Teleradiology's benefits also extend beyond just broader patient access to quality care. While the technology can be difficult to implement in Russia due to a lack of infrastructure, training, and expertise, successful adoption of teleradiology serves as a driving force to solve these problems, according to Oleg Pianykh, PhD, an assistant professor at Harvard Medical School in the U.S.
"Teleradiology pays back in many possible ways, but it takes patience to implement," he said.
Russia would seem a fertile market opportunity for teleradiology. With a huge land mass covering nine time zones, Russia also has a shortage of radiologists. There are only 1.4 radiologists per 10,000 people, roughly 56% of what's needed, according to Pianykh. In addition, there are not enough CT scanners, with an estimated nine per 1 million people.
These factors contribute to a situation of nonuniform healthcare in Russia, as the level of quality and available expertise often corresponds to the population density of the local area.
"If you go to major capitals like Moscow or St. Petersburg, you will find radiology very much in the same way you would find it elsewhere [in Europe]," he said. "But as soon as you drive 15 kilometers away, you'll be surprised at the diversity and the deviation from that level."
The adoption of teleradiology is held back by three problems: a lack of information technology related to medicine, a lack of understanding of the function and implementation of the DICOM standard, and unpredictable availability of financing, Pianykh said. This results in many projects that look more like patchwork, involving, for example, mailing of CDs or using Skype for teleradiology.
"Skype is a wonderful product that I use all the time to talk to my friends or family," he said. "But it's not a teleradiology solution, because it obviously lacks all the quality for diagnostic imaging display."
While these issues have created the same gaps in teleradiology experienced previously by other countries, the technology is now slowly becoming a functioning reality in Russia, he said.
About 15 years ago, teleradiology in Russia involved printing an image on paper, scanning the paper in a document scanner, and attaching the file to an email. When formal teleradiology projects first began in Russia about 10 years ago, physicians who were outside the hospital were then able to view images in DICOM quality over the Internet on a laptop.
The continuing evolution of teleradiology has seen its adoption in emergency departments, such as in St. Petersburg, where it's being used successfully, Pianykh said.
"Eventually, it starts also going beyond the scope of two major capitals," he said. "So you may find teleradiology solutions not only in Moscow and St. Petersburg, but also in places in Siberia, for example, where it will be needed badly because the population is so sparse [that] the quality of healthcare is so unpredictable. But they finally begin to overcome those problems, as well as implement solutions which would enable ... for example, diagnostic image distribution over public network channels."
For those who seek to implement teleradiology in Russia, it's important to begin by analyzing the problem rather than focusing on the solution, according to Pianykh. It's also incorrect to assume that you can simply take a successful teleradiology project at one institution and automatically replicate it at another site.
"The whole idea behind teleradiology is to optimize the resources for any particular clinic," he said. "But what they need to optimize varies a lot. If you have success in one hospital, you cannot always translate it literally to a different place. You have to study what they need. ... Teleradiology is hard to build from the top down. It always needs to be grown bottom-up from the needs of a particular hospital."
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