by admin on June 05, 2020


When patients require procedures that involve medical images, the actual scans are only half of the process. What remains is the reading, or interpretation, of the exam. This is usually handled by a doctor who's a radiologist. Common types of exam modalities include X-Ray (Radiography), MR or MRI (Magnetic Resonance Imaging), CT or CAT (Computed Tomography) and US (UltraSound), among others.


Initially, exams like X-Rays were read on film by being developed and placed on a lightbox mounted on the wall. This meant the radiologist had to be on location at the facility where the modality was located to interpret the X-Ray. When emergency situations arose after hours, physicians would often end up driving back into the hospital to be able to review the results of a study. Early advances to address this inconvenience were made possible using a modem and a camera-on-a-stick (which was literally as described). This crude method was a slow transmission, but marked the beginnings of remote viewing in medicine. With the advent of PACS (an acronym for Picture Archive and Communication System), access to receiving, displaying and storing exams from a multitude of modalities on one workstation was a giant leap forward for medical technology. But it was to go one further; sending exams, Telemedicine or Teleradiology.


Teleradiology is the transmission of patient images from one location to another for the purpose of sharing studies with other radiologists and physicians. It offers improved patient care by allowing radiologists to provide their expertise without having to be at the same location as the patient. This is particularly important when a subspecialty is needed (like a pediatric radiologist or neororadiologist). Essentially, Teleradiology makes it possible for trained specialists to be available around-the-clock. In order to protect private patient data from unauthorized access, the issue of being able to communicate securely is also a requirement. Teleradiology systems must be HIPAA (Health Insurance Portability and Accountability Act) compliant, to ensure that a patient's privacy is protected. Many times, this requires communication over a VPN (Virtual Private Network), though some advanced PACS systems offer built-in encryption and security (making VPNs unnecessary).


When a new exam is done, it is useful for a radiologist to have access to prior exams in order to compare results. The convenience of storage in a PACS system makes comparison with previous studies possible. Sometimes, awareness and organization of multiple prior studies presents a potential problem. Radiologists don't want to miss being able to reference a prior exam, but also don't want to be overwhelmed by what could be irrelevant studies. Patients could have multiple prior exams, but if one is on a different body part than the most current study, it may not prove useful. Or, if exams were acquired at different locations, organization of them by a facility's MRN (Medical Record Number) may not properly match them, as MRN naming conventions vary by site. This even presents a more dangerous situation, which is pairing unrelated exams due to unintentional MRN duplication. Add to this the potential for data entry typos common with human error, and the need for a reliable, configurable means of searching for prior studies is obvious. Sophisticated PACS systems overcome these problems using a Master Patient Index (MPI). This functionality ensures a radiologist can access all prior studies regardless of where they originated. This is because the MPI overcomes demographic variances from disparate centers. Flexibility in matching exam search, using not just MRN, but name, date of birth, gender and RIS system, may deliver more accurate search results. This offers invaluable exam pre-fetch capabilities for consolidated sites.


Teleradiologists can provide a Preliminary Read for emergency (or stat) cases, or a Final Read, for the official patient record and for use in billing. Preliminary Reports include pertinent findings. Final Reports include all findings and require access to prior studies and other relevant patient data. Turn-around time is often critical, with a 30-minute window common. The past 25 years have seen tremendous growth in Teleradiology utilization. From initially using individual radiologists to interpret occasional emergency studies from off-site locations--frequently in the radiologist's home, using a dial-up modem--it has expanded rapidly as the speed and accessibility of the internet improved and spread. Reading occasional studies per week turned into a handful per night, to working as much as a radiologist desired, with studies available 24 hours a day, seven days a week. Teleradiology saw the advantage of taking time zones into consideration; when it's the middle of the night in Los Angeles (and few radiologists may be available), it's early morning on the East Coast. Medical outsourcing grew rapidly, with radiology groups forming Teleradiology on-call services around the country. Some even expanded to taking advantage of international opportunities, using services based in India, Australia and Switzerland, to maximize the time zone difference for hospitals based in the United States. The American College of Radiology (ACR) requires physicians interpreting images in other states to be licensed in both the state where the image was generated, as well as the state where the interpretation takes place, which adds a further complication.


