radiologist necessitates greater responsibility for justification, for triage and for is to companies and to radiologists and radiology partnerships based in the UK.
It has the
the prioritisation of patients. Preliminary interpretation of images is likely to be This has addressed the considerable difficulties that were initially encountered
a greater part of the work of a radiographer as decisions relating to emergency with structure and phraseology of reports. Nonetheless, several off-shore reporting
potential to
image transfer and the urgency of formal review become crucial to proper services remain, apparently providing a service that is of high quality and valued
patient management. More demanding certainly, but also potentially much more by those who commission and use them.
address lack of
rewarding.
If it is so good, then why are not all services outsourced and delivered through
local expertise
Too good to be true? teleradiology? At present, at least, this is an issue of capacity. Those UK radiologists
There is much that can be learned from the use of teleradiology to deliver who are contributing to the delivery of reporting services and out-of-hours review
outsourced services. A far higher proportion of images are double reported than is will mostly have a day job and are unlikely to be able to extend their working
the case within most of UK practice; audit of the service is structured and regular days much further without compromising their performance, at least potentially. In
and undertaken by independent radiologists, and turnaround time for the report is addition, the impact of the European Working Time Directive has yet to be felt.
at a level that in most UK hospitals is only dreamt about.
Teleradiology has the potential to exploit team working within the radiological and
Does this sound all too good to be true? Sadly, the answer is ‘yes’. What is it that radiographic workforce. Already, highly skilled radiographers are contributing to
challenges this vision of Nirvana for medical imaging? The drivers for change the reporting of images in plain film radiography, in ultrasound and in some MRI
within radiology are not simply those that will improve patient care. Medical and CT applications. The use of mixed teams could address some of the shortfall of
imaging relies on expensive technology and uses expensive experts (radiological capacity for image review and reporting. However, the teleradiology environment
and radiographic) to deliver the service. The professional groups are governed has the potential to be very isolated and isolating. The isolated reporting
(properly) by very strict criteria of education and training accreditation and, in the radiographer without immediate access to medical opinion is extremely vulnerable
case of radiologists, revalidation. and such an arrangement is not effective team working, so carrying inherent risks
for patients.
So, cost is also a driving force. The demand is for a service which is cheaper,
as well as convenient; even, perhaps, located in the local supermarket where Surely, it must be possible to exploit the environment of other English speaking
the patient can drop in for an x-ray, in between the frozen peas and the pickled countries to expand the amount of work that can be outsourced and reviewed
onions. remotely. India has been proposed as a potential partner in such service delivery.
Indeed, already in Bangalore there are services particularly for out-of-hours
Value for money is an essential part of commissioning of health care and it is reporting that can address image reporting in the UK, the United States (US) and
right and proper that commissioners seek high quality care at a competitive Canada. Radiologists in these institutions are registered as specialists in the host
price. However, quality in clinical radiology is hard to measure. Speed of service countries and therefore the issue of qualifications does not arise.
is identified as an important measure of quality and this is certainly a major
contributor to the patient experience. But what of quality of report, of effect on EU member states are, however, restricted currently from sending images for
outcome, of communication with the patient, between radiologists and clinicians, review outside the European zone because of issues with patient consent. The US
radiologists and radiographers? How are these to be managed in the virtual health insurers will not reimburse providers outside of the US but it is a simple
environment? matter to furnish a preliminary report that is ’confirmed‘ by the reading radiologist
on the morning after images were read during the previous night in India. The
Outsourcing is the issue Indian service charges a fee that is less than that received by the US imaging
Much of the concern that has been expressed about teleradiology is rather more department, so everyone is happy.
about outsourcing of services, a model that is facilitated by teleradiology rather
than the technological change itself. Are the concerns valid? And, of course, India is awash with suitably qualified radiologists, isn’t it? Well,
actually, no. Radiologists in India are trained according to a model abandoned in
Well, after the somewhat ill-fated venture to off-shore the reporting of magnetic the UK more than 25 years ago. The uniformity of training and accreditation seen
resonance imaging (MRI) examinations to Europe, much of the outsourcing now in the UK is not replicated. The training of radiologists to Diplomate of National
58
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IMAGING & ONCOLOGY
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2009
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