Emergence of teleradiology, PACS, and other radiology IT solutions in Acta Radiologica.

For this historical review, we searched a database containing all the articles published in Acta Radiologica during its 100-year history to find those on the use of information technology (IT) in radiology. After reading the full texts, we selected the presented articles according to major radiology IT domains such as teleradiology, picture archiving and communication systems, image processing, image analysis, and computer-aided diagnostics in order to describe the development as it appeared in the journal. Publications generally follow IT megatrends, but because the contents of Acta Radiologica are mainly clinically oriented, some technology achievements appear later than they do in journals discussing mainly imaging informatics topics.

[Assessment of teleradiology patients in a major regional hospital]. / Charakterisierung teleradiologisch untersuchter Patienten an einem Krankenhaus der Schwerpunktversorgung.

PURPOSE: To evaluate teleradiology examinations regarding the most frequently requested exams and examined body regions. Additionally, the frequency of pathological changes depending on the examined region and clinical situation as well as the time profile for requesting teleradiology (daytime, day of the week) were analyzed. MATERIALS AND METHODS: A retrospective analysis of all consecutive teleradiology exams in 2018 that were reported in the radiology department of a major regional hospital and scanned in three referring primary health care institutions regarding clinical history, working diagnosis and requested body region was performed. Additionally, the date and time of the examination were analyzed. RESULTS: A total of 1207 CT (computer tomography) scans that were reported as part of the teleradiology agreement were included. The most frequently requested examination was a cranial CT (77.9%) with 14.6% pathological findings, followed by abdominal CT (14%) with 63.9% pathological changes, spine/extremities (8.8%) with 50% pathological changes and CT of the chest (7.9%) with 53.7% abnormal scans. Most teleradiology requests were referred on weekends between 8 am and 4 pm, followed by 4 pm to 6 pm on weekdays. The smallest number of scans was requested between 2 am and 4 am. CONCLUSION: Most teleradiology CT requests focus on brain examinations, followed by abdominal CT, CT of the spine and extremities and CT chest. Most cranial CTs do not show an acute pathology, while abdominal CTs had the highest rate of pathological findings.

Work-style reform and use of information and communication technology among diagnostic radiologists in Japan: results of the 2018 JRS/JCR joint survey.

PURPOSE: The purpose of this study was to investigate recent trends in work-style reform and the use of information and communication technology (ICT) among board-certified diagnostic radiologists in Japan. MATERIALS AND METHODS: We conducted online questionnaire surveys of board-certified radiologists of the Japan Radiological Society (JRS) and registered training institutions. Completed surveys were obtained from 1192 radiologists and 275 training institutions (response rates of 25.5% and 38.1%, respectively). Respondents were assured of confidentiality. RESULTS: 13.5% (134/991) of full-time radiologists and 56.7% (89/157) of part-time radiologists had shifted some of their work to teleradiology at home. In addition, 52.9% (83/157) of part-time radiologists and 27.3% (12/44) of board-certified individuals who had stopped working as radiologists responded that they would consider starting full-time work in hospitals, if teleradiology at home was permitted as part of full-time work. Furthermore, 16.7% of training institutions (46/275) had introduced teleradiology systems for radiologists, and 47.2% (108/229) of the remaining training institutions wanted to introduce teleradiology systems in the future. CONCLUSION: Teleradiology using ICT is already a part of Japanese radiologists' workload. Work-style reform may progress with the use of ICT, such as part-time radiologists, and board-certified individuals who stop working as radiologists, becoming full-time radiologists.

Media messaging in diagnosis of acute CXR pathology: an interobserver study among residents.

The objectives of the study were to determine whether diagnostic accuracy and reliability by on-call teams is affected by communicating chest radiograph (CXR) images via instant messaging on smartphones in comparison to viewing on a workstation. 12 residents viewed 100 CXR images each with a 24% positive rate for significant or acute findings sent to their phones via a popular instant messaging application and reported their findings if any. After an interval of 42 days they viewed the original DICOM images on personal computers and again reported their findings. There were no statistically significant differences in accuracy, agreement, sensitivity, specificity, positive predictive value or negative predictive value between desktop workstation viewed images and images sent via the mobile application. Media messaging is a useful adjunct for quick second opinions on radiological images, without significant decay in diagnostic accuracy. If technical, ethical and legal issues are addressed, it could be incorporated into practice as a useful adjunct.

