This page was updated on March 20, 2025, to reflect feedback from the radiology community.
Introduction
Modern CT and MRI manufacturers have developed the technology to enable scanners to be operated remotely. When used appropriately, this technology holds great potential to expand the reach of skilled technologists, especially in rural and underserved areas. However, without appropriate safeguards, the technology could have a detrimental impact on patient care.
The American College of Radiology (ACR) supports the use of remote scanning as long as it is conducted in manner that promotes patient safety, imaging quality, and personnel development. The purpose of this document is to describe the position of the ACR on remote scanning, including high-level principles that provide the foundation for more specific guidance documents produced by the ACR.
Opportunities enabled by remote scanning
Remote scanning holds potential to improve imaging in several ways:
Extended technologist expertise: CT and MRI scanning requires advanced skill. Deploying these skills for all protocols at all imaging sites in a healthcare organization can be challenging, especially in the face of staffing shortages. Remote scanning technology can enable experienced and specialized technologists to apply their expertise more broadly, overcoming limitations imposed by travel.
Improved productivity: The ability for a technologist to remain located at a single location and quickly move from scanner to scanner can enable the productive use of these highly skilled individuals and facilitate the efficient use of scanners. This is especially important in the setting of limited availability of skilled technologists.
Improved patient access: Limited availability of technologist skill may especially limit patient access in rural and underserved environments. Remote scanning may facilitate improved access to specialized imaging services in these communities where patients live.
Protocol management: Optimizing, updating, and standardizing CT and MRI protocols across a geographically dispersed organization is difficult. Conducting these activities from a remote location may improve standardization while decreasing the expense of maintaining protocols.
Improved supervision, coaching, and support: With the ability for remote supervision, less experienced technologists can observe and perform exams of greater complexity than what they might otherwise be able to independently perform. This is especially helpful with complex procedures, changes in protocols, and introduction of new software or equipment. Remote scanning can also facilitate closer personnel supervision, more frequent coaching, and greater access to expert consultation.
Potential risks associated with remote scanning
If not used properly, remote scanning may have a detrimental impact on patient care in a number of ways:
Insufficient number of onsite personnel: Physical presence of attentive individuals in the control room (with clear visibility to the scan room) offers multiple patient care advantages that may not be obvious. For example, trained onsite personnel may observe unfolding problems such as those related to changes in patient status, patient positioning, IV tubing connections, scanner status, or objects or personnel in the scanning environment. Hence, scanner operation without adequate staffing of qualified onsite monitoring personnel poses a risk to patients, possibly in non-obvious ways.
Insufficient qualifications of onsite personnel: Relaxation of standards for qualifications of remotely supervised onsite operators increases the risk of safety events, including those related to MRI safety, CT radiation, and contrast administration. Insufficient qualifications of personnel may also compromise image quality as well as patient experience and trust in the health system.
Reduced technologist skill: If not properly organized, the pervasive use of remote technologists could reduce incentives for organizations to invest in training of onsite personnel, which could serve to exacerbate rather than diminish shortages of skilled technologists. Training of onsite personnel could be further impeded by business pressures for remote technologists to complete high volumes of exams or scan multiple patients simultaneously.
Detrimental impact on coordination and relationships: Ambiguity in decision-making authority can lead to mistakes arising from lack of coordination. Furthermore, interpersonal relationships between remote and onsite technologists can potentially be compromised in the absence of regular in-person contact, which can undermine teamwork and compromise patient care.
Recommendations Regarding the Use of Remote Scanning
The overriding principle in remote scanning is that patient safety, exam quality, and patient experience must always be maintained to the same level as for scanning with the primary technologist onsite.
Personnel
A fully qualified technologist, licensed in the jurisdiction where the study is performed, must be in direct control of the scanner at all times, whether the individual is located onsite or remotely.
When an exam is conducted remotely, the remote technologist must be fully qualified to operate the local scanner, according to the local site’s protocols. The remote technologist must provide undivided attention to one exam at a time and should remain engaged for the entire duration of the exam.
Additionally, a qualified onsite operator, such as a technologist assistant, must also be actively involved in each remote scanning case. This individual should actively monitor the scanner, the patient, and the scanner environment to help ensure high standards of quality, safety, and patient care. The qualified onsite operator must be a technologist or have a recognized role in the organization that includes having completed appropriate training in patient care management and basic scanner operations.
