Digital X-rays Save Time, Maybe Lives

That's how it would go on a good day. Sometimes it took much longer even weeks, she knew from experience for a doctor to obtain and interpret patient Xrays and schedule a followup appointment. And that meant more time away from work, more trips to the hospital, more waiting and more chance of an injury or illness worsening before it could be treated.

Nosco was surprised, therefore, when immediately after her Xray session, the technician sent her back to her doctor empty handed. In her doctor's office, she was even more surprised when the physician displayed her Xrays on a desktop computer monitor.

Rapidfire, digital Xrays still aren't the health care norm, but thanks to a telemedicine test project here, the way DoD medics obtain Xrays soon could change.

Telemedicine is sweeping health care worldwide, according to DoD officials. New and emerging technologies allow doctors to "see" and treat patients from thousands of miles away, consult with specialists and exchange information and ideas.

The military health services system endorses telemedicine as a means to higher quality care in particular for frontline troops. Service medics used telemedicine in Somalia, and the Navy routinely employs the technology aboard ships. Currently, the Medical Advanced Technology Management Office at Fort Detrick, Md., is fielding telemedicine support packages for medical units in Bosnia.

Madigan's Medical Digital Imaging System replaces acetate film with digital radiology imagery. Technicians store the imagery and medical interpretations on laser discs for quick access. The imaging system is a computer graphics package tailored to meet the specific needs of a medical institution, said Dr. (Lt. Col.) Greg Bender, chief of radiology here..

"Teleradiology allows us to recover and keep track of patient images at a rate we've never been able to achieve in the past," he said. DoD medical facilities typically lose 25 percent of all Xrays taken, he noted. "A lot of times when doctors and patients move, they take their films with them, and that stuff gets lost," Bender said. "With the system, the images are stored in a permanent archive on laser discs." Every five years, he added, DoD recycles Xray film to recover silver used to process the negatives. Digital images, however, can be retained as long as necessary.

About 40 percent of the time when film Xrays are available, Bender said, the data contained in the patient's medical record is unavailable. Here, the information stays with the images on the storage disc.

"With teleradiology, we have fingertip access to more than a million patient records. Clinicians can look at their patient's images and compare them with other patient images in a minute or two, right at their desktop terminal."

Bender compared teleradiology's speed and accessibility with a time study done at Tripler Army Medical Center, Hawaii.

"The average primary care clinician [at Tripler] spends 45 minutes a day obtaining Xray information," he said. "Fortyfive minutes per day per staff clinician is a lot of time that we're able to recover by using teleradiology."

The Madigan system supports 16 radiologists, 24 resident physicians, 76 technologists and 120 work stations. Since March 1992, when teleradiology was implemented here, users have stored 9 trillion bytes of patient imagery and data. One chest Xray is about 1 million bytes.

Teleradiology proved its worth at Madigan, according to Bender. Now, under a separately funded project, other medical facilities in the area will benefit from the telemedicine initiative.

Project Seahawk links Madigan with federal medical facilities in the Puget Sound area through telemedicine programs including teleradiology. Participants include the Bremerton Naval Hospital and McChord Air Force Base Clinic, and smaller, more distant Navy clinics.

"Madigan treats a lot of referral patients from the other facilities," Bender said. "Teleradiology should cut down on the number of referrals, because we can review the images and share information back and forth on the computer."

Telemedicine saves time. Whether the new technologies save the government money will be learned over time, Bender said.

Madigan shares membership in an international teleradiology users group with civilian hospitals in London and Vienna, the Veterans Affairs hospital in Baltimore and Brooke Army Medical Center in San Antonio, Texas.

"The lessons we learn as we deploy the systemwill help streamline the technology and make it cheaper, but the real efficiencies to be gained are in diseases detected at an earlier stage, and lives saved," Bender said.

For more information about telemedicine projects, visit the DoD Telemedicine Testbed home page on the World Wide Web at http://www.matmo.army.mil.