The Effects of Real-Time Interactive Multimedia Teleradiology System.

This study describes the design of a real-time interactive multimedia teleradiology system and assesses how the system is used by referring physicians in point-of-care situations and supports or hinders aspects of physician-radiologist interaction. We developed a real-time multimedia teleradiology management system that automates the transfer of images and radiologists' reports and surveyed physicians to triangulate the findings and to verify the realism and results of the experiment. The web-based survey was delivered to 150 physicians from a range of specialties. The survey was completed by 72% of physicians. Data showed a correlation between rich interactivity, satisfaction, and effectiveness. The results of our experiments suggest that real-time multimedia teleradiology systems are valued by referring physicians and may have the potential for enhancing their practice and improving patient care and highlight the critical role of multimedia technologies to provide real-time multimode interactivity in current medical care.

Results of an Italian survey on teleradiology.

OBJECTIVES: The aim of this study is to present the results of the Italian survey on teleradiology (TR). METHODS: Two radiologists created an online electronic survey using the Survey Monkey web-based tool. The questionnaire was then improved by suggestions from a multidisciplinary group of experts. In its final form, the survey consisted of 19 multiple-choice questions. Space was left below each question for participants to add their personal comments. Members of Italian Society of Medical Radiology (SIRM) were given 2 weeks to perform the survey. RESULTS: A total of 1599 radiologists, corresponding to 17 % of all SIRM radiologists, participated into the online survey. As a result, 62 % of participants have a positive opinion on teleradiology, while 80 % including 18 % with a negative opinion believe that teleradiology will have a future. 55 % of responders (n = 874) use teleradiology in their clinical practice. The majority of users adopt intra-mural teleradiology for coverage of emergencies (47 %), of night and weekend shifts (37 %) or to even out distribution workload (33 %). Most responders still show concern on the use of teleradiology. In particular, they think that teleradiology is too impersonal (40 %), and that it is responsible for insufficient communication with the referring clinician (39 %). CONCLUSIONS: The majority of Italian radiologists are favorable to teleradiology. However, they have concerns that teleradiology may further reduce communication with the referring clinician ad patient.

A novel approach to optimize workflow in grid-based teleradiology applications.

BACKGROUND AND OBJECTIVE: This study proposes an infrastructure with a reporting workflow optimization algorithm (RWOA) in order to interconnect facilities, reporting units and radiologists on a single access interface, to increase the efficiency of the reporting process by decreasing the medical report turnaround time and to increase the quality of medical reports by determining the optimum match between the inspection and radiologist in terms of subspecialty, workload and response time. METHODS: Workflow centric network architecture with an enhanced caching, querying and retrieving mechanism is implemented by seamlessly integrating Grid Agent and Grid Manager to conventional digital radiology systems. The inspection and radiologist attributes are modelled using a hierarchical ontology structure. Attribute preferences rated by radiologists and technical experts are formed into reciprocal matrixes and weights for entities are calculated utilizing Analytic Hierarchy Process (AHP). The assignment alternatives are processed by relation-based semantic matching (RBSM) and Integer Linear Programming (ILP). RESULTS: The results are evaluated based on both real case applications and simulated process data in terms of subspecialty, response time and workload success rates. Results obtained using simulated data are compared with the outcomes obtained by applying Round Robin, Shortest Queue and Random distribution policies. The proposed algorithm is also applied to a real case teleradiology application process data where medical reporting workflow was performed based on manual assignments by the chief radiologist for 6225 inspections. CONCLUSIONS: RBSM gives the highest subspecialty success rate and integrating ILP with RBSM ratings as RWOA provides a better response time and workload distribution success rate. RWOA based image delivery also prevents bandwidth, storage or hardware related stuck and latencies. When compared with a real case teleradiology application where inspection assignments were performed manually, the proposed solution was found to increase the experience success rate by 13.25%, workload success rate by 63.76% and response time success rate by 120%. The total response time in the real case application data was improved by 22.39%.

Effect of teleradiology upon pattern of transfer of head injured patients from a rural general hospital to a neurosurgical referral centre: follow-up study.

