Feature Medical imaging

Outsourced radiology: will doctors be deskilled?

BMJ 2008; 337 doi: https://doi.org/10.1136/bmj.a785 (Published 11 August 2008) Cite this as: BMJ 2008;337:a785
  1. Amy Davis, editorial registrar
  1. 1BMJ
  1. adavis{at}bmj.com

    Outsourcing of radiology has boomed in recent years as hospitals struggle to keep up with the increased demand for imaging, but how well does it work? Amy Davis reports

    The technology available to radiologists has changed dramatically over the past decade. The internet, affordable high performance computers, the wide adoption of digital imaging, and picture archiving and communication systems (PACS) have propelled radiology into the digital era. These changes mean that imaging and interpretation are no longer confined to the one site—an image taken in a UK hospital can be viewed almost immediately somewhere else.

    Remote assessment has become embedded in the United States. Even back in 1999, a survey of US radiologists found that 75% of radiology practices with more than one radiologist and 30% of practices with only one radiologist did their on-call work from outside the hospital, using teleradiology.1

    Although this technology has undoubted benefits for clinicians and patients, the digital revolution has directly led to and accelerated the outsourcing of images. UK trusts, unable to cope with the volume of work, are taking advantage of regulations that allow them to outsource reporting of images within the European Union without patient consent. But critics of outsourcing question its long term effects on radiology—can teleradiologists really maintain the same high standards of quality in their reports as in-house staff? Have the benefits of teleradiology been

    overhyped, especially its speed and cost effectiveness? And will transferring images of a single type or subspecialty to outside companies threaten to deskill the radiologists and trainee practitioners in our hospitals?

    Supply and demand

    Demand for radiology has increased because today’s clinicians realise that an objective radiology report is more reliable and informative than a subjective physical examination.2 Gone are the days when patients in accident and emergency departments would have plain radiography and …

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