Imagine you have a severe headache and call 911. An ambulance transports you to the ER where concerned doctors immediately order a CT scan of your brain. You probably assume a radiologist at the hospital will interpret the scan, and consult with your ER doctors about the proper diagnosis. For patients at many hospitals, however, the last part of this story unfolds much differently.

Now the radiologist reading your scan is often in a different hospital, state or even country. Teleradiology, where digital versions of X-rays, CT or MRI scans are sent to off-site radiologists, is commonplace. Some hospitals contract with an outside company for the reading of certain scans, while others have outsourced the entire department. "The majority of hospitals use teleradiology in one form or another," explained Jonathan Linkous, the CEO of the American Telemedicine Association.

The Problem With Teleradiology

You might be wondering why it matters if radiologists are on-site as long as they are qualified. The answer mainly comes down to one word: communication. Radiologists in other locations may only submit a written report, and never consult with the on-site physician. This can result in mistakes, radiology errors and sometimes tragic results.

Take the case of a Pennsylvania woman who arrived at the hospital with severe head pain. A digital copy of her CT scan was sent to one imaging company who then sent it to another subcontractor. That subcontractor sent it to a radiologist at his home in Hong Kong, who noted a ring around a mass in the patient's head. Unfortunately, the radiologist didn't explain in his written report what the ring meant-a buildup of fluid that is frequently fatal if not treated immediately. Since no alarm was raised, the woman was discharged.

In the morning, another off-site radiologist looked at the scan to review the diagnosis. Since he agreed with the findings of the Hong Kong radiologist, and assumed the ER doctors had connected the dots, he did nothing to alert ER physicians either.

The woman was later found by her parents lying unconscious in her bathroom. She now has permanent brain damage.

If only the ER doctors and off-site radiologists had actually spoken, the severity of the woman's condition would likely have been conveyed. Her case highlights the dangers of too great of reliance on technology, and too little emphasis on physician communication.

Source: MSNBC, Is a doctor reading your X-ray? Maybe not, Katherine Eban, 26 October 2011.