Revised Statement on the Interpretation of Radiology Images Outside the United States
The ACR has become aware of several recent statements in the national and local media that promote outsourcing or sending of imaging exams of patients in the United States for interpretation in foreign countries. However, these statements have omitted a number of important conditions that are necessary to protect patients and to ensure the delivery of high quality radiological care.
As the leading organization for medical radiology, with a long record of dedication to ensuring quality patient care, the ACR is very concerned about the implications of overseas radiology and its potential effect on patient care in the United States. The ACR believes that physicians who interpret images by teleradiology should meet or exceed the same standards met by physicians practicing within the United States. Certification by the American Board of Radiology is the best means for the health care consumer to judge the qualifications of the radiologist. To achieve these standards, physicians who interpret images by teleradiology shall: (1) be licensed to practice medicine in the state where the imaging examination is originally obtained as well as possess any medical or other licensure required within the jurisdiction of the interpretation site; (2) be credentialed as a provider and maintain appropriate privileges in the health facility or hospital in the United States where the examination was obtained; (3) have appropriate medical liability coverage for the state in which the examination was obtained; and (4) be responsible for the quality of the images being interpreted. Physicians practicing outside the United States must willingly agree to submit to the jurisdiction of and be completely accountable to all applicable state and federal laws in the United States.
Radiology groups, hospitals and other entities in the United States should only enter into contracts for interpretation of imaging examinations provided from outside the United States with those physicians who meet the preceding criteria.
It is unethical and likely fraudulent for a physician who has not personally interpreted the images obtained in a radiologic examination to sign a report or to take attribution of an interpretation of that examination rendered by another physician in a manner that causes the reader of a report to believe that the signing radiologist was the interpreter. This practice, known as ghost reporting, should be strictly prohibited.
Facilities and physicians engaged in the practice of sending images to a site outside the country for interpretation should be prepared to immediately disclose that information to patients, upon request, along with the details indicating compliance with the above criteria.
Patients in the United States expect high-quality care and service from fully licensed and accountable medical practitioners. Patients also have the right to expect that all physicians who are providing their care, including radiologists, are practicing with a high level of skill and safety as provided by meeting state licensure and hospital credentialing requirements. Patients also expect that their physicians will be subject to all state and federal laws governing the practice of medicine and held accountable for their actions. As physicians, we must insist that all physician services be held to the same high standards to ensure the absolute best for our patients.
May 2006