Radiol med (2016) 121:652–659

DOI 10.1007/s11547-016-0640-7

COMPUTER APPLICATIONS

Results of an Italian survey on teleradiology

Francesca Coppola1 · Corrado Bibbolino2 · Roberto Grassi3 · Luisa Pierotti4 ·
Roberto Silverio5 · Francesco Lassandro6 · Emanuele Neri7 · Daniele Regge8 

Received: 7 February 2016 / Accepted: 5 April 2016 / Published online: 23 April 2016
© Italian Society of Medical Radiology 2016

Abstract  survey. As a result, 62 % of participants have a positive

Objectives  The aim of this study is to present the results opinion on teleradiology, while 80 % including 18 % with
of the Italian survey on teleradiology (TR). a negative opinion believe that teleradiology will have a
Methods  Two radiologists created an online electronic future. 55 % of responders (n = 874) use teleradiology in
survey using the Survey Monkey web-based tool. The ques- their clinical practice. The majority of users adopt intra-
tionnaire was then improved by suggestions from a multi- mural teleradiology for coverage of emergencies (47 %), of
disciplinary group of experts. In its final form, the survey night and weekend shifts (37 %) or to even out distribution
consisted of 19 multiple-choice questions. Space was left workload (33 %). Most responders still show concern on
below each question for participants to add their personal the use of teleradiology. In particular, they think that telera-
comments. Members of Italian Society of Medical Radiol- diology is too impersonal (40 %), and that it is responsible
ogy (SIRM) were given 2 weeks to perform the survey. for insufficient communication with the referring clinician
Results  A total of 1599 radiologists, corresponding to (39 %).
17 % of all SIRM radiologists, participated into the online Conclusions  The majority of Italian radiologists are
favorable to teleradiology. However, they have concerns
that teleradiology may further reduce communication with
* Francesca Coppola
francesca.coppola@aosp.bo.it the referring clinician ad patient.
1
Radiology Unit, Department of Diagnostic Medicine Keywords  Teleradiology · Italian survey · Insourcing ·
and Prevention, S. Orsola Malpighi Hospital, 15, Albertoni
Outsourcing · Picture archiving communication systems
Street, 40138 Bologna, Italy
2
SNR Foundation, Via Farini 62, 00185 Rome, Italy
3
Radiology Unit, Department of Medicine and Surgery, Introduction
Magrassi-Lanzara, Second University of Naples, Naples,
Italy
4
In the recent update of the white paper of the European
Medical Physics Unit, Sant’Orsola-Malpighi Hospital,
Society of Radiology Teleradiology (TR) is defined as “the
Bologna, Italy
5
exchange of radiological images and patient-related data
User Co‑Chair IHE‑Italy, Servizio di Radiologia,
between geographically different locations for purposes of
Misericordia Hospital, Azienda USL Toscana Sud Est,
Grosseto, Italy primary interpretation, expert consultation and/or clinical
6 review by digital transmission” [1]. TR is part of a largest
Monaldi Hospital, Via Leonardo Bianchi, 80131 Naples, Italy
7
effort of the European Community (EC), with an aim of
Department of Translational Research, University of Pisa,
improving the quality of the health system and of reduc-
UO Radiodiagnostica 1-AOUP, Edificio 30A, Via Paradisa 2,
56124 Pisa, Italy ing healthcare costs [2]. Implementation of high speed
8 information technology (IT) highways, the availability and
Department of Surgery Science, University of Torino,
Candiolo Cancer Institute, Strada Prov. 142, Km 3,95, low costs of large data storage facilities, and the diffusion
Candiolo, 10060 Pisa, Italy of picture, archiving and communication systems (PACS)

