CHICAGOWith the Internet, specialty radiology
departments should be able to provide a virtual link that gives clinicians
anywhere in the country or the world the same access to expert image
interpretation as their colleagues in major metropolitan areas, said Michael P.
Recht, MD, director of the Section of E-Radiology, Cleveland Clinic Foundation.
He spoke at the 86th Annual Meeting of the Radiological Society of North
As Dr. Recht pointed out, many parts of the country cannot
afford to support a cadre of subspecialty radiologists, such as cardiac,
musculoskeletal, or neurologic radiologists. So clinicians who order
subspecialty diagnostic imaging workups either have to turn to a general
radiologist or interpret images themselves.
"We don’t think that’s the best method of providing
medical care. We think if a patient has already gone to an expert, that expert
physician ought to be able to get an expert radiologist to interpret images.
That’s what we will be able to provideworking in connection with
subspecialty radiologists to provide that extra level of interpretation, that
extra level of care," he said.
A virtual radiology department already is beginning at the
Cleveland Clinic Foundation. The hospital system is hiring a radiologist to
interpret images for clinicians from thousands of miles away, Dr. Recht said.
Making a virtual radiology department possible is the ability
of the Internet to transmit digital images reliably, quickly, and cost
effectively. At RSNA, Dr. Recht showed that digital computed tomography (CT)
and magnetic resonance (MR) images could be transmitted over the Internet in as
little as 5 seconds.
None of the images or image data were lost during transmission,
and the resolution of images sent over the Internet was as high as that of
images sent over dedicated telecommunication lines, he said.
A Cost-Saving Measure
Dr. Recht decided to test the Internet as an alternative method
for transmitting digital MR and CT images because of potential cost savings. He
explained that the Cleveland Clinic Foundation has been transmitting radiologic
images by dedicated, point-to-point communication lines between its 13
hospitals and constantly expanding number of family health centers.
A T1 line that links an independent imaging center in Indiana
to the Cleveland Clinic radiologists costs $3,800 a month, he said. If the
bandwidth dropped down to 128 K, the line still would cost almost $1,000.
High-speed Internet communication lines, however, range in price from $100 to
$200 a month.
Dr. Recht wanted to be sure that the Internet would not
increase transmission time to unacceptable levels. Unlike a dedicated telephone
line, which is a direct connection between an acquisition device through a
router to a radiology image viewing station, the Internet places many detours
in the path of an image on the way to its destination.
Images traveling over the Internet also must be encrypted to
protect patient confidentiality, which could slow down the process.
Internet vs Dedicated Line
Dr. Recht compared image delivery over the Internet and
dedicated telecommunications lines of nine MR and six CT examinations that had
been randomly selected from his clinical practice. Each of the cases contained
between 26 and 256 separate images.
In this study, Dr. Recht found that the Internet was just as
fast as dedicated phone lines, taking less than 1 second per image with higher
bandwidth. Data compression made Internet image transmission fast enough to use
while scanning patients.
"If you send images that are not compressed, it takes 30
to 40 seconds per image, whether you’re using dedicated or Internet
communications. This is very long, if you are lying on the table and having a
CT exam. But when we use compression, we’re able to decrease the speed of
transmission down to 1 second," he said.
As a result of the findings from this study, the Cleveland
Clinic is switching from dedicated telecommunications lines to the Internet.
Dr. Recht estimates that the Cleveland Clinic will be transmitting 30,000 CT
and MR cases in 2001 over the Internet and saving 30% to 50% in image
Similar savings could be achieved elsewhere, he suggested.
Imaging centers that perform only a small volume of CT or MR scans would have
to spend $2,000 a month to transmit images over dedicated phone lines.
"If you are only going to be doing 100 cases a month, that
means each case costs up to $20 to transmit. That’s not feasible
economically. We believe we can get that cost down into the $5 or $6 range,
which any community medical center can absorb," he said.