CHEST TELERADIOLOGY IN A TEACHING HOSPITAL EMERGENCY PRACTICE

OBJECTIVE. New standards for hospital accreditation and health care re imbursement may require that faculty subspecialists be more available after regular working hours to supervise residents in academic radiolo gy departments, We designed a receiver operating characteristic study to determine whether a thoracic radiologist who evaluated computed rad iography (CR) images of the chest at a home-based teleradiology workst ation could add significant value to a junior resident's interpretatio ns of films within the hospital for acutely ill patients. SUBJECTS AND METHODS. Using a hybrid cassette, we obtained analog chest films and CR images simultaneously for each of 252 acutely ill patients in the e mergency department and in an intensive care unit. Interpretations of the analog films by three first-year residents were analyzed for 11 pa rameters deemed critical for patient management. Likewise, CR images o f the same chest studies were viewed on a home teleradiology workstati on by a faculty thoracic radiologist who analyzed the images for these 11 interpretive parameters. All interpretations by radiology resident s and by the home-based thoracic radiologist were then compared with t he interpretations of a consensus panel consisting of another thoracic radiologist and a full-time emergency department radiologist. RESULTS . Analysis of the pooled results from the three junior residents as a group failed to show significant differences between their interpretat ions of chest films and the interpretations of CR images by a thoracic radiologist at a home workstation, However, we observed significant d ifferences for several image interpretation parameters between individ ual residents and the home-based radiology subspecialist. CONCLUSION. The data confirm that significant value can be added to the interpreta tions of chest films by individual junior residents when a home-based thoracic radiologist uses teleradiology to provide expert interpretati ons. Accordingly, it is reasonable to infer that on-line supervision b y faculty subspecialists via teleradiology could be used to complement the scheduled visits that are being made now by individual faculty me mbers of our institution to interpret films periodically with a radiol ogy resident during overnight and weekend periods.