The outbreak of the COVID-19 pandemic brought to light the significance of teleradiology for both patients and healthcare providers. If not for teleradiology and telehealth, remote delivery of healthcare services would not have been possible during the pandemic.
Designed to provide overnight subspecialty radiology services to emergency departments, teleradiology is one of those few technological innovations that has grown rampantly in the last couple of years mostly due to the advent of the unprecedented pandemic.
The adoption of teleradiology is increasing robustly, so much so that the global teleradiology market size which was estimated at USD 7.54 billion in 2021 is projected to grow at a CAGR of 16.79% and reach a value of USD 22.34 billion by 2028.
The pandemic has propelled the fast growth of teleradiology to an extent that it is now becoming the new normal of healthcare delivery.
Here’s a brief overview of teleradiology; What it is, how it works, its benefits and uses for providers, practitioners, and patients; and its next era of evolution with AI.
Table of contents:
3. Telehealth vs. teleradiology vs. telemedicine
4. How does teleradiology work?
7. Fast-increasing potential of the teleradiology market
8. Impact of AI in teleradiology
👉 Suggested Read: Bridging the Clinical Communication Gap in Medical Imaging
1. What is teleradiology
Teleradiology, also known as tele-reporting, is the practice of sharing patient images (X-rays, CT scans, MRIs, etc.) through telecommunication services to remote locations for review or consultation, or formal interpretation. Teleradiology allows radiologists to read images from remote locations, enabling healthcare providers to extend their services to locations where there is radiologist scarcity.
2. Evolution of teleradiology
The evolution of teleradiology dates back to as early as the 1920s when dental x-rays were shared across health facilities for consultation. During the early days, teleradiology was carried out by capturing patient images using digital cameras and uploading them to a computer. These images were then transmitted to radiologists across health centers through the internet. After reading the images, the radiologists would send back their reports in the same manner.
However, the transmission of patient images was not as easy or quick as it is today with modern telecommunication devices and mobile networks.
In India, tele-reporting arrived a little later. Teleradiology was first used in India in 1996 by a private imaging center in Mumbai, Jhankaria Imaging, for the immediate transfer of CT scans during emergencies. The first tele-reporting company in India was established in Bangalore under the name Teleradiology Solutions – where US-board certified radiologists provided services to health centers in India, the US, and Singapore.
3. Telehealth vs. teleradiology vs. telemedicine
Telehealth refers to the use of telecommunication technologies and electronic information to deliver healthcare services and information. Telehealth is a much broader term and both teleradiology and telemedicine come under Telehealth.
In simple terms, telehealth allows long-distance communication between physicians and patients, which includes care, guidance, reminder, monitoring, intervention, education, and even remote admission.
Telehealth is beneficial and applicable to numerous fields in healthcare, including:
- Chronic disease monitoring and management
- Dentistry
- Physical therapy
- Occupational therapy
- Counseling
- Disaster management
Telemedicine enables healthcare professionals to assess, diagnose, and treat patients through telecommunication technology. Telemedicine allows healthcare professionals to provide primary and specialty care to patients in the comfort of their residence or workplace.
The most common types of telemedicine are:
Interactive Medicine – enables patients and physicians to communicate in real-time in HIPAA compliant manner.
Remote Patient Monitoring – lets health care professionals observe patients that live at home via mobile medical devices.
Store and Forward – allows healthcare providers to share patient information with practitioners from other locations.
Teleradiology is a branch of telemedicine, in which a patient’s radiological image is transmitted electronically to offsite radiologists for review and reporting. The teleradiologists will study the image and provide key insights about the images along with suggestions for further patient care.
Teleradiology is used for radiological images like ultrasounds, PET/CT, x-rays, CTs, and MRIs.
Some of the key benefits of teleradiology include lower costs, fast turnaround, access to subspecialty fellowship-trained radiologists, higher efficiency, better access to rural areas, etc.
