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

"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.

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 Providers- DD News

Our company has been recently covered by DD News as it was female oriented programme, they focussed on positive for ladies as they can work from home with teleradiology. Featured in this video are our main Radiologists Dr Sumer Sethi and Dr Priya Chudgar.  Being one of the pioneers of this business in India, this coverage by leading official news channel in the country is another feather in the cap of Prime Telerad Providers (P) Ltd-Teleradiology Providers.

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.

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

Low Cost Teleradiology for Stoke- Thai Study

According a Thai study by Kanitpong Phabphal et al in J Telemed Telecare 2008;14:439-442, They have developed a low-cost system using a PDA phone as the receiving equipment. The experimental system was based on a notebook PC to send the images and a PDA phone to receive them. A total of 100 images from clinically suspected strokes within the previous 24 hours were transmitted to a neurologist. The mean transmission time was 48 s per image. The diagnosis from the PDA phone image was in complete agreement with the diagnosis from the original image in cases of acute ischaemic stroke, intracerebral haemorrhage, metastasis and in normal scans. However, there was agreement in only 7 of the 8 cases (88%) of subarachnoid haemorrhage. The study showed that good accuracy can be achieved with a low-cost system for teleradiology consultation in stroke.

Teleradiology Providers

Spinal Dermoid-MRI

This is a 25 year old man with a intradural lesion showing lipid content. T1, T2 and Fat Sat images are shown. A diagnosis of dermoid was made.

Dr.Sumer K Sethi, MD
Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences)

Radiology Preliminary Read Concept

Teleradiology Providers offers an offshore service that provides a preliminary report of various radiological studies producing a detailed report that a U.S. radiologist may utilize to prepare the official final diagnostic report. This service is an unique innovation that in a way is a method which allows the so called demon of out-sourcing to be used in a collabrative method. This allows increasing the efficiency of the the radiologists in places wherein they have higher loads (like US) and overcomes the legal barriers, wherein the Indian counterparts are just providing the preliminary report, which is neither final nor binding. This in particular may be useful for clincal trial reporting and plain filsms a model that has been used by Singapore goverment wherein they outsource the x-rays to have their radiologist read the CT and MRIs and hence reduce the waiting lists. Further it increases the workflow just as it is postulated that computer aided diagnosis will help in reducing the loads, i personally feel it is preliminary reads which will ultimately improve the workflow.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

ACL Tear

Normally ACL may show a striated signal distally caused by interspersed fat and synovium between the 2 bundle and proximal ligament appears. Any discontinuity or signal change in the ligament is indicative of ACL tear. There are some indirect signs of ACL tear like focal areas of increased signal in the lateral tibial plateau and femoral condyle, pivot shift injury (combination of signal changes in lateral femoral condyle and posteror lateral tibial plateau, abnormal slope of ACL, avulsion of the anterior tibial spine, segond fractur (capsular avulsion fracture of the lateral tibial plateau and kissing contusions involving the anterior tibia and femur resulting from hyperextension injury. This case shows ACL avulsion tear on MRI image.

Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers
Editor-in-chief, The Internet Journal of Radiology
Director, DAMS (Delhi Academy of Medical Sciences

Legal issues of Telemedicine

"Doctors have been practicing some form of telemedicine since before the invention of the telephone. And while the communication technology has evolved—doctors can now conduct a video consultation with colleagues in the next county or on the next continent—laws governing these events have not kept up. There is no universal law of telemedicine, and different states take significantly different approaches to regulating it. Consequently, jumping into telemedicine without first analyzing a few critical legal issues could have serious consequences. "

Full detialed article appeared on April 30, 2008 in HHN Magazine online site by David D. Storey

Radiology Grand Rounds XXII

Here is a case of Spinal ependymoma recuurence for the Radiology Grand Rounds submitted by Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

Pathology-Ependymomas are believed to account for 60% of all primary neoplasms of the spinal cord and filum terminale. Intraspinal ependymomas are most easily grouped into 3 classes: intramedullary lesions, myxopapillary ependymomas, and metastases from an intracranial origin. Intraspinal ependymomas are believed to arise from the ependymal cells lining the central canal, from the ventriculus terminalis of the conus, from within the filum terminale, or from cerebrospinal fluid (CSF) dissemination. xopapillary ependymomas arise almost exclusively in the region of the conus and filum terminale. They account for as many as 90% of tumors in the conus.

