Teleradiologists working from home and veterinarians who utilize remote digital radiographic image archives and/or cloud PACS services might find that they are in the 1-2% of the population who run afoul of new broadband Internet bandwidth caps.
Comcast, ATT, and Cox recently enacted bandwidth caps. Bandwidth caps limit the amount of data users can download each month. Comcast has a bandwidth cap limit of 250GB/month. AT&T has a limit of 150GB/month for DSL users and 250GB/month for Uverse users. Cox has a variety of plans ranging from 50-250GB/month.
Although these limits may seem relatively high and, as Charlie Douglas, Comcast's director of communications states “the new bandwidth cap will affect less than 1 percent of Comcast customers.” Moreover, "Two-hundred-and-fifty gigabytes is an extremely large amount of data.1"
For the average household that might be true. For the veterinary radiologist and large volume veterinary practice using remote digital radiographic services, including teleradiology and cloud PACS, that statement might not be true.
Before we get to a discussion of just how much or how little these bandwidth caps afford the user, we should take a minute to consider the Canadian experience with bandwidth caps. What we learned from Canada is that there is no guarantee that current bandwidth caps will not shrink or fail to scale as our bandwidth hunger grows. After a ruling by Canada’s regulatory agency last year authorized usage-based billing, what used to be 200-GB or unlimited Internet service plans suddenly became limited to 25 GB per month. Users exceeding their allotment are charged $2/GB in overage fees2.
Making sense of the numbers: In order to understand what we are talking about lets look at some numbers. According to Comcast a user will need to do the following to go over their 250GB/month bandwidth cap:
• Send 50 million emails (at 0.05 KB/email)
• Download 62,500 songs (at 4 MB/song)
• Download 125 standard-definition movies (at 2 GB/movie)
• Upload 25,000 hi-resolution digital photos (at 10 MB/photo)
Seems like a lot right? Well, it isn’t. It isn’t because these examples offered by Comcast fail to consider the activities that many normal people3 do with their internet and (understandably) what veterinary teleradiologists and veterinarians do with their bandwidth. For example, the veterinary teleradiologist working from home might also do the following:
• Listen to internet radio while working = 10GB/month4
• Use Netflix like a normal person and go for the high definition movies at 2.3 GB/hour (more than double what Comcast uses in their estimates)
• Backup their computer data each with a service like Mozy or Carbonite. Depending on the music and photo collection that could be several more GB/month
• Have kids running around the house with their iPad watching Youtube videos5: add several more GB/month.
• Have kids who like to play online games: add a few GB/month
• Download Mac OSX Lion: 4GB (it is the only way to get the new OS upgrade BTW)
These normal activities will amount to several GB/month for the average user and we still have not considered the amount of data that teleradiology applications or cloud based digital radiography services may require.
AT DVMinsight we routinely receive uncompressed digital radiographic images that are between 10-33mb for a single image6 . Multidetector CT and some MRI studies can be enormous with some as large as 640mb/study. Ultrasound studies with video clips can exceed 200mb. Consider the following:
• Estimate an average of 60mb/radiographic study (4 images at 15mb/image)7
• Estimate an average of 500mb for a CT or MRI study8
• Estimate and average of 250mb for ultrasound study
Using some rough estimates, consider that a radiologist could easily read 30 case/day, 3 CT’s/day and 3 ultrasound studies/day and a veterinary referral hospital could upload that much information as well. That would put the user in the range of 120GB/month just for the daily imaging workload.
As you can see, if you are an average teleradiologist with an average family you could easily go over the AT&T DSL bandwidth cap and some of the lower priced Cox packages if you thrown in a few movies, Youtube downloads, and some internet radio to get you through the day. Personally, I am using well in excess of 150GB/month right now. Even smaller multidoctor veterinary clinics might go over the lower priced Internet packages with their digital radiography volumes if the utilize teleradiology or Cloud PACS/remote archive.
Steps you can take to make sure you do not run afoul of your ISP: Avoiding bandwidth cap headaches should be relatively easy9 if you follow these rules:
1. Rule #1 Don’t be cheap: You are a power user. Suck it up and get a premium service package. Veterinarians ( you know who you are) - getting home DSL for your practice is not going to cut the mustard anymore. Radiologists - you need to consider this a cost of doing business. Veterinarians - you need to add this cost to the cost of your remote archive or Cloud PACS.
2. Rule #2: Use compressed images when you can. Image compression is not taboo. Be sure to buy a digital radiography system or use a remote archive or cloud PACS that can compress images as they are uploaded. Radiologists, be sure you are using a platform that can compress images when you download them10. If you are having veterinarians send images directly to your PACS be sure that you insist that they compress their images before sending.
What happens if you go over your bandwidth cap? These are new rules so that is hard to say. Comcast says that they “will contact customers who go above the 250GB limit and ask them to curtail their use. If a customer goes over the monthly limit again during the next six months, Comcast will suspend service for a year.”
Bottom line: Bandwidth caps are here and veterinary radiologists and veterinarians must consider these caps as they do business and purchase digital radiography equipment and remote digital services including teleradiology and Cloud PACS. If companies decide to lower the current caps, we may all be in for a very expensive wake up call.
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1. http://www.computerworld.com/s/article/9113823/Comcast_sets_monthly_bandwidth_limit_for_customers
2. that’s $7 just for downloading Tron: Legacy). http://www.wired.com/magazine/2011/07/st_infoporn_bandwidth/
3. Call me a geek, nerd or cord cutter but I have not had cable TV for 3 years. Hulu and netflix work just fine thank you. If you want to cut the cord, here is a guide to getting started: http://lifehacker.com/5475091/how-can-i-ditch-cable-and-watch-my-tv-shows-and-movies-online
4. Rdio (www.rdio.com) beats Spotify but if you must use spotify be sure to check out helper websites to help you curate your world: http://mashable.com/2010/03/26/websites-spotify-fans/
5. If you have a kid you are sitting there smiling. You know it. I know it.
6. Some of the newer high megapixel CCD systems are just unwieldy when it comes to image file size. 30mb for a single image. Come on vendors – that is just not necessary.
7. This is a little high but humor me. We get loads of studies with recheck images with 30 images attached, GI series with 20 images, etc.
8. We are not there just yet but in our practice we are seeing more and more multidetector CT studies coming in. In a few years, this will be the norm.
9. At least at the current levels. If, however, these caps are lowered it is going to get real expensive, real fast to be a veterinary teleradiologist or use some Cloud PACS vendors.
10: Hold your hats - shameless advertisement coming your way: Radiologists - DVMinsight (www.dvminsight.com) can decrease your internet bandwidth useage by up to 20x in some cases.
About FHAVR :Matt Wright DVM DACVR is the CEO of DVMinsight. At the prodding of the radiologists he put his ideas and conversations online. Ultimately, this series of articles will be turned into a book that he hopes young radiologists will read and consider. Profits from the sale of the book will go toward funding a DVMinsight Business Development center where young radiologists can look for business advice about setting up their business; and legal advice regarding employment agreements. Currently, the articles are free but if you would like to contribute to the DVMinsight Legal Defense Fund, all contributions are welcome