2017년 대한민국 영상의학검사 원격판독의 실태: 대한영상의학회 회원 설문 조사

최문형,어홍,정승은,우현식,정우경,황재연,이종석,최준일,조은석,도경현,김승훈 대한영상의학회 2019 대한영상의학회지 Vol.80 No.4

Purpose To evaluate the differences in opinion among radiologists working in different types of medical institutions in Korea, through questionnaires. Materials and Methods Korean board-certified radiologists who participated in the survey in 2017. Results Of the 316 radiologists who responded to the survey, 46.1, 20.3, 16.3, and 10.1% were working in university hospitals, general hospitals, hospitals, and clinics, respectively. More than half the radiologists (52.1%) considered teleradiology necessary, and the most-cited reason was a flexible work style. On the contrary, poor quality of radiology reports was the most-cited reason for considering teleradiology unnecessary. Although regulations for image quality, work environment, and radiology reports were considered necessary, the smaller the size of medical institution, the lower was the agreement rate. Among all responders, most radiologists thought that teleradiology would reduce the scope of radiology. However, most radiologists working in clinics thought that teleradiology would expand the field of radiology. Most responders (94.2%) required teleradiology guidelines provided by the Korean Society of Radiology. Conclusion The results of this survey showed radiologists’ perspective on various aspects of teleradiology. There were significant differences in opinion among radiologists working in different types of medical institutions. 목적 원격판독에 대한 영상의학과 전문의의 인식에 대한 설문조사를 통해, 대한영상의학회회원들의 원격판독에 대한 의견을 조사하고, 영상의학과 전문의의 근무 형태에 따른 차이를분석하고자 한다. 대상과 방법 2017년 온라인 설문조사에 참여한 영상의학과 전문의를 대상으로 하였다. 결과 316명의 영상의학과 전문의가 설문조사에 참여하였고, 46.1, 20.3, 16.3, 10.1%가 대학병원, 종합병원, 병원, 의원에 근무하였다. 응답자의 52.1%가 원격판독이 필요하다고 생각하였고, 원격판독이 필요한 이유로는 근무 환경의 유연성 강화를, 원격판독이 불필요한 이유로는 판독의 질적 저하를 가장 높은 비율로 선택하였다. 원격영상 및 원격판독 환경에 대한 규정, 판독소견서의 필요성은 대부분의 응답자가 필요하다고 응답하였으나 근무하는 의료기관의 규모가 작을수록 필요하다는 응답률이 감소하였다. 전체 응답자에서는 원격영상판독이장차 영상의학과 전문의의 영역을 축소시킬 것이라는 의견이, 의원에 근무하는 전문의들은확대시킬 것이라는 의견이 더 많았다. 원격판독에 대한 학회 차원의 가이드라인의 마련이 필요하다는 응답은 94.2%였다. 결론 이번 설문조사를 통해 원격판독의 다양한 측면에 대한 영상의학과 전문의의 인식을 알수 있었고, 근무 의료기관의 규모에 따라 설문 문항의 답변에 차이가 있었다.

원격판독 의료기관에서 시행한 원격판독의 동료평가: 세부전공분야와 촬영장비에 따른 판독 불일치 정도와 불일치 판독의 임상적 의의 비교

Seo Hyung Suk,Park Jai Soung,Oh Yu-Whan,Sung Dongwook,Lee A Leum 대한영상의학회 2021 대한영상의학회지 Vol.82 No.6

