Remote/rural hospitals most affected
– Global phenomenon

4. Radiologist to Population (per mill)
Bangladesh 1
India 10
Japan 30
England 48
Singapore 50
Germany 92
USA 100
Spain 112
France 130
•14 countries in sub Saharan Africa have no radiologist (Source: WHO)

5. Emergency Teleradiology Evolution
• Increase in emergency imaging utilization
– Dependence on imaging as a triage tool
– Rapid advances in CT technology
– CT primary modality – trauma, vascular
• Increasing need for immediate reporting
• Technology – Broadband, DICOM, PACS/RIS
•
CJEM 2013;15(3):161-166

6. Emergency Teleradiology
24 x 7 x 365 access – instant reporting
Time Advantage – work follows the sun “Nighthawk”
Improved radiologist lifestyle

7. International Model
• Day-night time difference allows for
• Better performance – biorhythms
• Increased productivity
• Enhanced service levels
• Better accessibility

8. Global Teleradiology

9. Clinical Applications
• Trauma
• Stroke
• Acute Abdomen- stone, diverticulitis, volvulus
• Acute Thorax – PE, Aortic dissection
• Sonography – RUQ, Early pregnancy, Torsion
• Nuclear Medicine - VQ, GI bleed
• Pediatric Emergencies – intusussception, appendicitis

10. Trauma- role of Teleradiology
1. Immediate detection improves
patient outcomes – aortic injury,
burst fracture, vascular injuries
2. Staff support at residency programs
3. Decrease need for patient transport
from rural centers (Emerg Med J
2007;24(8):550-552)

11. Stroke – role of Teleradiology
•Teleradiology can shorten the time to
thrombolysis
•Early diagnosis – dense MCA, insular ribbon
•Immediate detection of contraindication for
thrombolysis – bleed, aneurysm, mass
•Early detection of complications – herniation,
hemorrhagic conversion of infarct.

12. Mobile

13. Role of Emergency Teleradiology
• Immediate report
• High report quality by emergency radiologist
– Comfort level with all imaging modalities
– Experience in all emergent scenarios
– Speak the same language as the ER doctor/trauma
surgeon
– These translate to better patient outcomes

14. Teleradiology Benefits
• Improved Communication
– Immediate accessibility to ER doctor/specialist
– Support for Technologist – protocols, rescans
• Radiologist Productivity, Efficiency, Lifestyle
• Cost benefit – economy of scale

15. Teleradiology Technology
• Connectivity: Highspeed broadband network
• VPN
• Datacenter
• Cloud

16. Teleradiology Technology
• Teleradiology Workflow Platform
• Intelligent assignment of cases
• Inter-radiologist consultation
• Analysis of performance
• Goal – to promote efficiency and productivity

17. Teleradiology Operations
• Communications center
Calls for additional clinical info or images
Critical values communication
SMS alerts
•Coordination between sites
and radiologists
•Complex scheduling

18. QA and Peer Review
The need:
• Low margin for error in emergencies
• High risk
• Potential poor outcome
The Process:
• Intense internal and External peer review
• Training and CME - online

19. QA Analysis/tracking
Continuous peer review
Detailed Analysis of trends
Corrective measures
Overall QA Grades 2008
23%
4% 23%
2%
31%
0%
0%11%
3%
3%
Grade 0 Grade 1 Grade 2 Grade 2/3 Grade 3
Grade 3/4 Grade 4 Grade 4/5 Grade 5 Not Reviewed
Rad X QA Grades for 2008
0
15
0 0
8
2
15
3 3
46
20083
1
10
100
1000
10000
100000
N
otR
eview
ed
G
rade
0
G
rade
1
G
rade
2
G
rade
2/3
G
rade
3
G
rade
3/4
G
rade
4
G
rade
5
TotalQ
A
sTotalC
ases

20. Teleradiology Research

21. Continuing Education and
Training
Necessary in telerad environment
Continuous quality improvement
Knowledge update
Stimulate research

22. Online education portal : Radguru
Internal training
Teaching 800 DNB PGs across the country

23. Regulation and Accreditation
• Radiologist
• Certification/Licensing
• Insurance
• Organizational – JC, MOH, KLAS
• Technical – FDA, CE, HIPAA

24. Challenges in Teleradiology
• Insufficient Clinical Data – access to HIS/EMR
• Large Image Datasets – Routers
• Outages - redundancy in infrastructure
• Evolving client expectations – mindset changes

25. How does Teleradiology benefit
Emergency Radiology?
• Teleradiology is now an integral part of emergency radiology
coverage
• The greatest impact of Teleradiology has been in the
emergency radiology space
• The increasing adoption of teleradiology worldwide benefits
the subspecialty of emergency radiology

26. The future
• More international utilization of emergency
teleradiology
• Evolution towards subspecialization
• Increased focus on quality standards and metrics
• Integration with other telemedicine consultations

27. Email: info@telradsol.com
THANK YOU FOR YOUR ATTENTION

28. www.telradsol.com
KLAS® rates Teleradiology Solutions the No.
1 National Teleradiology Provider in the
US (2011)
www.teleradfoundation.org
TS gives back
www.radguru.net
Training Radiologists globally
http://www.teleradtech.com
RADSpa-a teleradiology platform for
the world
www.rxdx.in
RXDX-Whitefield's premier 24
hour multispecialty clinic
http://www.imagecorelab.com
Clinical Trials Imaging
www.healtheminds.com
Tele counselling