INS turns to digital X-ray system

INS turns to digital X-ray system

Telemedicine service speeds screening of illegal aliens for tuberculosis at centers across the country


The Immigration and Naturalization Service is building a telemedicine system that lets doctors in Baltimore screen X-rays for signs of tuberculosis in illegal aliens at INS centers around the country.

The change from film to digital X-rays has reduced the wait for screening from as long as three days to a matter of hours.

'The guideline is four hours, but they're doing it much faster than that, often within one hour,' said Geralyn Johnson, chief operating officer for the Public Health Service's Immigration Health Service.

By using digital X-ray equipment, INS can screen detainees for signs of tuberculosis within hours.
Digital Imaging Acquisition Networking Associates of Severna Park, Md., a telemedicine service provider, is supplying and operating the screening system under a multimillion-dollar contract with the Public Health Service.

Subcontractor WAMnet global healthcare, a division of WAMnet Inc. of Eagan, Minn., provides the managed network and archives the digital X-rays.

IHS began testing teleradiology at the INS center in Port Isabel, Texas, in 1999. It now is moving digital X-ray equipment and network connections into six more centers.

Eventually, 11 INS centers will use the screening system in response to the re-emergence of tuberculosis, Johnson said. Because about 20 percent of detained aliens eventually are released into the United States, limiting their exposure to TB while at INS centers is a public health matter.

About 5,000 illegal aliens await deportation hearings at INS facilities at any one time, and another 15,000 are held in local, state and federal jails. IHS screens those at INS centers for infectious disease, but because their stays often are short, the usual TB tests have sometimes failed to detect infected persons in time to isolate them.

'We decided to do this when the Centers for Disease Control and Prevention recommended chest X-rays as a way to screen' about three years ago, Johnson said. 'Radiologists are very expensive,' so the X-rays had to be shipped to a medical center for evaluation, taking as long as three days.

Before setting up its own teleradiology network, 'we tried to partner with a lot of other people,' Johnson said. 'We had a long list of reasons why it didn't work.'

Finding the right fit

They first tried the military, which had 'so much red tape,' Johnson said. The health service offered to reimburse the Air Force for handling the X-rays, but the Air Force had no way to accept payments. The Army 'moved too slowly,' Johnson said. 'It never developed.'

When DIANAssociates set up the first pilot in Port Isabel in 1999, X-rays were transmitted to a Veterans Affairs Department medical center in Milwaukee. But it was not open 24 hours a day and could accept only a limited number of images.

Detainees at the El Centro, Calif., INS facility must be checked for TB before being released.
Last August the health service began using the University of Maryland Medical Center in Baltimore, which is available 24 hours, seven days a week, and accepts an unlimited number of images. The Maryland facility will evaluate X-rays from all 11 INS centers.

'We can have good quality control if we work with only one site,' Johnson said.

The digital X-rays are captured with the ddRChest-System from Swissray International Inc. of Elmsford, N.Y. DIANAssociates transmits the X-rays via the Diagnostic Imaging Communications (DICOM) protocol for medical imaging.

The 10M DICOM images go over a Fast Ethernet connection to the WAMnet network without compression. 'The American College of Radiology does not endorse compression algorithms,' said John Bremer, chief executive officer of DIANAssociates.

X-rays are viewed without processing on Swissray's SwissVision workstations under Microsoft Windows NT 4.0. Each workstation has 256M of RAM and a 21-inch monitor.

The INS centers have T1 links to WAMnet points of presence, and the University of Maryland center has multiple T1 connections. WAMnet owns parts of its secure managed network, leasing other parts from telecommunications providers.

WAMnet's roots are in the graphics industry, but the growing use of digital imaging in radiology and cardiology has made health care a promising niche market, said Mark Hunter, general manager of the company's global healthcare division.

Patient information goes along with the digital image, eliminating the need to fax patient information. The images will be archived and managed for at least three years at WAMnet's data center near St. Paul, Minn., where INS doctors and contractors can access them online.

In addition to the INS facility at Port Isabel, centers at El Centro, Calif., El Paso, Texas, Florence, Ariz., and New York City have linked to the teleradiology network. Centers in Miami and Buffalo, N.Y., will go online soon.


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