Trends and Insights Into Orthopedic Teleradiology: Q&A With Radiologist Douglas Smith

Written by Renee Tomcanin | June 16, 2010 | Print  |
Douglas Smith, MD, is the founder and owner of Musculoskeletal Imaging Consultants, a national teleradiology company specializing in musculoskeletal imaging. Dr. Smith trained in orthopedic surgery at Mayo Clinic in Rochester, Minn., before pursuing a radiology residency training at the Mallinckrodt Institute at Washington University in St. Louis.

Q: What benefits can teleradiology and digital imaging/radiology provide for orthopedic and spine surgeons?

Dr. Douglas Smith: During my orthopedic residency training at the Mayo Clinic I learned the necessity of a close working relationship with a trusted musculoskeletal radiologist (MSKR). When my professor had a question, I was dispatched to review an x-ray with our MSKR on a lighted Viewbox. Our MSKR marked the pertinent findings on the films for our use during surgery. At times I would have to search throughout the hospital to locate him or would discover that he was not available that week and we would postpone the surgery. At other times we would ask our MSKR to come to the operating room to help with imaging correlation with difficult anatomy. Most surgeons consider this close working relationship critical to their practice and resist anything that might jeopardize this relationship. Most surgeons are surprised to learn that teleradiology makes this relationship more geographically flexible and easier to access, thus enhancing rather than threatening it. As a surgeon, I recognize the importance of an accurate detailed report from a radiologist I know and trust. A surgeon in a busy practice must have immediate access to images and reports from multiple imaging centers. Time and ease-of-use are priceless features in a teleradiology interface.


I designed the MSKIC Virtual Viewbox method to reproduce the experience of two physicians reviewing a case on a light box without the need for you to chase throughout the hospital to find the radiologist. Using Virtual Viewbox, your personal MSKR is reviewing the images with you within 60 seconds of clicking the icon on your desktop. You can move the mouse and your MSKR can annotate images and even dictate the report or an addendum while you are consulting. The finalized report reflecting your consultation is immediately available. You can even use Virtual Viewbox while you are sitting with your patient in your exam room. If a question arises in the operating room, you can access the report and the annotated images attached to the report on your cell phone or anywhere you have internet access using HIPAA compliant, encrypted server access.

If your practice an in-office MRI unit, MSKIC teleradiology can provide the technological support for imaging sequence design and monitoring for image quality over time. If you are in a medical environment where your local radiology group is unwilling to read your scans or does not have the technical and strategic, MSK I see can provide expert reading. In changing climate for ownership rules for in-office MRI units, having a relationship with a teleradiology company may provide some options depending on the results of current legislative changes.

Q: In addition to Virtual Viewbox, what are some technological advances in radiology that you and MSKIC are currently using that have improved teleradiology for patients and physicians?

DS: eRAD "Practice Builder" software was specifically designed to meet your needs as a surgeon. Gathering x-ray film and reports from imaging facilities for each patient is time consuming and expensive for your practice. eRAD receives reports and images for each of your patients from multiple centers and collates the information into a single, Internet-accessible listing for each patient saving you by able time and money. MSKIC uses state-of-the-art voice recognition technology so finalized reports are available to you within minutes of completion of the exam. The salient images are annotated and attached to the finalized reports so you don't have to sort through images to find the key images. This also simplifies the insurance verification process. The appearance of the reports conveys to your patients that you are a center of excellence in orthopedic and spine surgery. You also have an option to receive reports directly into your electronic medical records system using HL7 technology. Most of our clients keep our eRAD software open on their computer in the clinic. At your request, our server will send you an e-mail notification when you have a report to review. With a click of the mouse, the report and annotated images are ready for review or printing. MSKIC uses secure, HIPAA-compliant e-mail and instant message technology to ensure patient security during communication of confidential patient information.

Q: What do you see on the horizon as far as the future of radiology and teleradiology? Do you expect more orthopedists and other surgeons to move toward using teleradiology?

DS: There is and upcoming physician shortage crisis will produce an additional shortage of experienced orthopedic and spine radiologists. Some imaging centers may be tempted to use less expensive newly trained or general radiologists or to outsource imaging studies to send their images to India for reading. Teleradiology will allow practices access to seasoned musculoskeletal radiologists and provide important business options for practices owning MRI scanners in the evolving climate of self-referral regulations.

I also predict very little use of film going forward, because printing, delivering and archiving film is slow and expensive. As more surgeons experience the speed and convenience of teleradiology and Virtual Viewbox consulting, reliance on x-ray film will decrease dramatically. Surgeons will quickly expect the high level of service only available from state-of-the-art teleradiology companies like MSKIC.

Q: What should orthopedic and spine practices look for in a teleradiologist or radiology group to ensure they are receiving the highest quality for their patients and their money?

DS: Practices should ask if they will have a seasoned, dedicated musculoskeletal radiologist assigned to their practice or if their studies will be farmed out to a pool of radiologists. Can they interactively review their studies with their radiologist? They should ask how long their images and reports are available online, and if reports can be delivered directly to their EMR using HL7 technology. They should ask if their radiologists will all be trained in the United States and have sufficient experience in the field. They should ask for the prospective teleradiology company to dictate some test cases to sample the quality of the readings and the reports. MSKIC offers a free Virtual Viewbox consultation. Call me and we can do an online case consultation together. Let me show you how the future of teleradiology is practiced at MSKIC today.

Learn more about Musculoskeletal Imaging Consultants.

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