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Radiol med (2016) 121:652–659 653

is rapidly closing the technological gap and favoring the group of experts for review. All proposed changes were
implementation of TR. However, PACS technology is discussed and introduced in the draft if consensus between
unevenly distributed in the EC. According to the e-Health experts was reached. In its final form, the survey consisted
Benchmarking III report of the European Commission, of 19 multiple-choice questions (“Appendix”). Space was
PACS availability is highest in Northern Europe (i.e., left below each question where participants could add their
>95 % of health facilities have one) while it is still scarcely personal comments.
distributed in some Southern EC countries [3]. The first set of questions was aimed at collecting infor-
Shortage of radiologists and geographical concerns (i.e., mation on the geographical location, age, institution and
large distances between healthcare facilities, low popula- working position of radiologists. The second section
tion density areas and adverse climatic conditions) are the included questions on the working environment of radi-
main drivers of TR demand. In many Northern European ologists, i.e., whether a PACS system was present in their
countries, TR has become part of the regular workflow for institution, if digital signature was adopted, etc. Radiolo-
purposes of workload balancing or to provide remote, off- gists were then asked to answer to a third set of questions,
hour radiological coverage, for emergency readings and to related to their experience with TR only if they were actu-
a lesser extent for subspecialty readings [4, 5]. In the past ally participating, in some form, to a TR project. The final
decade, several national and international commercial TR set of question was designed to understand more in depth
providers have emerged in Europe, facilitating the out- the opinion of the interviewed on TR. Multiple answers
sourcing of diagnostic readings [4, 6, 7]. On the opposite, were allowed in five questions. All 19 questions are laid out
in Southern European TR is still in its infancy possibly due in the “Appendix”.
to the technological gap, to the larger availability of radi- All invited radiologists were members of the Italian
ologists in some countries and to the more restrictive legis- Society of Medical Radiology (SIRM). Each radiologist
lation and guidelines [8]. However, the market analysts are was sent a personal email from the president of the Col-
expecting a growing demand for non-invasive diagnostic lege of Informatics by SIRM with an invitation to par-
imaging that could lead to an increased usage of TR in the ticipate into the survey, which was accessible through an
coming years [1, 2]. email link. Each individual could fill the survey form only
According to a recent European Survey, most radiolo- once. Two reminders were sent, respectively, after 1 week
gists look favorably at TR as it allows improved collabo- from the survey’s opening and on the final day. The survey
ration between peers, can be used to organize radiologists’ remained online for approximately 2 weeks, from June 20
workload, thus improving the quality and efficiency of until July 7. Survey Monkey statistical tools were used for
radiological services, especially, those of rural and under- the analysis of the quantitative data [11].
served areas [2, 9]. On the opposite, European radiologists
are concerned that TR will inevitably reduce communica-
tion with the referring clinician and with the patient. Other Results
important concerns are related to quality control, safety
issues and the risk that business oriented TR models might Population characteristics
undercut national tariffs [9]. In this context, Italy stands out
as the country with the second lowest number of inhabit- One thousand five hundred ninety-nine of the 9662 mem-
ants per radiologist and with one of the most careful and bers of the SIRM (17 %) participated into the survey.
patient centered TR guidelines [8]. Thirty-one percent of participants where 56–65 years old;
In June 2014, the Italian Society of Medical Radiology 26 % where 46–56 years old; 22 % where 36–45 years
(SIRM) promoted an online survey to gain information on old; 17 % where 25–35 years old. Only 4 % of participat-
the IT infrastructure of healthcare facilities throughout its ing radiologists had more than 65 years. The majority of
territory and on the current usage of TR. Italian radiologists responders were from the northern Italy (43 %); central and
were also asked give their opinion and to point out advan- southern Italy followed with a response rate of 30 and 27 %,
tages and limitations of TR. The aim of this study is to pre- respectively. Overall, 79 % of responders were employed in
sent the results of the survey. a public hospital and 21 % in a private institution. Partici-
pants into the survey were either academic or directors of
radiology units in 29 % of cases; only 8 % were residents.
Materials and methods
Teleradiology infrastructure
Two radiologists (FC, DR) created an online electronic sur-
vey using the Survey Monkey web-based tool [10]. The first Eighty-nine percent of responders had a PACS avail-
draft of the questionnaire was sent to a multidisciplinary able in their working environment; no difference in PACS

