Teleradiology

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In medicine, teleradiology is understood to mean any process in which radiological image material is transmitted to a remote location via a telecommunication device ( image transmission ).

Teleradiology according to RöV

In a narrower sense, teleradiology means the imaging examination of a person under the responsibility of a specialist doctor (usually a radiologist) who is not on site. The responsible radiologist is in direct contact with the requesting and executing body by means of electronic data transmission (for example, encrypted Internet tunneling or telephone connection). This form of teleradiology is defined in Section 3 (4) of the X-ray Ordinance (RöV) and is also referred to as " Teleradiology according to RöV ".

Teleradiology according to RöV also enables smaller hospitals to offer computed tomography (CT) without a specialist doctor always having to be on site. There are advantages especially in night, Sunday and public holidays. Teleradiological solutions have proven themselves over several years of productive use at various locations. However, the legislature has set high hurdles for the use of teleradiology according to RöV, which often results in lengthy approval procedures.

requirements

  • Appropriate equipment must be available (examination device and teleradiology facility at the examination site and a teleradiological receiving facility at the evaluation site).
  • A specialist who can technically operate the device must be at the examination site.
  • There must be a fast, stable line for transmitting the image data.
  • A radiologist must be on the receiving end to assess the images competently and to return his findings.

procedure

Before the examination, the question and the type of examination required are transmitted. The radiologist checks the justifying indication and determines the examination program. The investigation is carried out. After the implementation, the image data set is transmitted to the radiologist. The radiologist sends his findings back to the requesting office (by electronic mail, fax or telephone dictation, occasionally directly by telephone conversation with the requesting clinician).

Teleconsultation

The second major application area of ​​teleradiology is teleconsultation. With this form of teleradiology there is always a responsible radiologist on site. In particularly difficult to diagnose or dubious cases, the responsible radiologist can obtain a further opinion, for example that of a specialist at a university clinic, for the preparation of the findings. Mobile DICOM viewers are increasingly being used, which enable the uncomplicated exchange of radiological image material. The electronic transmission of image data means that the still widespread sending of images, for example by taxi, is no longer necessary . Since with this form there is always a responsible radiologist on site, the legal hurdles are considerably lower than with teleradiology according to RöV.

Amount of data transferred

Procedure Typical image resolution Kilobytes per image (lossless compressed) Images per examination Megabytes per exam
Chest x-ray 2048 × 2400 × 16 circa 1600 1 or 2 1.6 or 3.2
CT 512 × 512 × 16 200 50 to 100 10 to 20
MRI 256 × 256 × 8 20th 50 to 100 1 to 2
Sonography 512 × 512 × 8 100 10 to 50 1 to 5

The information is to be understood as a guide.

Particularly in the case of sonography (ultrasound examination), larger amounts of data may have to be transmitted, as color images and / or video sequences are sometimes generated. However, teleradiological applications in ultrasound are also rather rare, because to derive a good ultrasound image you need an experienced examiner who can then usually assess his images himself.

Standardization of teleradiology

Today (as of 2006), almost no proprietary solutions are used for image transmission in teleradiology, but standardized DICOM protocols. Unlike in the past, it is no longer necessary for both communication partners to use teleradiology software from the same manufacturer. However, some configurations (AE title, ports, host name or IP address, router setting) must be made before the initial communication, so that problems can arise, especially in the case of sporadic teleconsultations with changing partners.

To solve this problem, the German Radiological Society passed a recommendation in May 2004 for the standardization of teleradiology in Germany. According to this recommendation, the use of Open PGP -encrypted DICOM -E-Mail for image transmission should become the standard in teleradiology.

For Medical Devices Act (MPG) compliant teleradiology systems that support this standard are offered by the industry.

Since March 2009, DIN 6868-159 has been regulating acceptance and constancy testing in teleradiology according to RöV.

See also

literature

  • C. Rosenberg, K. Kroos, B. Rosenberg, N. Hosten, S. Flessa: Teleradiology from the provider's perspective-cost analysis for a mid-size university hospital. In: European radiology. April 2013, ISSN  1432-1084 . doi: 10.1007 / s00330-013-2810-5 . PMID 23604799 .
  • C. Rosenberg, S. Langner, B. Rosenberg, N. Hosten: [Medical and legal aspects of teleradiology in Germany]. In: RöFo: Advances in the field of X-rays and nuclear medicine. Volume 183, Number 9, September 2011, pp. 804-811, ISSN  1438-9010 . doi: 10.1055 / s-0031-1273220 . PMID 21442556 . (Review).
  • C. Rosenberg, K. Kroos, B. Rosenberg, N. Hosten, S. Flessa: Economic and legal aspects of teleradiology in Western Pomerania (POMERANIA project). In: FJ Bartmann, M. Blettner, PU Heuschmann (ed.): Telemedical methods in patient care. Health services research report, Deutscher Ärzteverlag, 2011, ISBN 978-3-7691-3494-0

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