Internet Creates Virtual Radiology Department

CHICAGO—With 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 86^th Annual Meeting of the Radiological Society of North America (RSNA).

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 provide—working 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 processing costs.

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.