Teleradiology and a Radiology Second Opinion: Prospects and Relevant Ins and Outs

Diagnostic radiology is a branch of medicine that produces images of internal organs, describes them, and draws conclusions regarding the nature of the abnormalities detected. Thus, the task of a radiologist is to detect suspicious phenomena at a very early stage and give them an accurate definition to allow the treating physician to plan further actions correctly. Originally it was ionizing radiation that was used to obtain images. However, nowadays high-frequency waves and magnetic fields are also applied for this purpose. Visual data is processed with the help of special software. The diagnostic radiologist will then describe what is seen on the display and draw conclusions. Actually, it is the conclusions that make the key purpose of imaging diagnostics. The effect of medical prescriptions directly depends on the accuracy of study interpretation. Therefore, many patients resort to a second opinion, i.e., a  reassessment of the images, in order to be sure of the correctness of the original report.

Teleradiology is the future of medicine

The development of communication technologies nowadays makes it possible to transmit the results of imaging radiology examinations (X-rays, CT, MRI) from the place where they were carried out to any distance in a very short time. This practice is called teleradiology.

It means that the specialist who interprets the images does not necessarily have to be in the next room. They could be read in another city or even another country. No hassle of mailing disks or, even more so, cumbersome printouts on x-ray paper. Delivering information to another side of the globe is a matter of minutes.

Why might you need it? First, some medical institutions have a shortage of specialists who are sufficiently qualified to evaluate data in a qualitative way.  Sometimes radiologists are too busy, and the response is unacceptably long.

Another reason is that radiology, like many other areas, has subspecializations, such as breast imaging, neuroradiology, and pediatric radiology. Simply put, a doctor who is good at diagnosing joints is far from always able to correctly differentiate the subtle structures of the brain. This requires special training and practical experience. Unfortunately, a doctor with the right competence may simply not be around. 

Radiologist's second opinion - what is it?

Imagine the situation: a patient receives a picture description with conclusions about the presence of a serious illness that requires serious treatment. This is not just a diagnosis, but a life-changing event that requires important decisions to be made. And quite naturally, before proceeding to action, the patient asks himself the question: "Could the doctor have made a mistake?

It is normal to have doubts about a diagnosis, even if it was made by a specialist you trust. The pace of medical development in general and radiology diagnosis in particular does not always allow physicians to keep up with all the changes and new trends. Unlike teleradiology, where an entire board of doctors can look at the results, one single specialist cannot resolve complex and controversial cases. It is impossible to fully master the knowledge of thousands of currently known diseases. The same applies to mastering all existing imaging techniques and special branches of radiology. Even the most conscientious radiological diagnostician cannot "grasp the immensity"

It is important that the expert for the review of the scans is not appointed by a particular medical institution, but is chosen by the patient. And one should not consider an alternative conclusion as a rebuke to the doctor who provided the initial report. It is simply a way to minimize the risk of error and to obtain additional information to help arrive at a correct, informed decision.

An expert opinion may indicate an error

One of the main reasons for many patients to seek reevaluation of images (including remote interpretation using teleradiology) is the desire to avoid errors. Statistics show that, to a greater or lesser degree, misinterpretation does sometimes occur. The reason may be imperfect readings, a lack of experience with a particular disease, or simply a lack of thoroughness. 

In particular, in January 2019, the Israeli Journal of Health Policy Research published data from a study showing that even a competent radiologist can miss up to 32% of neoplasms when transcribing lung x-rays, and in one in five cases of reassessment of the same image, the radiologist can give a contradictory assessment to his previous conclusions.  The same study notes quite frequent discrepancies in opinions concerning breast cancer (20%), pancreatic cancer (20-38%), and recommendations concerning spinal surgery (35%).

A second opinion from a radiologist helps draw a better plan of actions  

If the data are insufficient to identify the disease and/or develop a therapeutic plan from the outside expert's point of view, the report will note the need for additional investigations. Radiology second opinion often also indicates the possibility of reducing the radicality of the intervention (in other words, reducing the amount of surgery) or using a more gentle, minimally invasive surgical technique.

Confidence is an important component of treatment success

In addition to the obvious objective benefits, the remote expertise of another specialist through teleradiology also helps to create a favorable emotional background. After all, the need to make life-saving decisions is inevitably fraught with anxiety and worry about whether everything is going right. So, the better one is informed about the disease, the greater is the assurance that the actions taken are really well-grounded and correct. Above all, we are talking about steps that are no less important than, for example, buying an apartment or choosing a college. In such cases, we try to consider as many options as possible, become thoroughly familiar with all the details, and consult with friends and specialists.

The search for a second opinion in radiation oncology follows the same logic. It is a process of getting the maximum amount of relevant and accurate information from a reputable radiologist. The more of it, the deeper is confidence in having chosen the most correct path.  It relieves anxiety and gives the peace of mind so necessary to endure all challenges.

How do I find a reliable expert to re-evaluate the images?

Here the word "experience" implies more than just diplomas and certificates, although they are undoubtedly indisputable proof of professional achievements.

An important factor in gaining experience is the continuous updating of knowledge through ongoing practice and participation in research on specific topics. Physicians who devote time to scientific work and the exchange of knowledge with colleagues have the greatest competence in the diagnosis and treatment of a particular condition. It is they who can be considered the most reliable experts, and it is their opinion that is most valuable.

Important criteria to see if a radiologist is really competent to provide remote consultations include:

• authorship or co-authorship of publications on the problem;
• participation in clinical trials.

How can you make a radiology second opinion more effective?

For an appropriate teleradiology evaluation of radiology findings, the expert should obtain the most detailed information about the clinical context of the study. That is, in addition to the patient's age, examination date, and referral diagnosis, it is important to know the background, i.e., the reasons why the scan was ordered; the availability of previous diagnostic/treatment including the results, the family history in regard the particular condition, etc. Only then can a radiology second opinion be effective.

Often the accuracy of conclusions in radiology is higher if the physician can compare current data with previous findings. Sometimes patients are so focused on the present-day situation that the fact simply does not occur to them. But it should not be forgotten, because the presence, rate and nature of changes often provide very valuable information.

Obviously, the quality of teleradiology consultations also depends on the technical aspects of the procedure. Despite the fact that we encounter modern data transmission methods every day, the correct processing and delivery of images may still be a challenge. To solve this problem, it is better to contact the experts.

Final conclusions

In modern medicine, remote consultations using the opportunities offered by teleradiology open up broad prospects for both patients and doctors.  These include utilizing the potential of the most qualified specialists and technologies, improving the quality of diagnostics (including rare diseases requiring special knowledge), and the chance to protect oneself from mistakes. Good advice: to get the necessary help without delay and with maximum benefit, it is worth ordering the service through a specialized service. Experienced professionals will give advice on choosing an expert, make sure that all the necessary data is collected, and make the processes of transmitting it and receiving a response simple and safe.

References:

1. Benbassat, J. Obtaining a second opinion is a neglected source of health care inequalities. Isr J Health Policy Res 8, 12 (2019). https://doi.org/10.1186/s13584-019-0289-5
2. May, B.  Dann ist Teleradiologie sinnvoll. Radiologen Wirtschaftsforum Ausgabe 8/2018. https://www.rwf-online.de/content/dann-ist-teleradiologie-sinnvoll?subnotfound=1
3.  Golder, W. Zu oft die richtige Diagnose verfehlt. Schweizerische Ärztezeitung Ausgabe 2022/17.
4. https://saez.ch/article/doi/saez.2017.05356