Board (DNB) standard is widely considered to be equivalent to international undertaken more frequently because of lack of availability of previous images
training, but these were estimated to number approximately 3300 in 2005 by and to ensure that the investigation has maximum yield irrespective of clinical Drivers for
the Indian Radiology and Imaging Association. The remainder hold the DMRD, indication.
a qualification that is not considered internationally equivalent. This to serve change are
a population of 1.08 billion; there are more radiologists in the UK serving its Teaching and supervision would clearly be compromised if off-shore reporting
population of some 64 million, and the UK has fewer radiologists relative to its services were to replace major components of, or the entire, local reporting not simply
population than most countries in the European Union. services. While telecommunication, e-learning and remote supervision may offer
solutions to some of the lost learning opportunities, there is, as yet, insufficient those that will
The European working time directive is unlikely to receive much support in this evidence to suggest that the learning experience would be equivalent. This is
environment, particularly if high reporting rates are required to maintain financial particularly important if low tariff examinations are sent off-shore for reporting improve patient
viability of the service. – what then will be the training opportunities for learning first on simpler cases?
care
India is not the only country that is touted as having spare radiology capacity, but Finally, the patient
it is representative of the issues that are faced. Most have insufficient capacity What of the patient? Increasingly, radiologists have moved to the front line of
to address the delivery of universal access to modern imaging for their own health care delivery, discussing diagnostic and treatment options with the patient,
population, let alone shoring-up services within the western world. It is possible informing the patient about the outcome of their investigation, and contributing
that the use of overseas contracts could contribute to the underwriting of local to a service in which the patient is better informed and would like to be kept
services in those countries, so maintaining and stimulating the retention of informed. Would the loss to the service by moving the radiologist back into
experienced staff rather than losing large numbers to emigration. At present, the back room be more than compensated for by greater efficiency and would
there is insufficient data to determine whether this is a realistic expectation and this change in practice compromise radiology recruitment? Up to this point, no
considerable uncertainty that it will contribute much to the worldwide delivery radiological or radiographic post has been lost as a consequence of teleradiology.
of imaging services, given the appetite in the west for more, and more complex, The worldwide shortage of radiologists suggests that such losses are unlikely for
investigations. the foreseeable future.
More outsourcing problems The eventual role of teleradiology may, in fact, be that of improving patient care,
There remain, however, other issues that compromise the free flow of images as well as access to expert opinion, extending the role of the radiographer to
around the world and the delivery of reporting services from outside the UK’s provide more in the way of hands on imaging, and affording 24 hour collaboration
shores. across the world with a quid pro quo sharing of responsibility of image review
across the time zones. As for communication, perhaps a new generation of young
In the UK, the General Medical Council requires that doctors demonstrate their radiologists will function better than the old hands in the virtual environment of
continued fitness to practice by the process of revalidation and it would seem the professional chat room and ‘XR Txt’.
essential that the same requirement is made of radiologists delivering services
to UK patients, wherever the geographical location of the radiologist. Such Paul Dubbins is a consultant radiologist at Plymouth Hospitals
revalidation will depend on all the components including demonstration of team
NHS Trust.
working, continuing professional development, appraisal and demonstration of
audit of individual practice.
The isolated reporting
Consent for images to leave the country in which they are generated remains a
complex legal issue in respect of liability, although the commissioners will retain
radiographer is extremely
responsibility if they have commissioned services abroad.
vulnerable
Consent for high dose examinations may be compromised by the difficulties
engendered by communication at a distance. High dose examinations may be
2009
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IMAGING & ONCOLOGY
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