Experts call for European regulatory framework for teleradiology

Over the past decade, teleradiology has become a well-established practice in Europe. But without homogenous EU legislation, experts are concerned about possible clinical risks. Radiologists and an EU representative compared advantages and warned of legal and medical risks during a joint session of the European Society of Radiology and European Commission held Saturday, March 6.

The benefits of teleradiology are clear: it brings expertise within reach of remote hospitals where there is insufficient work to justify the appointment of local radiologists, it provides specialized knowledge to deal with complex problems, and it enables the examination of patients without the need for their transfer to tertiary centers. It is also particularly helpful in emergency medicine for centers that do not have 24/7 coverage. But the legal void concerning the use of teleradiology in the EU may impair patient care.

“There are many potential pitfalls, especially if teleradiology moves from its current specific role to a general method of service delivery,” said Prof. Luís Donoso from Barcelona, who is chair of the professional organization committee and a member of the executive council of the ESR.

Linguistic problems or incorrect wording in a report or description of clinical impact may occur during the practice of teleradiology. To increase safety, quality controls should be implemented.

A number of legal issues must also be cleared, such as proper accreditation of teleradiologists in the country where they deliver their services and agreements between local radiologists and the teleradiologist. Responsibility for the regulation of teleradiology must also lie with the state where the patient undergoes the imaging procedure. Likewise, if a patient is provided with a service from a country other than the one where treatment was received, he or she should be fully informed.

Teleradiology has yet to be defined as a medical act in its own right.

“The report is only a part of the clinical act. Our services include evaluation of examination requests, selection of the most appropriate imaging strategy, optimization of the examination performance, customization of the imaging protocol, and integration of imaging and medical information into the report,” Donoso said. The EU has taken steps to improve regulation by launching the CALIOPE initiative, a network which brings together 17 organizations representing national governments and eHealth competence centers as well as 11 EU stakeholder organizations.

But a lot remains to be done. Telemedicine and teleradiology should, for instance, be clearly differentiated, which does not yet seem to be the case.

“We try to identify everything legal and see how it is applied. We’re not doing such an in-depth analysis, yet,” said Catalina Dima from the EC’s Information Society and Media Directorate.

Note: a version of this article appeared in the 2010 ECR Today newspaper.