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DOI: 10.1055/s-0043-1771379
A Teleradiology System for Early Ischemic and Hemorrhagic Stroke Evaluation and Management
Abstract
Purpose Stroke is a cardinal cause of death and disability globally. It is an emergency condition where the rapidity of diagnosis is directly linked to the outcome. “Imaging is Brain” is, therefore, an important concept. The early diagnosis of stroke is crucial not only in guiding its effective treatment but also in estimating prognosis. This study aims to provide perspective on the implementation of international teleradiology in stroke evaluation, management, and care.
Methods A dedicated international teleradiology stroke network has been evaluated in our study between March 2019 and July 2022 where the interpretation and analysis of the computed tomography (CT) scans of the patients from distant hospitals in United States were performed by teleradiologists via high-quality Digital Imaging and Communications in Medicine (DICOM)-image transfer through a cloud-based radiology information system/picture archival and communication system platform RADspa.
Results Over a period of three and a half years, starting from March 2019, a total of 30,406 CT scans of 19,342 patients from 96 hospitals of 15 states in the United States were interpreted and reported by board-certified radiologists empaneled by Teleradiology Solutions. The mean report turnaround time for all noncontrast CT studies was 9.97 minutes at 95% confidence interval (CI: 9.89–10.05); for CT angiogram studies, it was 20.57 minutes 95% CI (20.38–20.77); and for CT perfusion studies, it was 13.72 minutes 95% CI (13.42–14.03).
Conclusion A dedicated international teleradiology stroke network designed in our study allowed for transmission, prioritization, evaluation, and management of CT cases performed in the setting of acute stroke in the study population. The results of our investigation indicate that teleradiology provides an effective solution for early diagnosis/interpretation of CT examinations performed internationally in the setting of acute stroke. This may further be used as a model or template for the development of a nationwide stroke network within our own country.
Ethical Approval
This retrospective study has been approved by the institutional review board (IRB).
Publication History
Article published online:
25 July 2023
© 2023. Indian Society of Vascular and Interventional Radiology. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)
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References
- 1 Feigin VL, Brainin M, Norrving B. et al. World Stroke Organization (WSO): Global Stroke Fact Sheet 2022. Int J Stroke 2022; 17 (01) 18-29
- 2 GBD 2019 Stroke Collaborators. Global, regional, and national burden of stroke and its risk factors, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Neurol 2021; 20 (10) 795-820
- 3 Jones SP, Baqai K, Clegg A. et al. Stroke in India: a systematic review of the incidence, prevalence, and case fatality. Int J Stroke 2022; 17 (02) 132-140
- 4 Accessed July 3, 2023 at: https://www.dailypioneer.com/2018/columnists/india—s-stroke-epidemiology.html
- 5 Aho K, Harmsen P, Hatano S, Marquardsen J, Smirnov VE, Strasser T. Cerebrovascular disease in the community: results of a WHO collaborative study. Bull World Health Organ 1980; 58 (01) 113-130
- 6 Types of Stroke and Treatment. Accessed July 3, 2023 at: https://www.stroke.org/en/about-stroke/types-of-stroke
- 7 Akbarzadeh MA, Sanaie S, Kuchaki Rafsanjani M, Hosseini MS. Role of imaging in early diagnosis of acute ischemic stroke: a literature review. Egypt J Neurol Psychiat Neurosurg 2021; 57 (01) 175
- 8 Advani R, Naess H, Kurz MW. The golden hour of acute ischemic stroke. Scand J Trauma Resusc Emerg Med 2017; 25 (01) 54
- 9 Di Stefano V, De Angelis MV, Montemitro C. et al. Clinical presentation of strokes confined to the insula: a systematic review of literature. Neurol Sci 2021; 42 (05) 1697-1704
- 10 Puig J, Shankar J, Liebeskind D. et al. From “Time is Brain” to “Imaging is Brain”: a paradigm shift in the management of acute ischemic stroke. J Neuroimaging 2020; 30 (05) 562-571
- 11 Accessed July 3, 2023 at: https://timesofindia.indiatimes.com/blogs/voices/how-artificial-intelligence-and-teleradiology-can-be-used-for-early-stroke-diagnosis/
- 12 Birenbaum D, Bancroft LW, Felsberg GJ. Imaging in acute stroke. West J Emerg Med 2011; 12 (01) 67-76
- 13 Bashshur RL, Krupinski EA, Thrall JH, Bashshur N. The empirical foundations of teleradiology and related applications: a review of the evidence. Telemed J E Health 2016; 22 (11) 868-898
- 14 Mitchell JR, Sharma P, Modi J. et al. A smartphone client-server teleradiology system for primary diagnosis of acute stroke. J Med Internet Res 2011; 13 (02) e31
- 15 Demaerschalk BM, Vargas JE, Channer DD. et al. Smartphone teleradiology application is successfully incorporated into a telestroke network environment. Stroke 2012; 43 (11) 3098-3101
- 16 Pohjonen H, Ross P, Blickman JG, Kamman R. Pervasive access to images and data–the use of computing grids and mobile/wireless devices across healthcare enterprises. IEEE Trans Inf Technol Biomed 2007; 11 (01) 81-86
- 17 Konduru SST, Ranjan A, Nallajerla JS. et al. Study of symptoms, risk factors and prescribing patterns in cerebral stroke patients. Indian Journal of Pharmacy Practice 2017; 10 (01) 20-26
- 18 Chinda B, Medvedev G, Siu W. et al. Automation of CT-based haemorrhagic stroke assessment for improved clinical outcomes: study protocol and design. BMJ Open 2018; 8 (04) e020260
- 19 Mullins ME, Lev MH, Schellingerhout D, Gonzalez RG, Schaefer PW. Intracranial hemorrhage complicating acute stroke: how common is hemorrhagic stroke on initial head CT scan and how often is initial clinical diagnosis of acute stroke eventually confirmed?. AJNR Am J Neuroradiol 2005; 26 (09) 2207-2212
- 20 Chen RJ. Wei G, Dense MCA Sign. Journal of Education and Teaching in Emergency Medicine Published online 2017
- 21 Lakomkin N, Dhamoon M, Carroll K. et al. Prevalence of large vessel occlusion in patients presenting with acute ischemic stroke: a 10-year systematic review of the literature. J Neurointerv Surg 2019; 11 (03) 241-245
- 22 Pop NO, Tit DM, Diaconu CC. et al. The Alberta Stroke Program Early CT score (ASPECTS): a predictor of mortality in acute ischemic stroke. Exp Ther Med 2021; 22 (06) 1371
- 23 Trongnit S, Reesukumal K, Kost GJ, Nilanont Y, Pratumvinit B. Reducing laboratory turnaround time in patients with acute stroke and the lack of impact on time to reperfusion therapy. Arch Pathol Lab Med 2023; 147 (01) 87-93
- 24 Eigles S, Panughpath SG, Kalyanpur A. Enhancing turn-around-time (TAT) on stroke protocol head CT reports via continuous quality improvement (CQI) methodology in a busy teleradiology practice. Am J Exp Clin Res 2015; 2: 102-104
- 25 Solenski NJ. Telestroke. Neuroimaging Clin N Am 2018; 28 (04) 551-563
- 26 Accessed July 3, 2023 at: https://dghs.gov.in/content/1363_3_NationalProgrammePreventionControl.aspx#:~:text=The%20Government%20of%20India%20has,under%20the%20National%20Health%20Mission