title: Using the Internet for image transfer in a regional trauma network: effect on CT repeat rate, cost, and radiation exposure.
abstract: OBJECTIVE
  The aims of this study were to evaluate an Internet-based and compact disc-based image transfer system and to compare this system with others in the literature, specifically regarding effects on repeat imaging rate, cost, and radiation dose to patients transferred to a level I regional trauma center.
  
  
  METHODS
  Five hundred consecutive trauma patients transferred to a level I trauma center between June 1 and July 15, 2009, were included in the study. Images were transferred from an outside facility to the trauma center using the Internet and compact discs and uploaded to the trauma center's PACS. Radiographic studies and CT scans at the trauma center were classified as outside studies, completion studies, or repeat studies. Repeat rate, costs, and radiation doses of transferred and repeated CT scans were calculated.
  
  
  RESULTS
  Four hundred ninety-one patients met the inclusion criteria. The patients' average age was 40.5 years, and 70% were men. The average Injury Severity Score was 14.7. Three hundred eighty-three patients had 852 CT studies and 380 nonextremity radiographs imported into the trauma center's PACS. At the trauma center, 494 completion CT scans and 2,924 radiographic studies were performed on these patients. Sixty-nine repeat CT scans were performed on 55 patients, equalling a 17% repeat rate. The total value of imported CT studies was $244,373.69. Repeat imaging totaled $20,495.95, or $84.65 per patient with transferred CT studies.
  
  
  CONCLUSIONS
  Using a combination of the Internet and compact discs to transfer images during inter-hospital transfer is associated with much lower repeat rates than those in the literature, suggesting that regional PACS networks may be useful for reducing cost and radiation exposure associated with trauma.
authors.affiliation: Department of Radiology, Santa Clara Valley Medical Center, San Jose, California, USA.
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Flanagan
authors.forename: Annemarie
authors.initials: A
authors.lastname: Relyea-Chew
authors.forename: Joel A
authors.initials: JA
authors.lastname: Gross
authors.forename: Martin L
authors.initials: ML
authors.lastname: Gunn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000413:Alaska; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D016250:Compact Disks; D017046:Cost Savings; D005260:Female; D006801:Humans; D007061:Idaho; D007223:Infant; D007231:Infant, Newborn; D015601:Injury Severity Score; D020407:Internet; D008297:Male; D008491:Medical Informatics Applications; D008875:Middle Aged; D009009:Montana; D010360:Patient Transfer / Q000191:economics / Q000706:statistics & numerical data*; D011829:Radiation Dosage; D011873:Radiology Information Systems / Q000458:organization & administration*; D019233:Retreatment / Q000191:economics / Q000706:statistics & numerical data; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers; D019564:Unnecessary Procedures / Q000191:economics / Q000706:statistics & numerical data; D014861:Washington