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654 Radiol med (2016) 121:652–659

Table 1  Recapitulated requirements that responders considered important for implementation of TR (total number of responders 816, multiple
choices allowed)
Statement Responders that consider the statement
important (%)

1. Clinical data and patient’s images should be available only to the reporting radiologist 261 (32 %)
2. Patient should be informed at the time of imaging that his images will be reported 225 (28 %)
by a radiologist through a TR service and should give written consent
3. Correspondence between images received by the reporting radiologist and patient 316 (39 %)
sensitive data should be verified
4. Technical protocols from the site that performs the examinations are periodically 160 (20 %)
verified
5. Quality control of transmitted images should be performed, assuring 177 (22 %)
no loss of information occurs with image compression (lossless)
6. Clinical request specifying the indications to the exam should always be available 482 (59 %)
7. Patient clinical data and previous imaging studies should always be available for comparison 558 (68 %)

Table 2  Summarizes the usage of TR in Italy (total number of responders 896, multiple choices allowed)
Statement Responders (%)

1. TR is used to report examinations performed in the Institution where I work (remote management procedures 424 (47 %)
of intra-company deferrable urgent/emergency)
2. For reporting of examinations performed in the facility where I work (remote management procedures intra hospital) 298 (33 %)
3. As part of regular workflow in the institute where I work (outsourcing) 110 (12 %)
4. For a second or expert opinion from a colleague with another sub-specialty 194 (22 %)
5. For a second opinion from a colleague with a different specialty (for example a neurosurgeon) 143 (16 %)
6. For online multidisciplinary meetings 44 (5 %)
7. On a temporary basis (staff shortages, holidays and illness) 60 (7 %)
8. For night and week-end coverage 334 (37 %)
9. For double reading (for example mammography) 63 (7 %)
10. For research or teaching purposes 47 (5 %)
11. Other 79 (9 %)

distribution was observed between private and public prac- Usage of teleradiology
tices. Sixty-five percent of participants (65 %) adopted
digital signature at the time of the survey. Of the 1551 radi- Usage of TR is summarized in Table 2. Of the 874 respond-
ologists that replied to the specific question in the survey, ing radiologists (55 %) that used TR in their clinical prac-
702 (45 %) did not use TR in their clinical practice. Of the tice, the majority adopted an intra-mural solution—they
remaining, 737 (48 %) adopted TR in-hospital on dedi- report examinations from a Radiology Unit located either
cated workstations, 137 (9 %) worked from home and 92 within the same hospital or in a different hospital but of
(6 %) on mobile devices (note that multiple answers were property of the same institution—for emergency calls
allowed for this question). (47 %), for night and weekend coverage (37 %) or to even
The large majority of users (75 %) sent their report out distribution workload (33 %). Only 12 % of respond-
through a direct connection with the radiology informa- ers adopt an extra-mural option, i.e., where the interpreting
tion system (RIS). In reverse, patient’s clinical information radiologist is working for another company, not affiliated to
was obtained with a direct connection with RIS in 53 % of the institution that is providing the examinations [1]. Out-
cases; by phone in 27 %; by fax in 8 %; through a dedicated sourcing is adopted more frequently by private institutions
platform in 7 %, by e-mail in 4 % and by instantaneous than in public hospitals (28 vs 9 %).
messaging in the remaining 1 %. Table 1 lists the require- Approximately half of responders working with TR
ments that the responding radiologists consider important receive requests for a second opinion, mainly for the
for implementation of TR. following reasons: examinations of any kind (24 %),

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Table 3  Summerizes the advantages of teleradiology in the opinion of responders

Strongly disagree Disagree Neutral Agree Strongly agree No opinion Total n° of responders

