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By: AMFS Expert and Board Certified Radiologist

Your patient has shortness of breath. The ER physician suspects a pulmonary embolism, and orders a CT angiogram of the chest. An hour later the Tele-Radiology report calls it negative. The patient goes home and tragically passes away from a pulmonary embolus.

Review of the images the next morning by the local radiologist suggests the presence of a left lower lobe clot. Finger pointing and disagreements ensue as the Tele-Radiologist in another state claims the images were suboptimal and incorrectly sent, and that the equipment and Tele-Radiology quality is substandard. There is confusion as to the responsible party for the liability.

Tele-Radiology, which is the electronic transmission of radiologic images from one location to another for the purposes of interpretation and/or consultation, has increased many fold in the last decade. According to statistics, there has been a greater than 15% annual increase in Tele-Radiology, compared to less than a 2% increase in the number of radiologists.  Very soon, it is expected almost every after-hour image at a hospital will be reviewed by a Tele-Radiologist. Most hospitals will have contracted radiologists that supply this service, or the contracted radiologist or hospital may engage a third party for this after-hours service. Tele-Radiology may also be the only radiology service offered in smaller rural communities.

This increasing use of Tele-Radiology is compounded by the exponential increase in number of images, newer image-intensive modalities such as CT, issues concerning image quality, technical compliance, and the qualifications of the reading radiologist.

Given that medical care will increasingly involve immediate radiology interpretation, and this in turn involves increasing Tele-Radiology, there will undoubtedly be an increase in litigation regarding the liability of a Tele-Radiology error.

Following are some general items that should be considered in reviewing Tele-Radiology cases in the future:

According to the American College of Radiology:

1.  Radiologists who provide the official interpretation of images transmitted by Tele-Radiology should maintain licensure that is required at both the transmitting and receiving sites (in both states if this is applicable).

2.  The radiologist performing the official interpretation is responsible for the quality of the images being reviewed (in the scenario above, the Tele-Radiologist should have declared non-diagnostic images, if this was the case).

3.  Communication is a critical component of Tele-Radiology, and the radiologist should render interpretations in accordance with the “American College of Radiology Standards for Communication: Diagnostic Radiology”.

4.  Transmission and equipment criteria should be in compliance with the ACR/NEMA(National Electrical Manufacturers Association) Digital Imaging and Communication in Medicine (DICOM) Standard.  Tele-Radiology is not appropriate if the available Tele-Radiology system does not provide images of sufficient quality to perform the indicated task. When a Tele-Radiology system is used to render the official interpretation, there should not be a clinically significant loss of data from image acquisition through transmission to final image display. For transmission of images for display use only, the image quality should be sufficient to satisfy the needs of the clinical circumstance.

5.  Formalized and documented policies on Quality Assurance and Improvement by the transmitting institution/hospital should be integrated in the Policies and Procedures.

Appropriately utilized, Tele-Radiology will improve access to radiologic interpretations and thus significantly improve patient care. However, given the realities of this rapidly evolving part of medicine and the increasing chance of error, close vigilance to quality and standards is necessary. AMFS is able to answer questions and supply experts to address radiology and Tele-Radiology matters.

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