Does teleradiology produce 'filmless' hospitals?

The recent development of teleradiology has met an increasing success amongst medical experts. Still, there are important administrative difficulties to overcome which makes it very unlikely that we will be able to talk of 'filmless' hospitals in the near future. A supplementary issue constitutes the present lack of international standardisation with regard to image file formats. A lot of mutual deliberation has to be done before we can benefit to the full from the revolutionary advantages teleradiology potentially has to offer. In the recent issue of the Journal edited by the European Health Telematics Observatory, the French Drs. Vincent Hazebroucq, Christine Hoeffel and Professor AndrÈ Bonnin, are explaining their views.

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The recent development of teleradiology has met an increasing success amongst medical experts. Still, there are important administrative difficulties to overcome which makes it very unlikely that we will be able to talk of 'filmless' hospitals in the near future. A supplementary issue constitutes the present lack of international standardisation with regard to image file formats. A lot of mutual deliberation has to be done before we can benefit to the full from the revolutionary advantages teleradiology potentially has to offer. In the recent issue of the Journal edited by the European Health Telematics Observatory, the French Drs. Vincent Hazebroucq, Christine Hoeffel and Professor AndrÈ Bonnin, are explaining their views.

The introduction of computer networks and the Internet has created the belief in the false ideal of the paperless society during the last decennia. We have grown used to the concept of word-processor text file but it would be inadequate to suggest an analogy with the image file. Hard copy on paper usually appears as a faithful reproduction of a computer text file. A different matter forms hard copy on film. It is no more than just one of the multiple views that you can obtain from the image file.

The radiologist has a duty to select among a huge volume of digital data what information should best be visualised, printed, transmitted or stored. In order to guarantee an exact diagnosis, he has to choose the most adequate visualisation mode for the patient's data. In any case, the transfer of the image file offers more detailed information than still print on film. Here however, a problem arises since most of the current teleradiology systems are transmitting secondary digitised images in 8 bit from film hard copies. As a consequence, a quantitatively important loss of data occurs in comparison with the native file in 12 bit.

This would not be too bad if a qualified radiologist has made the deliberate choice to dispose of quantitatively less data since the qualitative loss is negligible. Problems however are likely to occur in case an uninformed person needs a teleconsultation. Evidently, the tele-expert will only be able to give advice based on the data which is transmitted. It is not altogether impossible that diagnosis would be different when built upon the data from the original hard copy. The plea for a 'filmless' hospital, if relevant at all, is therefore not without any danger.

Additionally, every telemedicine station manufacturer at present has his own proprietary software and images file format. Compatibility with other soft- or hardware not always has been established. The need for international standards seems to be obvious but solutions such as H320 and Digital Imaging and Communications in Medicine (DICOM) have not exactly been elaborated for telemedicine. Yet, universal standardisation might enable medical tele-imaging to become as popular as a 'radiological fax' or a 'medical minitel'. It may be more than worth the while to unite the information experts' efforts in order to establish a norm.


Leslie Versweyveld

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