TELERADIOLOGY - SGPGI Experiences

Archna Gupta

Department ofRadiologySanjay Gandhi Postgraduate Institute ofMedical Sciences, Lucknow, Uttar Pradesh, India

Author radiologist, but the main role is in emergencyArchna Gupta - Associate Professor, radiology, especially for pre andDepartment of Radiodiagnosis, SGPGIMS, intraoperative diagnosis of images in terms ofLucknow. agupta(sgpgi.ac. in consultation and reporting as well as in tele-

education and teleconsultation in routineworking hours. Teleradiology increases the

Abstract efficiency of the doctor by ensuring that heTeleradiology is the electronic transmission of spends most of his time delivering quality careradiological images from one location to to the maximum number of patients. Theanother for the purpose of interpretation and importance of teleradiology is that patientsconsultation. With the advent of latest can be effectively diagnosed and treated at anyhardware and software technology in time of the day or night, with a diagnosiscomputer and imaging and boom in provided within minutes.information technology sector, effective and Images can be captured from modalities suchuseful teleradiology practice is now a reality. as CT, MR, ultrasound, and computedPotential of teleradiology in health care and radiography. Visual information could bemedical education is being realized in India as compressed in digitized signals, transmittedwell. Teleradiology breaks geographical and over conventional telephone lines, and thentime barriers and helps achieve accurate reconstructed at a distant site as high qualitydiagnoses in the shortest possible time. images. In a manner similar to thatWe present our experience of teleradiology at experienced with personal computers, thea tertiary care medical centre over last four price of both the necessary hardware andyears. software has tumbled, bringing this new

facility within reach of smaller provider units.Introduction It requires hardware with enough

storage capacity and facility for data archivingTeleradiology is the process of electronically and software for real time and still imagetransmitting radiologic images and related capturing, image optimizing and imageconsultative text from one point to another transferring to remote places by availabletypically over standard telephone lines, digital telecommunication links. The practice ofcomputer-assisted transmission, wide area teleradiology is limited by the quality ofnetwork (WAN), or over a local area network image and its rate of transfer. Real time case(LAN). Teleradiology is therefore a facilitator discussions are being done with audio andfor more optimal medical care. It is not a form video conferencing.of imaging but rather the technology orprocess of image transfer/transmission. Material & MethodsThrough teleradiology, images can be sent to With an aim to increase the awareness ofanother part of the hospital, or around the teleradiology among the radiologistworld. It enables radiologists to render community and to assess the usefulness anddiagnosis and to consult remotely. It can be difficulties encountered in teleradiologyapplied to all areas and activities of a practice in India, we conducted first

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interactive teleradiology session in India With the success of all these sessionsbetween PGIMER, Chandigarh and now proceedings of most of the routineSGPGIMS, Lucknow, during endocrine conferences are simultaneously being livesurgery conference. Images are digitized and telecasted in Cuttack, Indiaforwarded to the department of radiology ofPGIMER, Chandigarh and both way Resultsinteractive videoconferencing discussions According to the response on a questionnairewere held. We also conducted 18 static and provided by Department of Radiology,live tele-eduation and tele-consultation PGIMER Chandigarh, and Cuttack, India, thesessions with Department Of radiology, SCB participants in the initial teleradiologyMedical College, Cuttack, during September- sessions, when sessions were being done with2001 to Feb 2002. More than 70 sessions were ISDN Link, perceived the overall perceptiondone after satellite link facilities are provided of video quality as good, and sound quality asto the teleradiology sections with three unsatisfactory. Telephone line had frequentmedical colleges of Orissa. Seven disconnectivity and slower image framespostgraduate students and faculty members transfer rate. However, the course content wasfrom Cuttack participated in the sessions. The interactive and educative and was consideredemphasis was on renal, hepatic, useful by both residents and consultants.neuroradiology, gastrointestinal and endocrine The sessions were well appreciated andradiology including all cross sectional images diagnoses were made in most of the cases inand conventional X-rays. Special emphasis conventional radiology images by participantswas given to the cases, which are routinely not at Cuttack and the cases were consideredavailable at the remote server to make the excellent and educative as they were notstudents and radiology fraternity aware to routinely seeing those teaching cases and notsuch cases, however all routine diagnostic having the opportunity of having the state ofcases are given equal importance for the art diagnostic imaging modality. Image andpurpose of radiology resident teaching sound quality was fair and they appreciatedprogramme. Clinical details of cases were sent live images over still images. In tele-by email beforehand or discussed during live consultation with SCB Medical College,conference as per requirement. Interactive live Cuttack, limited opinion could be offered fromimages were transferred and both way SGPGI except in the conventional radiologicaldiscussions were held by videoconferencing. images as the quality of images were veryTele-consultation was done in a similar poor and the resolution of images were notmanner receiving stored and real time good. Quality of sound and images wereradiological images along with clinical details improved drastically when sessions werefrom Cuttack. conducted with satellite link.

From August'2005, we started routine After our initial experience we startedteleradiology sessions with the state of regular teleradiology sessions using eitherUttaranchal, India. Private medical stored digital images or transferring real timepractitioners as well as the radiologists are cases followed by video conferencing fortaking active participation in all these discussion. Sessions were conducted once in asessions. Telereporting is all a routine practice week during last two years from March 2003with state of Uttaranchal as it's a developing till date with radiology Departments of SCBstate and not much expert radiology fraternity Medical College, Cuttack, MKCG Medicalis available there. College, Behrampur and VSS Medical

College, Burla Orissa. Fully worked up,

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uncommon cases on particular sub-specialties used and in bandwidth of telecommunicationlike urogenital radiology, endoradiology, links. Store and forward teleradiology is nowgastrointestinal and hepatobiliary radiology becoming common among radiologists forand neuroradiology were presented from our individual consultation and discussion. Withinstitute to residents and consultants of the improvement in the quality of digitalradiology department of these medical archiving and in software and hardwarecolleges and interactive discussion was done technology in the near future, digital scanningby video conferencing. Cases and discussions and archiving at higher bandwidth willwere well appreciated. We also conducted improve drastically the teleradiologytele-education on interesting topics in consultation. Finally, the quality of imagesradiological subspecialty with three medical and image optimization always plays a majorcolleges during last one year. We also role in making decisions at the remote end.received difficult cases for tele-consultation.Limited opinion could be offered with furtherrecommendations for fine needle aspiration Address for Correspondencecytology. Limitations were suboptimal qualityX- rays and use of protocols not suitable for Dr Archna Guptathe final diagnosis. However, our opinion Associate Professorhelped them in diagnosing and managing the Department of Radiologycases. Sanjay Gandhi Postgraduate

All the sessions conducted with state of Institute of Medical SciencesUttaranchal were well appreciated. Now it's a Lucknow -226104, Indiaroutine practice to provide second opinion in Email: agupta<sgpgi.ac. inall difficult cases and preferably in CT andMRI films from state of Uttaranchal, India

Conclusions

Teleradiology is the way of the future. Itincreases the reach of the physician who canutilize his skills to the maximum number ofpatients rather than being confined bygeography. The gratifying thing in this work isthe immediacy of it. Additionally, the costs ofteleradiology are continuously diminishing,particularly given the fall in broadband costsworldwide. Efficient Web-based teleradiologysystems allow for rapid and economicaldistribution of radiologic images toradiologists located anywhere within a globaloffice. There can also be substantial costsavings in terms of ongoing/recurrent costs offilm, processing, etc. Teleradiology is in adeveloping phase in our country. It requiresawareness among radiologists and needsimprovement in the quality of instruments

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