In House Radiologist versus Outsourcing

This eternal debate continues with Sep 2011 issue of Journal of the American College of Radiology, where authors talk of  value-added services by having radiologists in house: (1) patient safety, (2) quality of the images, (3) quality of the interpretations, (4) service to patients and referring physicians, (5) cost containment, and (6) helping build the hospital's business. 

 However, according to me, a mixed approach where in we have teleradiology complementing the inhouse team, by means of 1) vacation coverage,  2) added expertise for example we help one of our centres in cardiac CT and other in MSK MRI, 3) Peer Review , 4 ) Second opinions.

Contrast Reaction and Teleradiology

There is an interesting query raised in the Sep 2011 edition of American Journal of Roengtenology which discussed the liability issue of a teleradiology group reading radiology reads remotely with regards to the anaphylaxis and anaphylactoid reactions. This is what the debate starts as. Full article can be accessed at- AJR September 2011 197:W537; doi:10.2214/AJR.10.5533

"Does a radiology group that pays to outsource contrast reaction coverage to another physician group (for example, emergency department physicians), on a “perclick” basis, paying those physicians to cover for any and all reactions on site while the radiologists interpret the radiologic studies remotely off site, expose the radiology group to increased risk medicolegally? Or is the risk decreased because most people would rather be resuscitated by an emergency department physician than by a radiologist."

How to decide on a Teleradiology Service Provider?

Telerad Providers are a leading teleradiology service provider based out of India.

1. Are the Radiologists reading your studies well qualified and have the subspecialist experience? 

We recently tied up with different centres in Indian subcontinent, once was looking for Cardiac CT reads and other was looking for second opinions on MRI studies.

2. Is the main radiologist the owner as well? 

Well particularly in India there are many software companies venturing into reading as well and usually lack the expertise and level of care a radiologist owner will give.

3 Key images added to report. 

We do this routinely and our referring centres love it.

4. Having dedicated radiologist assigned, this helps in building the trust and comfort of the referring physicians.

5. Web and cloud based software.  

We have our own cloud based dedicated server, which ensures  client access to reports all the time. 

6 Quality control process.

Teleradiology Providers-Interview in Medindia

Lakshmi Gopal of Medindia spoke to Sumer Sethi, MD, Sr Consultant Radiologist and Director of Teleradiology Providers, a unit of Prime Telerad Providers Pvt Ltd. An author of many academic papers and books on radiology, Dr Sethi specializes in musculoskeletal and neuroradiology.  The demand for radiologists is great in India and abroad - they are, however, in short supply. 


Teleradiology helps adjust this imbalance. India has a lot of talent and our doctors have emerged as one of the major providers of teleradiology services in the Indian subcontinent, the US, Africa, and the Middle East. Its key strength is that we have extensive experience working across both public and private hospital facilities. We have sub-specialist abilities and experience in the areas of neuroradiology, breast and cardiac imaging.  We also provide our own customized teleradiology software along with a dedicated web-based server platform and have the ability to link up with any centre in the world irrespective of the Internet speeds available. 

 Interview is featured here- 

Teleradiology: Bringing Round-the-clock Patient Care to Your Doorstep

iPhone and Stroke

"Doctors can make a stroke diagnosis using an iPhone application with the same accuracy as if they use a medical computer workstation. According to researchers  this can be particularly useful in rural medical settings."

Reference and Further reading- Healthcare IT News

"Teleradiology Providers" in Business Today

Another player is the four-year-old Teleradiology Providers, which seeks its clients among Asian and African countries. "We started with two radiologists and focused initially on the subcontinent, in contrast to other companies, which were started for US clients," says Sumer Sethi, Director at the New Delhi company. The company now has tie-ups with hospitals in six countries. "There is plenty of growth potential if quality is maintained," says Sethi

This is how May edition of Business Today, Top business magazine in India goes about, in their article Imaging the world, remotely, India's teleradiology companies thrive.  The article discusses main business models in country in Teleradiology and its pros and cons. For our company, this gives us more encouragement and recognition of our business model.

Barriers to Telemedicine: India and the world

Hurdles in developement of telemedicine are different in developing and developed countries.