INTRODUCTION: The optimal management strategy for patients with head injury admitted to a non-specialist hospital is uncertain. The aim of this study was to evaluate the outcomes of victims of head injury requiring hospitalisation but initially admitted to a rural level II trauma centre without a neurosurgical facility but with a system for neurosurgical consultation via teleradiology. METHODS: Patients admitted for head injury during 2006-2011 were included. Late transfer of patients initially hospitalised in the level II trauma centre was evaluated for treatment failure, defined as clinical or radiological deterioration. RESULTS: Five hundred and sixty-two patients were initially hospitalised in the level II trauma centre. Evaluation of late transfers showed that only 23 (4.1%) represented real treatment failures due to clinical or radiological deterioration. The clinical course was altered by primary intent to hospitalise patients in the level II trauma centre in only one patient. CONCLUSIONS: Selected patients with head trauma who have a pathological CT scan may be safely managed in level II trauma centres following neurosurgical consultation using teleradiology. Review of treatment failures is necessary to ensure proper ongoing management of a system in which neurosurgical patients are selectively transferred to trauma centres with neurosurgical capacity.

A national teleradiology programme in Mali: implementation and results.

We reviewed the national teleradiology programme in Mali to establish whether it improved diagnosis for patients and improved the referring doctor's ability to give an accurate diagnosis. The teleradiology programme connected the University Hospital in Bamako to all seven regional hospitals in Mali and one private health clinic. The pilot phase began in 2005 in three hospitals. Initially the implementation involved connections via broadband, but subsequently satellite antennae were provided at three remote hospitals in the north. Between 2005 and 2013, X-ray and mammogram images from 5628 patients were read by teleradiology. Radiologists provided the sole diagnosis for 29% of cases (i.e. the referrer did not make a diagnosis) and altered the regional doctor's diagnosis in 12% of cases. The proportion of cases for which the regional doctor gave no diagnosis decreased from 93% to 24% over the same period, indicating an increase in the doctors' confidence and incentive to test their own diagnosis. The percentage of cases for which regional doctors made an inaccurate diagnosis decreased to 3% in 2013. Use of the teleradiology service varied widely between hospitals. Successful implementation depended on local ownership of a network, which was developed in close collaboration with hospital leadership, national radiologists and other healthcare personnel.

A Feasibility Study of Real-Time Remote CT Reading for Suspected Acute Appendicitis Using an iPhone.

We aimed to evaluate the feasibility of an iPhone-based remote control system as a real-time remote computed tomography (CT) reading tool for suspected appendicitis using a third-generation (3G) network under suboptimal illumination. One hundred twenty abdominal CT scans were selected; 60 had no signs of appendicitis, whereas the remaining 60 had signs of appendicitis. The 16 raters reviewed the images using the liquid crystal display (LCD) monitor of a picture archiving and communication system (PACS) workstation, as well as using an iPhone connected to the PACS workstation via a remote control system. We graded the probability of the presence of acute appendicitis for each examination using a five-point Likert scale. The overall sensitivity and specificity for the diagnosis of suspected appendicitis using the iPhone and the LCD monitor were high, and they were not significantly different (sensitivity P = 1.00, specificity P = 0.14). The average areas under the receiver operating characteristic curves for all CT readings with the iPhone and LCD monitor were 0.978 (confidence interval 0.965-0.991) and 0.974 (0.960-0.988), respectively, and the two devices did not have significantly different diagnostic performances (P = 0.55). The inter-rater agreement for both devices was very good; the kappa value for the iPhone was 0.809 (0.793-0.826), and that for the LCD monitor was 0.817 (0.801-0.834). Each rater had moderate-to-very good intra-observer agreement between the two devices. We verified the feasibility of an iPhone-based remote control system as a real-time remote CT reading tool for identifying suspected appendicitis using a 3G network and suboptimal illumination.

Value of interactive scanning for improving the outcome of new-learners in transcontinental tele-echocardiography (VISION-in-Tele-Echo) study.