Though teleradiology and telemedicine are different processes, there are some similarities between the two. For instance, both processes enable health centers to provide high-quality patient care from a distance.
4. How does teleradiology work?
Teleradiology works on the concept of sharing images. And here’s a brief overview of how tele reporting works:
* DICOM-compliant radiological equipment
Almost all the modern radiological equipment is DICOM compliant. DICOM, which stands for Digital Imaging and Communication, facilitates storing and sharing of medical images. The DICOM system integrates all the hardware equipment such as scanners, servers, networks, and printers from different manufacturers into one system.
* Image transfer
The time taken for image transfer majorly depends on the software and hardware components used by the health facilities. And there are numerous ways of transferring the images:
- Image transfer over the internet
- Image transfer over the ethernet (direct connection of equipment across centers)
- Image Streaming
* Image viewing
The transferred images are then viewed by the radiologists on a high-resolution screen.
* Report generation and sharing
After reading the images, the radiologist creates a report and shares it with the health center that assigned the case. The radiologist might also share the reports with referring physicians on request.
5. Uses of teleradiology
5.1. Imaging Studies at Health Institutions
The primary use of teleradiology is to share radiological images with qualified radiologists from other health centers for any need like preliminary reading for an emergency, second reads, workload distribution, etc.
5.2. Research Studies
Research scientists can make use of teleradiology to connect with qualified radiologists to read scans or other radiological images. With tele reporting, scientists no longer have to leave their laboratories to gather information.
5.3. Nighthawk
One of the most significant benefits of teleradiology is Nighthawk reporting, which is outsourcing radiology reporting at night. Countries like the US can reduce the burden of night shifts on their radiologists by availing nighthawk radiology reporting services.
5.4. Holiday Tele Reporting
Radiologists’ are at higher risk of burnout than physicians. According to a recent Medscape survey, 47% of respondents (radiologists) reported burnout. This is because radiologists are unable to maintain a balance between physical and professional life and hardly go on vacation to destress themselves.
Just like nighthawk reporting, holiday tele-reporting helps in managing or reducing radiologists’ workload when on vacation or sick leave by distributing their cases to teleradiologists. With holiday tele-reporting radiologists take week offs or go on vacations without worrying about piling cases or emergency work calls.
5.5. Second Opinion
In certain cases, hospitals look for a second opinion. And during such situations, patients have to travel to other healthcare institutions to acquire a second opinion, which can be avoided using teleradiology.
In some cases, surgeons look for specialists’ opinions. With teleradiology, surgeons can easily and quickly get opinions from specialists which might take more time and effort otherwise.
5.6. Sub-specialist Reporting
Radiologists skilled or qualified in sub-specialties such as musculoskeletal, oncology imaging, pediatrics, neuroradiology, cardiac angiography, and emergency radiology can help health centers that lack subspecialty radiologists through teleradiology.
5.7. Teaching
Not just hospitals and healthcare providers benefit from teleradiology. Even medical colleges can make use of tele reporting for demonstrating medical procedures, enabling training radiologists and physicians to attend lectures from remote locations
6. Benefits of teleradiology
Teleradiology brings numerous benefits to health centers. Some of them are:
6.1. Increased reach with qualified radiologists
The concept of teleradiology stemmed from the lack of skilled radiologists and its negative impact on healthcare delivery. Though health centers had advanced CT and MRI scan equipment, they were unable to provide the desired quality of services or patient care. The lack of qualified radiologists also increased the workload of in-house radiologists and in turn led to increased diagnostic errors or reporting errors or delayed diagnosis.
Teleradiology enables health centers to connect with skilled radiologists across different centers and states, thereby enabling health centers to assign a fair workload to the in-house radiologists. Not just that, numerous rural and urban areas are facing a dismal rate of radiologist scarcity, which can be better dealt with using tele reporting.
