Teleradiology in interstitial lung disease: first experiences

Abstract

Introduction: High resolution computed tomography (HRCT) is essential in the diagnostic algorithm for idiopathic pulmonary fibrosis (IPF). If identifiable causes of interstitial lung disease (ILD) are absent, an HRCT showing a typical usual interstitial pneumonia (UIP) pattern is diagnostic for IPF. Here we report first experiences with a teleradiology-project that offers physicians the possibility for second opinion HRCT read regarding the presence of UIP pattern in patients with suspected IPF. Methods: HRCT were uploaded through a secured internet connection. Only images in original Digital Imaging and Communication in Medicine (DICOM) format were accepted. HRCTs were assessed by a radiologist and a pulmonologist, both experienced in the diagnosis of ILD. According to current guidelines each HRCT was rated showing either typical UIP pattern, possible UIP pattern, or being inconsistent with UIP pattern. Results: Between March 2015 and January 2017 we received 160 HRCTs for a second opinion read from physicians in 10 different Eastern European countries. All images were of diagnostic quality. In 58/160 (36%) patients a typical UIP pattern was diagnosed, possible UIP pattern was detected in 27/160 (17%), and in 75/160 (47%) patients the prevailing pattern was considered as inconsistent with UIP. Conclusions: Our data demonstrate a useful application of teleradiology to provide expert reading of HRCT in patients with suspected IPF, particularly when local radiological expertise is limited. This project is not intended to replace local multidisciplinary panels, but to support local panels by providing specific expertise. More experience will be needed to define the role of teleradiology in patients with suspected IPF.