Dr Pramod Lonikar, Secretary, Maharashtra State Branch of Indian Radiological & Imaging association and Treasurer, Indian Radiological & Imaging Association, New Delhi shares his insight on the recent development Indian radiology has witnessed.
Teleradiology, a part of broad pecialty of telemedicine, has gone far ahead of its umbrella fraternity in last few years. Teleradiology is interpreting or reporting of images like X-rays, CT scan, MRIs, sonography, Colour Doppler and 2D Echo Studies from remote places. A radiologist sitting at a place away from hospital or clinic interprets
radiological images with help of computers, Internet and specialised software.
From traditional to digital The technique of teleradiology is commercially available worldwide since the 1980s and has evolved over the time with the advancements in technology. In India, initially, use of teleradiology was limited to reporting of CT and MRI cases from home, especially at night times. The Internet connectivity was
slow, specialised software were not commercially available at those times, most machines were not Digital Imaging and Communications in Medicine (DICOM) compatible. These factors limited the growth of the specialty in India, apart from limited expectations of clinicians from radiologists.
Before advent of cross sectional imaging, ultrasonography and colour Doppler, traditional radiology was limited to X-rays, angiographies and some contrast studies which were also part of X-rays. So in emergency room X-rays were most of the times interpreted by clinicians and on next day morning were reported by radiologists. Of-course operations were most reliable mode of diagnosing the diseases. However, technological advancements in sonography, color doppler, CT and MRI broadened the scope of knowledge.
As technology advanced and subspecialities like neurology, nephrology developed, it demanded more expertise from the field of radiology. At this juncture demand of radiologist was on rise. Surgery as a diagnostic tool started becoming an obsolete method. Sonography, color doppler, CT, MRI were more helpful to diagnose more accurately.
These new techniques changed the face of radiology services worldwide. Information Technology was a sunrise sector then, thus, it was natural that India got first-movers
advantages in the field of teleradiology. Skilled manpower, time zone difference for serving emergency hours, cheaper remunerations as compared to their counterparts in USA, UK, and willingness to work on weekends played pivotal role in the development of outsourcing of these services to India. Lexicon Nighthawk “ reporting during night hours has increased as the number of hospitals increased, dayhawk – services during day hours have also increased and created a huge business opportunity.
Serving the un-served
Today, USA, UK and Singapore are the main countries outsourcing to India. Many companies are involved in this enterprise; these are mostly owned by radiologists. Off late some major companies have entered this field, which may lead to a major leap due to funds infusion. Every year there is increase in number of radiologists by two percent whereas demand for radiologists is increasing by 15-20 percent annually. With the increased penetration of health services in India, there is a huge demand for teleradiology services.
Many hospitals cannot afford full time radiology services, so they avail teleradiology services. People in remotest of places can now get expert opinions in diagnostics. Cheaper technology and net connectivity has helped thoroughly. This is a win-win situation for hospitals, patients and radiologists. With increased penetration of health services across India, especially as many big hospital chains expanding their services to tier II and tier III cities, need of teleradiology is bound to increase.
There are no set standards for teleradiology in India. To perform final reporting of a radiology assignment originating from USA, Europe, Singapore, concerned-board certified radiologists are needed. American College of Radiology has formulated a set of norms in this regard. As an Indian context is considered, there are no set norms for in-shore work and there are no any statutory guidelines.
The growth story of India in this domain has been contributed by the private players, though there is a high potential at government level as well. Government hospitals at all levels, from public health centers to district hospitals- are facing scarcity of radiologists and use of teleradiology can benefit in a big way. Government partnership and private players can change the face of healthcare facilities in the remotest place of India. Teleradiology is growing in-shore in India; though the exact size of market is not known it is estimated to be proportionate to growth of healthcare and health insurance sector in the country.