Purpose The purpose of this study was to evaluate the rates of unacceptable diagnosis and clinically significant diagnostic discrepancy in radiology sections and imaging modalities through a peer review of teleradiology. Materials and Methods Teleradiology peer reviews in a Korean teleradiology clinic in 2018 and 2019 were included. The peer review scores were classified as acceptable and unacceptable diagnoses and clinically insignificant and significant diagnostic discrepancy. The diagnostic discrepancy rates and clinical significance were compared among radiology sections and imaging modalities using the chi-square test. Results Of 1312 peer reviews, 117 (8.9%) cases had unacceptable diagnoses. Of 462 diagnostic discrepancies, the clinically significant discrepancy was observed in 104 (21.6%) cases. In radiology sections, the unacceptable diagnosis was highest in the musculoskeletal section (21.4%) (p < 0.05), followed by the abdominal section (7.3%) and neuro section (1.3%) (p < 0.05). The proportion of significant discrepancy was higher in the chest section (32.7%) than in the musculoskeletal (19.5%) and abdominal sections (17.1%) (p < 0.05). Regarding modalities, the number of unacceptable diagnoses was higher with MRI (16.2%) than plain radiology (7.8%) (p < 0.05). There was no significant difference in significant discrepancy. Conclusion Peer review provides the rates of unacceptable diagnosis and clinically significant discrepancy in teleradiology. These rates also differ with subspecialty and modality. 목적 동료평가를 시행하여 원격판독 불일치의 정도와 불일치 판독의 임상적 의의를 세부전공분야와 촬영장비별로 평가하고자 하였다. 대상과 방법 한 국내 원격판독 의료기관에서 2018년과 2019년에 시행한 동료평가를 대상으로 세부전공분야와 촬영장비별로 판독 불일치를 분석하였다. 동료평가 점수를 적격 진단과부적격 진단으로 분류하였고, 판독 불일치는 임상적 의의에 따라 무의한 불일치와 유의한 불일치로 분류하였다. 카이제곱 검증으로 통계를 시행하였다. 결과 총 1312건의 동료평가 중 부적격 진단은 117건(8.9%)이고, 총 462건의 진단 불일치 중유의한 불일치는 104건(21.6%)이었다. 세부전공분야에서 부적격 진단율은 근골격(21.4%)이가장 높았고(각각 p < 0.05), 복부(7.3%)는 신경두경부(1.3%)에 비해 높았다(p < 0.05). 유의한 불일치는 흉부(32.7%)가 복부(17.1%)와 근골격(19.5%)에 비해 높았다(각각 p < 0.05). 촬영장비에서 부적격 진단은 MR (16.2%)이 일반촬영(7.8%)에 비해 높았고(p < 0.05), 유의한불일치는 차이가 없었다. 결론 동료평가를 통해서 원격판독의 부적격 진단과 임상적 유의한 불일치의 정도, 세부전공분야와 촬영장비에 따른 차이를 알 수 있었다.

Evaluation of Radiographic Positioning Techniques Used in Local Hospitals after Teleradiology Consultation

Sojin Kim,Miju Oh,Yooyoung Lee,Minju Lee,Jiyoung Ban,Uhjin Kim,Jiwoon Park,Jaepung Han,장동우 한국임상수의학회 2022 한국임상수의학회지 Vol.39 No.6

The purpose of this study was to evaluate the radiographic position- ing techniques used in local animal hospitals, identify the most common posi- tioning problem, and determine whether there were changes after teleradiology consultations. From September 2016 to April 2021, 15 local animal hospitals that requested radiographic interpretation more than 10 times and for more than six cases of thoracic radiographs were selected. Six sets of two-views of (lateral and ventrodorsal [VD] or dorsoventral [DV] views) digital thoracic radiographs from six dogs per hospital were evaluated in four categories. For the lateral view, radiographic technique scores used in ten local animal hospitals improved, one remained the same, and four became worse. For the VD/DV view, the score for eleven hospitals improved and worsened for four. The most common problem was rotation (57/90) for the lateral view, followed by an inappropriate field of view (59/90), and incorrect beam center (71/90). For the VD/DV view, an inappro- priate field of view (54/90) was the most common problem, followed by asym- metry (63/90), and incorrect beam center (73/90). Every factor, except rotation in the lateral view, improved after obtaining technical consultation; however, the degrees of improvement were not remarkable. There was no significant correla- tion between the number of requests and the degree of improvement. Accord- ing to the results, the radiographic technique used in local animal hospitals was improved by technical advice on teleradiology. These changes make it possible to provide accurate diagnoses of the requested images. There are some limita- tions regarding the indicators of evaluation and the number of cases; therefore, further studies that use detailed indicators in large cohort group are needed. In addition, an effective method of teaching should be developed to improve ra- diographic techniques in local animal hospitals.

