Teleradiology a boon for Arizona's rural communities
Dr. Kai Haber holds up an X-ray from the 1940s, a time when X-rays were placed on thick glass plates. Bethany Conway photo

Advances in medical technology allow specialists at University Medical Center to diagnose radiological images sent over the Arizona Telemedicine Network from hospitals on the Hopi, Navajo and Apache

reservations.

The technology can be traced back to the University of Arizona Radiology Department and the work of Dr. Terry Ovitt, Dr. Sol Nudelman and Dr. Paul Capp in the early 1970s.

“That group of physicians developed digital radiography – the whole process behind it,” said Dr. Elizabeth A. Krupinski, a professor in the University of Arizona departments of radiology and psychology and the Arizona Telemedicine Program’s associate director for evaluation. “Unfortunately we didn’t patent it, but we developed it all here and we’re one of the main groups in promoting digital radiography and in developing the computer work stations that go along with viewing the images.”

Due to its digital nature, radiology simply lends itself to the field of telemedicine – a rapidly developing trend in which the transfer of digital images allows doctors to work from afar. Through an association with the Arizona Telemedicine Network, the university’s teleradiology program provides services to more than 20 sites across the state. Described as “the 500-pound gorilla” on the Arizona Telemedicine Program’s network, the program sees more than 100,000 cases a year, roughly 90 percent of all telemedicine cases.

A man walked into the emergency room at Whiteriver Hospital on the White Mountain Apache Reservation recently, expressing concern because he had been progressively losing his voice. Years ago, doctors would have taken X-rays, asked him to come back in a week and sent the images to Phoenix by truck.

This time, a CAT scan was performed and doctors sent the images digitally to the UMC Radiology Department. Thirty minutes later, they had their answer.

“Unfortunately, this man had a large cancer growing in the back of his mouth at a dangerous level,” said Dr. David Yost, clinical director of Whiteriver Hospital. “We were able to get him on an airplane and send him to Phoenix where specialists were able to attend to him within 24 hours.”

The man, a single example of how teleradiology has changed clinical medicine in Arizona’s rural communities, is now undergoing multiple procedures in Phoenix.

“The availability of the telemedicine allowed us to get him to a place where he was stabilized and had the ability to think rationally about what he was going to do next,” Yost said.

From emergency CT scans to ultrasounds, the wait time for results has gone from days or weeks to minutes.

“Teleradiology allows for accurate and efficient interpretation of the images so the information gets back to the primary-care physician and he or she can treat the patient in a more timely manner,” Krupinski said.

In Arizona, the practice of teleradiology began with a pilot program in Globe in 1997. Soon after, the UMC Radiology Department signed a contract with the Navajo Nation in 2003.

“We went from doing three or four cases a week to doing 100,000 cases a year almost overnight,” said Dr. Kai Haber, director of teleradiology at the University of Arizona.

As the program grew, other hospitals, including those on the Hopi, Zuni and Apache reservations, followed suit. Haber said that at one point, the university was the largest teleradiology provider in the United States. Today, private providers have a hold on the market, but the university’s program still stands out due to its academic nature.

“It really is one of the leading (teleradiology programs) in the country,” Krupinski said. “It was one of the first ones, and for an academic medical center, we are doing a high volume of cases.”

Today, it is the workstation that continues to evolve.

“Instead of viewing images on big computer work stations, people are talking about reading certain types of images on iPads,” Krupinski said.

Haber added that there is even the potential for viewing certain images over mobile phones.

There probably will be further advances in the future that could replace these lengthy trips, Krupinski said.

“Way in the future is certainly the possibility of trying to do more complicated things such as interventional radiology,” she added.

In the meantime, Haber said the teleradiology team will continue offering residents of some of the most remote areas of Arizona the same radiology emergency service provided at urban hospitals.