A large-scale, Web browser-based radiological information system integrated with a picture archiving and communication system (RIS/PACS) has been installed in regional and remote radiology centres of Western Australia. This provides patients in rural areas with local access to advanced medical imaging. User attitudes to the changes were surveyed in a six-week period starting in March 2005. A total of 53 people completed the survey (62% response rate). Respondents were eight radiologists, 21 medical imaging technologists, 10 administration officers and 14 reception staff. All groups gave average ratings of the system's quality. All staff rated the information quality of the system as good. On-site information technology support was judged to be reliable, professional and empathic towards user concerns. There was a broad range of opinion between groups, but on average they were satisfied. The lack of a modern network, comparable to what is available in the metropolitan areas, has impeded the full potential of RIS/PACS in the smaller rural centres.
Summary
Lameness originating from injury to the pelvis and lumbar spine remains a diagnostic challenge for equine veterinarians. Nuclear scintigraphy is frequently used to aid in the localisation of injuries to this region; however, the lack of image contrast due to anatomical superimposition in the pelvis and lumbar spine complicates image interpretation. To the authors’ knowledge, the use of single‐photon emission computed tomography (SPECT) has not been previously reported in the horse. This article describes the clinical use of SPECT in the horse to aid the diagnosis of injury to the region of the sacroiliac joint and lumbar vertebrae which was not identified on planar imaging.
We have established a nuclear medicine teleradiology service for rural and regional areas of south-west Western Australia. This study aimed to evaluate whether existing treatment models had altered in ways which were directly related to improved medical outcomes and reduced cost. Preliminary observation into musculoskeletal injury of the ankle joint included diagnosis of 10 radio-occult talar dome lesions which in some cases had not been identified until six months after the trauma. Several cases suggest that nuclear medicine provided a more timely diagnosis and actively altered treatment. Further, the potential role of radiologists as primary-care extenders in guiding appropriate investigations and defining the nature of the illness before specialist consultation may lessen the economic burden on public health care while creating economies of scale by expanding the clinical usefulness of the nuclear physician over a large rural area.
A portable nuclear medicine (NM) processing system was established in Kalgoorlie and an acute myocardial perfusion scintigraphy (MPS) service was provided for the local regional hospital. After scanning the patient, the data were processed on a laptop computer and JPEG images were transmitted to a secure Web server. A secure email message, with the URL link enclosed and a provisional indication of normal or abnormal findings, was sent to the referring clinician from the NM facility. Use of the Internet allowed for a group consultation between the NM technician, the referrer and the cardiologist in Perth. During a three-month study period, 42 patients were referred for exclusion of acute coronary syndrome. Of these, 21 (50%) demonstrated abnormal perfusion studies, two of which were classified as requiring urgent medical intervention. Seventeen studies were normal (41%) and four (10%) were designated equivocal. There was an alteration in the treatment plan for 32 patients (76%), including four for whom admission or further investigation was deemed unwarranted. The results suggest that MPS findings, distributed via the Internet, allow for earlier risk stratification and have a direct affect on clinical decision making.
Limited accessibility to certain medical imaging services in regional and rural centres has led to the use of alternative modalities, which may not be best practice or which require patients to travel considerable distances for diagnosis. Data collected over three years were examined to determine the clinical effect of nuclear medicine teleradiology (NMT) and its effect on diagnostic patterns for the investigation of cardiovascular disease, radio-occult musculoskeletal injury and oncology. In comparison with two other rural, non-NMT areas of similar demographic profile, there was a significant shift in the delivery of care in terms of diagnostic work-up. NMT input led to the detection of disease and a change to therapeutic management in 122 cases and eliminated the need to transfer patients to another facility for unnecessary and expensive examinations in 38 cases. While NMT is more costly than conventional nuclear medicine services, it permits faster access to specialist consultation, provides for better management and is likely to reduce overall health costs by reducing the volume of inappropriate tests and treatment practice.
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