Teleradiologists recommend more follow-up imaging but with lower clinical yield
Teleradiologists recommend more follow-up imaging than on-site rads, but those recs tend to be less likely to be completed, according to new research.
The findings suggest that the recommendations also have lower clinical yield for outpatient CT scans than those of on-site docs. The retrospective study, published Sept. 16 in Academic Radiology, evaluated whether differences in interpretation setting affected physicians' follow-up recommendation behavior, adherence and oncologic clinical effectiveness.
Experts involved in the analysis believe their findings have important implications for the specialty, as the demand for teleradiology services has seen significant growth in recent years.
“Initially developed to provide after-hours coverage and for areas deprived of specialized medical services, teleradiology has evolved into a service model that supports not only emergency department images, but also elective imaging interpretation for outpatients in tertiary care hospitals,” Jungheum Cho, MD, PhD, with the department of radiology at Seoul National University College of Medicine, South Korea, and colleagues noted. “The motivation for expansion of teleradiology includes not only improved efficiency and workflow flexibility but also the potential for cost reduction by reducing on-site staffing requirements and enabling centralized workload distribution within healthcare systems.”
Researchers analyzed more than 24,000 outpatient abdominopelvic CT interpretations from nearly 15,000 patients performed between 2023 and 2024 at a single institution. The exams were randomly assigned to either on-site radiologists or teleradiologists. The group assessed three measures: recommendation proportion, adherence proportion and oncologic clinical effectiveness, defined as the proportion of recommended follow-up exams that produced a positive finding.
Teleradiologists recommended additional imaging at a rate of 5.5%, compared with 1.5% for on-site readers; this translated to nearly fourfold higher odds of making a follow-up recommendation among teleradiologists. Researchers also found greater variability in recommendation behavior among individual teleradiologists.
Higher recommendation rates, however, did not translate into greater follow-up completion or clinical yield. Patients were significantly less likely to complete exams recommended by teleradiologists compared with recommendations made by on-site rads. The oncologic clinical effectiveness of teleradiologist recommendations also was significantly lower, with an odds ratio of 0.36.
The group noted that these findings could be owed, in part, to the fact that teleradiologists often report for multiple systems that each have differing protocols. This could make them more likely to err on the side of caution with their follow-up recommendations.
Regardless, the results suggest that the interpretation setting likely influences not only how frequently radiologists recommend additional imaging but also the consistency and downstream clinical value of these recommendations. The authors noted that differences in recommendation behavior could have implications for imaging utilization, particularly when recommendations are made for incidental or indeterminate findings.
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In addition to her background in journalism, Hannah also has patient-facing experience in clinical settings, having spent more than 12 years working as a registered rad tech. She began covering the medical imaging industry for Innovate Healthcare in 2021.