The Empirical Foundations of Teleradiology and Related Applications: A Review of the Evidence

Introduction: Radiology was founded on a technological discovery by Wilhelm Roentgen in 1895. Teleradiology also had its roots in technology dating back to 1947 with the successful transmission of radiographic images through telephone lines. Diagnostic radiology has become the eye of medicine in terms of diagnosing and treating injury and disease. This article documents the empirical foundations of teleradiology. Methods: A selective review of the credible literature during the past decade (2005?2015) was conducted, using robust research design and adequate sample size as criteria for inclusion. Findings: The evidence regarding feasibility of teleradiology and related information technology applications has been well documented for several decades. The majority of studies focused on intermediate outcomes, as indicated by comparability between teleradiology and conventional radiology. A consistent trend of concordance between the two modalities was observed in terms of diagnostic accuracy and reliability. Additional benefits include reductions in patient transfer, rehospitalization, and length of stay.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/140295/1/tmj.2016.0149.pd

The effect of the introduction of picture archive and communication systems (PACS) on patient radiation doses and patient management

This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University, 20/12/2000.This thesis considers the effects of Picture Archive and Communications Systems (PACS), on both patient radiation doses and patient management. PACS is a relatively new technology which acquires, transmits, and stores radiological images digitally. This thesis investigates the doses which are required to produce radiographic images which are acceptable to radiologists and referring clinicians, and compares these doses with those required for the film/screen systems which they are replacing. A review of the literature shows that despite claims of dose reductions, very little good evidence exists about dose changes with the introduction of PACS. A comparison of images of test objects indicates that the images are comparable under limited conditions, that PACS has a much wider latitude than film (>250 mAs), and that contrast detail improves with increase in exposure. Two original observational studies are described in which PACS and film doses are compared for examinations of two groups of adult patients. The results indicate that the doses for PACS equate to those used with a 300 speed film/screen system thus necessitating dose increases of around 30% for the majority of adult patients in the UK. The issue of whether the number of images which are repeated, with additional patient doses, due to unsatisfactory images (rejected images), or unavailability of the images when clinically required (lost images), is addressed and indicates that PACS may allow a dose saving of 1.1 % and 1.4% respectively. The overall result of these studies indicates that the widespread introduction of PACS is likely to increase population doses. Two original studies which consider patients within the Accident and Emergency department are described. These studies aim to produce evidence to justify the introduction of the new technology, despite higher radiation doses, by identifying improvements in patient management which might improve patient outcomes. The results of these studies provide little evidence of such benefits to patients. This thesis concludes that the use of current PAC systems produces an increase in the radiation dose to the adult population in the UK, without demonstrable improvements in patient management

Imaging of the Breast

Early detection of breast cancer combined with targeted therapy offers the best outcome for breast cancer patients. This volume deal with a wide range of new technical innovations for improving breast cancer detection, diagnosis and therapy. There is a special focus on improvements in mammographic image quality, image analysis, magnetic resonance imaging of the breast and molecular imaging. A chapter on targeted therapy explores the option of less radical postoperative therapy for women with early, screen-detected breast cancers

The use of a figure-of-merit (FOM) for optimization in digital mammography: an exploratory study in Malta

This PhD thesis comprises an exploratory study in digital mammography physics that portrays two essential components. The first component (1) presents the first national survey of the technical performance of mammography equipment in Malta using the European Protocol [1-3]. This demonstrated considerable differences in the technical performance of the mammography units across the country with a wide range in performance, patient dose and image quality. A common problem was that many clinics had implemented computed radiography (CR) systems to replace existing film-screen (FS) systems without due consideration to optimization. All direct digital (DR) mammography units met current international technical performance standards and the effectiveness of DR mammography in reducing patient dose and maintaining high image quality compared to CR has been confirmed. The second component (2) was to explore the use of a figure-of-merit (FOM) for optimization and characterisation in digital mammography. The use of image quality parameters in digital mammography such as contrast-to-noise ratio (CNR) or signal-difference-to-noise ratio (SDNR), signal-to-noise ratio (SNR) and detective quantum efficiency (DQE) have been traditionally used for the quantitative evaluation of the system performance against international standards or guidelines. The use of FOMs is relatively new and may be considered as a new quality assurance tool in digital mammography permitting the quantitative and simultaneous assessment of image quality and patient dose. The main objective in having a FOM is to have a numerical expression representing the efficiency and efficacy of a given system gauging how good or poor a system is performing. This may be useful in optimization and in predicting a predetermined or expected image quality with a given amount of radiation dose for a given system. The most interesting aspect of the FOMs in this work will be to investigate and explore the possibility for inter-system comparison

Full-Field Digital Mammography for Breast Cancer Screening: An Example of Evidence, Lost in Translation

