Outsourced Radiology Reporting Linked to Rise in Inappropriate Imaging Recommendations, Study Finds

Outsourcing radiology reporting may be contributing to a significant increase in unnecessary imaging recommendations, according to new research published in Clinical Radiology. The study found that a substantial portion of reports completed by teleradiologists included follow-up imaging suggestions that were either inappropriate or lacked sufficient clinical justification.

The findings raise concerns for healthcare organizations increasingly relying on teleradiology services to meet growing imaging demands. While outsourcing can help alleviate reporting backlogs, it may also introduce inefficiencies and unintended consequences that affect patient care and increase costs.

“In addition to the growing costs associated with an increasing reliance on outsourcing, external reporting potentially brings with it other impracticalities,” said lead author Samuel Ebbs, with the Royal United Hospitals Bath NHS Foundation Trust in the UK. “These may include the challenge clinicians face when trying to discuss findings on scans, a misunderstanding of or lack of access to up-to-date clinical details, a disparity in referral thresholds and a lack of knowledge of local referral and onward management guidelines.”

For the study, researchers reviewed 248 outsourced CT scans of the chest, abdomen and pelvis. They examined the imaging and non-imaging recommendations made by teleradiologists and compared them with those from in-house radiologists. Each recommendation was assessed for clinical appropriateness based on patient context and imaging findings.

The results revealed that outsourced reports were significantly more likely to include additional imaging recommendations compared to in-house reports. In 26% of cases, the teleradiologist’s suggestions were considered inappropriate, while only 4% of recommendations from in-house radiologists were judged similarly. Furthermore, outsourced reports more frequently contained vague or unclear guidance, which can complicate downstream care decisions and add confusion for referring physicians.

The authors suggest these discrepancies may be due to limited access to electronic health records, laboratory results and direct communication with referring clinicians. Teleradiologists often lack the broader clinical context necessary to tailor their recommendations, which may prompt them to take a more cautious approach and suggest extra imaging to avoid missing important findings.

“This has the potential to increase the workload and costs for local radiology departments, in turn reducing the cost-effectiveness of outsourcing as a means of tackling the increasing reporting demand,” the team noted.

To address these issues, the researchers recommend improving access to patient records and communication channels for off-site radiologists. Organizations considering or currently utilizing teleradiology services may benefit from investing in infrastructure that ensures remote readers are equipped with the same clinical context and decision support tools available to in-house radiologists.

As imaging volumes continue to rise, the findings underscore the importance of evaluating not just turnaround times but also the clinical value and downstream implications of outsourced radiology reporting.