Teleradiology Project for

Latvia

Luxembourg
Med-e-Tel, Luxexpo
6-8 April, 2005
Authors & Institutions

E. Stumbris, MD, Riga Municipal Agency “Telemedicine

Centre “, Riga, Latvia;
Z. Baidekalna, Riga Municipal Agency “Telemedicine Centre “,
Riga, Latvia;
I. Eglajs, Latvian Development Institute, Riga, Latvia;
B. Pure, Latvian Development Institute, Riga, Latvia;
W. Ullrich, PhD, European Academy of Interdisciplinary Medicine,
Berlin, Germany;
B. Slabbaert, European Academy of Interdisciplinary Medicine,
Uttwil, Switzerland;
“It’s an amazing invention, but who
would ever want to use one?”
-Rutherford Hayes (in 1882), upon using the telephone for the first
time.
American College of Radiology (ACR) has
developed standards and
recommendations for digital radiography

"Teleradiology is not appropriate if the

available teleradiology system does not
provide images of sufficient quality to
perform the indicated task. When a
teleradiology system is used to produce the
official interpretation there should not be a
clinically significant loss of spatial or
contrast resolution from image acquisition
through transmission to final image display."
PACS benefits:

• Immediate availability of duplicate original images - The

system can immediately produce an exact duplicate of the
image without loss of image definition that results with film.

• Ability to adjust image contrast and other parameters -

Image contrast can be adjusted essentially eliminating the
problems of images being "too light" or "too dark." In
addition, images can be magnified, rotated and flipped,
measurements can be made and the images can be annotated
as needed.

• Increased quality of patient care - The system

automatically enters patient demographic and exam specific
data on every image, and allows instant access to specific
images. The computerized records will be securely archived
on a hospital server. Upon request, the patients' images can
be copied to a CD to give to their PCP.
• Improved communication - "One significant advantage is
the PACS allows radiologists to type in short reports that are
stored digitally and will stay with the images," said Robert
Posteraro, M.D, radiologist on staff at Covenant. "This will
certainly improve communication between physicians, which
can lead to better care for our patients."
• Complete image management - Radiology staff will no
longer be concerned with tracking down files and travelling to
multiple storage areas to retrieve old films. Images will be
accessible at all times and instantaneously retrievable
Goals of Riga Municipal Agency
“Telemedicine Centre”

o development and coordination of telemedicine

development projects in the City of Riga
o development of a single telemedicine network in
Riga
o organisation of practical telemedicine consultations
o attraction of the EU financing and other
international finances to the City of Riga
The Main Directions of the
Development of Telemedicine in the
City of Riga

o teleradiology
o telecardiology
o patient consulting
o telemedicine system in emergency assistance
o telemedicine anti-terror systems
o home telemedicine
o teletraining
Teleradiology Project of Riga city
Goal

To develop the radiological information system RIS,

the medical image arhivation and communication
system PACS and a videoconference system for
Riga City medical institutions that would ensure
linking of the medical institutions through the
Internet and ISDN lines with Latvian hospitals and
competence centres of foreign radiologists.
The Current Situation in Latvia

o decreasing number of qualified medical experts

o necessity of involving qualified external medical
experts in treatment process
o lack of information exchange between Riga’s
hospitals
o the hospitals are partly ready for operation with
digital format ( only part of apparatuses has DICOM
output option )
Teleradiology Project Benefits

o significantly reduced patient consultation time

o substantially shorter time of setting diagnosis
o earlier started therapy of the patient
o reduced period of time spent by the patient in a
hospital
o improved general health condition of residents of
Riga
Tasks of Telemedicine Centre

o financing teleradiology project by using the grant

o attracting additional investments
o renting the teleradiology system to the various
hospitals
o central data storage and technical support service
Advantages of the Renting as the
Method of Project Implementation

o to implement the project in the maximum number

of medical institutions
o to implement the project under the supervision of
the involved municipal department
o to eliminate the activities related to technical
maintenance and service for the hospital
o facilitate the establishment of Telemedicine Centre,
that will provide common data storage and
technical support services
Dynamics of Reduced Costs or Alternative
Income Created by the Project for a
Seven-Year Period for one Hospital

EUR 700,000

EUR 600,000

EUR 500,000

EUR 400,000

EUR 300,000

EUR 200,000

EUR 100,000

EUR 0
1st year 2nd year 3rd year 4th year 5th year 6th year 7th year
Project Implementation will
Reduce

o personnel costs (reduce of the number of radiology

laboratory assistants )
o material costs ( film images )
o costs for storing of digital data in CDs
 Dynamics of Expenditure Created by
the Project for one Hospital

EUR 174,000

EUR 173,000

EUR 172,000

EUR 171,000

EUR 170,000

EUR 169,000

EUR 168,000

EUR 167,000

EUR 166,000

1st year 2nd year 3rd year 4th year 5th year 6th year 7th year
Necessary Hospital Investments

o repair and development of premises for placement

of teleradiology equipment
o installation of ISDN line
o financial investment to cover the additional costs in
first project implementation phase
Teleradiology Project Additional
Costs

o additional expenditures for electricity

o depreciation of capital assets
o payment for rent of teleradiology equipment
o data transfer costs for subscription of ISDN line and
INTERNET line
o purchase of data storage floppy disks
Step-by-Step Implementation of the
Project

o the images fully duplicated by the film images -

half a year period
o decrease duplication of images to 50% - one year
o decrease duplication of images till 20% - one year
o about 5% using films for the rest of the seven year
period
The Income From the Project

o will start with the moment when the digital images

will be duplicated by film images only for 50%
o the initial investments of the hospital will be
justified in 1,6 years
Dynamics of Net Profit Created by
the Project for one Hospital

EUR 450,000

EUR 400,000

EUR 350,000

EUR 300,000

EUR 250,000

EUR 200,000

EUR 150,000

EUR 100,000

EUR 50,000

EUR 0

1st year 2nd year 3rd year 4th year 5th year 6th year 7th year
Riga city teleradiology project for
hospital Gailezers
General Hospital Gailezers
International presentations

“Teleradiology Project for Latvia”

International Hospital, Equipment & solutions
(June 2004, volume30, Nr. 4)
“Telemedicine Development Perspectives in
Latvia” Exhibition and Conference Guide,
LUXEXPO Luxembourg (April 21-23, 2004)

EuroPACS-MIR 2004 in the enlarged Europe

(September 16-18, 2004, Trieste - Italy)
International cooperation:
Charite Berlin Radiologiesches Institut
Charité Campus Charité Mitte
Charite Berlin Radiologiesches Institut
Charité Campus Charité Mitte
Hospital in Wien
Luxembourg Med-e-Tel,
Luxexpo (April 21-24, 2004)
Time: Tele-imaging in Medicine, China
with Europe, April 1, 2005 London,
The Royal Society, Steering Commitee
USA and Canada
Thank You for Your
Attention!

Riga council, Telemedicin agency

Ratslaukums 1, LV-1539, Latvia
Phone: 00371 710 5254
E-mail: egils.stumbris@rcc.lv