Principle 1. Primacy of the patient
1.1. The care provided by a local and physically present radiologist is always preferred. At no time should international clinical teleradiology be provided to a facility without the knowledge and consent of the local radiologist;
1.2. The practice of international clinical teleradiology must be in the best interest of patient care. It should not diminish the close link between the patient, clinician and clinical radiology facility which is critical to good patient care; and
1.3. It should set workload at a level to ensure that the quality of care and interpretation accuracy is not compromised.
Principle 2. Uniform standard of care
2.1. International clinical teleradiology should be practised under uniform standards to meet community’s needs; and
2.2. The minimal requirements as summarized under the IRQN Principles of International Clinical Teleradiology should be adopted.
Principle 3. Image quality
3.1. Image quality cannot be compromised;
3.2. There should not be loss of clinically significant diagnostic image quality (CSDIQ) and / or data; and
3.3. The referring facility, referring radiologist and interpreting radiologist must be responsible for image quality.
Principle 4. Radiologist
4.1. The same principles of specialist qualification, credentialing, registration, licensure, certification, continuing professional development, re-validation, malpractice indemnity requirements that exist in the referring facility apply to the interpreting radiologist but additionally certain added requirements may be prescribed in the jurisdiction of the interpreting radiologist by the appropriate authorities;
4.2. It is the responsibility of the facility contracting international teleradiology services to ensure that the interpreting radiologist meets these requirements;
4.3. It is the responsibility of the facility contracting international teleradiology services to inform the interpreting radiologist of the potential legal liabilities and the remedies for providing such services. The interpreting radiologist should seek appropriate legal advice and obtain adequate liability insurance prior to the commencement of practice; and
4.4. Liability coverage at referring and interpretation facilities is governed by international law and plaintiff should not be required to litigate in a foreign jurisdiction.
Principle 5. Communication
5.1. An adequate understanding of the language of the referring facility including idiomatic use and specialist vocabulary is essential; and
5.2. The interpreting radiologist must be available and able to communicate directly with the referring facility and / or referrer to discuss the clinical background, findings for an urgent study or an unexpected diagnosis.
Principle 6. Medical Imaging Technologist
6.1. The medical imaging technologist must be certified, trained in teleradiology and works under the supervision of the referring facility radiologist.
Principle 7. Documentation
7.1. A Service Agreement must clearly define and document the legal arrangements and responsibilities between the referring and interpreting facilities; and
7.2. Urgent or significant unexpected findings should be transmitted
to the referring clinician and / or the patient without delay.
Principle 8. Security
Principle 8. Security
8.1. The facilities must comply with all data protection standards as laid down by the local jurisdiction;
8.2. The Policies and procedures for security of patient identification and image data must be documented;
8.3. Measures to safeguard the system against intentional or unintentional corruption must be in place; and
8.4. Guidelines must be documented for the use of teleradiology data for education and research purposes.
Principle 9. Ethics
9.1. System to document electronic “fingerprints” of the interpreting radiologist including verification of routing must be in place to prevent the “ghosting” of reports, i.e. ensuring the radiologist signing the report has interpreted and reported the examination.
Principle 10. Quality control
10.1. Proper audit procedures must be established and are consistent at both referring and interpreting facilities;
10.2. The radiologist should participate in the quality assurance process and be involved in documenting that process; and
10.3. Policies and procedures for the monitoring and evaluating
effective management, safety and proper performance of equipment
should be in place.
A team of IRQN Referral Guidelines Working Group members were
invited to a WHO consultancy on “Referral Guidelines for Appropriate
Use of Radiation Imaging” in its Geneva HQ during March 2010. The
35 invited experts from 19 countries representing 23 international,
regional and national agencies and professional organizations have
agreed to collaborate and work towards the common objective and
develop a common set of referral guidelines on an appropriate use of
diagnostic imaging and interventional procedures. The experts also
agreed that it was feasible to conduct an international project to
achieve this goal… More here
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