Teleradiology: Radiology's Trojan Horse?

For a growing number of radiologists, Web-based PACS and other teleradiology setups are creating the opportunity to work from the comforts of home or, at the very least, work off-site.

But with that flexibility comes a plethora of security issues, including the increasing danger of outside "hackers" accessing the company's network and obtaining confidential information. "It's a real worry, and until this past year, the imaging industry has not paid attention to security at all," says Michael Gray, president of Gray Consulting in Marin County, California. "The risk with telecommuting is that someone could hack into the system, and access hospital or patient information, or simply just create havoc. Thankfully, with the advent of HIPAA, hospitals are being forced to become very focused on security issues."

But still, Gray says, the virtual private network (VPN) connections that companies install to encrypt network traffic between an employee's off-site PC and the company network are not always enough. "In a lot of cases, it comes down to money. How much do you want to spend on security and IT staff? Unfortunately, hospitals or radiology practices don't always want to," he says. Typically, $500 is needed for a basic "firewall" security system on a telecommuter's PC, with hundreds of thousands more required for the corporate system. "And physicians in particular want things to be as easy as possible when working from home. They might not want to log in and log out every time, for example. And I can tell you that the basic WinTel security is just not enough." Gray adds that telecommuting security issues have been a concern with teleradiology for quite some time. "But there's much more concern now, with the Web being more prominent," he says.

Hospitals and radiology practices now have to worry about a "U-Turn" hacker attack on telecommuters, according to an article at Forbes.com ("Trojan Horse, Meet the Home Office," July 15). In this type of attack, a hacker targets an unsecured home PC, gaining access to the computer user's password for access to the internal company network. A hacker can then pretend to be that employee, accessing confidential information. In one of the more popular versions of this attack, a so-called Trojan horse email provides a method of allowing someone on the open Internet to access corporate networks.

Installing security systems in telecommuting radiologists' homes can also create logistical problems if the company's number of home office workers expands.

Ultimately, Gray says he is worried more about what goes on inside the hospital than outside. "I can tell you many instances I've seen of PCs just sitting there with the last patient's identification on the screen, and nobody seemed to want to do anything about it," he says.

Technique Allows CT Radiation Dose Reduction for Children

A study in the August issue of Radiology describes a new technique that can lower the radiation dose that CT delivers to children.

The new technique, studied by researchers at the University of California Davis, Sacramento, tailors the dose based on a child's size. The research team studied CT images acquired using simulated pediatric patients of varying sizes to determine the lowest dose possible without loss of image quality. They found that abdominal CT radiation doses can be reduced by 80% from the standard adult level for children with a 5-inch abdominal diameter, and by 9% for those with a 10-inch abdominal diameter. To measure a patient's size, the technologist may wrap a measuring tape around the body part to be scanned, or use software measurement tools available on the CT computer.

The research team also reported that using the dose reduction factors outlined in the study would result in a population dose reduction of 77% in an evenly distributed population between 0 and 14 years of age.

The dose delivered to pediatric patients has recently come under scrutiny, as more children are exposed to radiation as a result of the increasing number of beneficial medical applications for pediatric CT.

Self-Referred Imaging Centers Proliferate

Self-referred imaging centers are proliferating across the United States, particularly in California and New York, according to a study in the August issue of Radiology.

The centers, where people with no health-related symptoms can undergo imaging examinations without a physician's recommendation, are currently proliferating in  areas of the country populated by wealthy and highly educated people, says the study, which looked at 88 imaging centers across the country. A research team led by Judy Illes, PhD, senior research scholar at the Stanford Center for Biomedical Ethics and the Department of Radiology, Stanford University, Stanford, Calif, found that of those 88 centers, 30 were in California, while 13 were in New York.

More than half the centers studied offer full-body screening, with heart and lung scans being the most frequently offered procedures. The research team looked at the Web sites of the self-referring centers to evaluate geographic and demographic distribution, type of center and services available, cost, and procedures for reporting results. Full-body scans ranged from $795 to $995 at the centers.

The study's authors recommend rigorous study of self-referred imaging prior to broad adaptation to protect health care consumers from unregulated repeat examinations, unexpected health consequences from invasive follow-up, and unwarranted health care expenditures beyond the expected out-of-pocket expenses.

Survey Results Suggest Turnaround Time Getting Shorter

Staff increases, longer hours, and the implementation of PACS are among the factors behind decreasing turnaround time, and most departments are providing nighttime coverage, according to the results of the Decisions in Imaging Economics Turnaround Time survey.

A total of 88 respondents filled out the 16-question survey, with 38% of those reporting an average turnaround time of 0-12 hours, from procedure complete to final report; 61% said their department's turnaround time had become shorter in the previous 12 months. "Our turnaround time has become shorter, and I would think that would be happening across the industry," says Jay Becker, RT, of Decatur County Memorial Hospital, Decatur, Ga. "Staffing is part of thatwe've got two whole shifts working now."

