Teleradiology – Page 2 – Cloudex Radiology

Teleradiology Proves as a Reliable, Efficient and Economically Viable Services for All Stakeholders

The discovery of Radiology by Wilhelm Roentgen, Professor of Physics at University of Wurzburg, Germany in 1895; has revolutionized the way trauma and illnesses are diagnosed and treated. Today, Radiology is not only aiding the diagnostic skills of the physician but also used for quantitative measurement of anatomic and functional processes, image-guided invasive interventional procedures, and an assessment of functional / performance of the organs.

Technology and Teleradiology:

Teleradiology integrated with advanced technology is capable of delivering rapid, reliable, real-time healthcare services without any delay/interruptions irrespective of the geographical limitations and access to specialized reporting services. The digital radiological images are compatible to be viewed on different electronic mediums (electronic monitor/display, note pads, mobile). The radiological image reaches the Radiologist’s workstation without any subsequent intervention for enhancement and review. Various software (PACS & DICOM standards) and hardware support the whole system in maintaining the quality of the image during the process (acquisition, transmission, storage, retrieval); and different compression techniques are employed to contain huge data and maintain the integrity of the digital images. Healthcare service delivery with quality, promptness, correct diagnosis, and appropriate treatment adds to the patient’s satisfaction. This whole system encompasses reliability, efficiency, and economically valued services for every stakeholder.

Reliability: The protocols, technology-based systems, and multimedia-driven communication channels have made Teleradiology one of the reliable medical services. The other contributing factors are quality of reports, access to a range of tele-reporting services (nighthawk/subspecialty / after-hour services/emergency / second opinion/weekend), experiences and expertise of the radiologists. And this reliability is intangible. It supports the referring physician or emergency department in real-time similar to on-site radiologist whereas for the centers (primary/secondary) present in rural or in geographically challenging places (for e.g., mountain terrains) it provides the physician in delivering medical care without any delay, helps the patient in deciding on transfer (trauma/emergency) or shift to a tertiary center, and encourages the efficient use of the healthcare facilities.

Efficiency: Time is a crucial factor in patient care delivery. Teleradiology contributes to it by enabling Physician to take important decisions and delivering prompt services. It improves the Emergency department’s capacity & throughput whereas, in multispecialty tertiary hospitals, it works out as an alternate coverage for after-hours / vacation/weekends and plays important role in clearing the department’s stack. Teleradiology enhances the efficiency of healthcare centers (Secondary / Primary / Diagnostic centers) by facilitating patient care without delay, providing access to subspecialty reporting, handling postoperative complications, and reducing the readmission rates.

Economical, low-budget solutions with high value for money have been encouraging and are one of the main reasons for constant transformation and adaptation of teleradiology in line with the technology and demand in medical services. Every stakeholder, be it patient or hospital management or radiologist or treating physician gains reasonably from Teleradiology. The satisfied patient adds a competitive and winning edge to serving medical facilities.

– Clinically, the Physician is able to gain patient confidence and satisfaction by delivering prompt patient care with accurate diagnosis and appropriate treatment.

– Radiologists are able to manage better work-life balance and have networked with sub-specialty radiologists.

– Hospital management wins in multiple ways; efficiently provides medical services round the clock, handles emergency / critical cases without added costs or overheads, delivers patient care without any delay/interruption. And thereby succeed in achieving popularity with word-of-mouth promotion through satisfied patients.

– Patients are the ultimate beneficiary of this whole system with prompt medical care which not only saves time and money but also lives. Availability of imaging reports at once provides an option to decide on many things like treatment plan/necessity to travel or shift to a specialized center, organizing fund, and emotional support.

