A History of Teleradiology

The term teleradiology pertains to the transmission of images obtained via radiology – x-rays, CTs,  MRIs, ultrasounds, ect  – from one place to another; it serves the purpose of sharing of information and new findings among radiologists of the world, and is a useful diagnostic and remote consulting tool. With a history of nearly half a century now, this technique is built on the foundation of the advances in the fields of computer technology and telecommunication that enable information to be transmitted over long distances digitally.

The concept of wire transmission for communication was first developed in the form of the telephone, nearly 150 years ago. Since then, the application of the same technique has been instrumental in the evolution of telemedicine, the practice of utilizing doctors not at the same location as the patient. In the 1930s, the Queen Mary ocean liner used the ship’s marine radiotelephone for medical consultation purposes. A physician on board would transmit information to outside sources for consultation, and would act as a consultant for those needing medical attention on other ships.

Through the 1960s and 1970s, extensive research and experimentation was conducted to perfect the technique of closed circuit and broadcast television for transmitting medical images captured by x-rays. These images generally pertained to radiology, dermatology and pathology. A breakthrough was recorded when Dr. Kenneth T. Bird (Massachusetts General Hospital, Boston) was able to install an interactive television system that connected the hospital to Logan Airport and could thus be used to provide medical care to travelers.

A similar case was that of the Walter Reed General Hospital in Washington D.C., which established a link between the radiology department and the emergency room by means of closed circuit television. However, in those early days, the process of transmission was rather tedious, as only one image could be shared at a time, and this coupled with the low quality of contrast and resolution meant that the system was more of an exhibit for the hospital than a practical tool. Over the next few years, the poor quality and high operation and maintenance costs of telemedicine led to its rejection by most healthcare centers.

By the early 1980s teleradiology primarily existed in the form of physical copies of films being mailed to a radiologist who when then record a report onto a cassette tape, which would be mailed back to the originating facility for transcription into a paper report. The turn around time on these studies were measured in days, if not weeks.  This could work for routine studies, but not for anything emergent.

Even though some modalities (CTs, MRIs, X-Ray machines, ect) produced digital images, or produced films that were capable of being scanned into a digital image, these digital copies were very difficult to display on machines from other manufacturers.  In 1983, American College of Radiology (ACR) and National Electrical Manufacturers Association (NEMA) joined forces to create an open standard for digital storage of medical images. This standard, ACR/NEMA 300, had some problems and limitations that didn’t lead to a widespread adoption by manufacturers.

In 1988 a second version of the standard was released, generally referred to as ACR/NEMA V2.0. In this version transmission of the images was performed via a dedicated 2 cable (EIA-485). This standard was more widely accepted, with the likes of, DeJarnette Research Systems, General Electric Medical Systems, Merge Technologies, Siemens Medical Systems, Vortech (now Kodak), and 3M supporting the standard.

In 1993 the third edition of the standard was released and renamed to DICOM. With this edition of the standard network support was added, making teleradiology truly possible.

In 1994, the American College of Radiology (ACR) published its first standard for teleradiology. The ACR suggested that radiologists providing interpretations maintain licensure at both the initiating and receiving sites, and hold hospital credentials.  ACR recognition was an important step for legitimizing the practice of teleradiology.

By the late 1990s several pure teleradiology companies had formed and were finding great success. vRad, Nighthawk, and Radlinx were early pioneers in the field. Nighthawk is a particular interesting case as they were the first company to position radiologists in Europe and Australia to maximize the time zone difference with the States. A doctor working in the afternoon in Australia is covering the graveyard shift in the States.

Interestingly enough the next real change in teleradiology would come at the hands of a merger between vRad and Nighthawk in 2010. As a result of the merger several radiologists found themselves looking for work. Some of these radiologists went to work for other teleradiology companies, while others took advantage of the recent advances in cloud computing and were able to cheaply start their own teleradiology company, some radiologists even took both routes.

This radiologist as a free agent concept has left the market in an interesting position. Most teleradiologists work from home and will have several teleradiology companies they work for. The software needed to provide teleradiology services has come down so far in price that it is affordable to an individual.

The teleradiology market today stands as one with 100s of companies competing with each other not only to secure clients to read for, but to secure contractor radiologists to provide those reads.




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