Specific radiological requirements have to be considered for realization of telemedicine. In this article the goals and requirements for an extensive implementation of teleradiology are defined from the radiological user's point of view. Necessary medical, legal and professional prerequisites for teleradiology are presented. Superior requirements, such as data security and privacy or standardization of communication, must be realized. Application specific requirements, e. g. quality and extent of teleradiological functions as well as technological alternatives, are discussed. Each project must be carefully planned in relation to one's own needs, extent of functions and system selection. Topics like legal acceptance of electronic documentation, reimbursement of teleradiology and liability must be clarified in the future.
A questionnaire was sent by mail to 4400 radiologists (i.e. to at least 1000 radiological institutions). The response rate was about 5%. The results showed that 47% of respondents felt well informed about teleradiology, 49% not enough and 3% not at all. Image and report transfer as well as interfaces to reference databases, educational applications, technical quality surveillance and product support (maintenance) were considered to be increasingly important areas. Smaller institutions (1-3 doctors) judged expert consultation as more important than bigger institutions. Standardization, system stability and data security were demanded as well as guidelines, for example concerning the linking of report and image, correct documentation and required image quality. Technically most demands can be fulfilled today but this technology is not yet commonly included in teleradiology systems.
Teleradiology offers many applications for quality assurance in medicine. The spectrum reaches from electronic consultations in emergency or special cases and double reading--along with new models of cooperative work and medical networks--to technical quality assurance and integration into interinstitutional and patient controlled health records. Regional teleradiology networks based on server concepts can fulfill the developing technical and organisational requirements. The increasing mobility arising from smaller radiological equipment and improved accessibility to experts with minimized visualisation and reporting systems will change the radiological world of tomorrow, especially in combination with the usage of knowledge based systems in reference data bases and computer assisted diagnosis (CAD). Teleradiology by itself must be liable to quality assurance measurements to prevent unnecessary radiation exposure or danger to the doctor patient relation.
IntroductionFor the evolution and acceptance of solutions in telemedicine - concerning e. g. liability, economics, security, medical and technical quality - it is very important to learn what the opinion and concepts of the present and future users - the medical professionals - are.MethodsIn 1997 a questionnaire was sent to 4400 German radiologists in hospitals and private offices with a response rate of 5 %. Intensive statistical analysis has been performed by SAS. The survey has been funded by the German government represented by BMBF and DFN. To evaluate the changes in the opinion and technical requirements a second questionnaire was sent to 1500 radiologists in May 1999.ResultsThe results showed that in 1997 only 47 % of responders felt well informed about teleradiology. 83% of the radiologists use PC, 52% have installed workstations, 33% use the DICOM 3.0 Standard, PACS are installed in 14 % of the institutions. In the opinion of German radiologists its main future application areas will be the emergency and expert consultation, but - more and more - radiologist services were expected to be provided from home or central offices too. Image and report transfer plus common telemedicine integration as well as interfaces to reference databases, educational applications, technical quality surveillance and product support (maintenance) were considered to be increasingly important areas. Smaller institutions judged expert consultation as more important than bigger institutions. Technical standardization and system stability were strongly demanded. From the medico-legal point of view, there was a demand for as strong as possible an association between radiological report and image, appropriate data security, and solutions of liability questions as well as for guidelines, e. g. of correct documentation and necessary image quality. Links to RIS and PACS were considered especially important for those who already work with these systems. The introduction of fair payments was mainly a matter of the radiologists in private consulting rooms. Most of radiologists thought that lossy compression should be allowed if no loss of relevant information occurs.DiscussionTechnically most demands can be fulfilled today but are not yet commonly included in teleradiology or telemedicine systems. Other aspects as legal or financial requirements must be discussed and solutions provided before the majority will use telemedicine. It must be recognized that there exist many different application areas with different requirements. Local conditions and interests of radiologists - and other medical or non-medical groups - are different too.
Teleconferences with high image quality can be set up between workstations and PCs using the Kamedin system. Depending on the possible decrease in transportation costs, teleconferencing is cost-effective under certain conditions. Teleradiology has additional advantages, such as the acceleration and optimisation of patient management.
Legal prerequisites have substantial influence on the development of teleradiology. At an expert meeting (Mannheim, 8.6.2001) a proposal for a teleradiology article in the new German x-ray ordinance has been set up. An exception of the demand for a doctor trained in radiation protection at the point of examination shall be established for emergency cases. To realize the intended improvement of patient care measurements for quality assurance concerning the medical personnel and processes are necessary. Along with other current developments the basis of secure regional teleradiology networks is now built up.
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