Cloudex Radiology Solutions backs the quick TAT with reliability and efficiency…

Cloudex’s panel of qualified, experienced, and expert teleradiologists are capable of providing the interpretation of the radiological image with accuracy and profoundness in details that aid in the revelation of the underlying cause of abnormalities. Our team stands up to the statement on quality as briefed in Radiographics, 2011. 31(6): p. 1511-27 – “Quality in radiology is multi-dimensional and includes measuring, monitoring and improving various aspects of the workflow, including examination appropriateness, procedure protocol, the accuracy of interpretation, timely communication of imaging results as well as performance improvements in safety and efficiency”. We, at Cloudex work with the hospitals / diagnostic centers as a team in ensuring quality patient care from the point of entry, through scan to report delivery by involving the reporting radiologist at each stage ensuring the right protocol, adequacy, and safety of procedure while delivering the accurate interpretation within expected TAT.

Cloudex along with its reliable and efficient team delivers teleradiology services and helps its referring physician or medical facility in winning more satisfied patients as a winning edge in this competitive field.

At Cloudex, we support you to have that winning edge.

SCREENING MAMMOGRAPHY

Mammography is an X-Ray of the breasts carried out on a machine dedicated to it because the breast is not of uniform thickness and requires a dedicated unit. It is conical in shape, narrow in the region of the nipple. The tissues need to be flattened to separate them & achieve better visualization. Moreover, the breast moves with respiration and needs to be fixed. Hence, compression is applied to the breast resulting in a little bit of discomfort for few seconds. The compression results in the reduced thickness of the breast and the radiation to the breast are decreased. The benefits of mammography far outweigh the slight discomfort.

When mammography is carried out on an individual without any symptoms, it is called screening mammography whereas if carried out on an individual with symptoms, it is called diagnostic mammography in which additional views have to be carried out.

With the advancement in technology and the world going digital, mammography machines are now digital. Hence, mammograms carried out anywhere can now be viewed by expert breast radiologists in any part of the world thanks to teleradiology. The scans can be viewed & reviewed very easily & comfortably from anywhere, which is a huge benefit. Considering the lockdowns during Covid times where one couldn’t travel, this makes it so comforting for patients to get their mammography at a local setup and get an expert from any part of the world to give an opinion on it. It saves a lot of time, money & effort.

Breast cancer like many other cancers is a silent painless disease and by the time it becomes a palpable lump, it is fairly large in size. Early detection leads to a reduction in morbidity & mortality and more options of treatment. Hence, screening mammography is important as it can detect cancer before it becomes palpable.

At times there is no mass palpable and microcalcification is the only sign of malignancy. Screening helps to detect cancers when they are too small to be palpable as well as the ductal carcinoma in situ. Microcalcifications, the hallmark of breast cancer are detected only on mammography.

Screening protocols vary from country to country depending on the incidence of breast cancer.

In India, for the general population, the protocol is as follows:-

Once between 35-40 years of age. If the breast is dense on the mammogram, an ultrasound must also be carried out.

2. Age 40-50 Once in 2 years

3. Age > 50 Once in 18 months -2 years if the breast is fatty and annually if dense.

Screening is continued usually till 75 years or till the time, there is the likelihood of life expectancy of 10 or more years.

However, for the high-risk group, screening is more aggressive. Depending on the risk, at times MRI breast is started annually starting at 25 years and mammography at 35.

In the case of 1st-degree relatives of those with premenopausal breast cancer, Screening is started 10 years earlier than the age at which the relative was diagnosed.

For women in the reproduction age group, screening is best done in the immediate postmenstrual phase when the breast is softest and there is no likelihood of pregnancy. Ideally, no talc/ deodorant should be used prior to the test to avoid artifacts. A two-piece dress is ideal for the test which takes less than 10 minutes. Two views, craniocaudal & mediolateral of each breast are carried out which results in global imaging including the axillae. With the new full-field digital mammography machines with tomosynthesis, the information from mammograms is way more than the older machines.