Possibility to discuss cases 53 (3.6 %) 60 (4 %) 72 (4.8 %) 758 (50.9 %) 503 (33.8 %) 44 (3 %) 1490
in a collaborative network
Greater efficiency and 146 (9.9 %) 239 (16.2 %) 109 (7.4 %) 587 (39.7 %) 374 (25.3 %) 22 (1.5 %) 1477
improved radiological
services
Better distribution of the 199 (13.7 %) 334 (22.9 %) 206 (14.1 %) 411 (28.2 %) 262 (17.9 %) 44 (3 %) 1456
workload throughout the
organization
Improved communication 1801 (2.4 %) 307 (21.1 %) 156 (10.7 %) 515 (35.4 %) 262 (18 %) 33 (2.3 %) 1453
with referring clinicians
Profession is now more 216 (15.1 %) 326 (22.8 %) 307 (21.5 %) 317 (22.2 %) 173 (12.1 %) 91 (6.4 %) 1430
attractive for young new-
comers
It is useful to reduce costs 119 (8.1 %) 447 (30.6 %) 190 (13 %) 358 (24.5 %) 293 (20 %) 53 (3.6 %) 1460
There aren’t particular 356 (25.2 %) 619 (43.7 %) 138 (9.7 %) 161 (11.4 %) 102 (7.2 %) 39 (2.8 %) 1415
advantages of the use of
teleradiology

Table 4  Shows opinions about disadvantages of teleradiology

Strongly disagree Disagree Neutral Agree Strongly agree No opinion Total

Insufficient integration of patient history/ 85 (5.7 %) 418 (28.3 %) 68 (4.6 %) 580 (39.2 %) 305 (20.6 %) 21 (1.4 %) 1477
previous studies
Insufficient communication with referring 65 (4.4 %) 394 (26.8 %) 119 (8 %) 578 (39.3 %) 292 (19.8 %) 24 (1.6 %) 1472
clinicians
Too impersonal, no contact with radiogra- 67 (4.5 %) 282 (19 %) 157 (10.6 %) 552 (37.2 %) 406 (27.4 %) 18 (1.2 %) 1482
pher and radiologist
Too impersonal, no contact with patient 61 (4.1 %) 212 (14.1 %) 141 (9.4 %) 610 (40.6 %) 461 (30.7 %) 16 (1.1 %) 1501
Insufficient quality assessment 95 (6.6 %) 452 (31.4 %) 241 (16.8 %) 360 (25 %) 196 (13.6 %) 93 (6.5 %) 1437
Involves complex logistics 88 (6.2 %) 394 (27.9 %) 253 (17.9 %) 412 (29.2 %) 165 (11.7 %) 99 (7 %) 1411
Technology is too unstable/insecure 160 (11.1 %) 537 (37.2 %) 183 (12.7 %) 349 (24.2 %) 145 (10 %) 69 (4.8 %) 1443

neuroradiology consultancies (17 %), evaluation for inter- it (68 %) with respect to radiologists that are not using
ventional radiology procedures (13 %), and pediatric radi- TR in their clinical practice (53 %). Radiologists working
ologist’s consultancies (4 %). On the opposite, approxi- in private practices on average have a higher opinion of
mately half of responders send out request for a second TR (72 %) with respect to radiologists working in public
opinion for the following reasons: neuroradiology con- institutions (59 %). Academic radiologists and Directors
sultancies (30 %); examination of any kind if particularly of Radiology Units were generally more positive on TR
complex (18 %), evaluation for interventional radiology (70 %) with respect to radiologists working in other posi-
procedures (8 %) or for pediatric radiology examinations tions (60 %). Perceived advantages and disadvantages of
(5 %). TR are summarized in Tables 3 and 4, respectively. Main
concerns of participants into the survey relate to fear of
Perceived advantages, disadvantages and threats losing control over their business (63 % of responders),
of teleradiology instability in the job market and in radiologists’ income
(63 % of responders), reduced quality of reports (47 %
Sixty-two percent of participants into the survey had a of responders), loss of radiological skills (47 %), a nega-
positive opinion on TR while 80 % including 18 % with tive effect on resident’s training (34 %) and slow speed
a negative opinion, are convinced that TR will have a in communicating the results of an urgent examination
future. Those already using TR have a better opinion of (33 %) (Table 5).

