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Judging technology based on the good it accomplishes.

Dr. Philip Kline is not a technical man when it comes to telecommunications technology, but he knows what he likes.

What he likes is basic rate ISDN.

"What does ISDN stand for anyway?" he asks in the middle of an interview about how his radiology group, M&S Imaging Associates, is using the Integrated Services Digital Network. The long form of the acronym means little to him, but what 128 kb/s of bandwidth can accomplish means a lot.

Kline's radiology group of 13 technicians is connected to five hospitals in San Antonio, Texas, using equipment from Telrad and basic rate service from Southwestern Bell. They transmit and receive medical images--X-rays, computerized tomography (CT) scans, magnetic resonance imaging (MRI) and ultrasound.

The basic application hasn't changed in the five years that M&S Imaging Associates has been moving images, but the speed and resolution of the images has vastly improved in the six months that ISDN has been at work.

In 1988 the radiologists began using Image Data Photophones, with 12inch screens. They received images over analog lines at very low bit rates. An image would fully transmit in about five minutes.

"We were thrilled, because it meant we could cover three or four hospitals. One person could cover all of them in the hours between 5 p.m. and 7 p.m. He could do most of the imaging work without leaving the office," Kline notes. It was clearly preferable to keeping several technicians on call to travel to the hospitals and read images there.

"It meant much better service to the hospitals and patients," Kline adds. "That system worked fine, and in the months that followed, the number of films we were reading increased. We added another hospital, and pretty soon instead of getting just one or two calls a night, we were up to 18."

Most of those calls came between 5 and 10 p.m., when people are out and about and health emergencies are more likely. As the number of hospital requests increased, the technological limits of the equipment became apparent. That formerly acceptable five minutes of transmission time meant hospitals were running into busy signals when they tried to send images, and during the transmission the technician was unavailable for a voice call.

"We told the company we needed a faster system. It seemed they had the technology, but we didn't have the phone lines. They were able to increase the baud rate a little, and gave us an upgraded computer with a 19inch screen. We were happy with the small advance until one of our partners, who has a background in electrical engineering, began to discuss all this with the company," Kline explains.

That led to installation of ISDN lines, and the result "is a miracle," Kline declares. "We now get virtually instantaneous transmission. A digitized image comes through in five seconds. They can send us higher-resolution images of such things as chest X-rays or bone film if they need to, and it's still a fast process."

The radiologists use Telrad IDS 286 voice-data station sets. The sets allow voice on one B channel and data on the other. Data moves via the station set's RS-232 port to the Image Data Photophone, a PC-like device with a large screen.

Do the 1,000-by-750-line screen and ISDN's cleaner transmission really provide good enough images to make important medical judgments?

Kline says they do, at least with the CT scans, MRI and ultrasound images. For X-rays, he says the resolution falls short. For them, he'd like to see about a fourfold improvement.

"We need higher resolution on X-rays to catch subtle things. So we try to let our emergency room friends know we would rather defer on those and read them live," Kline says. That isn't a real problem, he explains, because most of the time an X-ray is for a less critical situation. A CT scan, on the other hand, may be from a stroke patient who really benefits if treatment can be started in a few minutes.

Most radiologists in the group have ISDN lines to their homes, where they maintain their offices. Kline says they use half the line (one B channel) for the image transmission and the other for voice communication. That enables a

technician to discuss images with the hospital medical staff as they arrive.

"The big advantage isn't just access in remote locations," Kline observes. "It is also access during bad weather. Snow and ice. or flooding, can keep a doctor from getting to the hospital and that can be solved with a system like this.

"In San Antonio, occasionally we get snow and ice, and Texas isn't prepared for that kind of weather. Also, in weather like that you're bound to see trauma. That is where the system becomes nearly indispensable. If there is nice weather, you could always drive to the hospital and see an X-ray live."
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Copyright 1993 Gale, Cengage Learning. All rights reserved.

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Title Annotation:integrated services digital network communication in San Antonio hospitals
Author:Tanzillo, Kevin
Publication:Communications News
Article Type:Column
Date:Oct 1, 1993
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