High-risk individuals:

There are risk factors that one can’t change-:-

1. Getting older.-most breast cancers diagnosed after age 50. With advancing age immunity decreases.

2. Low immunity includes diabetes, autoimmune disorders, patients on immunosuppressants & chemotherapy

3. Inherited gene mutations, such as BRCA1 and BRCA2.

4. Early menarche before age 12 and late menopause post 55 results in prolonged exposure to hormones and increased risk

5. Dense breasts are a risk factor & also result in difficulty in the detection of abnormalities on a mammogram.

6. Prior history of breast cancer or certain non-cancerous breast diseases like atypical hyperplasia or lobular carcinoma in situ.

7. Family history of breast or ovarian cancer. Risk is high if a first-degree relative or multiple maternal/ paternal family members with breast or ovarian cancer. A first-degree male relative with breast cancer also raises a woman’s risk.

8. Prior H/O radiation therapy to the chest or breasts ( say for Hodgkin’s lymphoma) before age 30.

9. Diethylstilbestrol (DES), given to prevent miscarriage raises the risk for the woman & her daughters.

10. Pollution & adulteration

Risk Factors one Can Change:-

Sedentary existence

2. Obesity with increased abdominal circumference.

3. Hormone replacement therapy & oral contraceptives

4. Having the first pregnancy after age 30, not breastfeeding, and not having borne children raises the drink

5. Smoking & drinking.

6. Stress- combat it through yoga, exercise, and meditation.

Have you got your screening mammography done? If eligible for it and you haven’t got it done, PLEASE DO IT NOW.

Author:

Dr.Padmavati Dua

Erstwhile Senior Consultant

Diwan Chand Aggarwal Imaging Centre, New Delhi

Yashoda Hospital, Kaushambi, Ghaziabad

Col. Pant’s Imaging Centre, Green Park, New Delhi

PACS: Diminishing the Distance and Enabling the Real-Time Services in Teleradiology

The pandemic time has unveiled a plethora of opportunities and brought in a paradigm shift in work culture – Remote Working, driven by technology. This has enabled the continuation of services irrespective of location and time without compromising the quality-of-service delivery. But this remote working is not a new concept in Radiology. Many radiologists have been supporting the clinicians irrespective of their location and time through teleradiology and delivering quality patient care without delay.

Teleradiology, identified with remote working is actually vibrant, spontaneous, and into real-time work. All this is possible because of PACS.

PACS – Picture Archiving and Communication System; a system involved in acquiring the medical images, transmission, viewing, storage, and retrieval of same images. Basically, PACS is an electronic version of the file room and reading room for radiologists. PACS works as a host that integrates the radiological images acquired from different radiological imaging modalities (X-Ray, Ultrasound, CT, MRI, PET Scan, Nuclear Medicine, etc…) with a network of information system (RIS and or HIS), EMR, different work stations and image storage/archival system.

Since 1980, PACS has undergone many transformations in multiple ways. All these have been worked out to improve – the transmission of images without any compromise on its quality, archiving and retrieving of data (images and other information) for reference without any delay, communication between the referring Physician, and reporting radiologist. The fundamental parts of PACS are – imaging acquisition, display workstations, archive servers. The workflow is customized based on the modality of images and criticality of the cases marked in the raised work orders

Today, the Web-based PACS offers many additional features like AI-Assisted Decision Support systems, Multi-Media Enhanced Reporting (MMER), an intuitive user interface, intelligent work aids (personalized tools and layout), mobile extensions, multimedia communication tools, etc that boost reading/reporting, making it a smart PACS. It is a coordinator between multiple processes (software & hardware) and applications enabling the image reporting as a real-time service supporting referring physicians.

The benefit of all these features has resulted in reduced TAT, improved productivity of department, better management of emergency / critical cases, and maintenance of data security. It also enables the viewing of images for reporting from anywhere – inside the department or at the nursing station or on mobile gadgets (mobile/notepads/laptops) or remote reporting sites (Teleradiology).

PACS infrastructure is evolving with advancements in medical imaging technologies and it is highly scalable to keep up the pace with the increasing number of imaging and reporting. This scalability can involve – the addition of more no. of imaging modalities, storage space, no. of work stations, integration of artificial intelligence and machine learning or any other features.