MRI-On T1-weighted images, ependymomas generally appear isointense relative to the normal cord, hyperintense relative to the normal cord on T2 weighted images. Ependymomas are and intensely enhancing with the administration of a gadolinium-based contrast material.

Hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.

Case by-
Dr.Sumer K Sethi, MD

Consultant Radiologist ,VIMHANS and CEO-Teleradiology Providers

Editor-in-chief, The Internet Journal of Radiology

Director, DAMS (Delhi Academy of Medical Sciences)

Internet Journal Of Radiology

I would like to thank Internet Scientific Publications and Dr Oliver Wenker for giving me this opportunity to be the "Editor-in-Chief" of the Internet Journal of Radiology. This journal is an Open-access journal, which means Every peer-reviewed research article appearing in this journal is 'open access', or universally and freely accessible via the Internet.

Anybody who would like to be part of the editorial process are requested to send me an email. If reviewers are important, authors are more so. Without articles, there is no journal. We welcome all publications related to Radiology including Case reports, Original papers, Letter to editors regarding previous publications, Review articles and pictorial essay. Papers on non-traditional subjects like computers in radiology, role of internet and web 2.0 are also welcome.

Dr Sumer K Sethi, MD
Editor-in-chief, The Internet Journal of Radiology TM ISSN: 1528-8404
Sr Consultant Radiologist VIMHANS, Delhi
CEO-Teleradiology Providers Author- Sumer's Radiology Site

Radiology Grand Rounds XX

Here is a case of Tendoachilles Tear for the Radiology Grand Rounds submitted by Dr Sumer Sethi of Teleradiology Providers. Concept and Archive of the Radiology Grand Rounds is available at- Radiology Grand Rounds.

In Greek mythology, Achilles was a Greek hero of the Trojan War, the central character and greatest warrior of Homer's Iliad which takes for its theme the Wrath of Achilles.Later legends state that Achilles was invulnerable on all of his body except for his heel. These legends state that Achilles was killed in battle by an arrow to the heel, and so an "Achilles' heel" or Achilles' tendon has come to mean a person's principal weakness.

Axial and saggital MRI of the ankle show an abnormal contour and altered signal intensity involving the tendoachilles, On the T2 and fat suppressed image is an area of high signal in the tendon suggesting tear. Clinical signs for complete tear are Thomson's test and inability to tiptoe.

Hope you enjoyed this edition of Radiology Grand Rounds submissions are requested for the next Radiology Grand Rounds posted every month last sunday. If you interested in hosting any of the future issues contact me at sumerdoc-AT-yahoo-DOT-com.

Images Courtesy
Teleradiology Providers

Ryles Tube Misplaced Into Cranial Cavity

Here are some images of a polytrauma patient referred to us for a CT scan interpretation. One look at the images make you feel scared, just look at the way Ryles tube is coiling in the cranial cavity. probably he had a cribiform plate fracure through which the tube got accidentally pushed into the cranial cavity. We present the Scout film and CT sections. 35 cases of intracranial nasogastric tube insertion have been reported in the international literature. A complex craniofacial fracture is the most common predisposing factor.

Similar Case on Radswiki

Case by Dr Sumer Sethi-MD, Dr Jaya Shanker,MD

Teleradiology Providers

Radiology Blog-now four years old

Wishing all our readers of this blog a very happy and prosperous new year 2008. The concept of this blog is to provide and discuss radiology related information and has been doing so for last four years (since 2004). I welcome all our readers to actively participate by commenting on the cases and submitting their own radiology related experiences.

Our sister concern- Teleradiology Providers

Pilocytic Astrocytoma- MRI Findings

"Four predominant imaging patterns of pilocytic astrocytoma have been described: (a) mass with a nonenhancing cyst and an intensely enhancing mural nodule, (b) mass with an enhancing cyst wall and an intensely enhancing mural nodule, (c) necrotic mass with a central nonenhancing zone, and (d) predominantly solid mass with minimal to no cystlike component. Although most cyst walls do not enhance, some may enhance intensely, even as much as the mural nodule; however, cyst wall enhancement is not necessarily indicative of tumor involvement . Beliefs vary among neurosurgeons regarding whether to resect the cyst itself in cases of pilocytic astrocytoma. Some advocate complete resection, others biopsy, and still others no resection . Removal of the cyst wall has not been linked with improved survival ."

Case submitted by

Dr MGK Murthy, Dr Sumer Sethi

Teleradiology Providers