Study: Ship-to-Shore Teleradiology Feasible

CHICAGO — A 24-hour teleradiology service for cruise ships has the potential to improve immediate patient care in emergencies, a researcher reported here.

Four cruised ships – each with more than 2,500 passengers — were outfitted with mobile digital x-ray units using digital storage imaging plates (Siemens Polymobil). Digital x-ray images were transmitted in a standardized fashion from the cruise ships to a land-based, tertiary hospital via satellite internet, explained Frank Oliver Henes, MD, of the University Medical Center Hamburg-Eppendorf in Germany.

In 86% of the cases, the initial report by the physician on board matched the report in the tertiary hospital. However, in 14% of the cases, the radiologist in the tertiary hospital detected pathologies that were previously missed by the physician on board, he said in a presentation at the Radiological Society of North America (RSNA) annual meeting.

“Using a VPN tunnel, we were able to demonstrate a robust and well-functioning workflow allowing a routine high standard interpretation of x-rays that were imaged on board by experienced radiologists in a tertiary hospital,” Henes said. “The radiologists in the tertiary hospital detected pathologies … which were previously overlooked, and potentially would not have been treated.”

Cruise ships have come under fire recently because of multiple incidences of gastrointestinal illness outbreaks. Common injuries related to cruise ships include fractures.

Henes and colleagues conducted the study from February 2017 to September 2018. Patient ages ranged from 4 to 90 years. Henes said each ship performed an average of one imaging study a day. The cruise ships had a medical suite staffed by two physicians (internal medicine, surgery, intensive, and/or emergency medicine), two nurses, and one medical assistant.

“Using VPN secured data, transfer of images was managed together with patient data and integrated to the PACS (GE Healthcare Centricity Universal Viewer). In the tertiary hospital, images were analyzed by the radiologist on-call and reports were immediately sent back via VPN,” they wrote.

Overall, 410 x-rays of 355 patients were acquired on board and successfully transmitted via satellite from the cruise ships to the tertiary hospital. The vast majority were skeletal x-rays (n=349) with fracture after a trauma being the most frequent query (n=259). The other cases were chest x-rays (n=52), with pneumonia (n=36) being the most frequent query, and abdominal x-rays (n=9). No pathologies were seen in 246 cases.

Common pathologies were:

• Fracture or dislocation: n=77
• Osteoligamental injury: n=11
• Arthrosis: n=16
• Others: n=49

Among those cases, ships’ doctors made first diagnoses in 129 examinations, and the land-based radiologists concurred with those diagnoses in 111 cases, Henes said. In 18 cases, the land-based radiologist disagreed with the finding of the physicians on board, including eight trauma incidents that were initially not considered fractures, but were diagnosed as fractures by the land-based radiologists, he said. There were also six cases that were diagnosed on board as fractures, but not by the land-based reading.

RSNA session moderator Karen Lee, MD, of Beth Israel Deaconess Medical Center/Harvard Medical School in Boston, told MedPage Today that “the doctors on board these ships are usually general practitioners, so it is always a good thing to have another set of eyes — of a skilled radiologist — reading these images, even if they are thousands of miles away.”

“This does appear to be effective in getting better diagnoses for these patients,” Lee added. “I really wonder what might be next – it is almost like setting up urgent care centers on cruise ships.”

However, she questioned the potential for widespread use of ship-to-shore teleradiology as “there is a lot of money involved in setting up a teleradiology system, and then there is the question of who is going to pay for the treatment, especially when the patient may be in international waters, or in territorial waters of another government. In the United States, it is all about insurance and who is covered.”