Rasu Bickram K. Shrestha MD, Presenter: Nothing to Disclose

Yuri R. Parisky MD, Abstract Co-Author: Nothing to Disclose

Donald S Harrell MD, Abstract Co-Author: Nothing to Disclose

Richard I Kitney PhD, Abstract Co-Author: Nothing to Disclose

Stefan Claesen PhD, Abstract Co-Author: Nothing to Disclose

Anthony W Huntsinger, Abstract Co-Author: Nothing to Disclose

Mammoth Hospital is a remote, 15-bed facility, designated by the federal government as a Critical Access Hospital in the ski resort area of Mammoth Lakes, 700 miles from Los Angeles. This paper describes our 2 year experience in the design and implementation of a unique teleradiology service with the Univ. of Southern California, highlighting the system architecture, network challenges as well as technical and practical considerations.

The teleradiology service at Mammoth Hospital was implemented in two phases: Phase 1 - creation of an imaging network; Phase 2 – installation of a DICOM-connector service. We have developed and used a web-based PACS, called PIRILIS, which includes a stand alone DICOM image viewer. Images are digitally acquired at Mammoth from these scanners: 1 CT, 1 MR, 1 CR and 1 Ultrasound. These are sent via the DICOM-connector box at Mammoth (with encryption and compression) over a T1 network to the DICOM Server at USC. The studies are accessed using a web-browser, or via direct query-retrieve from within the image viewer. We have developed and used multi-threaded image loading algorithms and on the fly JPEG thumb-nail creation to enhance remote access. We assessed parameters including network bandwidth issues, study accessibility, diagnostic efficiency, user satisfaction, security and technical limitations such as network connectivity and workstation/ computer types used for the readings.

The total cost of the implementation was miniscule. Furthermore, as the system is web-based, radiologists are able to access these images from virtually anywhere. The benefits of this system are at several levels: resolved issue of shortage of radiologists at remote hospital, brought expert specialist care to an otherwise impossible setting, optimized workflow, better patient management and cost-savings.

The implementation of our cost-effective remote teleradiology model was successful. The future integration of further remote imaging centers throughout California into this ‘single’ network with a centralized data repository will result in the creation of a virtual grid of imaging centers, with instantaneous access to images and expert radiological diagnosis.

R.I.K.: Board of Directors of ComMedica LtdR.B.S.: Clinical Research Fellow for University of Southern California and ComMedica LtdS.C.: Employee of ComMedica Ltd

Shrestha, R, Parisky, Y, Harrell , D, Kitney, R, Claesen, S, Huntsinger, A, Implementation of a Cost-Effective Remote Teleradiology Service between Los Angeles and Mammoth Mountains, California: Technical and Practical Aspects.  Radiological Society of North America 2004 Scientific Assembly and Annual Meeting, November 28 - December 3, 2004 ,Chicago IL. http://archive.rsna.org/2004/4415926.html