In developing countries:

1.  cost 
2.  infrastructure lack

In developed countries

1. Legal issues over the protection of data 
2. Licensing issues.
3. relatively more penetration of healthcare facilties,leading to less of felt need.

Teleradiology Providers- IRIA 2011

This is one of stills from IRIA 2011, the largest Indian Radiology congress, where Sumer Sethi was invited as faculty to present Asian -African perspective-Teleradiology. According to him teleradiology represented a paradigm shift in the way radiology is practised.

Teleradiology session in IRIA-2011 gets covered in Express Healthcare

My talk in IRIA 2011 on Teleradiology-Asia Africa Perspective  gets covered in Express Healthcare

"Sumer Sethi, Founder Director, Teleradiology Providers, Delhi on the other hand spoke about opportunities in Asia-Africa. Comparing the past and the present day radiology, he said that the future can be visualised. Being the internet era, radiology and imaging has witness a paradigm shift, believed Dr Sethi. He further went on to say that what we see today is Imaging 2.0 which has five important parameters namely: quality, dependability, flexibility, speed and cost. Today, India's healthcare spending has increased with increased education, growing significance of health insurance and rise in income, informed Dr Sethi. Highlighting the advantages of teleradiology, he mentioned that teleradiology can be of immense use during emergencies, when doctors are on leave, as an option for soliciting second opinions as well as serving a support system for sub-speciality expertise."

IRIA-2011, Teleradiology Panel Discussion

For all those interested in Teleradiology, IRIA 2011, Delhi,  largest Radiology Congress in Indian subcontinent has organised panel discussion-symposia on this topic with may distinguished speakers, including yours truly, who was invited to do similar talk in IRIA 2008. This year my topic is Asian-African Perspective- Teleradiology.  Schedule for the event is given below. All attending the conference are welcome to meet me around this event, to be held in Hotel Ashok and my talk is scheduled for 29, Jan 2011, 16.40pm. Any suggestions for the talk or comments are welcome.

Telestroke

According  Steven R. Levine and Mark Gorman, MD  From the Center for Stroke Research & Henry Ford Stroke Program in Stroke. 1999;30:464-469; Time is of the essence for effective intervention in acute ischemic stroke.  They emphasize that computer-based technology can now be used to integrate electronic medical information, clinical assessment tools, neuroradiology, laboratory data, and clinical pathways to bring state-of-the-art expert stroke care to underserved areas.


Further reading and reference

"Telestroke" The Application of Telemedicine for Stroke

Hairline fractures and Teleradiology

I am not sure if this has been reported before but problem with online reporting is not with complex disorders or with syndromes as our team compromises of senior rads and they are well versed with these situations. Problem possibly is with hairline fractures.

Usually we get no clinical information at all especially in orthopaedic plain films let alone any information on point of tenderness, so we are likely to miss some of the hairline injuries and as soon as we miss any findings we being a teleradiology company cases get bounced back to us very fast and referring physicians think we missed a simple HAIRLINE FRACTURE!

Do you also have similar experiences with reading plain orthropedic films without history?

Desmoid Tumour-MRI

Desmoid tumors are classified as extra-abdominal, intra-abdominal, or located within the abdominal wall. Abdominal wall desmoid tumors arise most commonly from the aponeurosis of the rectus abdominus muscle with out without intraabdominal extension.. Extra-abdominal tumors typically occur in the shoulder, chest wall, thigh, inguinal region, and back. Clinical symptoms are masked by the slow growth of the tumor and depend on the site to tumor involvement.
Desmoid tumors have a similar attenuation to muscle on contrast-enhanced CT images. However, CT cannot distinguish a desmoid tumor from similar soft tissue tumors, making histological diagnosis necessary. MRI enables better tissue characterization of desmoid tumors by demonstrating intratumoral areas of low signal intensity on all pulse sequences. The low signal intensity is due to the presence of abundant collagen within the lesion. Desmoid tumors appear as low-signal intensity masses in a background of high-signal intensity fat on T1-weighted MR images. These tumors have variable signal intensity on T2-weighted MR images. In mature desmoids, areas of abundant fibrosis results in low signal intensity on T2-weighted images. Longstanding tumors are low in signal intensity on T1 and T2-weighted MR images and enhance only minimally after intravenous gadolinium chelate. In the acute phase, tumors may have regions of high signal intensity on T2-weighted images that also show heterogeneous increased enhancement. Tumor recurrence is a frequent finding after surgery and is easily detected using MRI.