Radiologists have options when it comes to recording their impressions as part of their interpretation. Some capture their thoughts in audio recordings, which are then transcribed by a transcriptionist. Some launch a dedicated voice-recognition system, which transcribes their thoughts in real-time as spoken, and some use common voice-recognition programs interfaced with their PACS system. Many make use of dictation templates, including "normals", which present an expected result for patients not presenting pathology, and can be easily tailored for selective patients with a few mouse clicks.


When urgent findings are discovered during the interpretation, the radiologist needs to confidently communicate that result to the referring physician. This is often referred to as Critical Results. In addition to communicating the critical finding to the referring physician, the radiologist often follows up with the referring for an update on what actions were taken as a result.


With the ImageQube Cloud, teleradiology is available with all the functionality needed for utmost efficiency. It offers a configurable, remote application delivering real-time, fully-functional, fault-tolerant access to studies, with the capability to display all modalities, including built-in PET Fusion, Digital Mammography (with Tomosynthesis) and ABUS. All core radiology tools are native, including MPR, Anatomic Triangulation, MIP, Slab Imaging and more. The ImageQube Cloud is secure, without requiring VPNs. This means exams can be uploaded from the facility to the Cloud Data Center securely using its DICOM Upload application, and users can access studies securely logging in from anywhere. Using a sophisticated Master Patient Index, radiologists can rest assured that any related prior exam is made available to them for comparison. This MPI is configurable, with four different confidence settings in presenting archived exams, including matching:
  1. Medical Record Number and Last Name.
  2. Last Name, First Name and Date of Birth.
  3. Last Name, Date of Birth and Gender.
  4. Last Name, First Name.
As the search criteria loosens, more potential patient matches are presented as possible prior exams. Radiologists can choose from these for comparison studies. ImageQube Cloud can not only auto-distribute exams to specified users by specialty, schedule or a multitude of other configurable variables, but also allows for exams to be downloaded from the Cloud to local computers. This comes in handy since the quality of internet connections may fluctuate for some users; download to local may deliver better interaction performance and speed. Once the exam interpretation is complete and internet connection re-established, the new exam status is automatically synchronized with the ImageQube Cloud in the Data Center. ImageQube Cloud offers great flexibility in dictation. Users can choose to capture recordings using its built-in transcription module, or auto-launch a third-party dedicated voice-recognition system, where the Medical Record Number is sent across and the patient file opened. Or, the user can take advantage of the ImageQube's integrated dictation module using their own Dragon software for voice-recognition capabilities. The dictation module allows users to sign preliminary reports, sign final reports, add an addendum to a final report, or take advantage of templates, including custom and "normals" templates. Reports generated on ImageQube Cloud can have custom headers and footers, if desired. There's a built-in "state machine", which tracks an exam's progress. If turnaround time is limited by contract, the ImageQube Cloud offers elapsed time reporting, so affected exams are prioritized. The ImageQube Cloud includes the ability to email out the report when completed. Paperless workflow is enabled on the ImageQube Cloud, with the ability to scan documents directly into patient portfolios, or drag-n-drop any file. Referring physician portals can be accessed securely in real-time, containing images, reports, key images, print pages and annotated images highlighting pathology. Instant messages can even include images, and be sent securely between users. ImageQube Cloud includes its own, built-in Critical Results application, which not only allows a radiologist to confidently communicate an urgent finding to a referring physician with an acknowledgement of receipt, but can prompt the radiologist for follow up, if desired, while creating a log of all communication activity. ImageQube Cloud's API is configurable, and can easily integrate with today's EHR technologies. It even includes the ability to limit access to only states where a radiologist is licensed to practice. With auto-assignment, and an effortless, rules-based workflow distribution, its convenience is state-of-the-art. ImageQube Cloud makes PACS available without any of the usual barriers to entry. There's no hardware to install, no minimum volume or commitment, no up-front costs or capital investment and no VPN required. It includes unlimited licenses, online archive, disaster recovery, maintenance and support and software upgrades in a competitive, per-exam price. The ImageQube is platform and browser independent, so it runs on any desktop operating system. With cumulative pricing discounts, and the ability to scale from individual users to large facilities without sacrificing functionality, the ImageQube Cloud can fulfill the PACS needs of any type of user. You don't need an IT department; installation is almost DIY. Start your one-month free trial today!