Local physicians request teleradiology restriction be lifted

By Sean Feagan, Local Journalism Initiative Reporter

A group of local physicians and representatives of the Town of Strathmore are requesting that provincial rules be changed to allow wider provision of remotely supervised medical imaging services in town.

Ultrasound, magnetic resonance imaging (MRI) and X-ray, are used to provide visual representations of interior structures within people’s bodies. While imaging itself can be performed by a technologist, these techniques require a physician, typically a radiologist, to interpret the image and provide diagnosis and direct treatment.

A newer technique is teleradiology, in which the images are captured remotely in one location, then sent to another location where they are interpreted. One prominent type of teleradiology is remotely supervised ultrasound, which has wide application, is relatively low-cost compared to other imaging techniques and is of minimal risk, as it uses sound waves rather than radiation to generate images. 

The College of Physicians and Surgeons of Alberta (CPSA) establishes medical standards and guidelines, including those for diagnostic imaging that establish how these techniques can be used throughout the province. One rule therein is that the approval of remote ultrasound interpretation and supervision is restricted to communities located more than 100 kilometres from an urban centre.

The intent of the restriction is to ensure the highest quality of care for patients (while balancing access to care), as on-site interpretation and supervision by an imaging specialist remains the gold standard for ultrasound provision, explained Jessica McPhee, CPSA’s director of communications.

Strathmore Hospital can perform teleradiology, specifically remotely supervised ultrasound, through its emergency department because it was grandfathered in, and thus bypasses this restriction, explained Dr. Ward Fanning, a local physician. But the provision of teleradiology services there is “very spotty,” he said. “We’ve been left high and dry many times.”

However, given the town’s proximity to Calgary, anywhere else in Strathmore, such as a doctor’s office or medical clinic, is thus not eligible to provide remotely supervised ultrasound, Fanning explained.

“This is a very simple test,” he said. “There are many private places that would start up tomorrow if they were allowed to do the teleradiology with the ultrasonographer in Strathmore, wherever they may be, and the image getting transmitted to Calgary.”

The actual difference between remote and onsite supervision is limited. “You can envision a radiologist sitting in his office in Calgary, with the tech(nologist) sitting maybe three exams rooms down the hall – he has the potential to go down and look at the patient, but in reality, it often doesn’t happen,” said Fanning. “In effect, it’s teleradiology.”

In response to this “seemingly arbitrary” rule, four local physicians (including Fanning), Mayor Pat Fule and the town’s Chief Administration Officer James Thackray are sending a letter to Tyler Shandro, Alberta’s minister of health, to ask the province to address the matter with the CPSA. This letter was accepted for information by town council during its regular meeting on Sept. 2.

Having teleradiology facilities in Strathmore would reduce wait times, improve quality of health care for rural patients, and would alleviate pressure on the emergency department at the Strathmore Hospital, the letter asserts.

The letter also affirms that offering remote ultrasound close to home reduces patient anxiety and is more efficient and cost-effective.

“If somebody comes into emergency, and has a simple gallstone or kidney stone, we have to spend hundreds of dollars to ship them into Calgary by ambulance to get the ultrasound and ship them back,” said Fanning.

Furthermore, given the COVID-19 pandemic, the restriction means vulnerable patients must travel from areas of low rates of infection, such as Strathmore, to places where infection risk is higher, such as Calgary, the letter states.

The issue has been on the town’s radar for some time. The Town of Strathmore created a resolution at the 2019 Alberta Urban Municipalities Association (AUMA) convention, asking the Alberta government to address the restriction with CPSA. The motion passed with 92 per cent of member constituencies in support.

“This is not a new proposal by any means,” said Fanning.

CPSA is currently reviewing its standards, which includes considering feedback it attained from stakeholder consultation that ended in January 2020. The review was sidelined by COVID-19, but is now restarting, and any further proposed revisions will be distributed for additional stakeholder consultation, said the CPSA’s McPhee.