DeCorato D R, Kagetsu N J, Ablow R C
Department of Radiology, St. Luke's-Roosevelt Hospital Center, New York, NY 10019, USA.
AJR Am J Roentgenol. 1995 Nov;165(5):1293-6. doi: 10.2214/ajr.165.5.7572522.
The purpose of our study was to assess the efficacy of a commercially available digital teleradiology system in the off-site interpretation of radiologic studies performed in the emergency department.
Over a 6-month period, all radiologic studies performed at Roosevelt Hospital between the hours of midnight and 8 A.M. were digitized and then transmitted over a T1 fiberoptic link to the radiology department of St. Luke's Hospital, 4.8 km away. A total of 829 radiologic examinations were performed, 17 of which were lost to follow-up, leaving 812 studies available for review (693 plain radiographs, 118 CT exams, and one MR imaging study). The preliminary teleradiology interpretations were performed by a resident on duty (with between 1 and 3.5 years of training) using a commercially available teleradiology system (Vortech PDS; Kodak Health Imaging Systems Inc., Dallas, TX) at St. Luke's Hospital. This interpretation was compared with the official film interpretation (which was used as the gold standard) performed within 24 hr by a board-certified attending radiologist at Roosevelt Hospital. All studies with clinically significant discrepant interpretations were redigitized, and the digital images were reviewed by at least two attending radiologists. Side-by-side comparison was made with the original analog examinations to determine the source of the discrepancy. Discrepant images were then graded in conjunction with an attending physician from the emergency department to determine the clinical impact on patient management.
Clinically significant discrepancies (those with the potential to affect patient management) in image interpretation were found in 38 cases (5% of the total). Of these 38 cases, three cases (0.4%) were due to an inadequate digital image while 14 (2%) were due to interobserver error. Two (0.2%) discrepancies were due to film reader error, and 19 (2%) were due to digital image reader error. Reasons for inadequate digital images included underpenetrated radiographs and drifting of the laser digitizer.
Commercially available teleradiology equipment can be both reliably and effectively used for off-hours interpretation of radiologic studies made in the emergency department.
我们研究的目的是评估一种商用数字远程放射学系统在急诊科进行的放射学检查远程解读中的有效性。
在6个月的时间里，罗斯福医院在午夜至上午8点之间进行的所有放射学检查都被数字化，然后通过T1光纤链路传输到4.8公里外的圣卢克医院放射科。总共进行了829次放射学检查，其中17次失访，剩余812项检查可供审查（693张平片、118次CT检查和1次MRI检查）。初步的远程放射学解读由圣卢克医院一名值班住院医师（接受过1至3.5年培训）使用商用远程放射学系统（Vortech PDS；柯达健康影像系统公司，得克萨斯州达拉斯）进行。该解读与罗斯福医院一名获得委员会认证的主治放射科医生在24小时内进行的官方胶片解读（用作金标准）进行比较。所有具有临床显著差异解读的检查都重新数字化，数字图像由至少两名主治放射科医生进行审查。与原始模拟检查进行并排比较以确定差异来源。然后，与急诊科一名主治医生一起对差异图像进行分级，以确定对患者管理的临床影响。
在图像解读中发现38例具有临床显著差异（有可能影响患者管理）的情况（占总数的5%）。在这38例中，3例（0.4%）是由于数字图像不充分，14例（2%）是由于观察者间误差。2例（0.2%）差异是由于胶片阅读器误差，19例（2%）是由于数字图像阅读器误差。数字图像不充分的原因包括射线穿透不足的平片和激光数字化仪的漂移。
商用远程放射学设备可可靠且有效地用于急诊科非工作时间放射学检查的解读。