BACKGROUND: Point-of-care (POC) echocardiography may be helpful for mass triage, but such a strategy requires adequately trained sonographers at the remote site. The aim of this study was to test the feasibility of using a novel POC echocardiography training program for improving physicians' imaging skills during preanesthetic cardiac evaluations performed in a community camp organized for treating cataract blindness. METHODS: Seventeen physicians were provided 6 hours of training in the use of POC echocardiography; nine were taught on site and eight were taught online through a transcontinental tele-echocardiography system. The trained physicians subsequently scanned elderly patients undergoing cataract surgery. The quality of images was graded, and agreement between local physicians' interpretations and Web-based interpretations by worldwide experts was compared. RESULTS: A total of 968 studies were performed, with 660 used for validating physicians' competence. Major cardiac abnormalities were seen in 136 patients (14.2%), with 32 (3.3%) deemed prohibitive to surgery in unmonitored settings. Although good-quality images were obtained more frequently by physicians trained on site rather than online (P = .03), there were no differences between the two groups in agreement with expert interpretations. The majority of physicians (70.6%) expressed satisfaction with the training (average Likert-type scale score, 4.24 of 5), with no difference seen between the two groups. The training resulted in significant improvements in self-perceived competence in all components of POC echocardiography (P < .001 for all). CONCLUSIONS: This study establishes the feasibility of using short-duration, one-on-one, personalized transcontinental tele-echocardiography education for wider dissemination of echocardiographic skills to local physicians in remote communities, essential for optimizing global cardiovascular health.

On-call service of neurosurgeons in Germany: organization, use of communication services, and personal acceptance of modern technologies.

BACKGROUND: A significant proportion of acute care neurosurgical patients present to hospital outside regular working hours. The objective of our study was to evaluate the structure of neurosurgical on-call services in Germany, the use of modern communication devices and teleradiology services, and the personal acceptance of modern technologies by neurosurgeons. MATERIALS AND METHODS: A nationwide survey of all 141 neurosurgical departments in Germany was performed. The questionnaire consisted of two parts: one for neurosurgical departments and one for individual neurosurgeons. The questionnaire, available online and mailed in paper form, included 21 questions about on-call service structure; the availability and use of communication devices, teleradiology services, and other information services; and neurosurgeons' personal acceptance of modern technologies. RESULTS: The questionnaire return rate from departments was 63.1% (89/141), whereas 187 individual neurosurgeons responded. For 57.3% of departments, teleradiology services were available and were frequently used by 62.2% of neurosurgeons. A further 23.6% of departments described using smartphone screenshots of computed tomography (CT) images transmitted by multimedia messaging service (MMS), and 8.6% of images were described as sent by unencrypted email. Although 47.0% of neurosurgeons reported owning a smartphone, only 1.1% used their phone for on-call image communication. CONCLUSION: Teleradiology services were observed to be widely used by on-call neurosurgeons in Germany. Nevertheless, a significant number of departments appear to use outdated techniques or techniques that leave patient data unprotected. On-call neurosurgeons in Germany report a willingness to adopt more modern approaches, utilizing readily available smartphones or tablet technology.

A QR code based zero-watermarking scheme for authentication of medical images in teleradiology cloud.

Healthcare institutions adapt cloud based archiving of medical images and patient records to share them efficiently. Controlled access to these records and authentication of images must be enforced to mitigate fraudulent activities and medical errors. This paper presents a zero-watermarking scheme implemented in the composite Contourlet Transform (CT)-Singular Value Decomposition (SVD) domain for unambiguous authentication of medical images. Further, a framework is proposed for accessing patient records based on the watermarking scheme. The patient identification details and a link to patient data encoded into a Quick Response (QR) code serves as the watermark. In the proposed scheme, the medical image is not subjected to degradations due to watermarking. Patient authentication and authorized access to patient data are realized on combining a Secret Share with the Master Share constructed from invariant features of the medical image. The Hu's invariant image moments are exploited in creating the Master Share. The proposed system is evaluated with Checkmark software and is found to be robust to both geometric and non geometric attacks.

Teleradiology based CT colonography to screen a population group of a remote island; at average risk for colorectal cancer.

PURPOSE: To prospectively assess the performance of teleradiology-based CT colonography to screen a population group of an island, at average risk for colorectal cancer. MATERIALS AND METHODS: A cohort of 514 patients living in Madeira, Portugal, was enrolled in the study. Institutional review board approval was obtained and all patients signed an informed consent. All patients underwent both CT colonography and optical colonoscopy. CT colonography was interpreted by an experienced radiologist at a remote centre using tele-radiology. Per-patient sensitivity, specificity, positive (PPV) and negative (NPV) predictive values with 95% confidence intervals (95%CI) were calculated for colorectal adenomas and advanced neoplasia ≥6 mm. RESULTS: 510 patients were included in the study. CT colonography obtained a per-patient sensitivity, specificity, PPV and, NPV for adenomas ≥6 mm of 98.11% (88.6-99.9% 95% CI), 90.97% (87.8-93.4% 95% CI), 56.52% (45.8-66.7% 95% CI), 99.75% (98.4-99.9% 95% CI). For advanced neoplasia ≥6 mm per-patient sensitivity, specificity, PPV and, NPV were 100% (86.7-100% 95% CI), 87.07% (83.6-89.9% 95% CI), 34.78% (25.3-45.5% 95% CI) and 100% (98.8-100% 95% CI), respectively. CONCLUSION: In this prospective trial, teleradiology-based CT colonography was accurate to screen a patient cohort of a remote island, at average risk for colorectal cancer.

