Radiology on Cruise Ships

Cruise ships have different operational requirements to land-based clinics. Space for radiology facilities is particularly restricted, and bandwidth is extremely limited too. In addition, satellite connectivity can mean loss of intermittent internet connection depending on ship’s location and local weather conditions. Furthermore, intuitive user experience is especially important as the equipment is not in constant use.

Fortunately, radiology equipment has come a long way since the days of film and chemistry, and tele-radiology has matured and improved. This guide will assist cruise ship staff responsible for installing or upgrading shipboard radiology / teleradiology facilities.

The STCW 2010 Manila amendments mandate a high standard of shipboard care and a “prearranged system that medical advice by radio or satellite communication to ships at sea is available at any hour of the day or night.” American College of Emergency Physician (ACEP) guidelines mandate medical staff on call 24 hours a day, and both physicians and registered nurses must have at least three years of post-graduate experience in general and emergency medicine or board certification in emergency medicine, family medicine or internal medicine.

There are three important items to consider when modernizing cruise ship x-ray radiology systems:

• Image acquisition – the x-ray equipment itself
• Teleradiology – secure image transfer and report return
• Remote reporting – reporting of images and radiologist advice

Cruise Ship Remote Reporting

Instead of specialist remote reporting providers, most cruise companies make use of the hospital or centre that provides many other non-radiology facilities to the company, such as medical / nurse / technician training or pathology services to give just a couple of examples. We recommend continuing with this arrangement in most cases, in order to benefit from the continuity of pre-existing relationships.

Be cognizant however that the hospital may have internal factors to consider, such as:

• public health provision vs private reporting for your company
• radiologist contracts for private work or for out-of-hours reporting
• extent of the hospital’s medical negligence cover vs that provided by the radiologist

You can make it easier for the hospital to handle these internal factors by providing clear data on number of exams ‘in hours’ and ‘out of hours’ of the hospital’s timezone.

Cruise Ship Teleradiology

Use a system independent of your x-ray provider, but also independent of your reporting provider, in order to maintain business flexibility.

From a technology perspective, the system must be secure, but not be dependent on VPNs as they don’t work well over intermittent connections, and must be proven to work over high-latency satellite connections. It should also have zero on-site installation needed, so you can roll it out without the project management overhead of having to also co-ordinate ships’ docking schedules. Finally, for medically disembarked passengers, a system that allows transfer any site worldwide without special intervention or setup is optimal.

bbRad Serverless is strongly recommended for cruise ships’ teleradiology because:

• it’s a proven solution, as demonstrated by Carnival, the world’s largest line
• it works with any x-ray provider and any remote reporting provider
• ship staff can connect and share with any hospital without any supplier involvement
• your project team can roll out remotely with minimal effort
• it works on low-bandwidth, high-latency satellite connections without using VPNs
• it is fully secure and supported with all required information governance controls

Finally, if your healthcare provider doesn’t offer a reporting service, you would also use bbRad to exchange images and reports with independent radiologists or specialist remote reporting providers.

CR or DR Imaging Equipment

The biggest space savings come from DR (Digital Radiography) where the image is captured directly onto a flat panel detector without the use of a cassette. CR (Computed Radiolography) involves the use of a cassette that houses the imaging plate similar to traditional film-screen systems, but CR can still be surprisingly compact.

The usual provisions for limiting the risk of radiation exposure at the workplace still apply to both technologies.

User friendliness is vital as the equipment is not in constant use. For example Brandywine Imaging, a multi-vendor equipment and consumables dealer describe Konica’s CR control station: ’Any technologist, with or without CR experience can consistently generate optimized diagnostic images with minimal training’

The systems also needs to stand up to physical handling at sea, and all providers will test for this, as shown in this clip drop-testing a Konica Minolta AeroDR flat panel detector.

Summary

Large cruise ships can benefit from advanced telemedicine arrangements, as they carry trained medical personnel, modern medical facilities and satellite data connections.

CR or DR systems bring considerable space savings across your fleet and should be accompanied by a proven teleradiology solution such as bbRad Serverless that can connect with your remote reporting provider of choice as well as user-added hospitals for medically disembarked passengers.

Upgrading your Medical Facilities?

We provide the teleradiology system, and I (Marco) can also help with independent suggestions to get your ‘whole package’ working smoothly, from x-ray manufacturers to reporting radiologists. Contact Marco Crispini directly using the form below

Disclosure: Carnival is a user of Cypher IT’s bbRad system