Overseas Reading

There was quite a flutter of conversation this year at RSNA over having Indian radiologists pre-read  studies and having those findings delivered to a US radiologist. Dalai has a post about it. In general almost everyone that I have talked to is completely opposed to overseas reading from radiologists. It will not shock some of my readers to learn that I am not.

So when I was a researcher we conducted numerous reader studies under controlled conditions. For those of you not familiar when researching the impact of new technologies or methodologies on the accuracy of radiologist findings we display carefully selected cases in a controlled manner. There is a specific task such as identify the cervical spine fractures. There is a set of normal cases with no pathology included in the dataset. The process is extremely onerous and tedious. However you get quantifiable data on the radiologists accuracy. So what’s good accuracy? I would say above 80% and the radiologist is quite good. Very few people will cross the 90% barrier.

Now to determine what a good US radiologists accuracy should be obviously you would need a much larger study. But lets for the sake of argument say that the average radiologist is correct 75% of the time. What if an Indian radiologist could show that he was also correct 75% of the time. Why should he not be allowed to read?

A potentially much more valuable but much, much harder to obtain metric would be tying the findings and recommendations of a radiologist to patient outcomes. This is much harder to prove since patient care is a very complicated animal with many players all of whom get to make decisions that may conflict with one another. I just feel that I have to mention this since this would be a truer measure of quality than simply accuracy.

So where does that leave us? Will this happen? No. It would not matter if the Indian radiologist was right 90% of the time over a large number of studies. The ACR would simply say that they were not US trained and could not be as good as American radiologists. As an across the board statement that is most probably true. However I do consider it to be unprovable since I don’t know where the data would come from. If someone else wants to contest that view please do so.

It turns out that it is easy to say that the Indian radiologist would do a bad job. It sounds true to main street America. And more importantly it helps people feel good, which it turns out is more important than being right.

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