Body scans performed by experts using remote control software on personal computers can produce better quality images than those obtained by on-site operators, according to a study published in the November issue of the journal Radiology.
Patients, unfortunately, still need to visit the hospital to get strapped into sophisticated scanning equipment. Technologists must also be present to give patients instructions and to administer any necessary contrast agents, intravenous fluids that make internal anatomy more visible to the imaging device.
The study evaluated images from some of the most complicated body scans, such as those looking for subtle heart deformations in children or those scanning blood vessels for difficult-to-detect problems. Scans of 30 patients were performed by an on-site operator, and scans of another 30 patients were performed by an off-site operator who remotely controlled all the imaging parameters using a personal computer.
For all exams, an on-site technologist made sure patients were comfortable and properly positioned within the machine. The on-site and remote technologists communicated over a hands-free telephone connection.
All scans were performed on the same MRI (magnetic resonance imaging) machine, and the images were then ranked for quality by other experts blinded to patient details and whether images were taken by an on-site or remote operator.
Ninety percent of remote scans received an “excellent” rating, as opposed to 60 percent of scans performed with the operator onsite. The study authors concluded that the difference could be explained because of experience.
The remote operator had over 20 years of experience in radiology, while most scans performed by local operators had 2 to 15 years of experience. (The remote operator performed local scans on nine of the 30 local patients, but the study did not compare his performance between the remote and local scans.)
Teleradiology is not new. Scores of experts in India analyze images from patients in America. In this case, teleradiology lowers costs and speeds diagnosis because radiologists in India charge less, and their workday occurs after U.S. working hours.
However, this application is different because it would control the scans itself and allow a facility to perform specialized procedures even without specialized staff.
“As the speed and reliability of the Internet increases, it seems inevitable that distance will provide no barrier to the global application of this technology,” said J. Paul Finn lead author and chief of diagnostic cardiovascular imaging at the David Geffen School of Medicine at the University of California at Los Angeles. He noted that remote control of sophisticated scans should work for computed tomography as well as MRI.
Ultra-thin client software allowed the MRI to be controlled remotely. It used a derivative of VNC (virtual network computing), an open-source platform-independent protocol for controlling a computer from a remote console with a standard transmission control protocol. Software on the local computer scans for updates to images on the screen.
The connection between the remote and operator systems must be real-time with very little latency. However, a high-bandwidth connection is probably not necessary because large image files do not need to be transferred in real time.
For this study, information sent between the computers was not encrypted because it was a single, closed-network institution. The software has not been evaluated in situations where encryption would be necessary.
