Stelios C. Orphanoudakis.
Institute of Computer
Science, FORTH, Heraklion, Crete, Greece
Dept. of Computer Science, University of Crete, Heraklion, Crete, Greece.
Abstract
In recent years, advances in information technology and telecommunications have acted as catalysts for significant developments in the sector of health care. These technological advances have had a particularly strong impact in the field of medical imaging, where film radiographic techniques are gradually being replaced by digital imaging techniques, and this has provided an impetus to the development of integrated hospital information systems which support the digital transmission, storage, retrieval, analysis, and interpretation of distributed multimedia patient records (i.e. structured collections of attribute, text, image, and voice data) [1]. Thus, medical imaging has become an important application domain for the use and validation of new information and telecommunications technologies. In particular, these technologies are currently used to enhance the capabilities of all diagnostic medical imaging modalities and to provide added-value services to the health care community, with an aim toward improving the delivery of health care and ultimately patient outcome.
Teleradiology consists of a set of added-value telematic services, implemented over an advanced telecommunications infrastructure and supported by different information technologies and related applications. The main goal of teleradiology is to provide different levels of support for remote diagnostic imaging procedures. In this paper, teleradiology is also considered in the general context of an integrated regional health telematics network, emphasizing its role and its interaction with other information and networking services.
The basic services supported by an integrated teleradiology services network (ITSN) are: telediagnosis, teleconsultation, telemonitoring, and tele-management. Other added-value services which can also be provided over an ITSN include access to high-performance computing facilities in order to execute computationally intensive image analysis and visualization tasks [1], information retrieval from remote databases containing material of reference and educational value, etc. The underlying technology of teleradiology services consists of transmitting and receiving workstations with appropriate user interfaces, an advanced telecommunications network, and teleradiology specific modules for synchronous teleconsultation, image processing, image management, etc. Although teleradiology services may be established on a point-to-point basis between single communicating nodes, in the case of large health care facilities, it is desirable that a PACS (Picture Archiving and Communication System) or IMACS (Image Management And Communication System) exist at both ends of a communications link. This would facilitate the management of local resources at the transmitting and/or receiving end.
The justification for the effort and cost of developing teleradiology services lies in the modern health care environment, which exhibits the following interesting characteristics [2-4]:
· Medical diagnosis is becoming increasingly dependent on the results of imaging and laboratory tests rather than clinical findings alone. For example, approximately 70% of patients admitted to a hospital require some form of diagnostic examination [2].
· New diagnostic imaging modalities require subspecialty medical personnel to guide image acquisition and produce the primary diagnostic report. This scientific and technological progress has increased the number and complexity of parameters which must be considered by medical professionals for proper health care delivery. Conferencing between personnel of different subspecialties is often required to arrive at an accurate final diagnosis and to plan the course of therapy. Thus, physical conferencing or teleconferencing and teleconsultation are becoming increasingly important in routine clinical practice.
· Technology is evolving rapidly, thus reducing the capital and operational cost of diagnostic equipment and hardware required for medical information systems. At the same time, the cost of medical personnel is increasing, accounting for up to 70% of the total health expenditures in the European Union [4].
· Modern lifestyle requires immediate medical support and increased quality of care in remote areas with a lower healthcare practitioner-to-population ratio, such as tourist resorts, oil plants, ships at sea, etc. Thus, the health care system is spreading outside major hospitals and other well-equipped medical facilities. To provide continued and seamless care, across different levels of the health care hierarchy, to an increasingly mobile population, health telematics networks and services are needed at a regional, national, and transnational level.
Potential benefits of teleradiology services include improved access to diagnostic imaging facilities, reduced costs (less travel and work-leave expenditures, etc.), reduced isolation for both patients and medical personnel, and improved quality of care through real-time diagnosis, advanced decision support tools, increased collaboration and continuous education, reduced loss of patient data, and direct access to remote computational facilities for advanced image processing and 3D visualization. The above benefits are likely to become evident after a transition period, during which users of teleradiology services receive proper training and learn to trust them, potential legal issues are resolved, and capital and operational costs are reduced, while service quality is improved with new technological developments.
Technological advances in teleradiology cannot be considered independently of the revolutionary developments which have occurred in the past twenty years in the field of medical imaging, paving the way for an increasingly important role of information technology and telecommunications in health care. The diagnostic imaging department of the future will make extensive use of computer networks, mass storage devices, and sophisticated workstations at which humans and machines will interact, assisted by advanced information processing tools and techniques of knowledge engineering, to achieve integration of multimodality imaging data and expert medical knowledge [5]. In many modern diagnostic imaging departments, this development is already in progress [3]. Computer networks also provide physical links to other hospital departments and patient wards in order to improve interdepartmental communications and patient monitoring procedures. Image management and communication systems (IMACS) form the core of such an environment, responsible for the acquisition, storage, communication, display and manipulation of diagnostic medical images and related patient data [6]. Teleradiology services build upon and extend this environment to interhospital or hospital to point-of-need communications on a regional, national, or global scale. Therefore, teleradiology can be considered as an extended virtual radiology department that encompasses available physical and human resources over a wide region in order to support remote diagnostic procedures and patient management. This presentation will consider in greater detail related technical issues and possible teleradiology scenarios at various geographical scales.
References
1.- Orphanoudakis SC. Supercomputing in medical imaging. IEEE Eng. Med. Biol. vol. 7, 16-20, 1988.
2.- Mun S.K, Freedman M, Kapur R. Image management and communications for radiology. IEEE Eng Med Biol 1993; 12: 70-80.
3.- Chimiak WJ. The digital radiology environment. IEEE J Selected Areas Commun 1992; 10: 1133-1144.
4.- Rossing N. EC research: telematics for health care and standardization. IEEE Eng Med Biol 1993; 12: 70-74.
5.- Rennels GD, Shortliffe EH. Advanced computing for medicine. Scientific American 1987; 257: 154-161.
6.- Orphanoudakis SC, Tsiknakis M, Chronaki C, Kostomanolakis S, Zikos M, Tsamardinos Y. Development of an integrated image management and communication system on Crete. In: Lemke HU, Inamura K, Jaffe CC, Vanier MW, eds. Proceedings of CAR’95, Berlin: Springer 1995: 481-487.
Corresponding Author:
Prof. Stelios C. Orphanoudakis
Institute of Computer Science
Foundation for Research and Technology - Hellas
PO Box 1385
Heraklion GR 71110
Greece
Fax : + 30 81 391601
e-mail: orphanou(at)ics.forth.gr
URL: http://www.ics.forth.gr
Oral presentation at EuroPACS'98, Barcelona, Spain