Philip Komenda, administrative director for the Greater Baltimore Medical Center, Baltimore, says, "There's really no standard in the industry in terms of turnaround time, which is why this survey is interesting. We have been evaluating our turnaround time anyway, because we're in-between information systems right now. This is partly to see if we can justify PACS."

A total of 33% of those responding to the survey worked in hospitals with 100-199 beds; 24% were in hospitals with 200-299 beds; 15% were from hospitals with 300-399 beds; and 28% worked in hospitals with 400 or more beds. Among the respondents who said turnaround time was shorter, an equal number (32%) pointed to increased staff and working longer hours as the reasons; 23% said the implementation of PACS was the reason.

Of the 16% that said turnaround time was longer, 40% spotlighted a volume increase as the impetus, with another 40% suggesting a lack of staffing.

Other findings from the survey:

• 48% of respondents have PACS deployed; 44% use teleradiology systems.
• 60% reported they were "satisfied" with their referring physician; 24% said "not satisfied.
• 49% said 1 hour was an acceptable turnaround on a stat request; 37% said 1-2 hours was acceptable; 4% said by the end of the shift was acceptable.
• 73% of respondents provide nighttime coverage of the ER/ICU/PICU, while 27% did not provide coverage.
• In terms of volume in the past 2 years, 22% said it grew at a pace of less than 10%; 50% said it grew between 10 and 24%.
• 48% said teleradiology within the practice/department was the nighttime coverage strategy; 15% said outsourced teleradiology was the strategy; and 37% said on-site coverage was the strategy.

Additional tables are posted online at www.imagingeconomics.com.InSight Health Services Corp, Lake Forest, Calif, has announced that one of its wholly owned subsidiaries has completed the purchase of the majority of assets of the mobile imaging business owned by Wexford, Pa-based CDL Medical Technologies. This includes 14 MRI units, four PET units, three CT units, and one lithotripsy unit, all of which operate in various Mid-Atlantic cities. The assets being acquired by InSight are those that operate in Ohio, Connecticut, Maryland, West Virginia, Virginia, Indiana, Pennsylvania, and New Jersey...National Imaging Resources (NIR), Willoughby, Ohio, and Viatronix Inc, Stony Brook, NY, have signed a 1-year, renewable national sales and distribution agreement enabling all NIR members to sell the 2D/3D Viatronix workstation into the radiology market...Caelum Corp, Rockville, Md, has received two grants from the National Cancer Institute, Department of Health and Human Services, under the National Small Business Innovation Research (SBIR) program. The first award is a Phase II grant that provides continued support of the company's research on computer-aided diagnosis to enhance thoracic CT images. The second is a Phase I grant for detection of lung cancer via registered temporal images...MDS Nordion, Ottawa, Canada, a supplier of medical isotopes, has announced that it is licensing technology to NTP Radioisotopes Ltd, a subsidiary of the South African Nuclear Energy Corp, that will see NTP become a contract supplier to MDS Nordion of yttrium-90, an isotope used in radioimmunotherapies to treat cancer...Eastman Kodak Company, Rochester, NY, and Siemens Medical Solutions have announced an agreement in which Siemens' sales representatives will sell medical imaging systems from Kodak's Health Imaging Group. The 3-year global agreement is an expansion of previous regional agreements between the two companies and is effective immediately. Under the agreement, Siemens will begin selling Kodak CR and digital laser printing systems directly to Siemens customers. In addition, Air Products, Lehigh Valley, Pa, has announced that its KeepCOLD® Cryogenic Fill Services Program will be the exclusive cryogenic provider for Siemens Medical's entire US MRI magnet base through December 2007. Under this agreement, Air Products will be providing more than 1,100 Siemens MRI units with liquid helium and nitrogen, as well as related on-site fill services...AMICAS Inc, Boston, a Web-based PACS company, has been named to Deloitte & Touche's Technology Fast 50 Program for New England for the third year in a row. The program ranks the 50 fastest-growing technology companies in the region, based on percentage of growth in fiscal year revenues over 5 years, from 1998 to 2002...Philips Medical Systems has announced several new and expanded research collaborations, now under the company's molecular imaging business unit. Collaborations under way include those with Washington University/Kereos; Theseus Imaging; University Victor Segalen Bordeaux, France; University of California, San Francisco; and the University of Michigan...Swissray America, Elizabeth, NJ, announced a direct sales force expansion from eight to 28 sales representatives. The sales force has completed training and is now in the field...The American Healthcare Radiology Administrators (AHRA) has announced that it has formed a partnership with Berlex Laboratories Inc, Wayne, NJ, to further the education of professionals in radiology administration. Under the partnership, Berlex will provide a grant to publish the first textbook in a series planned by the AHRA in support of its new certified radiology administrator (CRA) program. The textbook, Financial Management in Radiology, will address fiscal health care management issues that are important to radiology.