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Table 5  Summarizes the possible threats and dangers of teleradiology

Strongly disagree Disagree Neutral Agree Strongly agree No opinion Total

Radiologists could lose control of their 90 (6 %) 371 (24.6 %) 87 (5.8 %) 595 (39.5 %) 339 (22.5 %) 23 (1.5 %) 1505
business
Instability of jobs and/or income for radiolo- 61 (4.1 %) 309 (20.9 %) 121 (8.2 %) 599 (40.6 %) 326 (22 %) 61 (4.1 %) 1477
gist
Loss of quality radiological reports 107 (7.2 %) 520 (34.8 %) 118 (7.9 %) 402 (26.9 %) 312 (20.9 %) 34 (2.3 %) 1493
Danger of missing urgent pathology 165 (11.2 %) 675 (46 %) 110 (7.5 %) 326 (2.2 %) 148 (10 %) 43 (2.9 %) 1467
Negative effect on training of residents 120 (8.2 %) 563 (38.5 %) 182 (12.4 %) 316 (21.6 %) 180 (12.3 %) 101 (6.9 %) 1462
Loss of radiological skills 155 (10.5 %) 603 (40.7 %) 116 (7.8 %) 341 (23 %) 220 (14.9 %) 45 (3 %) 1480

Discussion individual X ray examination is under the sole responsibil-

ity of the radiologist [20]. A legislative solution is being
In this large Italian survey, 62 % of radiologists participat- sought to solve the above reported conflicting positions.
ing into the survey have a positive opinion of TR, and 80 % Third, language barriers probably represent a limitation to
are convinced that it will have a future. Radiologists value cross-border implementation. Finally, if supported by ade-
most the possibility to discuss cases in a collaborative net- quate IT infrastructure, the prevailing opinion in this survey
work to improve the efficiency of the radiological service is that insourcing could actually bring about an improve-
and to reduce costs. ment in communication between imaging doctor, patient
Approximately, half of radiologists participating into the and referring clinician. Accordingly, the Italian radiologist
survey use TR in their clinical practice, in the large major- feels that the most important advantage of TR is the pos-
ity of cases as an intra-mural solution. With this form of TR sibility of working in a collaborative network and contextu-
the presence of at least one radiologist must be guaranteed ally his major point of concern is that it is too impersonal
within the hospital facility; health personnel must comply and that the contact with the patient and referring clinician
with the newly published Italian guidelines [12]. may be lost. This is a point of major concern also for radi-
Outsourcing is rare in Italy (Table 2) [8] and is mainly ologists in other countries. Indeed, the European Society
adopted in private practice. This somewhat conservative of Radiology (ESR) and the American College of Radi-
approach is in contrast with the northern European and ologist ACR white papers state that “patients are the pri-
North American vision of TR where outsourcing appears mary focus; first and foremost, all TR relationships should
to be far more common [13–18]. There are several possi- be patient centred” [18, 21, 22] and that the Royal College
ble reasons for these differences. First, Italy has a very high of Radiologists (RCR) similarly affirms that the “optimum
population density and the highest number of radiologists radiology service is one provided locally where radiolo-
per inhabitant after Denmark [19]. This may well reduce gists can maintain a regular dialogue with both referrers
the need for extra-mural TR. Second, Italy has adopted the and those acquiring the images, only in this model can
restrictive guidelines of the Istituto Superiore di Sanità on patients benefit fully from the integration of imaging into
the implementation of TR, which is allowed in outsourcing the pathway of care” [23–25]. Italian radiologists seem to
only for screening examinations such as mammography, believe that the optimum radiology service is one provided
as it requires double reading [8]. Italian guidelines allow locally where radiologists can maintain a regular dialogue
routine intra-mural TR between different locations if these with both referrers and those acquiring the images; only
are within the same radiological unit and within the same in this model can patients benefit fully from the integra-
hospital, or between radiology units or departments of the tion of imaging into the pathway of care. However, they
same Institution. TR is allowed between different hospitals also believe that there are circumstances in which TR can
only for emergency studies if one of the facilities does not be beneficial, most significantly when seeking a specialist
have radiologist on duty or on call due to the small number second or subspecialty expertise opinion or for peripheral
of performed examinations [8]. It has been recently debated disadvantaged areas or disaster.
on whether technologist may be allowed to perform con- There is a significant methodological limitation to this
ventional radiograms without contrast media injection to study as only 17 % of radiologists of the SIRM responded
outpatients with the prescription of the general practitioner, to the survey. Individuals responding to the questionnaire
without the radiologist being present in the health facility might have been more motivated to answer because of their
to justify the examination and to obtain informed consent. personal interests or because more knowledgeable on IT.
In a recent lawsuit, the judge ruled that justification of each For this reason, it is not possible to affirm that the results

