International Teleradiology can soon offer a solution to the silent prayers of numerous radiologists whose eyes crave for nothing more than a good night’s sleep. It is not an uncommon sight to find patients being subjected to middle of the night CT scans or other forms of radiological examinations following arrival at the emergency department. Such examinations have no doubt yielded the necessary clinical information regarding further management of the victims, but have also raised concerns about the effects of sleep deprivation on health care professionals.

It is now possible for an Indian radiologist to perform X-ray examination on a patient admitted to the emergency department in a U.S. hospital. The X-ray film can then be taken up for analysis by a team of radiologists located in Israel, Australia or Switzerland. The findings can then be communicated back to the United States either through fax or telephone depending on the situation. Sounds impossible? We are definitely not talking about medical fiction but an emerging branch of radiology commonly referred to as International Teleradiology.

The new technology has already captured a secured position in several hospitals in the United States. Teleradiology Solutions, NightHawk Radiology Services, and Virtual Radiologic are some of the notable industry leaders in this regard. The American College of Radiology, has recommended that such distant radiologists should be board certified to avoid any discrepancy in the reporting. Furthermore, they need to be provided with appropriate licenses to ensure that the examination was indeed performed at a source facility, authorized to do so.

The leading Teleradiology giants have agreed with the above recommendations and further state that all their overseas Teleradiology services adhere to different aspects related to licensure, certification, hospital privileges and medical insurance. ‘You can't reach over and slap the radiologist on the back, but every other aspect of the interaction is preserved,’ says Dr. Arjun Kalyanpur, who is currently running Teleradiology Solutions, a ‘nighthawk’ company, based in Bangalore. The speed of the examination, the accuracy of the clinical information obtained and the low incidence of technical problems are some of the distinct advantages of International Teleradiology.

The Centers for Medicare and Medicaid Services (CMS) restrict payment to radiologists, outside the United States. This problem is being overcome by obtaining a preliminary report from the overseas radiologist who receives a payment ($50 to $75 per radiograph) from either the hospital or the local U.S. radiologist. The preliminary report is soon supplemented with a U.S. radiologist's final, primary report. Issues have been raised by the ACR regarding the tendency of domestic radiologists to overlook the images and sign it off scrutinizing the films for a second time.

The suspension of the Wipro trial in 2003 that involved the testing the Teleradiology services through Indian radiologists (neither licensed nor board-certified) based in the U.S no doubt question the potential of such controversial overseas services. The willingness of Indian radiologists to work for low wages and the reduction in financial burden would probably aid in the survival of such an industry.

Although the technical challenges related to Teleradiology services have now been overcome, widespread use of the technology would be possible without effective implementation of the ACR guidelines and settlement of licensure and reimbursement related issues. To conclude, it would be reasonable to allow for a healthy competition among international and domestic radiologists, taking into consideration the most important aspect of the health care industry, the health care provider and the patient.