Digital radiography can save a veterinary practice money on film, processing costs, and technician time. However, many veterinarians are surprised to find that there may be additional (some say hidden) costs associated with digital radiography installations. One of the costs that veterinarians generally don’t consider is the cost of their internet connection. In some cases, the internet connection to the practice will have to be upgraded as part of a digital radiography installation.
A fast internet connection is essential to any digital radiography installation because veterinarians will want to 1) back up their images off site and/or 2) send images out of their hospital for teleradiology consultation. DICOM images are large so a broadband connection is essential. The following will give you a feeling for how large a DICOM image file really is.
- This web page: 13kb
- A 3 page Microsoft Word Document: 20kb
- An average size Power point Presentation: 2000Kb
- An MP3 music file: 6000kb
- A radiographic DICOM image file: 8000-15000kb
A 2 view thoracic evaluation is therefore about 20,000kb (20mb) or equivalent to 1000, 3 page Microsoft Word documents. A broadband connection is essential if you intend to transmit these images out of your hospital. However, all broadband connections are not created equal.
When purchasing broadband for your veterinary hospital, the broadband company will charge according to the bandwidth (speed) you are getting. The bandwidth is described by two numbers. The first number is a download speed. The second number is an upload speed. As one ISP advertises:
- Up to 3 Mbps/768 Kbps: $XX.XX/mo.
- Up to 1.5 Mbps/384 Kbps: $XX.XX/mo.
- Up to 768 Kbps/128 Kbps: $XX.XX/mo.
Most residential and business services provide higher bandwidth for downloads than for uploads because most customers spend more time online downloading information (surfing the web) rather than uploading information (sending e-mail, pictures, etc). This is exactly opposite of what is needed for teleradiology and backing up your digital radiography images. Teleradiology and offsite backup require fast upload speeds so be sure that you consider the upload speed when shopping for broadband.
Keep in mind that the speeds quoted by Internet service providers (ISPs) are usually the fastest clocked speed on that type of connection under ideal conditions. Unfortunately, conditions on the internet are rarely ideal so the download and upload speeds you actually get at your practice will likely be lower than advertised.
Most of the time, you should be able to connect at 75 percent to 80 percent of the top speed available at your location. There are numerous factors will decrease your maximum download and upload speeds. With DSL, performance drops as distance increases between your modem and the local phone company office. Cable modem service can slow down as more cable users connect to the Internet in your immediate neighborhood. During peak usage times (such as after-dinner hours), both kinds of service may seem slower because network congestion can overload your ISP.
Now that we have the technical mumbo jumbo out of the way, we can get to the real questions that veterinarians ask. These are:
- What type of broadband connection should I get?
- What is the minimum upload speed that I need to reliably and easily backup my images and get teleradiology consults?
- Will the connection I currently have work for me?
What Type of broadband connection should I get?
The answer to that question will depend on what is available in your area. Your options are cable, DSL, and a T1 line. The upload speeds of satellite connections are usually pretty slow so satellite is generally not ideal. If you have enough speed (bandwidth) in your service any of these three will work. Bottom line: shop around and see what is available in your area.
What is the minimum upload speed that I need to reliably and easily backup my images and get teleradiology consults?
This is a tough question. The short answer is the faster the better but cost and availability will be limiting factors for most veterinarians. I recently asked a large human teleradiology company doing thousands of studies per year what they recommend to their clients and they responded:
“I know of hospitals that are uploading images at about 256 kbps and still happy with the read turn around time. Most cable modem and DSL speeds are sufficient. 'Business class' in either of these technologies would most definitely be sufficient. All locations will be different, and most should be evaluated because there are a lot of variables that will affect the speeds.”
In our practice, the two referral practices that send us the most referrals (up to 20-30 studies per day) have upload speeds in the range of 344-369Kbps. We don't hear any complaints about upload speed from these hospitals.
So, for a minimum, I recommend that you try to get a broadband package that will provide you with a maximum upload speed in the range of 300-400Kbps.
Will the connection I currently have work for me?
There are two ways to answer that question. First, you can test you upload speed at an online speed testing websites. One of these is www.speedtest.net
A second method is to send images to a test server and see how long it takes to transmit the images. If you would try this real world test, please contact me and I will give you instructions on how to send images to a test server.
One last (important) point to consider.
Pushing images to a DICOM server is a simple task that usually only requires one or two mouse clicks. When purchasing a digital radiography system be sure that you can push images to a remote DICOM server.
When you are talking with your vendor about sending DICOM images, also be sure to ask the vendor if the digital radiography system is able to send images as a background process. There are some systems (gasp...including the workstation I use to review films) that cannot send images as a background process.
If the workstation cannot send images as a background process, the workstation is effectively "locked down" and can't be used for anything else until all of the images are sent. This may seem like an insignificant problem until you are faced with not being able to access your workstation. If you only have one or two workstations in your practice, this may become a tremendous hassle.
Ideally, you want a PACS that can send images as a background process. If your PACS cannot offer you this service, I don't think that it is unreasonable to ask the vendor for a free workstation that you can put in a remote corner of your hospital that you can use to send images. This will ensure that your digital radiography installation won't shut down while you are exporting images.