According to a study conducted in Japan, entitled “ Geographic Distribution of Radiologists and Utilization of Teleradiology in Japan: A Longitudinal Analysis Based on National Census Data”, radiologists shortage in rural and urban areas is dramatically increasing. The authors of the study stated that teleradiology can help deal with the radiologist shortage. Even countries like the U.S., India, etc., that have inadequate qualified radiologists, can benefit from tele reporting.
👉 Suggested read: Mitigating errors in radiology reports
6.2. Reduced time and effort
Getting second opinions for certain diagnosis can be made easier with teleradiology, as it allows physicians to connect and consult with doctors or radiologists from different time zones, reducing their time and effort in traveling.
Even though health systems have tried using emails to get second opinions quickly and avoid traveling, the response time was still not satisfactory, as emails aren’t designed for the purpose and turned out to be a slower medium of communication for sharing radiology information.
6.3. Easy transfer of complex data
Data sharing has become easier and faster with technological advancements. Complex diagnostic images can be easily shared, even to the remotest of areas if they have relevant supporting equipment.
6.4. Round-the-clock services
Healthcare is a round-the-clock industry, which calls for 24/7 diagnostic services to support emergencies that can arise during the night. Making radiologists work double shifts or extended hours due to radiologists’ shortage doesn’t actually solve the problem. Matter of fact, it can lead to other problems like diagnostic errors and reporting errors due to fatigue and overwork.
Rather, hiring teleradiologists from alternate time zones can be a better solution. For instance, countries like the US and the UK can avail teleradiology services from Asian countries like India and Singapore for their night shift, as it would be daytime for these countries.
6.5. Reduces costs
Teleradiology eliminates the need to search extensively for radiologists to acquire patient images, reducing the cost burden on radiology departments. Also, availing teleradiology services instead of hiring in-house radiologists saves shift allowances and night allowances for health centers.
6.6. Improved patient satisfaction
A health system’s quality of patient care is measured through a patient’s satisfaction. With the help of teleradiology, health systems can effectively provide care to the elderly and trauma patients, who cannot travel far for healthcare services. Also, people from remote and rural areas will have increased access to healthcare services with tele reporting.
7. Fast-increasing potential of the teleradiology market
Teleradiology is becoming more reliable than ever before, and it is now the new normal for most diagnostic centers and health systems. Tele reporting is already used in 20 countries and sub-regions worldwide and the adoption rate is likely to increase exponentially in the coming years for the following reasons:
- Radiologist scarcity
- Increasing demand for specialized modality reads like CT scans and MRI that require radiology professionals with particular skills
- Growing demand for out-of-hours reporting, particularly in time-critical situations, e.g. neurology
- Increased use of cloud-based technology makes implementing IT infrastructure for teleradiology less complex
- Legislation services supporting third-party support reading services (within and outside the country)
- The increasing number of workflow tools designed particularly for teleradiology applications
- Increasing use of AI in medical imaging and diagnostics
8. Impact of AI in teleradiology
AI has become the new face of diagnostic radiology services, offering a competitive advantage for teleradiologists and teleradiology service providers in terms of reading time and accuracy.
The success of tele reporting service providers is determined by the following factors:
- Accuracy of the reports generated by teleradiologists
- TAT or turnaround time of the reports
- Workflow and decision support processes used to prioritize urgent/critical cases
- Objectivity and quality of reports
And AI can help teleradiologists with all the above factors.
For instance, PACS are now AI-driven, meaning PACS systems can now automatically prioritize cases based on their criticality. RADIOLens is a real-time example of an AI-powered PACS software that can automatically sort and prioritize cases based on their criticality. It also allows users to read images from mobile devices and report on the go.
What’s even more interesting is that AI algorithm developers are associating with teleradiology service providers to tweak their algorithms for increased accuracy and reading speed.
Numerous health tech firms are also providing AI-powered teleradiology reporting services with increased accuracy and reduced TAT. Synapsica is one such AI health tech firm that offers AI-powered teleradiology services with the highest level of accuracy in the market and reduces turnaround time by 80%.
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