Teleradiology in today’s world

Twenty five-year-old Avinash is hit by a lorry as he rides home on his motorcycle on a poorly lit road one evening. He is rushed to a local nursing home where a CT scan is performed. In 15 minutes, a team of radiologists report the presence of internal bleeding confirming the medical officer’s diagnosis of head injury. Avinash is rushed into surgery, and a potential fatality is averted.

This sounds like any one of hundreds of road accidents that occur daily in India. So why does it merit any further discussion?

The differentiator?

What differentiates this incident is that Avinash’s accident occurred in a small town in Nagaland which can only be reached by road. A qualified radiologist would have to travel 24 hours to reach here. The 15 minute turnaround time between taking a CT scan and obtaining a report was possible because a team of radiologists from Bangalore was available, able to obtain the scan and send back the report, all within a time span that makes the difference between life and death.

Boon for small town dwellers

This is the new world of teleradiology. This technique of imaging has allowed healthcare providers to harness technology to provide quick, high-quality and widely accessible specialist care.

Let’s go back to Avinash’s story for a moment. Isn’t it unusual that a remote nursing home in Nagaland should have access to a CT scanner but not to a qualified radiologist? Unfortunately, the answer is no. Over the past few years, investments in Indian healthcare have grown rapidly, with the result that hospitals and diagnostic centres have mushroomed across the country. The bottleneck now has moved to manpower: recruiting and retaining a radiologist is increasingly challenging, even in the metros. By utilising the expertise of specialists, wherever they may be, teleradiology provides a means of overcoming this bottleneck.

Overcoming geographical boundaries

Today, over 70 per cent of clinical decisions are made on the basis of diagnostics like radiology and laboratory results. Further, medical science is evolving rapidly and developments like the 256-slice CT and 3T MRI produce images that can be interpreted only by highly qualified specialists. Teleradiology allows patients to overcome the constraints of geography to access the benefit of this small pool of specialists.

The other great benefit of teleradiology is in providing 24 X 7 coverage. This is one of the main reasons why 75 per cent of American hospitals contract with at least one teleradiology company, which helps them distribute the load and ensure radiologist availability throughout the clock. This in turn allows the rationalisation of escalating healthcare costs by optimising radiologist productivity, better utilising expensive CT and MRI systems and contributing to the development of imaging science by knowledge sharing.

Technology developments have facilitated teleradiology in several ways. The progress made in 3G networks, mobility devices and broadband connectivity has facilitated the quick transfer and seamless integration of radiology images across geographic locations. Teleradiology has been built on the foundation of technology like PACS and video conferencing facilities which helped overcome the fundamental limitation of the radiologist not being able to view previous images and the inability to directly discuss cases with the reporting radiologist.

Factors limiting growth of teleradiology

Several factors have prevented teleradiology from growing as fast as requirements suggest. Primary among these is the ambiguity in the legal system which results in unclear liability sharing between different stakeholders and hence an unwillingness to take risk. The lack of awareness and discomfort with technology among hospitals and physicians has also constrained growth. Further, it is currently often considered acceptable for non-specialists to read and report on complex radiology images. Nevertheless, as the healthcare system evolves, both patient communities and insurers will increasingly insist that reports be read by a qualified radiologist.

The other limitation in teleradiology adoption by hospitals has been the requirement for an onsite radiologist to perform ultrasound scans. The growing demand-supply gap will inevitably result in the development of sonologists, trained ultrasound specialists who represent a qualified alternative to an onsite radiologist. This is a trend that countries across the world have witnessed in response to radiologist scarcity and it is only a matter of time before it reaches India.

The growing demand, the acute shortage of radiologists, the complexity of the specialty and the enabling technology will continue to be growth drivers and ensure that teleradiology is here to stay.