PACS in Hospitals / Tele-reporting service providers with different modalities and multiple work stations use Vendor Neutral Archive (VNA) which brings about compatibility between the different software of imaging machines and PACS’ networking. VNA ensures seamless functioning of data receiving, transmission, integration, and archival and saves time by providing one viewing experience/interface irrespective of the origin of data acquisition.

Cloudex Solutions: extending teleradiology with cloud-based PACS

Cloudex has set its tele-reporting infrastructure with the advanced smart PACS that provides a convenient workflow and easy-to-use interfaces/dashboard. These advanced online PACS is capable of handling multiple modalities and multiple workstations providing the browser as the main viewing tool enhancing the faster TAT.

The teleradiologists login into the browser and start with the flexibility of time ensuring the tele-reporting services for 24x 7 x 365. Now hospitals / diagnostic centers have the advantage of need-based tele-reporting depending on the imaging modality/subspecialty/timing (full time or night hawk services) instead of traditional reporting apart without a huge investment in digitalized workflow and storage. The experience of the PACS administrator adds a lot of value especially in critically marked/emergency cases apart from their regular maintaining or managing or troubleshooting roles.

Cloudex with its flexibility in working and range of tele-reporting services aims to support its clients (healthcare service providers) in overcoming obstacles faced while delivering patient care and have a winning edge towards patient satisfaction.

At Cloudex, we support you to have that winning edge.

Panademic Crisis Boon Teleradiology

A medical system by which patient’s radiological images from a variety of health care facilities are transmitted electronically for review and reporting by experienced, offsite radiologists and that’s teleradiology. The resulting reports are then transmitted back to the original facility, providing key insights about the images and helping to determine the course of further patient care. The true fact is that this system is grown within the medical field over the last number of decades, only a few are familiar with the particulars of teleradiology.

Now in the present scenario use of teleradiology is highly recommended as the covid 19 crisis threatens the entire world. Moreover, it ensures the safety of professionals and patients simultaneously. However, optimization of IT solutions and implementation of the right change process is a significant milestone for a successful transition.

Radiology plays an important role during the pandemic as it is essential to maintain the continuity of the health service to the patients. Using such technology based on the transmission of radiological patient images from one location to another and allows radiologists to provide services without having to be in contact with the patient is peculiarly important to minimize the expansion of the covid 19 virus.

In some countries, radiology departments in public and private experienced this solution of remote working, showing a positive impact during the outbreak.

The physical distance between the technologist radiologist, the referring physicians, and the patient is of great advantage now as concerns the present situation. If the concerned patient is in self-quarantine due to exposure to a covid patient, in such situation teleradiology helps much with doctors as being able to read, albeit from far x-rays or CT scan of coronavirus patients.

In China at an early stage of a pandemic outbreak, before swab testing was really available, CT scan was used by doctors to assess the probability of covid 19 infections, same time used to track and monitor the progression of the disease as described by some researchers from China.

Teleradiology allows radiologists to work and be productive when isolated from the rest of their community, while the necessity for social distancing is inevitable in the current pandemic, definitely help to restrict the virus transmission. This practice of receiving images to interpret from a facility and that too is out of radiologists’ geographical vicinity is a truly valuable contribution at this time of unprecedented crisis. By supporting areas of the physician shortage and backing up they are in hospital counterparts, teleradiology serves in a significant way to relieve some of the stresses that global health care systems are currently experiencing.

Medical Science has proven time and again that when the resources are provided, great progress in the treatment, cure, and prevention of diseases can occur.

When there is a crisis we can use two brush strokes to write the word ‘crisis’. One brush stroke stands for danger and the other for opportunity. In a crisis, be aware of the danger but on the other hand recognize the opportunity. It’s really an unpredictable situation for the medical field globally, the danger is on the way we move on. But on the other side of the coin, we are forced to find innovative solutions to problems we may never face before.
When we approach the crisis from a hopeful perspective rather than with a stance of resistance, we can navigate this difficult situation by making it beneficial for the modern medical system knows to be teleradiology.

