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Teleradiology Revisited
Jeff Pasternack

In the June 2000 issue of The Medical Bulletin, you may recall that I mentioned the services of a company called eTrauma. Their prime service is providing physicians with the ability to view X-rays, MRIs and CT scans real time via the Internet. While the images are not diagnostic quality,'s efforts represent a major improvement in the development of tools suitable for use in cyber medicine.

Considering the vast changes in the technology landscape since that time (not to mention the value of our portfolios…ouch!) and the focus of this edition, I placed a call to Mark Maloney, Chief Operating Officer of eTrauma to learn about new teleradiology developments. As with all firms I mention in this column, I have no fiduciary relationship with eTrauma and you should come to your own conclusions about their offering.

By way of a reminder, for images to be considered diagnostic quality, they must conform to a certain standard. Initially developed by the American College of Radiology and the National Electrical Manufacturers Association, the Digital Imaging and Communications in Medicine (DICOM) Standard has been developed to meet the needs of manufacturers and users of medical imaging equipment for interconnection of devices on standard networks. The design of the standard was aimed at allowing simplified development for all types of medical imaging. DICOM also provides a means by which users of imaging equipment may assess whether two devices claiming conformance will be able to exchange meaningful information.

Notwithstanding the phenomenal rate of image compression technology, serving DICOM images over the web won't be possible in most office situations for quite some time yet. Generally, the images are too highly defined for common monitors. Additionally, the sheer byte size of the images and the limitations most physician offices have with respect to the speed of their Internet connection make for slow, and thus undesirable, delivery. These limitations are temporary, however, and as compression algorithms and modem speeds advance through the next several years, diagnostic-quality images will eventually be served across the web.

Smith and Nephew have marketed ETrauma's basic product, Internet emergency imaging via web browser, since last year and the basic service remains the same. However, at the American Association of Orthopaedic Surgeon's meeting in San Francisco at the end of February, eTrauma introduced OfficePACS. OfficePACS is a turnkey low-cost solution to the high cost of plain film in the private practice setting. Current PACS solutions are even more expensive and too complicated, ergo the value proposition of OfficePACS.

"Bottom line," said Maloney, "OfficePACS is cheaper and faster that plain film. We use CR coupled with our software system that incorporated intranet ease with Internet access through the core product RemoteImage. OfficePACS produces diagnostic quality digital imaging (DICOM), one can transition from film to digital imaging, it uses your existing x-ray equipment and it allows off-site viewing of your images."

In Europe, a project called MTM (Multimedia Terminal Mobil) is also offering a teleradiology package based off of CHILI. CHILI is a second-generation teleradiology system with additional functions for telecardiology. It has been developed in cooperation with the German Cancer Research Center and a technology transfer company
"Steinbeis Transferzentrum Medizinische Informatik" in Heidelberg, Germany.

According to their web site,, "the introduction of CHILI will reduce current costs. We have found savings in film material, the transportation of patients, staff, as well as from the sharing of resources. We know from experience that these clearly savings outweigh the resulting costs of the ISDN lines. With rapid information flow a further reduction of costs is possible, e.g. shorter hospitalization times of patients."

By using the mobile version of CHILI, physicians can access images on handheld devices such as Compaq's iPAQ. One handy feature is that multiple users can view the same image during a conference call and, through the use of separate cursors, discuss the image and point out areas of interest. Using a handheld that has Internet access, such as the Palm VII, physicians can review images, attach notes and then email, or simply beam, the files to one another for discussion.

During morning rounds, for example, a medical team consisting of students, nurses and physicians, can go from patient to patient and discuss cases and treatments without carrying the physical CT or MR scans, or X-rays requiring light boxes. By using a barcode scanner connected to the handheld, the team can walk into the room, scan the barcode and access the patient's history, supporting images and test results from various information systems. By tapping into the wireless network, all this data can be shared instantly and equally by everyone on the team.

While the use of handheld computers is only beginning to catch on in area hospitals, technologies such as CHILI and eTrauma's RemoteImage are demonstrating the effectiveness that high tech can impart on patient care. With images available online, attending physicians can remotely consult with specialists for advice on examination procedures, treatments or results even though they aren't at the hospital. Given the slow adoption rate of technology by the health care industry as a whole, however, it may take several more years before we see the proliferation of these tools. For more information on the technologies discussed in this article, please visit the following web sites:, and

Jeff Pasternack is the president of Dynamic Consulting Group, a franchise partner of 1-800-GOT-JUNK? and author of the TechnoPeasant Review.
If you have questions or comments about this column, please write to him at