Teleradiology: opportunities, problems, implementation

With the introduction of computerized tomography and magnetic resonance imaging in the early 1970s, computers became integral to the imaging process. Shortly thereafter, scanners that create digitized images from film were introduced and teleradiology--images transmitted in real time--became possible. In the early 1980s, the idea of a picture archiving and communications system (PACS) began to develop. It promised to retrieve, connect and store every kind of image, from x-ray to CT, and render film obsolete. However, inflated expectations and inadequate technology hindered PACS implementation. Digital imaging offers the following benefits over film-based systems: - Less space is needed to store imaging studies. - Digital imaging files can be faster and easier for referring physicians to retrieve than film and are not susceptible to loss and damage. - Digital images can be enhanced, contrasted, colored and otherwise manipulated to maximize available information. - There are no chemicals to dispose of. While telemedicine promises to increase the efficiency and effectiveness of medical professionals, wide-scale implementation faces the following obstacles: - It has been difficult to establish a uniform standard that allows file transfer among systems made by different vendors. - There are unresolved legal questions about "interstate" medical practice as it occurs in teleradiology and about standards of care and image quality. - Any system available on a network is vulnerable to unauthorized users who may invade the database or operation of the system, and it is very difficult to detect fraud--data that has been tampered with--in digital records. - Connections to remote locations depend on local telephone lines, which may be slow. Other options are available, but they may be too expensive for facilities in the rural areas that need them the most. - Digital imaging equipment is still very costly to acquire and install. The future of telemedicine rests now with those who implement it. Once instituted, it will surpass traditional medicine by reducing the expense of storage and misplaced information and allowing faster and more accurate diagnoses.