Teleradiology Enhancing The Patient Satisfaction and Quicker TAT for Referring Physician

Once upon a time, teleradiology was considered as a fragmented and interrupted experience where the images, texts, and speeches were getting delivered on a different medium. And the poor communication between the referring physician and teleradiologist might have resulted in confusion in the patient’s mind or the high cost or undesirable clinical outcomes.

Currently, technological advances have revolutionized the way teleradiology is conducted and are contributing to quality healthcare service delivery. Today, teleradiology represents the integration of the many advanced multimedia technologies which supports the upload/download of reports along with other necessary support documents (other than radiological images), display of images (multiple viewing/screening options), tools for image annotation, image/report archival and retrieval, communication between the group/team, audio reporting and its conversion into text report are some of the important features facilitating the remote reporting equivalent to real-time reporting.

At present, Teleradiology addresses the key concern of the referring physician – accurate report at the earliest with the provision of communicating with teleradiologists in real-time.

These concerns get addressed and benefit him in multiple ways.

Benefit of Support from the extended team during the deciding moments becomes crucial for those who are based in healthcare centers where the radiology department works in stipulated working hours or patients are referred to other centers for radiology services. In such a scenario, the treating physician is benefitted by receiving accurate reports within the decided TAT and can interact with the teleradiologist for further clarification. Overall, the referring physician has an extended team outside his team (employed/assigned team) to support him in providing quality patient care and on whom he can rely during his crucial deciding moments.
Benefit of 24 x 7 Reporting services empowers the referring physician in providing quality patient care round the clock without any delay. This benefits the physician as well as the patient in saving the time and cost, the shift of patient to emergency service and unexpected situation.
Benefit of Expert Opinion when an ambiguous situation. A qualified and expert panel of subspecialists can support the referring physician in more than one way – correct diagnosis, prognosis, and working out the appropriate treatment plan or in understanding/monitoring the treatment outcome. This works wonders for the multispecialty hospitals who need the subspecialty reporting and expert opinions for critical cases additional to their regular radiologist’s reporting; especially in cases of Orthopaedic, Neurology, Oncology, Paediatric or Emergency to name a few.
Benefit of Remote Reporting has brought about a paradigm shift in the quality of patient care extended in primary or secondary care centers located in tier 2 / 3 towns or geographically challenging locations. Teleradiology has built a connection where referring physicians can interact with the reporting teleradiologist in real-time. As a result, Referring Physician can inform the patient about the criticality of the patient in emergency cases and guide the patient in taking appropriate action or referring a patient to comprehensive healthcare centers at right time.
Benefit of Selective Reporting services is an option where the referring physician can choose from different types of teleporting services based on the need; like during the absence of regular radiologists due to holiday/weekend / off-duty / night-time. The different services available to opt for are night call reporting, weekend reporting, overload reporting, vacation reporting. All these selective options are available to ensure patient care without any delay.
Benefit of Answers to the queries of Patient which helps in building trust. Many times, the internet-savvy patient from the metro and tier 1 town throws a series of queries for a better understanding of the situation and for taking appropriate action (shift to a specialty center for surgery/treatment). The patient’s interaction with the reporting teleradiologist who has given the detailed imaging report helps in briefing those critical characteristics playing a crucial role in prognosis. The building of trust depends on many aspects and this can prove to be one of the ways.

Cloudex Radiology Solutions empowers the Referring Physician with a winning edge…

Cloudex teleradiology services empowered with its qualified & experienced experts and subspecialty teleradiologist extends the benefits of technologically advanced infrastructure (RIS-PACS) supported with interactive multimedia components, advanced visualization, and communications (voice message/text/messenger app-based communication, etc.). All these features help in low TAT, quality reporting, and increase the Physician’s satisfaction and confidence with service resulting in the effective clinical outcome – patient care. In today’s competitive world where the patient is ready to go extra mile for better information, better patient care, better treatment option; Teleradiology empowers the referring physician with that winning edge.