2017년 대한민국 영상의학검사 원격판독의 실태: 수련병원 및 원격판독기관 설문조사와 인터뷰

우현식,최문형,어홍,정승은,도경현,이종석,김승훈,정우경,조은석,최준일,황재연 대한영상의학회 2019 대한영상의학회지 Vol.80 No.3

Purpose Teleradiology has been widely used nationwide in various ways. In order to prepare a guideline, it was recognized that a survey on the actual condition of teleradiology in Korea was necessary. Materials and Methods The questionnaires were administered to training hospitals. Interviews were also conducted with teleradiology centers and teleradiologists. The bid records of Government e-Procurement System (Narajangteo) was examined. Results The main reason for requesting teleradiology was manpower shortage. The contracts were made on a per-case basis and all were interpreted with the reading radiolgists’ names on the report. The report seemed to be delivered timely and access to clinical information was possible in some cases. The teleradiology fees collected from the e-procurement system were lower than those from other subjects, which is thought to be the result of the lowest bid method. Conclusion Guidelines for teleradiology should be developed on legitimate interpretations. In addition, continuous efforts to solve the problem of quality deterioration of teleradiology will be needed. 목적 원격판독은 다양한 방법으로 전국적으로 광범위하게 시행되고 있다. 원격판독에 대한학회의 입장과 방향을 제시하기에 앞서 우선적으로 원격판독에 대한 실태 조사가 필요하다는 인식이 있었고, 이에 본 연구를 진행하게 되었다. 대상과 방법 수련기관을 대상으로 설문조사를 실시하였으며 원격판독기관, 원격판독의를 대상으로 인터뷰를 진행하였다. 또한 공공의료기관에서의 원격판독에 대한 최저가 입찰의 실태를 알아보기 위해 나라장터의 입찰기록을 조사하였다. 결과 원격판독을 의뢰하는 주된 이유는 인력부족이었다. 계약 조건은 모두 건당 계약이었으며 모두 실명으로 판독하였다. 판독의 적시성은 확보된 것으로 보이며 임상정보에 대한 접근은 일부에서만 가능하였다. 나라장터에서 조사된 원격판독료는 다른 방식으로 조사된 원격판독료보다 낮았으며 이는 최저가 입찰 방식의 결과로 생각된다. 결론 원격판독에 대한 학회의 가이드라인이 명확한 법적 유권해석을 바탕으로 만들어져야하며, 원격판독의 질적 저하의 문제를 해결하기 위한 학회 차원의 지속적인 노력이 필요할것이다.

Clinical usefulness of teleradiology in general dental practice

Choi, Jin-Woo Korean Academy of Oral and Maxillofacial Radiology 2013 Imaging Science in Dentistry Vol.43 No.2

Purpose: This study was performed to investigate the clinical usefulness of teleradiology in general dental practice. Materials and Methods: Two hundred and seventy five cases were submitted for inquiry to the case presentation board of the website of The Korean Academy of Oral and Maxillofacial Radiology for a 5 year periods. The diagnosis results of those cases were analyzed according to the disease classification, the correlation with the patient's chief complaint, the necessity of additional examinations or treatments, the image modalities, and the number of dentists inquiring. Results: Differential diagnoses of normal anatomic structures were the most frequently submitted cases, covering 15.6% of all cases. Among 275 cases, 164 cases required no additional treatments or examinations. Panoramic radiographs were the most frequently submitted images, accounting for 248 inquiries. The 275 cases were submitted by 96 dentists. Fifty-two dentists wrote one inquiry, and 44 inquired 2 or more times. The average inquiry number of the latter group was 5.0 cases. Conclusion: A teleradiology system in general dental practice could be helpful in the differential diagnosis of common lesions and reduce unnecessary costs.

Clinical usefulness of teleradiology in general dental practice

Jin-Woo Choi 대한구강악안면방사선학회 2013 Imaging Science in Dentistry Vol.43 No.2

Purpose: This study was performed to investigate the clinical usefulness of teleradiology in general dental practice. Materials and Methods: Two hundred and seventy five cases were submitted for inquiry to the case presentation board of the website of The Korean Academy of Oral and Maxillofacial Radiology for a 5 year periods. The diagnosis results of those cases were analyzed according to the disease classification, the correlation with the patient's chief complaint, the necesity of additional examinations or treatments, the image modalities, and the number of dentists inquiring. Results: Differential diagnoses of normal anatomic strucures were the most frequently submitted cases, covering 15.6% of all cases. Among 275 cases, 164 cases required no additional treatments or examinations. Panoramic radio graphs were the most frequently submitted images, accounting for 248 inquiries. The 275 cases were submitted by 96 dentist. Fifty-two dentists wrote one inquiry, and 44 inquired 2 or more times. The average inquiry number of the latter group was 5.0 cases. Conclusion: A teleradiology system in general dental practice could be helpful in the differentaial diagnoses of common lesions and reduce unnecessary costs.