Second opinion by- Teleradiology Providers

Plantar Fascitis-MRI

Marked edema is evident within the heel pad, the flexor digitorum brevis, and within the calcaneus s/o plantar myo-fascitis with enthesopathy. Reported by Teleradiology Providers

Teleradiology Market Potential

"TechNavio, the market intelligence platform of Infiniti Research published its a new research report on the teleradiology market. The report says that the global market for teleradiology was around $6 billion in 2008, and is expected to grow at double digit rates in the next five years. The report says that “Technological advances and requirement to lower the healthcare costs have encouraged the healthcare services providers to outsource the diagnosis of radiology images to developing and low-cost countries. Also, the ease of entry for the new entrants in the teleradiology market has resulted in a higher competition in the market, and a greater number of teleradiology service providers.”
Source: TechNavio

Our Teleradiology Services- Teleradiology Providers

Ecchordosis Physaliphora-MRI & CT

Ecchordosis physaliphora is a rare congenital, benign, hamartomatous, retroclival mass derived from notochordal tissue that is typically located intradurally in the prepontine cistern. Ecchordosis physaliphora is usually asymptomatic. In rare cases, ecchordosis physaliphora can be symptomatic due to tumor expansion and compression of the surrounding structures and
extratumoral hemorrhage. Only one previous case of such a lesion with associated bleed is described in Turkish Neurosurgery 2009, Vol: 19, No: 3, 293-296. The differential diagnosis of EP also includes chordoma, dermoid, epidermoid, arachnoid cysts and partially thrombosed vertebrobasilar aneurysm. When a retroclival mass is established on MRI, any associated osseous stalk should be evaluated on thin-section CT as in our case which is classical for the diagnosis of Ecchordosis Physaliphora. This is 30 year old female with T1 and T2 hyperintense lesion in prepontine and retroclival region on MRI with no significant enhancement
Reported by Teleradiology Providers

Pancreatic Divisum-MRCP

MRCP FINDINGS:
Gallbladder is distended and there is no evidence of any filling defects within the lumen. Wall thickness is normal. There is no evidence of dilatation of the intrahepatic biliary radicles. Confluence of the right and left hepatic duct is patent. CBD is of normal caliber and no filling defect or calculus is seen within CBD. Dorsal pancreatic duct appears to open cranial to the opening of the CBD along with a small ventral pancreatic duct opening with the CBD in the region of major papilla. This may indicate a diagnosis of pancreatic divisum, further in view of history of recurrent pancreatitis. There is some beading in the pancreatic duct in pancreatic tail region. ERCP is suggested. Reported by Teleradiology Providers

Cervical Dermal Sinus-MRI

Congenital dermal sinuses are epithelium-lined tracts that extend from an opening in the skin through deeper tissues. Most dorsal congenital dermal sinuses are located in the lumbosacral area; a cervical location is unusual. This is a 13 year old girl patient.
Reported by Teleradiology Providers

Multiple Sclerosis-MRI

Multiple discrete variable sized ovoid perpendicularly directed T2W and FLAIR hyperintense lesions (plaques), appearing iso-hypointense on T1W images and hyperintense on T2W images involving bilateral periventricular and subcortical white matter regions, including the calloso-septal interface. 35 year old female, case reported by Teleradiology Providers

Haglund's Syndrome

Haglund syndrome is a common cause of posterior heel pain, characterized clinically by a painful soft-tissue swelling at the level of the Achilles tendon insertion. On the lateral heel radiograph the syndrome is characterized by a prominent calcaneal bursal projection, retrocalcaneal bursitis, thickening of the Achilles tendon, and a convexity of the superficial soft tissues at the level of the Achilles tendon insertion, a “pump-bump.

Reported by- Teleradiology Providers