................................................................................................................................. .............................................................. .............................................................. EDUCATION & PRACTICE Technology Q Teleradiology in an inaccessible area of northern India Amit Char, Arjun Kalyanpur, V N Puttanna Gowda, Anjan Bharathi and Jasbir Singh Teleradiology Solutions Pvt. Ltd, Bangalore, India Summary Teleradiology can be used to provide health care to rural populations, especially where there is a scarcityof resources, including on site radiologists. We have established a network link between acommercial teleradiology provider in Bangalore, south India and the Ramakrishna Mission Hospital (RKMH), located at over 3000 km away in the north east of India. Image files were transferred to Bangalore via an ADSL connection using secure file transfer protocol. In the 12-month period beginning in August 2007, atotal of 962 studies was sent to Bangalore from the RKMH. The average turnaround time for the report to reach the hospital once the images had been received in Bangalore was 6 hours for non-emergency cases. For emergency cases the turnaround time was consistently below 30 minutes. Because the RKMH was a charitable institution providing rural patients with free or low cost treatment, no charge was made for the reporting. Our experience demonstrates that remote implementation of teleradiology is possible in rural India. The service has proved valuable for the remote hospital concerned. Introduction Much has been written about the value of teleradiology for rural populations, especially where there is a paucity of technical, IT and medical resources, including on site radiologists. 1–3 The challenge is to incorporate effective and secure methods of image and radiology report transmission for rural populations. Our experience at Teleradiology Solutions concerns the Ramakrishna Mission Hospital (RKMH) which is located in Arunachal Pradesh, over 3000 km away from our organization in Bangalore, south India. Arunachal Pradesh is a state in north east India with an area of 84,000 km 2 . It is predominantly mountainous and relatively inaccessible, and has a mainly rural population of over 1 million. The RKMH is located in the state’s capital and is a referral hospital for the entire state. The hospital has the only CT scanner in the whole of Arunachal Pradesh. Although there was one qualified radiologist at the RKMH, there were large numbers of cases, particularly computerised tomography (CT) cases and no other radiologists on site to share the workload. To cope with the excess caseload, we set up a low-cost teleradiology system which allowed transfer of images and reports between the RKMH and Teleradiology Solutions. This paper reports the experience of the first 12 months. Methods To facilitate the transmission of data between the two sites, we were given access to a PC at the hospital. All settings were done remotely from Bangalore using remote access software (VNC). 4 Computer maintenance including anti-virus scanning, fine tuning and cache deletion, were all done from Bangalore. At the request of the on-site radiologist, the radiographers at the RKMH could transmit DICOM CT images to Bangalore as soon as the scan was complete. Images were sent in the form of compressed ZIP files by secure-file transfer protocol (sFTP) using the FTP client in Internet Explorer. Data were transmitted via a 256 kbit./s ADSL (asymmetric digital subscriber line) connection. Patient information including clinical details was entered into the Radiology Information System (RIS) by the radiographers which enabled a case-list to be generated (Figure 1). In Bangalore, we used the eFilm software (Merge Healthcare) for DICOM image viewing. After reporting in Bangalore, the reports (Figure 2) were sent back to the RKMH using the same RIS by the radiologists in Bangalore. The RIS system was configured to generate a final report from the details entered into the RIS (Figure 2). Requests for preliminary reports for emergency cases or notifications of failed image transmission were communicated by telephone or by encrypted email. Accepted 13 October 2009 Correspondence: Dr Amit Char, Medical Physics, A Floor, West Block, Queens Medical Centre Campus, Derby Road, Nottingham NG7 2UH, UK (Fax: þ44 115 970 9732; Email: dr.amitchar@gmail.com) Journal of Telemedicine and Telecare 2010; 00: 1–4 DOI: 10.1258/jtt.2009.009007 JTT-09-RW-07