Emergency Teleradiology SER 2016 Final
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Transcript of Emergency Teleradiology SER 2016 Final
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Welcome to theEmergency Teleradiology
Workshop Operations – Arjun Kalyanpur
Clinical Applications – M. Srinivasa Rao3D postprocessing – Roy D’Souza
Reporting Standards and Quality – Carl Aschkenasi
Medicolegal - Leonard BerlinTechnology – Firoz Latif
Workflow - Srinivas
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Emergency Teleradiology: Operations and Clinical Applications
Arjun Kalyanpur MDM. Srinivasa Rao, DNB
Roy D’Souza, MD
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Rationale for Emergency Teleradiology
• Global Radiologist shortages– Most radiologists concentrated in metros– Emergencies/remote areas most affected – Catastrophic outcome of delay
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Radiologist to Population ratios
US – 1: 10,000Singapore – 1: 20,000Japan – 1: 35,000India - 1: 100,000Bangladesh – 1: 1,000,000
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Evolution of Emergency Radiology• Increase in emergency imaging utilization– Dependence on imaging for rapid DX– Technical evolution of CT – speed,
resolution– CT now the primary modality for • Vascular occlusion• GI bleed• Perfusion imaging in acute setting
CJEM 2013;15(3):161-166
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Operations
• Scale – Multisite, multiradiologist• Smooth workflow and process in Virtual Environment • Seamless Coordination/Communication
Between Hospital and radiologist Between Coordinator and radiologistBetween radiologist and radiologist
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The Team
• Operations Manager• Coordinator• IT• Call center• Radiologist• Support team – Transcriptionist, Data entry
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The Process
• Hospital- Telerad Image Transfer• Case assignment workflow• Review and Dictation process• Communication of findings• Peer Review• Addendums and Errata
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Concepts
• Turnaround time
• Critical Values
• Standard Protocols (Stroke , polytrauma)
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Turnaround time
• SLA – based on clinical scenario• Stroke – 15 min• Stat – 30 min• Inpatient, MRI – 60 mins
• As Low As Reasonably Achievable• Mean and Outlier TAT• Verbal communication for complex cases
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Critical Values• Life threatening condition
• Tension pneumothorax• Ruptured Ectopic Pregnancy
• Physician to physician communication• Documentation/Tracking
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Standard ProtocolsStrokeTakes priority over all others (Time is brain)15 – 10 mins
MultitraumaFocus on traumatic findingsPrioritize reviewImmediate communication
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International Nighthawk Model
• Day-night time difference allows for• Better performance – biorhythms• Increased productivity• Enhanced service levels • Commensurate accessibility
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Challenges
• Insufficient Clinical Data • Large Image Datasets • Spikes in volume • Outages • Evolving client expectations
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Synergy between Teleradiology and Emergency Radiology
• The greatest impact of Teleradiology has been in the emergency radiology space
• Teleradiology is now an integral part of the delivery paradigm for emergency radiology services
• The increasing adoption of teleradiology benefits the subspecialty of emergency radiology by further enhancing its relevance and giving it greater visibility
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Dr. Srinivas Meka.Sr. Consultant
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Clinical applications
Emergency radiology or nighthawk coverage
American College of Radiology's 1999 survey. AJR Am J Roentgenol 2005;185:24–35. Emergency department image interpretation services at private community hospitals. Radiology 2004;231:190–197.
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Clinical ApplicationsEmergency radiology or nighthawk coverage:
Trauma Stroke Acute Abdomen- stone, diverticulitis, AAA, SBO Acute Thorax – PE, Aortic dissection Sonography – Torsion, ectopic NM - VQ, GI bleed Pediatric Emergencies – intussusception, appendicitis
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Trauma1. Decrease need for transport
(Emerg Med J 2007;24(8):550-552)
2. Rapid triage – aortic injury, burst fracture
3. Vascular injuries
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Stroke Shorten time to thrombolysis Early detection of subtle findings – dense
MCA, insular ribbon Immediate detection of contraindication
for thrombolysis – bleed, large infarct, aneurysm, mass etc
Early detection of complications – herniation, hemorrhagic conversion of bland infarct
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Acute thorax Aortic dissection – Early diagnosis and
detection of complications Intramural hematoma- Atypical form of
aortic dissection Surgical management if ascending aorta
is involved.
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Acute thoraxPulmonary thromboembolism:Rapid diagnosisIdentification of complicationsAid in early initiation of thrombolytic therapy.
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Acute abdomen:
Teleradiology aids in rapid and accurate diagnosis of several acute abdominal and pelvic pathologies.
Helps in initiation of appropriate therapy – Surgical versus non surgical.
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Acute abdomenRapid diagnosis of acute appendicitis and bowel pathologies.Identification of complications.
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Bowel pathologies
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Nuclear medicineExtremely helpful in diagnosing acute conditions such VQ scan for PE.HIDA scan for acute cholecystitis.GI bleed scan
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Vascular emergencies Aids in rapid diagnosis of
several vascular emergencies.
Aortic aneurysm rupture: Vascular injuries
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SonographyTeleradiology plays a major role in diagnosing potentially life threatening and organ salvaging conditions with a quick turn around time (TAT).
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Role of Emergency Teleradiology
• Immediate image review and turnaround• High report quality– Comfort level with all imaging modalities– Experience in all emergent scenarios– Speak the language of the ER – Peer review and QA
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Continuing Education and Training
Necessary in telerad environment
Continuous quality improvement
Knowledge update
Stimulate research
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Research Research into quality and process,
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Teleradiology helpful
Night radiology coverage Shortage of manpower (radiologists).Subspecialty reads. Catering to rural and semi-urban areas.Vacation coverage.Second opinions.For efficient radiology services.
Summary