Teleradiology is one of the fastest growing sectors of telemedicine, as well as one characterized by a large number of practical applications. As an example, use of External Off-Hours Teleradiology Services or EOTS (i.e. using teleradiology services during the hours that resident radiologists rest) has tripled in the five-year period from 2003 to 2007, with 45% of all radiology practices in the U.S. using them in 2007, as compared to just 15% in 2003.

As is almost always the case with remote access services, there is resistance to adapting them; after all, we all find it easier and more convenient to collaborate face-to-face with our colleagues, rather than over the phone, video, etc. Especially in the specific field of radiology, research has shown that there is a strong preference among referring physicians for local radiologists over teleradiology. Taking into account this resistance, the sector’s growth is even more impressive and one has to wonder about which driving force is hiding behind it, the most obvious candidates being, of course, cost reduction and quality increase.

As far as the cost-saving factor is concerned, it is interesting to note that in the above-mentioned research, referring physicians continued to show preference for local radiologists, even when strong economic (lower costs) and scheduling (less turnaround time) incentives were taken into consideration, hinting to the fact that neither cost nor time were the deciding criterion. Besides, the cost of the radiologist (also known as “professional cost”) is a very small percentage of the total cost of a radiology examination; as a consequence, cost-cutting strategies tend to focus on the hardware (machine, films, necessary chemicals, etc) that comprises the major part of radiology expenses.

On the other hand, quality has been shown to play an extremely important role in healthcare and teleradiology seems to be no exception. A really easy way to look at this is to consider the potential (or lack thereof) of outsourcing radiology services to off-shore companies: contrary to activities that can be easily off-shored, imaging evaluation and diagnosis is an extremely knowledge and experience intensive task, requiring highly-trained personnel. In view of this, it should come as no surprise that Wipro, the Indian outsourcing giant, has failed to infiltrate the U.S. teleradiology market, despite efforts dating back to 2003. It is also no surprise that a constant theme in teleradiology is the need for patient consent on the use of the service, since citizens in developed countries, with their medical expenses covered by public or private insurers, will not easily agree to compromising their perceived quality of care (by accepting services from an international expert) unless there are compelling reasons (e.g. unavailability of a local one).

In essence, teleradiology is behaving as the exact opposite of a typical “outsource-able” service. In such typical cases, low-level (from an educational point of view) jobs are outsourced from high-cost labour areas (cities, developed countries) to low-cost ones (rural areas, offshore companies in developing countries). Conversely, teleradiology is following the opposite path: high-priced professionals offer their services to areas in need of their expertise, either nationally (rural establishments having access to radiologists living in urban areas) or internationally (poorer countries that cannot afford or attract full-time radiologists resorting to using teleradiology services based in developed countries). The reason for this antithesis is, arguably, that the deciding factors in the two models are also antithetic: quality (for the case of radiology) as opposed to cost (for typical outsourced services).

In conclusion, there are several reasons to believe that the evolution of teleradiology has been based on the promise of offering higher quality services to locations that have little or no other alternative for accessing them, rather than the desire to drive costs down in these locations.

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