In these times when technology advances at a rapid pace, the question arises of the substitution of medical work through artificial intelligence. Is this our biggest threat or well before we need to discuss several other much closer issues?
Teleradiology, whose standardization was performed by CFM through Resolution 1890/2009 and later revised through Resolution CFM 2107/2014, established standards in which we highlight the main points:
Clinical Data - The transmission of examinations by teleradiology should be accompanied by the necessary clinical data of the patient, collected by the requesting physician, for the preparation of the report.
Patient Authorization - The patient must authorize the transmission of their images and data through informed, free and informed consent.
Local and distance specialistINSTANCE - The responsibility for the transmission of exams and reports at a distance will be assumed by a doctor specialized in Radiology and Diagnostic Imaging and with the respective registration in CRM.
Areas of practice I - Holders of Certificates of Performance in Mammography and Bone Densitometry can only assume the responsibility for the transmission of exams and issue report in the respective area.
Areas of practice II - For specific and unique activities in nuclear medicine, the person responsible must be a doctor holding the title of specialist in nuclear medicine, duly registered with the Regional Council of Medicine and authorized by the National Commission of Nuclear Energy (CNEN).
Areas of activity delimited III - For cases of hybrid imaging (radiology and nuclear medicine), the report should be issued by specialists in both areas.
Limits to the practicedistanceTheI - The use of teleradiology is prohibited for interventional procedures in radiology and diagnostic imaging and ultrasound examinations.
Limits to the practicedistanceTheII - In the case of non-contrasted General Radiology, for example, chest, extremity, spine, skull, and other radiographs, including mammography, and in case of emergency, when there is no specialist doctor in the health facility, the doctor responsible for the patient may request to the specialist physician due remote diagnosis support.
Required Expert - There must be, necessarily, a local specialist doctor in the services in which specialized or contrast radiology exams are performed, and also in those where computed tomography, magnetic resonance and nuclear medicine exams are performed.
Shared Responsibility - The professional responsibility for care lies with the attending physician's specialist physician who performed the examination. The specialist doctor who issued the distance report is sympathetic to this responsibility.
Headquarters in Brazilian territory - Legal entities providing services in Teleradiology must be headquartered in Brazil and be registered with the CRM of their jurisdiction. If the provider is an individual, he / she must be a physician with a specialist title (Radiology and Diagnostic Imaging) or certificate of area (Mammography or Bone Densitometry, except the limits imposed in the resolution).
Operating Standards - The Resolution contains an annex with the operating rules and minimum requirements for the transmission and handling of radiological examinations and reports.
Image Compression and Transmission - Communication protocols, file formats and compression algorithms should be in accordance with the current DICOM and HL7 standard. The evaluation of the compression rate is the responsibility of the radiologist registered with the CRM.
Viewing and processing images - It is the responsibility of the specialist in Radiology and Diagnostic Imaging (or certified in Mammography or Bone Densitometry) to ensure the technical characteristics of remote workstations, monitors and ergonomic conditions that do not compromise the diagnosis.
Security and privacy - Computerized systems used for the transmission and handling of clinical data, radiological reports, as well as for the sharing of images and information, must comply with CFM regulations. Specifically for teleradiology, systems must meet the mandatory requirements of the “Safety Assurance Level 2 (NGS2)” established in the Certification Manual for Electronic Health Record Systems in force, published by CFM and the Brazilian Society of Health Informatics (SBIS). ).
Well, we are in 2018 and the teleradiology whose resolution puts at the beginning of its writing:
“Art. 1 - Define Teleradiology as the exercise of Medicine, where the critical factor is distance, using information and communication technologies to send radiological data and images for the purpose of reporting, in support of locally developed activities. "
It is beginning to be distorted from its main objective, which would be to provide diagnostic support to a particular location where such analysis would not be possible, either for the absence of the on-site specialist or for support in the areas of radiodiagnosis he does not master.
Throughout Brazil, the CBR and its affiliates have received reports of terminations from radiology and diagnostic imaging specialists, whether they belong to Clinics and / or Hospitals, as their leaders have now sent MRI and CT images to other locations by teleradiology.
A few professionals are retained to follow contrast scans and perform ultrasound. Faced with this sad reality, the most injured and the patient who is now analyzed in a fragmented way, through his images, images that are totally distant from a clinical context that could be jointly analyzed between the radiologist of the Hospital or Clinic and the doctor. assistant to that patient.
Teleradiology has become the main thread to increase companies' profits in a scenario of complete devaluation of image remuneration, either by the Operators or by the Unified Health System.
The question remains: How far do we have responsibility for this? The payment by procedure, the Fee for Service, contributed to the radiologist seeking volume of exams.
The point is that for Operators, the volume started to be interpreted as effortless work and its valuation became smaller and smaller. And so a snowball was made. More and more volume, more work and less value, with little time to praise, left little time to talk about the patient, especially with the attending physician. We take distance from the line of care, we get lost behind the screens of workstations and then we were no longer seen.
How many times have we heard criticism from our colleagues from other specialties who said they had taken or followed up exams, but the radiologist was not seen. We even heard an aberration from Operators and even other colleagues that conventional radiology, mammography, CT and MRI were not dependent on medical examinations.
Hence the attempt to divide the sonographers from the other doctors who performed other diagnostic imaging procedures. They tried to divide so that the image lost strength in search of its valorization and so came the CBHPM, and we, belonging to SADT, became an attachment. Everything had negotiating priority and SADT, if possible, would be negotiated later. At ANS meetings we have recently been called passive doctors, that is, they would only have to do what was required. The absurdity of proposing to separate SAD from T. Colleagues from other specialties calls us doctors of scale medicine has been absurd.
Faced with all this scenario, came the Teleradiology, to seal once and for all the professional exercise of the one that does not appear. The absence of presence has been replaced by the virtual world.
Colleagues then ask: what to do? And the answer may be to take back all that we have lost.
Primarily, the union. If we accept submission, we will not succeed. This union also means associativism and support for the medical entities that represent us, because they alone cannot act!
At the same time, we need to approach the patient and his attending physician. The radiologist must be inserted again in the line of care, contacting the patient and also the person responsible for his care. We need to show that we can contribute a lot!
We need to value our work, fight for decent pay and report those who take our work away from us through teleradiology. However, practicing unfair competition is prohibited by the code of medical ethics (Article 51 of Res. CFM 1931/2009).
And will Artificial Intelligence replace our work? The answer is analogous: we need to use Artificial Intelligence to our advantage and use it to the best of our ability to assist in the clinical conduct of the patient.
We need to get back on the path we got lost, but no one can do it but us.
Dr. Cibele Alves de Carvalho
CBR Professional Defense Director