For cases in which the onsite operator is not a radiologic technologist, an onsite supervising technologist must also be physically present in the immediate vicinity of the scanner, to provide patient care and maintain safety of the environment where the procedure is being performed by a remote operator.
Remote scanning technology
Prior to first use, the remote scanning technology must be thoroughly tested, with adequate network speed and a high level of uptime reliability. Contingency plans must be in place for loss of remote connectivity at all phases of the exam.
The remote scanning system should incorporate technology that optimizes effective communication and situational awareness, including video conferencing in which both the remote technologist and the onsite operator can see each other and the scan room.
The remote scanning system should make it clear at all times to onsite operators when they are being monitored, as well as who has control of the console.
The remote system should enable visual and audio monitoring of patients, which may include two-way communication. Patients should be advised when remote scanning or supervision is being utilized and whether they may be visible to others via video. Video monitors at remote sites must be located in private locations in order to maintain patient privacy; any recordings that include patients must be appropriately secured and protected.
The organization should establish documented policies that ensure effective coordination between remote technologists and onsite scanner operators and make it clear who has authority to operate the scanner and make other scan- and patient-related decisions at any given time. Procedures should be established and training provided for the handling of problems, including emergency situations.
Personnel development
Remote scanning should be conducted in a way that supports local personnel development in an inclusive and constructive manner. Organizations should emphasize the use of remote scanning for training, support, and quality assurance activities.
In addition to meeting training and skill level requirements, remote technologists should have additional training in supervising and teaching onsite operators.
Since qualifications for qualified onsite operators are not yet generally defined or accepted, it is incumbent upon the organization to specifically define this role, including minimum training and experience qualifications. In the spirit of prioritizing personnel development, this role should be considered to be a career development or training role through which these individuals are expected to progress at a steady pace.
Remote supervision of less experienced onsite technologists should be considered to be a training activity, with the onsite technologist being granted graduated autonomy, progressing from observing to operating the scanner under close supervision to independently operating the scanner once prescribed milestones are met.
Program oversight
Remote scanning should be conducted within the construct of a well-managed program with commensurate governance and support, resources, oversight, and mechanisms to ensure quality and safety. Roles, procedures, and protocols should be documented, and adherence should be regularly reviewed.
Organizational leaders are accountable for the safe, effective, and patient-oriented application use of remote scanning. They should conduct regular assessments of remote scanning practices to ensure that standards for quality, safety, and patient experience are met.
Physician supervision
Physician supervision requirements are no different for remote scanning than for onsite scanning.
Contrast and safety management
Onsite supervision requirements for contrast management and reactions as well as for CT and MR safety are no different in the setting of remote scanning as for onsite scanning. While remote technologists should be facile in recognizing problems and helping to support local personnel in emergent and other unexpected situations, it remains incumbent on sites to ensure their procedures and supervision arrangements are prepared to manage all emergent situations independent of the remote scanning program.
Practical Application
More specific guidance regarding remote scanning can be found in the ACR Manual on MR Safety and the ACR Manual on Contrast Media. Additional guidance may be published through relevant ACR channels media. Guidance provided in this document should be considered to constitute the minimum standard for remote scanning; ACR Quality and Safety committees may provide more specificity or more strict requirements for given situations, as appropriate.
As the field develops greater experience with remote scanning, guidance provided by the ACR may be updated to reflect new evidence and conditions. Additionally, the ACR will continue to collaborate with other professional societies to further harmonize guidelines, as appropriate.
Accreditation
The ACR maintains accreditation programs for all imaging modalities, which provide extramural validation of high-quality imaging practices. The ACR Accreditation Program will apply the guidance contained in this document and other relevant documents in its evaluation of organizational practices in order to ensure that the highest standards for patient care, image quality, and personnel management are maintained in the use of remote scanning.
Conclusion
When used appropriately, remote scanning offers the possibility of enhancing patient care and access. However, because of the risks associated with remote scanning, organizations must take deliberate steps to ensure that remote scanning is performed in a safe manner that also ensures optimal patient care and experience and personnel management that is at the same level as standard scanning with the technologist onsite.
