Teleradiology Service Providers, 1996

Working from the extensive databases at the Telemedicine Information Exchange and Telemedicine Today, we compiled a list of what we felt were the most prominent U.S.-based teleradiology groups, and surveyed them about their activities. We were most interested in groups that are doing diagnostic interfacility teleradiology, as opposed to PACS teleradiology within an institution, or interim-read telearadiology. This is largely because interim-read teleradiology to physicians’ homes, for off-hour preliminary reads, has become so common that it would be nearly impossible to ferret out all of these deployments. Also, we felt that diagnostic reads are a reasonable bellwether of teleradiology trends, since only these are reimbursed. We do not pretend that this is an exhaustive accounting of teleradiology service providers. However, we do feel that we’ve contacted a majority of the most significant teleradiology practices that are interpreting remote, transmitted radiographs.

Internet Teleradiology: The Other PACS

Teleradiology is the most widely deployed application of telemedicine. In use since the late 1950’s, teleradiology is the "granddaddy" tele-imaging application. Numerous definitive studies (see Twenty Selected Teleradiology References, Vol. 4, no. 2) have shown that transmitted radiographic images (with the possible exception of mammograms; see Telemammography Feasibility, Vol. 4, no. 2) can be displayed on a remote monitor and interpreted with diagnostic reliability. In the past year teleradiology, which refers to the transmission of images between enterprises, has begun to integrate with PACS (Picture Archive and Communication Systems), which refers to image acquisition, management, and transmission within a single enterprise. The lines have been blurring as health care institutions link together their far-flung affiliate hospitals and clinics.

Decision Making for Teleradiology: An Interview with Dr. Jim Logan

Jim Logan, M.D. is President of Logan & Associates, Inc., one of the original telemedicine consulting firms. Their client list includes numerous public/private, rural/urban hospital-based health care delivery systems. In addition, they have provided services to medical organizations in Russia, Japan, Australia, Iceland, Scotland, France, Germany, Canada, Guam, South Korea, and the Peoples Republic of China. Dr. Logan completed a NASA-sponsored residency in Aerospace Medicine and is board-certified in the specialty. Since last August, he has served as the Telemedicine Clinical Director for the U.S. military's Pacific Regional Program Office (PRPO) based at Tripler Army Medical Center in Honolulu, HI. PRPO is a consolidation of the AKAMAI Telemedicine Project and PACMEDNET. One of his interests is finding low-cost ways of providing diagnostic teleradiology services throughout the Pacific Basin, a sparsely populated area that covers roughly a third of the planet's surface.

Cutting Edge Internet Teleradiology from 9 Leading Vendors

These nine companies (and there are surely more we haven’t identified) have committed significant resources to porting their technologies to Internet protocols. It is a gamble for all of them. Not because the Internet isn’t going to deliver on its promise. It is. The problem is that by its nature the Internet thrives under open standards, and no one has figured out how to make much money by developing a nonproprietary product. One strategy will likely be to use Internet capabilities as a "loss leader" bundled into a much larger package of information systems products.

A Telemedicine Primer

In an ideal world, there would be a radiologist constantly available at every facility capable of taking radiographs. In practice, this is not feasible. The traditional solution was to transport the X-ray film to the radiologist for reporting, or to use the services of a visiting radiologist ('circuit rider'). The availability of digital transmission allows the possibility of teleradiology, which is rapidly becoming commonplace as the costs of bandwidth and hardware drop.

What's New in Teleradiology -- Editor's Note.

Teleradiology is by far the most common telemedicine application. There are at least 10, and more likely 15 or more, diagnostic teleradiology cases for each interactive video patient-clinician consultation. Not only is there a lot of teleradiology activity, as shown in this issue’s review of teleradiology service providers; there is also a fair amount of money being spent on teleradiology equipment. A recent Frost & Sullivan estimate placed the 1996 world sales of teleradiology products at about $89 million. If PACS were considered in the equation, this figure would obviously be much higher.