Screening mammography is the gold standard for early breast cancer detection and a cornerstone of preventive medicine. Traditional mammography is currently being replaced by newer, more eloquent digital technology. Clinical trials have not proven that digital mammography reduces breast cancer mortality or burden of suffering. Nevertheless, the technology has spread according to Everett Roger's Diffusion of Innovation pattern. The purpose of this Master's Paper is closely to examine the process by which breast cancer screening in the United States has evolved from screen film mammography to full-field digital mammography. This is a qualitative, iterative analysis that triangulates analyses of the medical literature, elite interview responses, and media coverage to cultivate a storyline about the development and dissemination of digital mammography. The technology has spread because of our national hunger for computers and innovation, our eagerness to support the war on cancer, public perceptions about the technology's theoretical advantages, and ongoing efforts of advocacy groups to maintain health care equality. Although digital mammography is significantly more expensive than is screen film mammography, cost-effectiveness considerations have been deferred by many health care leaders. Regulating technologies such as digital mammography, which are extremely expensive but do not confer better public health outcomes, is a necessary component of fixing our health care system.Master of Public Healt

Interpretation of clinical imagingexaminations by radiographers:a programme of research

Background Studies which have investigated the interpretation of plain skeletal examinations by radiographers have demonstrated encouraging findings, however, the studies have not extended beyond this area of practice and radiographers' diagnostic performance for other more complex investigations has not been established. Comparisons of performance between groups of healthcare practitioners to date, has also been limited. Aim This research programme aimed to investigate the interpretation of clinical imaging examinations by radiographers, and other healthcare practitioners, in the provision of initial interpretations and/or definitive reports of plain imaging ( skeletal and chest) and crosssectional (magnetic resonance imaging [MRI] – lumbar/thoracic spine, knees and internal auditory meati [IAM]) investigations. Methods The eight studies utilised a variety of methodological approaches and included quasiexperimental and observational studies. One quasi-experimental study compared the performance of radiographers, nurses and junior doctors in initial image interpretation and another similar study included a training intervention; both utilised alternate free-response receiver operating characteristic curve (AFROC) methodology. Three of the observational studies investigated the ability of radiographers to provide definitive reports on a wide range of clinical examinations, including chest and MRI investigations, in a controlled environment. One large multi-centre observational study investigated the performance of radiographers, in clinical practice (A/E: skeletal examinations) during the implementation of a radiographic reporting service. The agreement between consultant radiologists' MRI reports of lumbar/thoracic spine, knee and IAM examinations was investigated in another observational study. The final study compared the reports of trained radiographers and consultant radiologists, with those of an index radiologist, when reporting on MRI examinations of the knee and lumbar spine, as part of a prospective pre-implementation agreement study. Results The first AFROC study demonstrated statistically significant improvements after training, for radiographers (A1=0.55 - 0.72) and nurses (A1=0.65 - 0.63), although the radiographers maintained a better overall performance post training (p=0.004) in providing an initial image interpretation of trauma radiographs of the appendicular skeleton. Radiographers also achieved statistically higher (p<0.01) AUC values (A1=0.75) than nurses (A1=0.58) and junior doctors (A1=0.54) in the second AFROC study. Three studies, which examined 11155 reports, were conducted under controlled conditions in an academic setting and provided evidence of radiographers’ high levels of accuracy in reporting of skeletal A/E (93.9%); skeletal non A/E (92.5%); chest (89.0%); MRI lumbar/thoracic spine (87.2%), knees (86.3%) and IAM (98.4%) examinations. In the multi-centre clinical study, the mean accuracy, sensitivity and specificity rates of the radiographers reports (n=7179) of plain examinations of the skeletal system in the trauma setting was found to be 99%, 98% and 99%, respectively. The considerable range of values for agreement, between consultant radiologists reports of MRI examinations of the thoracic/lumbar spine (k=0 – 0.8), knee (k=0.3 – 0.8) and IAM (k=1.0) was similar to other studies and resulted in a reasonable estimation of the performance, in the UK, of an average non specialist consultant radiologist in MRI reporting. In the final study, radiographers reported in clinical practice conditions, on a prospective random sample of knee and lumbar spine MRI examinations, to a level of agreement comparable with non-musculoskeletal consultant radiologists (Mean difference in observer agreement <1%, p=0.86). Less than 10% of observers' reports (radiographers and consultant radiologists) were found to be sufficiently discordant to be clinically important. Conclusion The outcomes of this research programme demonstrate that radiographers can provide initial interpretations of radiographic examinations of the appendicular skeleton, in the trauma setting, to a higher level of accuracy than A/E practitioners. The findings also provide evidence that selected radiographers with appropriate education and training can provide definitive reports on plain clinical examinations (A/E and non A/E referral sources) of the skeletal system and the chest; and MRI examinations of the knee, lumbar/thoracic spine and IAM to a level of performance comparable to the average non specialist consultant radiologist. Wider implementation of radiographer reporting is therefore indicated and future multi-centre research, including economic evaluations, to further inform practice at a national level, is recommended