By Dr CK Lim, Consultant Radiologist, Head of Radiology Department, Queen Elizabeth Hospital, Kota Kinabalu, Sabah

Professor Margulis’s very insightful article entitled Radiology into the Millennium is closer to home than we think. Right here in Malaysia, teleradiology is no longer something we read about in the more developed countries.

We report the early experience of teleradiology in the vast territory of Sabah. Here, with the shortage of Radiologists, teleradiology is targeted to “bring” the cases from remote areas to the main Radiology “hub” in Kota Kinabalu. Time is of the essence in some cases where decisions have to be made quickly to ensure the patient gets the right treatment as soon as possible.
 

Teleradiology is one of the components of the Multimedia Super Corridor – Kementerian Kesihatan Malaysia (MSC-KKM) teleconsultation project. It became fully operation in Sabah in March 2002. 

The teleconsultation network in Malaysia consists of 41 sites throughout the country except the state of Sarawak. In the state of Sabah, it links 4 district hospitals namely in Semporna, Beluran, Ranau and Kudat to the hub at Queen Elizabeth Hospital (QEH).
 

All these 4 district hospitals are equipped with state of the art equipment as well as a high end workstation to view x-ray images. 

The software is a Windows-based system designed and developed by Worldcare Health (Malaysia) Sdn. Bhd. , which is also providing the technical maintenance and training need. 

All these sites are connected using Integrated Switched Digital Network (ISDN) lines.
 

In Sabah, Teleradiology service is made available 24 hours a day to the 4 district hospitals. It is not designed to be a film reporting system but more for consultation on problem and difficult cases. The district medical officers are encouraged to refer radiographs for radiologist opinion so as to assist them in managing the patients. 

In the first 5 months (March to July 2002) of the service, there were a total of 90 cases referred for radiologist opinion. The radiographs referred for opinion included chest radiographs, which formed the majority (about 70%), abdominal radiographs, skeletal radiographs and a few intravenous urograms. These cases were from a variety of medical disciplines (Medicine, Surgery, Orthopaedic Surgery, Paediatrics). 

There were also 5 referrals from Queen Elizabeth Hospital (QEH) to Hospital Kuala Lumpur for Neurosurgical Opinion and one each for Urology and Hepatobiliary Surgical opinion based on CT (computed tomography) scans performed in QEH.
 

The radiologists in QEH found the quality of the digitized images of diagnostic value. However, there are plans to study this more carefully with sampling of original films from the district hospitals that were transmitted to QEH. It is important that there is no significant loss of detail on the digitized images so that the Radiologists are able to interpret these referred cases adequately.
 

The obvious benefits of the service are the reduction in time in getting an expert opinion. On average, the 4 district hospitals will get the reply in 6 hours as compared to the other district hospitals that will take an average 2 weeks to do so using the conventional method of sending the radiograph through ambulance service. 

It also helps in cutting down the number of unnecessary referrals to QEH or Hospital Kuala Lumpur. This saves costs, and inconvenience of traveling for the patient.
 

The telecommunications system has to become more reliable as currently, disruptions or “slow” lines can result in transmissions taking several hours to even days! Fortunately most of the time it only takes minutes for the transmission of data (images) from the district hospital to QEH. 

Teleradiology proves promising and hopefully can be fine tuned to the level where the quality of healthcare can be improved and there is maximum utilisation of existing resources.

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Last Updated:
Thursday, 21 August, 2003