Teleradiology is the most mature and rapidly evolving branch of telemedicine. It uses computers and telecommunication networks to transmit diagnostic images and data from one location to another for primary review and interpretation as well as specialist consultation.

HISTORY

One review claims that the first reference to telemedicine in medical literature can be traced back to 1950. It talks about how the transmission of radiology images began in 1948. Then Canadian radiologists built on this early work to create a teleradiology system well into the 1950s.

However, technology evolution in teleradiology began with the invention of RIS/PACS in the early 90S and then to workflow, enterprise teleradiology, cloud, and now its AI and deep learning at the doorstep. Like any other branch of telemedicine, teleradiology began as a solution to overcome the shortage of radiologists in remote areas, small hospitals, and emergency departments. In the early years of the 21st century, emergency nighthawk work was one of the chief drivers of global teleradiology by using time zones in the USA, India, Australia, and Israel.

There were concerns in the beginning that remote interpretation by external teleradiology providers would have potentially negative consequences for the specialty as a whole in the way of commoditization, reduced reimbursement, displacement of radiology groups from their hospital contracts, increased encroachment by non-radiology specialties, and loss of direct touch with the patient doubted to lower quality. These concerns were addressed with legalizations, HIPPA compliance, technology, and proactive efforts by teleradiology providers. Still, such concerns exist in developing countries, which is purely due to anarchy or lawlessness.

However, since the last few years, teleradiology has witnessed tremendous growth and has leaped since the covid19 pandemic. According to market surveys, global teleradiology is likely to become a 20-billion-dollar industry by 2025.

The obvious impacts of teleradiology on health care have been:

REDUCING THE TURNAROUND TIMES AND IMPROVING THE QUALITY OF REPORTS IN AN EMERGENCY SETTING

In the pre-teleradiology era, the scans in the emergency department either remained unreported till the following day or were reported late. The technician used to wake up the radiologist, who would drive down to the department every time to review the studies. Often, the radiologist spent the night without sleeping and then again work for the next day, which naturally affected the efficiency in the day and at night.

Today after the implementation of teleradiology, the benefits are apparent. The professional teleradiology groups have strict service level agreements with the hospitals to ensure rapid turnaround times. Accordingly, multiple experienced radiologists are scheduled to work in short shifts to cover the entire night. Rapid turnaround times as fast as ten minutes are provided by professional teleradiology service providers like Radever Teleradiology conforming with the dictum Time Is Brain. Thus ensuring early treatment in acute stroke, benefiting both the patient and the treating emergency clinician.

How has global teleradiology improved the quality of reporting?

Here are some of the reasons which we could make out through the perspective of our 12-year teleradiology practice in Radever. The first reason could be, by reporting a large number of cases daily with a pinpoint focus on emergency findings, immediate peer reviews, and feedbacks, a full-time teleradiologist today has gained a considerable competence to excel in the interpretation of acute findings such as pulmonary embolism, Hyperacute stroke on CT brain, aortic dissections, perforations, small pneumothorax on Xrays, detecting active hemorrhages, acute adrenal crisis and trauma. Thus, teleradiology enables a radiologist to become uniquely competent as an expert generalist who is comfortable interpreting CNS or GI, or Respiratory emergencies.

In this field, peer reviews and feedbacks are necessary. Apart from being instrumental in improving patient care and reducing the chances of any potential harm, peer reviews identify discrepancies and share learning from them. With this, practitioners can reduce the chances of further discrepancies and consequently improve report quality. There is also the fact that they contribute to departmental quality assurance (QA) programs which provide reassurance of safe service and stimulate service improvement. There is no doubt that peer review and feedback activity can promote self-improvement and learning when done with the right intention and attitude.

Utilization of time zone advantage in nighthawk international teleradiology to have fresh, awake radiologist who has taken adequate sleep can facilitate quality enhancement in emergency teleradiology.

SUBSPECIALTY TELERADIOLOGY – BRIDGING THE GAP

During our 12 years of practice in teleradiology, we have observed a constant rise in demand for better and specialized interpretations and patient’s expectations. We can not expect the best interpretation of an MRI wrist study if done by a radiologist who only occasionally looks at joint MRIs, no matter how advanced the MRI machine is. Needless to say, patients and clinicians deserve the best radiology interpretation irrespective of their geographical location, where the test is performed, or when (the time of day or night) it is performed.

The current trend that embraces subspecialty radiology services is a significant indication of the maturation of teleradiology. One substantial challenge in radiology development is that this will end matching suitable readers with the proper study. This is often hampered by location and economics as most radiologists are clustered in tier 1 and tier 2 cities. The small hospitals, tier 2, 3 cities, and remote areas are starved of subspecialty care. It’s not uncommon to find high-priced radiologists with salaries that are more than a facility’s revenues when outside large hospital systems and urban areas. Having this sort of pricing structure in small towns makes absolutely no sense.

This gap can be effectively covered with subspeciality teleradiology. With a network of subspecialty radiologists deployed either part-time or full-time, small and medium hospitals in small towns can enhance their patient care at a lower cost. In addition, teleradiology has variable pricing where small and medium hospitals don’t have to hire a full-time radiologist for as high as $700,000 when they can contract a subspeciality teleradiology service provider and pay him per click.

Thanks to these services, even general radiologists can get into what they do best and gain support from other experts. This trend is bringing a new paradigm that benefits small hospitals by elevating the service standards and separating them from the competition.

Due to the nature of the ambition and education of subspecialists, they need just the right volume of work to maintain competence in their field. In addition, subspeciality provides wider exposure to the subspecialists by connecting to the medium and small-town hospitals where their services are much needed and appreciated.

Some common subspecialty radiology services are ;

• Neuroradiology
• Gastro-Intestinal (abdomen) imaging
• Pediatric neuroradiology
• Musculoskeletal radiology
• Oncoradiology and nuclear imaging
• Breast imaging

IN REMOTE AREAS

Teleradiology is beneficial to small and medium healthcare organizations, especially in outpatient imaging centers and rural hospitals. Access to these services provides them with the experts they would otherwise have been unable to afford or recruit. It’s not uncommon to see rural areas operating without radiologists, but these small practices have the most significant need.

How can rural hospitals benefit from teleradiology and telemedicine? First, this health field helps in offering a quicker turnaround time for tests and consultations. Also, it brings about a better means to educate and inform healthcare providers while increasing the number of available services. Here are four distinct benefits that come with using telemedicine in rural communities:

• Outsourcing saves hospital costs
• Patients can save on travel time and other expenses
• It reduces the pressure of patients having to miss hours of work
• Local economies can bring in more dollars from using local health services like pharmacies and labs

CONCLUSION

With their pivotal role in patient care and emergency health services in small towns, teleradiologists are a core part of modern treatment plans. It’s also a field that is continuously updating its methods with technological advances. From all areas, we can see how teleradiology services positively impact affordable patient care while also sustaining smaller hospitals in a competitive space and increasing physician satisfaction.

According to Yulun Wang, president of the American Telemedicine Association, Telemedicine will become the core methodology of healthcare delivery in the future. That is where we are going to get the efficiencies we need to provide affordable care.