CASE REPORT: THE DANGERS OF TELERADIOLOGY

Teleradiology, what is it? It is the electronic transmission of radiological patient images, such as x-rays, CT's and MRI's, from one location to another for the purposes of interpretation and/or consultation....and almost all hospitals today are using these services. Hospitals like to use teleradiology services because it provides around the clock professional services, often at lower cost than having a fully-staffed radiology department on site.

We just concluded a medical malpractice case in Virginia involving teleradiology, and sadly the failures of the teleradiologist in our case resulted in the unnecessary death of a 47 year old man. The teleradiology company involved in the case is one of the largest such companies in the world, NightHawk Radiology Services. Our local hospital, Carilion Roanoke Memorial Hospital, contracted with NightHawk to provide radiologic services. The patient arrived at the hospital with a history of a thoracic aneurysm and complaining of back and flank pain. The attending Emergency Room doctor was aware of the possibility that the aneurysm could be the cause of the patient's symptoms and was also aware that a ruptured thoracic aneurysm meant certain death. So he correctly ordered a thoracic/abdominal CT scan to verify the status of the aneurysm.

No radiologist was available at the hospital so the CT films were sent, basically as an attachment to an email, to NightHawk Radiology Services. NightHawk then forwarded the CT films, again via the Internet, to a radiologist sitting at his home in Louisiana for interpretation. Unfortunately, the radiologist mis-read the CT films and determined there had been no change in the aneurysm and reported his findings back to the Emergency Room doctor, who gave the patient pain medication and sent him home. The CT film actually showed the aneurysm had gotten larger and was leaking, or bleeding. The patient was found dead by a family member 5 days later. The cause of death - ruptured thoracic aneurysm!

I am all for using technology to make us more productive, safer, and happier. However, when we go to our local hospital, how do we know who is really diagnosing our condition? Is it a local doctor who is easily accessible (and accountable) or is it a doctor sitting at home in Louisiana or India or China? It is something to think about!