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Radiol med (2016) 121:652–659 657

of this survey reflect the opinion of the entire Italian radio- 3. What is the site of your main professional activity?
logical community.
Private hospital 10.19 %
In conclusion, the majority of responders are in favor of
University hospital 12.06 %
TR and believes that it will have a future. In Italy, insourc-
Research institute 2.26 %
ing is adopted in the large majority of cases for coverage of
Private diagnostic centre 11.15 %
emergency on nights and weekend shifts. Second or sub-
specialty opinion is another common application of TR. 4. What is your professional degree?

Radiology resident 7.95 %

Compliance with ethical standards  Consultant radiologist self 15.70 %
employed (libero professionista)
Conflict of interest  The authors do not have any competing interest Radiologist with fixed term mana- 6.16 %
to be disclosed. gerial position (incarico dirigen-
ziale a tempo determinato)
Ethical approval  This article does not contain any studies with Radiologist with basic managerial 28.87 %
human participants performed by any of the authors. position (incarico dirigenziale di
natura professionale di base)
Radiologist with managerial 13.05 %
Appendix position with high specialization
(incarico dirigenziale di natura
Appendix shows all 19 questions with answers of the professionale elevate)
survey Radiologist director of simple unit 11.72 %
(incarico di direzione di struttura
semplice)
1. In which region do you work? Radiologist director of complex 13.51 %
unit (incarico di direzione di
Abruzzo 1.89 %
struttura complessa)
Basilicata 0.50 %
University researcher 0.86 %
Calabria 3.09 %
Professor associate (professore 0.99 %
Campania 6.80 % associato)
Emilia Romagna 9.76 % Professor (professore ordinario) 1.19 %
Friuli Venezia Giulia 2.02 %
5. Do you use digital signature in your Institute?
Lazio 12.47 %
Liguria 3.90 % Yes 65.38 %
Lombardia 15.99 % No 32.02 %
Marche 2.77 % Occasionally 2.60 %
Molise 0.38 % 6. How are radiological images stored in your Institute?
Piemonte 5.73 %
Puglia 6.49 % On a analog archive 5.73 %
Sardegna 1.89 % Each diagnostic modality has its 5.02 %
own archive
Sicilia 7.43 %
On a PACS system 17.64 %
Toscana 8.82 %
On PACS of the Department 48.16 %
Trentino Alto Adige 1.51 %
On PACS of 2 or more health 23.05 %
Umbria 1.57 %
facilities
Valle d’Aosta 0.44 %
On PACS; Images and clinical 8.11 %
Veneto 6.55 % data are accessible from elec-
tronic health records
2. What age group do you belong in?
7. Where do you usually use Teleradiology?
25–35 years old 16.96 %
36–45 years old 22.09 % I don’t use teleradiology (if you 45.26 %
46–55 years old 25.76 % answer yes go directly to ques-
tion 15)
56–65 years old 30.82 %
Within hospital on a dedicated 47.52 %
Over 65 4.37 % workstation
3. What is the site of your main professional activity? At home 8.83 %
Everywhere using a mobile 5.93 %
Public hospital 64.35 %