[Teleradiology: case series and experience acquired in the military field]. / La teleradiologia: casistica ed esperienza acquisita in ambito militare.

PURPOSE: Our aim was to evaluate the peculiarities of military teleradiology on the basis of the large case series collected between January 2006 and December 2010. MATERIALS AND METHODS: We analysed all radiological teleconsultations/telediagnoses requested by theatres of operations: Kosovo, Iraq, Chad, warships Etna (Indian Ocean) and Cavour (earthquake in Haiti), for a total of 1,132 cases. As part of the case series collected in Kosovo (n=827), we evaluated the entire sample of patients transferred to the Celio Military Hospital in Rome following a teleradiological diagnosis (27 examinations analysed). RESULTS: A total of 1,132 radiological examinations were requested (704 military and 428 civilians). Comparison between teleradiology diagnoses and diagnoses made after patient transfer showed almost perfect concordance based on Cohen's Kappa (κ) statistic (92.59% identical diagnoses), with only a small minority of false positive results (two cases, 7.4%). CONCLUSIONS: The use of teleradiology by the Military Medical Corps helped attain an accurate diagnosis in almost all cases, significantly reducing diagnostic errors and limiting transfers from theatres of operation to cases genuinely necessitating transfer.

Quality assessment of out sourced after-hours computed tomography teleradiology reports in a Central London University Hospital.

The study was designed to assess the quality of out sourced after-hours computed tomography teleradiology service reports. We evaluated 1028 patients over a time period of five month in 2009/2010 (437 female, 591 male, mean age: 51 years, range: 0-97 years) who were referred either by the A&E or other in house departments from 7 pm to 8 am for different reasons. Reporting was done by a teleradiology service provider located in the UK and Australia. Reports were assessed during the routinely performed morning meeting by a panel of in house radiologists. Assessment was done by a five point agreement scale (5="No disagreement", 1="…unequivocal potential for serious morbidity or threat to life"). In 811 (79%) patients no disagreement was found, 164 (16%) were rated as category 4, 40 (4%) as category 3 ("…likelihood of harm is low"). In 13 (1.3%) patients a decision of category 2 was made ("…strong likelihood of moderate morbidity but not threat to life"). No category 1 decision was made. As this was just a discrepancy decision, a follow up of the category 2 patients was done over a period of a maximum of 6 months. In 8 (0.8%) patients the in house reports were correct, in 2 (0.2%) patients the teleradiology service provider was right and in 3 (0.3%) patients the final diagnoses remained unclear. In conclusion there was a small rate (0.8%) of proven serious misinterpretations by the teleradiology service provider, but these were less than in comparable studies with preliminary in house staff reports (1.6-24.6%).

The performance of outside readings by radiology practices.

OBJECTIVE: The purpose of our study was to determine how many radiology practices perform outside readings, what characteristics affect the prevalence and volume of outside readings, and how practices are paid for outside readings. MATERIALS AND METHODS: We analyzed data from the American College of Radiology's 2007 Survey of Radiologists, a stratified random sample e-mail and telephone survey. A total of 480 survey responses were evaluated; responses were weighted to make them representative of all U.S. radiology practices. We provide descriptive statistics and multivariable regression analysis results. RESULTS: Overall, 40% of radiology practices in the United States performed outside readings in 2007. Outside readings constituted an average of 11% of the workload of these practices and 4% of the total workload of radiologists in the United States. Other practice characteristics being equal, academic practices, government practices, radiology units of multispecialty groups, and small practices had particularly low odds of performing outside readings. If they did perform outside readings, then, other practice characteristics being equal, small practices, solo practices, radiology units of multispecialty groups, practices in the main cities of large metropolitan areas, and those in nonmetropolitan areas had, on average, a relatively large portion of their workload consisting of outside readings. By far, the most common methods of payment were directly billing for the professional component or receiving a flat fee per study. CONCLUSION: Outside readings were a common activity among radiology practices in 2007. There was substantial variability among practice types, sizes, and locations in whether practices performed outside readings and, if so, how much outside reading they did.

