Tele-radiology lets Finns transcend distance

The recently announced plans to transform St Vincent's Hospital in Dublin into a one-stop medical treatment shop will have been welcome news for anyone who has had to make multiple trips to Dublin for specialist treatment.

In Finland, where distances to main hospitals can be many times greater, a similar problem is being addressed by technology: X-rays and scans are being digitally sent to the central hospitals rather than the patients themselves.

Known as tele-radiology, sending X-rays over communications channels is not new in Finland, a vast country of 338-million square kilometres and a population of just 5.1 million. As long ago as 1969, television channels were used to broadcast radiological images to central hospitals where radiologists could examine them and return a remote diagnosis.

With new communications technology, things have moved on. In Oulu, on the Baltic gulf of Bothnia, the university hospital currently serves a population of one million people spread across the northern half of Finland.

The hospital boasts a tele-radiological network including five frame-relay links to hospitals up to 250 kilometres away, a single 280 kilometre ISDN link, and a 600 kilometre ATM link to Helsinki. These links are used for exchanging various patient X-rays, CT scans, ultrasound scans, and other patient information stored using the DICOM medical standard.

Dr Kari Forsman, a radiologist in Oulu, demonstrated an X-ray of a pair of lungs he had just received from Kuusamo, 280 kilometres away. He said he can see more information on the pair of computer screens than he would normally see on a backlit board.

"If an area is underexposed we can bring it up like this," he explained, enhancing a white area of the image to reveal an area of shadow which he had to examine closely.

Praising the additional tools the software gave him, Dr Forsman cautioned that it does take longer to analyse an X-ray this way, and radiologists must also learn the software interface, provided by a local software company called Acta Systems. He said the lack of radiologists in Europe was driving the necessity for tele-radiology.

In one study of the effectiveness of the technology, Oulu found that in 108 urgent tele-radiological consultations for patients at Kuusamo health centre, some 200 kilometres away, 27 per cent of diagnoses changed, leading to 17 per cent changed treatments. Significantly, given that it costs $800 (€747) to transfer a patient between the two hospitals, transfer was made unnecessary in one case out of eight.

The study concluded that tele-radiology became more cost efficient than conventional methods once there were more than 200 severe cases per year.

If that's the present state of technology, then sending scanned images to mobile phones and personal data assistants (PDAs) represents the future.

Appropriately for Finland, where 60 per cent of the population carry mobile phones, research into mobile medical data is at the cutting edge.

Oulu University hospital is currently taking part in studies where patient scans are sent from remote hospitals to mobile devices in surgeons' pockets, using the data channels on GSM mobile phones.

Limitations of the technology mean it takes one minute to send one image over the 9,600 bits per second channel, and only 10 per cent of the image detail is sent. However, according to Dr Jaakko Niinimaki, radiologist and project researcher, in 20 out of 21 real cases the CT scan image was sufficient to allow a surgeon to make a preliminary report, with a final report possible in the remaining case.

With the planned deployment of third-generation mobile telephone networks in Europe in 2002, data rates to mobile phones will increase to two megabits per second. Dr Niinimaki said this would allow the transmission of full-resolution images.

The images in the above cases were of large brain infarctions and haemorrhages, Dr Niinimaki said. Using a Nokia 9110 Communicator device, he demonstrated how images could be rotated. He zoomed in and out to magnify or reduce images, and showed how previous treatment recommendations could be recalled. He said this technology, still only being tested but using real cases, would allow the hospital send images to doctors at home or out playing golf, for instance.

He said the current technology required large scanning equipment at the sending end, meaning scans could only be sent from well-equipped hospitals.

However, he predicted future developments would allow rapid scans to be sent from accident scenes, thereby improving vital immediate first aid.

While undoubtedly of benefit to patients, reducing the frequency of travelling to central hospitals and improving standards of local healthcare, spare a thought for radiologists. Already in demand due to a shortage, they will soon be expected to be ready to make diagnoses anywhere, anytime. It's little wonder one doctor sighed: "We're not so delighted with these things."

Eoin Licken is at elicken@irish-times.ie