Teleradiology can provide important diagnostic services to patients in outlying areas and, at the same time, increase the productivity of highly skilled professionals in urban areas. Baptist Hospital in Nashville, Tenn., offers a good example of the benefits to both the central hospital and the patients being served by outlying medical facilities.
Healthcare resources are primarily centralized in urban areas,
creating increased competition among large institutions. At the
same time, third-party payers continue to pressure hospital
administrators to redouble their cost containment efforts.
Teleradiology can provide important diagnostic services to
patients in outlying areas and, at the same time, increase the
productivity of highly skilled professionals in urban medical
centers. With teleradiology, diagnostic images are digitized and
transmitted electronically from distant medical facilities that
cannot afford a staff radiologist to a major medical center with
Baptist Hospital in Nashville, Tenn., offers a good example of
how teleradiology benefits both the central hospital and the
patients being served by outlying medical facilities.
An immense and impressive complex with nearly 1,000 physicians
on staff and 759 beds, Baptist Hospital spans a 7-block area near
downtown Nashville. The not-for-profit hospital's primary service
area covers seven counties in middle Tennessee via Baptist's
remote-site network, which consists of three different types of
•Baptist Centra-Care Centers, which require no appointments and
focus on patients with minor injuries or illnesses who have no
primary care physician. There are 14 of these centers currently in
•Occupational medicine centers provide therapeutic and
rehabilitation services to patients who are recovering from more
serious conditions. Four of these centers are in operation.
•Baptist Health Care Group consists of about 60 physicians in
Baptist-owned medical practices which serve patients from several
medical buildings located around the greater Nashville area.
•Baptist Bellevue Medical Center, located approximately 15 miles
west of Baptist Hospital, houses a number of primary care
physicians and pediatricians. It was also the site of a Baptist
Centra-Care walk-in clinic until recently. As a result, the
radiology department at Bellevue is one of our busiest remote
sites. It was, therefore, the logical choice for the teleradiology
pilot program initiated by Tom McBrayer at Baptist Hospital in
Approximately 20 percent of the patients who receive radiologic
exams at pilot sites require immediate readings. Before the
teleradiology system became operational, those patients had to be
Teleradiology has also offered monitary and efficiency gains to
Baptist Hospital. Couriers no longer are required to make film
pickups at remote sites twice a day. The films generated daily from
Bellevue no longer are hung on viewboxes and alternators at Baptist
Hospital for interpretation. An hour of a technologist's time each
day, which used to be dedicated to hanging and removing these
films, is now devoted to more productive tasks. Making diagnoses on
softcopy displays also has helped the radiologists improve their
Finally, the time savings resulting from the teleradiology
service is motivating private physicians who are not part of the
Baptist network to refer their patients to Bellevue. The system
eliminates the chance for films to be misrouted when they reach the
hospital, which results in lost time and, sometimes, in the need to
repeat the exam.
How the system works
In selecting the teleradiology system for Baptist Hospital, one
factor overshadowed all others: image resolution. Unless
radiologists are confident they are able to make accurate
interpretations from images on the monitor, the advantages we look
for from a system are lost. Image resolution is, therefore, of
We considered four different teleradiology systems and
discovered there is a direct, almost one-to-one correlation between
price and image resolution and transmission times. Baptist Hospital
chose the Kodak Digital ScienceTM medical imaging system, which
offers a 2K ¥ 2.5K-pixel maximum resolution, coming very close to
reproducing the clarity of the original film image.
The film is fed into the film digitizer. Up to six 14 ¥ 17-inch
images can be fed into the digitizer automatically. It takes about
one minute to create each 10-megabyte digital image file, which is
downloaded to the computer's memory.
Images are then viewed on a review workstation. If necessary,
the workstation controls can be used to enhance the images'
contrast and density to optimize readability before transmitting
them to the radiology department at Baptist Hospital. The
transmission time for each image, over T1 telephone lines, is
approximately one minute from Bellevue.
At the receiving end, Baptist Hospital is equipped with a
high-resolution two-monitor personal display system (PDS)
workstation. The monitors offer a maximum image brightness that is
five times that of an ordinary computer monitor.
The side-by-side monitors enable Baptist's radiologists to
compare images of the same patient taken at different times. The
entire image can be viewed, or the radiologist can zoom in on areas
of particular diagnostic interest.
Radiologists at Baptist Hospital make all interpretations from
images on the workstation; however, images also can be transmitted
to a networked laser printer for output on film.
Additionally, the radiology department at Baptist Hospital uses
a digital dictation system which makes it possible for remote sites
to access the radiologist's report via any touch-tone phone. The
report also is transmitted over telephone lines to a commercial
transcription service company which keys the report and transmits
it to the computer system at the hospital. The radiologist signs
off on the report electronically and the system automatically faxes
a copy of the report to the office of the physician who requested
We consider the teleradiology pilot program to be an unqualified
success. We measure this success by the willingness of our
radiologists to use the system; they are making primary diagnoses
from images on the monitor, and everyone concerned is enthusiastic
about the technology and the results.
We are anxious to try to apply digital imaging technology to the
reading of MRI and CT scans. We now spend $250,000 per year for
film for MRI and CT scans. This information can be archived on a
DAT disk or magnetic tape. Normally, images are transmitted and
interpreted, and are then output to film and placed with the report
in the patient's folder. But, if we can convince doctors to read
scans as well as x-ray images from monitors-selecting only the part
of the image that shows what the diagnosis was based on-we can
project a 50 percent savings in what we spend annually on film.
When all is said and done, patients benefit as much as medical
facilities from the adoption of digital imaging. First, treatment
can begin sooner because diagnoses can be obtained faster. Being
able to digitally enhance film images can often result in the
reduction of repeat imaging procedures. Finally, teleradiology
systems permit hospitals to provide more services to more patients
without increasing the number of employees. Ultimately, this helps
to contain the cost of health care for everyone. AR
Ms. Tucker is Director of Medical Imaging at Baptist Hospital in