영상치의학 분야에서의 원격판독

김조은(Jo-Eun Kim) 대한치과의사협회 2016 대한치과의사협회지 Vol.54 No.9

Teleradiology is the electronic transmission of radiologic images from one location to another for the purpose of interpretation and/or consultation. Today, images can be easily transmitted to another location using the high-speed internet. In medical area, teleradiology has developed rapidly in recent 10 years due to the imbalance between the demand and availability of diagnostic services. However, teleradiology in dentistry is still inactive. I would like to overview the current teleradiology system, and discuss the necessity and the potentiality.

Clinical usefulness of teleradiology in general dental practice

최진우 대한영상치의학회 2013 Imaging Science in Dentistry Vol.43 No.2

Purpose: This study was performed to investigate the clinical usefulness of teleradiology in general dental practice. Materials and Methods: Two hundred and seventy five cases were submitted for inquiry to the case presentation board of the website of The Korean Academy of Oral and Maxillofacial Radiology for a 5 year periods. The diagnosis results of those cases were analyzed according to the disease classification, the correlation with the patient’s chief complaint, the necessity of additional examinations or treatments, the image modalities, and the number of dentists inquiring. Results: Differential diagnoses of normal anatomic structures were the most frequently submitted cases, covering 15.6% of all cases. Among 275 cases, 164 cases required no additional treatments or examinations. Panoramic radiographs were the most frequently submitted images, accounting for 248 inquiries. The 275 cases were submitted by 96 dentists. Fifty-two dentists wrote one inquiry, and 44 inquired 2 or more times. The average inquiry number of the latter group was 5.0 cases. Conclusion: A teleradiology system in general dental practice could be helpful in the differential diagnosis of common lesions and reduce unnecessary costs.

원격 진료 시스템 : 기흉 및 속립성 결핵의 검출능

박노혁,배경수,신현웅,양근석,염헌규,류춘욱,김용길,서경진,강덕신 대한영상의학회 1996 대한영상의학회지 Vol.35 No.1

Purpose : To evaluate the clinical utility of the teleradiology system using the information super highway communication network. Materials and Methods : Two radiologists selected 101 cases of pneumothorax and 20 cases of miliary tuberculosis. There were scanned and transmitted to our hospital at a speed of 640 Kbps and displayed on a video monitor with a resolution of 1280 pixels/line $\times$ 1024 lines. Four radiologists divided into three groups :read the images group A read the images without image processing ; group B read the images with image processing, group C read the radiographic films on the view box. The authors compared sensitivity and specificity between the groups and checked their statistical significance using the Chi-square test. According to the location of the pleural line, we divided the pneumothorax into four types : continve on this live type 1, pleural line confined to the apex ; type 2, to the upper half ; type 3, to the lower half ; type 4, to the upper through lower half. We then compared sensitivity between the Three groups. Results : In the pneumothorax group, the average sensitivity of group A, B and C was 79%, 90% and 96%, and average specificity was 99%, 99% and 94%, respectively. There were statistically significant differences in sensitivity between group A and B and between group B and C (p<0.017).There were no statistically significant difference in specificity between group A and B or between group B and C. In the miliary tuberculosis group, the average sensitivity of group A, B and C was 73%, 78% and 90%, and average specificity was 95%, 95% and 100%, respectively. With regard to sensitivity and specificity, there was no statistically significant difference between group A and B or between group B and C but there was a statistically significant difference between group A and C (p<0.017). According to the location of the pneumothorax, for all types, the sensitivity of group A was less than that of group B and group B was less than that of group C. Conclusion : All groups showed reduced observer performance in the detection of pneumothorax and military tuberculosis when reading a transmitted image on the monitor-workstation compared with reading conventional radiographs on the view box. To improve the clinical utility of the teleradiology system, a higher resolution workstation and adequate image processing are required.

PC (Personal Computer)를 이용한 Emergency Teleradiology (Medical Image Transmission) System의 개발과 응용

김선호,유선국,박성욱,김원기 대한신경외과학회 1994 Journal of Korean neurosurgical society Vol.23 No.8

In the clinical practice of neurosurgery, there are frequent needs which require urgent communication between housestaff and attending physician due to the emergency situation But, the traditional methods such as telephone communication were not sufGcient and sometimes, result in misjudgment of patient's status. So, our research team develop the computer sottware which can be used for emergency surgical and medical decision making This software can transmitted the high quality images of CT, MRI and other X-ray with the conventional telephone line and personal computer system.