Exams

More than 50% (55.1%) of exam indications with teleradiology were represented by head trauma (29.4%) and surgical abdomen (25.7%).

More than 50% (55.8%) of exam indications with on-call radiology were represented by subarachnoid hemorrhage (19.3%), stroke (18.9%) and head trauma (17.6%). Surgical abdomen represented only 17.1% of exams indications with on call radiology.( Fig. 4 )

• Head CT scans represented more than 50% of all exams (50.2% with teleradiology and 57.2% with on-call radiology).

• Abdominal CT scans represented 27.2% of all exams with teleradiology versus 18.8% of all exams with on-call radiology.

• Angioscans represented 17.1% of all exams with teleradiology versus 10% of all exams with on-call radiology.

• Thoracic CT scans represented 3.9% of all exams with teleradiology versus 10.4% of all exams with on-call radiology.

• Musculo-skeletal exams represented 0.4% of all exams with teleradiology versus 3.6% with on-call radiology.

• Body scans represented 1.2% of all exams with teleradiology, versus none with on-call radiology. ( Fig. 5 )

Delays

The average delay between patient registration in the ER and reporting was longer with teleradiology :  4h35min with on call radiology versus 5h34min with teleradiology (p<0.01), due to an average delay between patient registration and exam requesting of 4h30 with teleradiology and 3h22 with on-call radiology (p=0.005). ( Fig. 6 )

Nevertheless, all radiological delays (between requisition and protocol, exam or reporting) were shorter with teleradiology ( Fig. 7 ):

• the average delay between referring and protocol was 37min58s with on-call radiology versus 3min46s with teleradiology (p<0.001)

• the average delay between referring and CT scan  was 1h12min with on call radiology versus 36min with teleradiology(p<0.001)

• the average delay between referring and reporting was 1h35min with on-call radiology versus 1h01 with teleradiology (p<0.001).

The difference between teleradiology and on-call radiology delays were for referring to protocol 34min12s, for referring to exam 36min and for referring to report 34min, all in favor of teleradiology.

Delays, when calculated for each type of indication,were significantly different between teleradiology and  on-call radiology for strokes, subarachnoid hemorrhages and head traumas. ( Table 1 Table 2 Table 3 Table 4 )

For these three indications, delays between registration and requesting or reporting (depending on ER patient management) were also significantly increased with teleradiology, whereas radiological delays between requesting and protocol, exam or reporting were significantly decreased with teleradiology.
Difference in delays for other indications was not significant because of an insufficient number of cases.

Radiation exposure ( Table 5 )
Average dose was lower when working with on-call radiology was 903.67 mGy.cm versus 1030.70 mGy.cm with teleradiology (p<0.01).
These findings applied also to brain CT scans for strokes, subarachnoid hemorrhages, and Abdominal CT scans for surgical abdominal pains.

However, exposure measurements do not take into account the different scanner hardware being used (various makers).
Differences were not significant for other indications due to an insufficient number of cases.

Requisition conformity to IPAQSS indicator  ( Table 6 )

All requisitions were available and conformed to IPAQQS indicator with teleradiology.
Only 78% of the exam requisitions were available with on-call radiology, and 60% of these requisitions conformed to IPAQSS indicators. One item was missing in 29%, two in 17%, three in 1%.

Staff satisfaction ( Table 7 )
7 physicians answered the survey in Croix Rousse Hospital versus 17 in Saint Luc-Saint Joseph Hospital.

Communication was reported for 85.7% of the physicians working with an on-call radiologist as satisfactory and for 14.3% as excellent.
It was reported for 47.1% of the physicians working with a teleradiologist as satisfactory and 52.9% as excellent.

All physicians working with an on-call radiologist found report turnaround time to be sometimes too long to obtain.
18.8% of the physicians working with a teleradiologist found report turnaround time to be too long to obtain, and 81.3% found reports to be most of the time immediately available.