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658 Radiol med (2016) 121:652–659

8. Which application do you use for Teleradiology? 11. What are the disciplines for which do you usually ask a second
opinion?
Same application utilized for other 87.40 %
radiological activities For pediatric examination 4.63 %
‘Stand alone’ application only for 8.21 % For evaluation of interventional 7.99 %
teleradiological activities procedures
‘Add on’ application of report- 4.39 % We don’t ask second opinions to 51.39 %
ing system with specific added other Institute
functions 12. How do you usually receive patient’s clinical informations?
9. What are the reasons of the use of teleradiology? (Table 2)
By telephone 26.78 %
For reporting of examinations 47.32 % By fax 7.82 %
performed in the company where By e mail 4.37 %
I work (remote management
By instant messaging software (ex. 1.03 %
procedures of intra-company
Viber, Whatsapp)
deferrable urgent/emergency)
By direct connection with RIS 52.64 %
For reporting of examinations 33.26 %
performed in the facility where Utilizing a dedicated platforms 7.36 %
I work (remote management 13. How do you usually send the examination’s report?
procedures intra hospital)
As part of regular workflow in the 12.28 % By telephone 4.30 %
institute where I work (outsourc- By fax 5.58 %
ing)
By e mail 6.28 %
For a second or expert opinion 21.65 %
from a colleague with another By instant messaging software (ex. 0.58 %
sub-specialty Viber, Whatsapp)
For a second opinion from a col- 15.96 % By direct connection with RIS 74.77 %
league with a different specialty Utilizing a dedicated platforms 8.49 %
(for example a neurosurgeon)
18. In conclusion do you think that teleradiology could be an advan-
For online multidisciplinary meet- 4.91 % tage or a disadvantage for radiologist?
ings
On a temporary basis (staff short- 6.70 % Yes, I am enthusiastic, I think that 10.03 %
ages, holidays and illness) teleradiology could be an advan-
For night and week-end coverage 37.28 % tage for radiologist
For double reading (for example 7.03 % Yes, I am generally favorable 51.86 %
mammography) No, I am generally unfavorable 18.31 %
For research or teaching purposes 5.25 % No, I am absolutely unfavorable, 11.53 %
Other 8.82 % I think that teleradiology is a
disadvantage for radiologist
10. What are the disciplines for which is required a second opinion in I don’t know, I am not convinced 8.27 %
your Institute?
19. Do you think that teleradiology could have a future?
We receive second opinion 24.37 %
requests for every kind of exami- Absolutely not 2.08 %
nation No 3.89 %
Neuroradiological consults 17.05 % I don’t know 14.01 %
For pediatric examinations 4.23 % Yes 58.63 %
For evaluation of interventional 13.04 % Absolutely yes 21.40 %
procedures
In out Institute we do not receive 48.74 %
second opinion requests
Other 6.52 % References
11. What are the disciplines for which do you usually ask a second
1. European Society of Radiology (ESR) (2014) ESR white paper
opinion?
on teleradiology: an update from the teleradiology subgroup.
We ask a second opinion for every 17.94 % Insights Imaging 5:1–8
kind of examination if particu- 2. Ranschaert ER, Barneveld Binkhuysen FHB (2012) European
lary complicated teleradiology now and in the future: results of an online survey.
Insights Imaging 4:93–102
For neuroradiological examination 30.21 %

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eu/information_society/eeurope/i2010/docs/benchmarking/ meeting, Nice
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4. Ross P, Sepper R, Pohjonen H (2010) Cross-border teleradiol- 17. Lienemann B, Hodler J, Luetolf M, Pfirrmann CWA (2005)

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