Visualizadores de imagens médicas gratuitos: é possível trabalhar apenas com eles? / Freeware medical image viewers: can we rely only on them?

OBJETIVO: Pesquisar visualizadores de imagens médicas gratuitos disponíveis na internet capazes de funcionar como cliente PACS (picture archiving and communication system) e avaliar suas principais funções e a viabilidade do uso em computadores pessoais. MATERIAIS E MÉTODOS: Foi feita pesquisa, no Google e em sites especializados, por programas gratuitos disponíveis para o Windows. Foram encontrados cerca de 70, sendo 11 capazes de funcionar como cliente PACS, e selecionados seis destes para análise: ClearCanvas Workstation, KPACS, Onis, Synedra View Personal, Mito e Tudor DicomViewer. Com base nas necessidades dos autores, 16 funções foram avaliadas. RESULTADOS: Dos seis programas avaliados, dois possuem 10 das 16 funções avaliadas e um possui apenas duas. Três realizam MPR (reconstrução multiplanar), um realiza MIP (reconstrução por projeção de intensidade máxima), dois realizam VR (renderizações volumétricas), dois funcionam como servidor PACS, dois geram CDs, um realiza fusão de imagens, três permitem utilizar múltiplos monitores e apenas um não é compatível com Windows 7. CONCLUSÃO: Diversos programas gratuitos estão disponíveis e não existe nenhum completo. Cabe ao usuário analisar e selecionar o programa que melhor se enquadra nas suas necessidades, porém, os programas Onis, Synedra e ClearCanvas se destacam, cada um com suas peculiaridades. É totalmente viável o uso de programas gratuitos para o dia-a-dia do radiologista.

OBJECTIVE: To search in the internet for freeware medical image viewers capable of running as a PACS (picture archiving and communication system) client, and to evaluate their main functions as well as the feasibility of their use in personal computers. MATERIALS AND METHODS: The Google search engine and specialized sites were utilized in the search for freeware softwares for Windows. The authors have found about 70 and among them 11 were able to run as PACS clients. Six were selected for analysis: ClearCanvas Workstation, KPACS, Onis, Synedra View Personal, Mito and Tudor DicomViewer. Sixteen functions selected according to the authors' needs were evaluated. RESULTS: Among the six applications, two presented 10 of the 16 functions, and one of them presented only two. Three perform MPR (multiplanar reconstruction), one performs MIP (maximum intensity projection), two perform VR (volume rendering), two can run as a PACS server, two can create CDs, one performs images fusion, three allow the use of multiple monitors and only one is not compatible with Windows 7. CONCLUSION: Although several freeware applications are available, no one of them is complete. It is up to the users to analyze and select the software that best suits their needs. However, Onis, Synedra and ClearCanvas stand out because of their own peculiarities. The use of freeware image viewers is entirely feasible in the radiologists' daily routine.

Teleradiology interpretations of emergency department computed tomography scans.

BACKGROUND: Teleradiologist interpretation of radiographic studies during after-hours Emergency Department (ED) care has the potential to influence patient management. STUDY OBJECTIVES: We sought to characterize frequencies of discrepancies between teleradiology and in-house radiology interpretations for computed tomography (CT) scans. METHODS: We conducted a prospective observational study comparing teleradiologist and in-house radiologist interpretations of CT scans obtained between 7:00 p.m. and 7:00 a.m. from the ED at a Level I trauma center. For each scan, discrepancies were characterized as major, minor, or no discrepancy. Follow-up data were used to characterize major discrepancies. RESULTS: Of 787 studies sent to teleradiology, 550 were scans of the head, cervical spine, chest, or abdomen and pelvis. Major discrepancies were identified in 32 of 550 studies (5.8%; 95% confidence interval 4.1%-8.1%), including 7 of 160 head CT scans, 1 of 29 cervical spine CT scans, 3 of 64 chest CT scans, and 21 of 297 abdominopelvic CT scans. We attributed 8 of the 32 major discrepancies to a teleradiology misinterpretation, with one case leading to an adverse event. CONCLUSIONS: We identified major discrepancies due to teleradiologist misinterpretation in 8 of 550 studies, with one patient suffering an adverse event. Our findings support the cautious use of teleradiology interpretations.