A Teleradiologist's Take on the New ACR Guidelines

June 7, 2013

Prepared to scoff, a skeptical teleradiologist takes a closer look at the ACR's recent guidelines for teleradiology.

Back in med school, one of my professors had a habit of ending many of his statements with the query, "Isn't it?" This rhetorical phrase was a holdover from his primary language, the rough equivalent of "OK?" Presumably, a student confused by the professor's preceding point could then pipe up to request clarification. Few, if any, ever did.

However, towards the end of semester, one of his "Isn't it?" inquiries got a wiseacre response from the rear of the lecture hall: "It is!" a student confirmed. Not missing a beat, the professor said, "I am glad you agree."

It can be nice to get unsolicited statements of support. Especially if, as with many holders of advanced degrees and certifications, you have become accustomed to receiving grades and other feedback for everything you do.

On the other hand, you might go the other route and bristle at the notion of the interloper who has approved of your conduct. Who asked him for his opinion? Think of the last time you got junk mail saying that you've been pre-approved for a loan or credit card. You could be annoyed at the outsider who's sticking his nose in your business. You might be thinking of all of the exams, courses of study, long hours of service, etc., that you successfully completed to get where you are today, and now this Johnny-come-lately is stepping in with his two cents? Especially since his "you're okay with me" carries the implication that, under other circumstances (and maybe in the future), he believes he has the standing to disapprove of you.

So the JACR published a white paper on the practice of teleradiology. Being a teleradiologist myself, I was naturally motivated to see what the ACR, of which I am a dues-paying member, had to say about the business model via which I practice my profession.

I have to admit, I was all set to get good and offended. I've seen more than a few rabidly anti-telerad sentiments amongst my fellow board certificate holders who, through plan or happenstance, have been fortunate enough to find on-site radiology jobs with terms they like and in locations where they wish to live. The majority of hateful commentary seems to come from those with anti-telerad axes to grind or simply ignorance of what teleradiology actually is.

Still, I could pretty easily imagine the authors of this white paper playing to such an audience, if not actively encouraging it.

Part of me was also irked at the notion of non-teleradiologists, under the aegis of the ACR, publically discussing whether my business model was up to their snuff. I suspect a similar white paper considering whether outpatient imaging centers are as good as hospital-based radiology departments would generate quite an uproar from the outpatient radiologist community. And the ACR itself might be a little put off if a white paper turned up in JAMA, setting forth guidelines on professional medical societies (whether or not such a write up found the ACR to be lacking).

So, yes, I had a chip on my shoulder as I settled down to read the piece. And then I noticed that at least one teleradiologist was amongst the authors - a hopeful sign of a fair and evenhanded treatment?

Proceeding through the write up, I found this hope to be borne out. Teleradiology was properly recognized as a legitimate mechanism for radiology coverage, as long as it's conducted with similar standards to onsite practices.

In other words, if my work for a hospital thousands of miles distant is comparable to the job which would be done if that hospital had been able to find a radiologist to do the same work onsite, there's no great wrong that needs righting. I can live with that. Standards are standards, no matter what your practice environment.