ABSTRACT
BACKGROUND: The current literature discusses aspects of quality assurance (QA) and sub-specialization. However, the challenges of these topics in a teleradiology network have been less explored. In a project report, we aimed to review the development and enforcement of sub-specialized radiology at Telemedicine Clinic (TMC), one of the largest teleradiology providers in Europe, and to describe each step of its QA. EVALUATION: The company-specific background was provided by the co-authors-current and former staff members of TMC. Detailed descriptions of the structures of sub-specialization and QA at TMC are provided. Exemplary quantitative evaluation of caseloads and disagreement rates of secondary reviews are illustrated. Description of Sub-specialization and Quality Assurance at TMC: Sub-specialization at TMC is divided into musculoskeletal radiology, neuroradiology, head and neck, a body, and an emergency section operating at local daytime in Europe and Australia. Quality assurance is based on a strict selection process of radiologists, specific reporting guidelines, feedback through the secondary reading of 100% of all radiology reports for new starters, and a minimum of 5% of radiology reports on a continuous basis for all other radiologists, knowledge sharing activities and ongoing training. The level of sub-specialization of each radiologist is monitored continuously on an individual basis in detail. After prospective secondary readings, the mean disagreement rate at TMC indicating at least possibly clinically relevant findings was 4% in 2021. CONCLUSION: With continuing and current developments in radiology in mind, the essential features of sub-specialization and innovative QA are relevant for further expansion of teleradiology services and for most radiology departments worldwide to respond to the increasing demand for value-based radiology.
ABSTRACT
PURPOSE: To investigate gender differences in diagnostic radiology practice, specifically, the differences in scope of practice, the frequency of consultations to other colleagues, and the error rates. MATERIAL AND METHODS: A retrospective observational study was performed including radiologists working for a European teleradiology provider between 2013 and 2019. Main outcome measures included the adjusted odds ratio of female gender for reporting cases in more than one subspecialty, the adjusted incidence rate ratio (IRR) of female gender for the count of second opinion requests to other colleagues, and the adjusted IRR of female gender for the count of radiologic errors. Multivariable adjustment was performed for covariates associated with experience, type of cases reported, part- or full-time employment, and reporting speed. RESULTS: A total of 213 radiologists (36% female) were included in the analysis of gender differences in scope of practice. Female gender was associated with a lower odds of reporting cases in more than one subspecialty with an odds ratio of 0.46 (95% confidence interval, 0.22-0.96). A total of 204 radiologists (36% female) were included in the analysis of gender differences in the count of second opinion requests to colleagues. There was a trend toward an association between female gender and higher odds of requesting a second opinion with an adjusted IRR of 1.6 compared with male gender, but it was not statistically significant (P = .08). A total of 199 radiologists were included (37% female) in the analysis of gender differences in the number of radiologic errors. Female gender was associated with a decrease in the odds of error with an IRR of 0.8 (95% confidence interval, 0.64-0.995). CONCLUSIONS: Female radiologists tend to have a narrower scope of practice and make fewer mistakes than their male counterparts, even after detailed adjustment for factors that might explain gender differences in scope of practice and errors.
