Keywords:
eHealth, Radioprotection / Radiation dose, Professional issues, CT, Teleradiology, PACS, Radiation safety, Health policy and practice, Acute
Authors:
B. Rosenberg1, H. von Zanthier2, C. Rosenberg1, N. Hosten1; 1Greifswald/DE, 2Berlin/DE
DOI:
10.1594/ecr2012/C-2601
Results
Justifying indication
Radiological examinations utilizing ionizing radiation in Germany require the justifying indication (= consideration of the radiation risk to the benefit of patient and population,
respectively) (6).
The justifying indication as stated by the teleradiologist is explicitly and exceptionally generated without direct contact to the patient (4,6).
On the other hand certified full-scale qualification in the field of diagnostics utilizing ionizing radiation is critical for the teleradiologist - so is the presence of a physician holding certified basic knowledge in the field of radiation physics at the site of the technical performance.
(see Fig.2)
Regionality of services
The German radiation protection law includes the principle of regionality of services: Teleradiological services may only be provided to clinics,
which can be reached by the teleradiologist within 45 - 60 min.
Permission of teleradiological services is always limited to a maximum of three years and depends on the proof of an exceptional demand.
Professional law/regulations
In general remote medical treatment is prohibited by law in both countries.
The practice of medically treating a patient who is not physically present momentarily is against German and Polish law.
Even though it is subject of recent controversies only in Germany (5).
Medical confidentiality in both countries is regulated through professional and criminal law.
Similarly a patient’s written consent to perform teleradiological services is necessary.
Data privacy has to be fully respected.
In contrast to German regulations disclosure of sensitive patient data may,
under circumstances,
depend on the doctor’s discretion.
Binational teleradiology scenarios
As presumed from an anticipated medical demand there are two probable scenarios displaying the conditions,
under which cross-border teleradiology in Pomerania can be performed.
In the first scenario (see Fig.
3) a peripheral hospital with regular personal (on-site radiologist) and technical CT capability demands an external superior diagnostic and/or therapeutic expertise within a regional network of hospitals.
A case-related remote second opinion is obtained based on interpretation of an electrically transferred CT picture set and may lead to patient transferral.
Scenario 1 describes a process of teleconsultation,
the primary justifying CT indication is not touched.
In the second scenario (see Fig.
4) a small peripheral hospital,
offering technical but no personal (no radiologist on site) CT capability,
acutely demands teleradiological service through a partner hospital within the regional network.
Primary justifying indication and image interpretation are both performed by the teleradiologist and to the benefit of the patient,
who will only have to be transferred if medically necessary.