BOSTON - The dearth of radiologists in the U.S. plays out across the entire spectrum of the healthcare delivery network, including the armed forces. The use of teleradiology during Operation Joint Forge in Bosnia proved to be a successful method of dealing with the shortage of professional personnel.
In a poster presentation at the 2003 Symposium for Computer Applications in Radiology (SCAR), Dr. Lance Williams of Womack Army Medical Center (WAMC) at Fort Bragg, NC, detailed a telemedicine solution the Army used to provide radiology coverage both in Bosnia and at WAMC.
The teleradiology installation took place at Eagle Base Hospital, from 2001 through 2002. The hospital is the U.S. Army’s Echelon III medical facility in the Multinational North Division of the North Atlantic Treaty Organization’s (NATO) peace operation in Bosnia.
Established in 1997, the facility was the stage for several telemedicine trials. However, there was little practical use of teleradiology for clinical purposes until 2001, when the facility received an FCR AC-3 CR system (Fujifilm Medical Systems USA, Stamford, CT) and an MV300 diagnostic radiology workstation (Siemens Medical Solutions, Malvern, PA) to add to its existing Picker (Philips Medical Systems, Bothell, WA) PQS CT unit.
In early 2002, Eagle Base obtained a RaQ Web server (Medweb, San Francisco) that was linked locally to the MV300 workstation as well as the telemedicine network. Medweb servers were also installed at the Landstuhl Army Regional Medical Center (LRMC) in Germany, WAMC, and the Walter Reed Army Medical Center in Washington, DC. This configuration provided the capability for all CR and CT examinations performed in Bosnia to be accessed via secure encryption on the World Wide Web.
Williams wrote that the satellite teleradiology link was utilized between November 25, 2001 and December 5, 2001 to provide coverage for the Eagle Base radiologist while he was on leave in the U.S. A total of 52 exams were transmitted to LRMC, and report turnaround time was stated as taking the same amount of time as if the Eagle Base radiologist had been present onsite. There were no actual or perceived lapses in patient care by the referring clinicians to the hospital, he reported.
Once the Web server was installed in 2002, Eagle Base was able to provide images for review by physicians at multiple locations, and they could help determine if a patient needed transport to Landstuhl for advanced procedures. This included a brain tumor case review that took place over the teleradiology hook-up and comprised neurosurgeons at LRMC and WAMC, as well as the Bosnia-based radiologist and the patient’s primary care physician.
In February and March of 2002, the Eagle Base radiologist was able to take emergency call coverage for the WAMC facility. This call schedule leveraged the shift duty of the Eagle Base radiologist, whose local working hours coincided with the midnight to 8 a.m. duty shift at Fort Bragg.
Diagnostic interpretations were performed by the Eagle Base radiologist for CT and MRI scans, as well as CR exams conducted at WAMC, according to Williams. There were no reported discrepancies between the Bosnia-based radiologist’s reads and local review of the interpretations conducted at WAMC, and no perceived decrease in the quality of patient care or report turnaround time.
Williams noted that the workload at the Eagle Base facility consisted of approximately 150-175 CR exams, 10-15 CT scans, and 3-5 U.S. exams per month, essentially less than 10% of the workload for a full-time U.S.-based radiologist. Because U.S. armed forces medical doctrine mandates the deployment of a radiologist at an Echelon III combat support hospital (CSH), U.S. facilities that are already short-staffed can be put in an even more precarious position in short order.
Williams wrote that teleradiology solutions, such as the one developed during Operation Joint Forge, could provide radiology coverage from an alternate location for CSH facilities, allowing radiologists to be present in a high-workload location while not lowering the quality of care at either location.
Alternatively, he postulated that when a radiologist needs to be deployed to an Echelon III location, they could use teleradiology for diagnostic reads to contribute to the overall workload of the home facility that had lost its services due to the deployment.
"The lessons learned during Operation Joint Forge have decreased the amount of time that it takes to implement teleradiology applications in current and future military operations," Williams wrote.
By Jonathan S. BatchelorAuntMinnie.com staff writer
June 11, 2003
The opinions expressed in the poster presentation are those of Dr. Lance Williams and are not necessarily representative of the Womack Army Medical Center, the Department of the Army, or the Department of Defense (DOD).
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