The New Normal or a Return to Normal: Nationwide Remote Radiology Reading Practices After 2 Years of the COVID-19 Pandemic.

On March 11, 2020, the World Health Organization declared the COVID-19 outbreak a pandemic [1WHO Director-General’s opening remarks at the media briefing on COVID-19 - 11 March 2020.https://www.who.int/director-general/speeches/detail/who-director-general-s-opening-remarks-at-the-media-briefing-on-covid-19---11-march-2020Date accessed: December 27, 2021Google Scholar]. Standard established workflows were interrupted in virtually every industry as social distancing mandates were issued by government and public health officials. Although many medical specialties were unable to adopt a remote work model, diagnostic radiology was well positioned to adjust, because remote reading already was a reality in many practices. Previous surveys assessed the national prevalence of remote reading among radiologists [2Rosenkrantz A.B. Hanna T.N. Steenburg S.D. Tarrant M.J. Pyatt R.S. Friedberg E.B. The current state of teleradiology across the United States: a national survey of radiologists’ habits, attitudes, and perceptions on teleradiology practice.J Am Coll Radiol. 2019; 16: 1677-1687Abstract Full Text Full Text PDF PubMed Scopus (34) Google Scholar,3Quraishi M.I. Rizvi A.A. Heidel R.E. Off-site radiology workflow changes due to the coronavirus disease 2019 (COVID-19) pandemic.J Am Coll Radiol. 2020; 17: 878-881Abstract Full Text Full Text PDF PubMed Google Scholar], with the most recent survey in March 2020, during the initial stage of the COVID-19 pandemic [3Quraishi M.I. Rizvi A.A. Heidel R.E. Off-site radiology workflow changes due to the coronavirus disease 2019 (COVID-19) pandemic.J Am Coll Radiol. 2020; 17: 878-881Abstract Full Text Full Text PDF PubMed Google Scholar]. At that time, radiologists from the Northeast were more likely to have implemented remote reading practices compared with other regions of the country [3Quraishi M.I. Rizvi A.A. Heidel R.E. Off-site radiology workflow changes due to the coronavirus disease 2019 (COVID-19) pandemic.J Am Coll Radiol. 2020; 17: 878-881Abstract Full Text Full Text PDF PubMed Google Scholar], attributed to the Northeast experiencing the greatest health care disruption during the initial COVID-19 outbreak [4Centers for Disease Control and PreventionCOVID data tracker.https://covid.cdc.gov/covid-data-trackerDate accessed: December 29, 2021Google Scholar]. However, as the COVID-19 pandemic persisted and impacted every region of the country, no follow-up studies have updated the prevalence of remote reading. The purpose of this survey is to assess the nationwide utilization of remote reading over 2 years after the start of the COVID-19 pandemic. Such information can be useful to help predict the future of remote reading. An online questionnaire gauging respondents’ perceptions of remote reading, specifically in relation to the COVID-19 pandemic, was created by four practicing radiologists and a medical student. The survey was further refined by administrators and statisticians at the ACR with experience in survey distribution. The questionnaire (e-only online appendix) was sent via e-mail to a representative sample of 7,407 ACR members. Data collection occurred between June 10 and July 5, 2022. Two e-mail reminders were sent to those who had not yet responded to the prior invitation about the questionnaire. A total of 345 questionnaires were completed among qualified respondents (4.7% response rate). For information on respondent demographics, see Table 1. Data analysis took place by ACR staff. SurveyMonkey (Momentive, San Mateo, California) and Excel (Microsoft, Redmond, Washington) were used for statistical analysis. The margin of error for results at the 95% confidence interval is 5.8%. Significance testing was achieved through t testing. Results were determined to be statistically significant at the 95% confidence level if t ≥ ± 1.96 [5Berland L.L. Tarrant M.J. Heitkamp D.E. Beavers K.M. Lewis M.C. Maintenance of certification in radiology: eliciting radiologist preferences using a discrete choice experiment.J Am Coll Radiol. 2022; 19: 1052-1068https://doi.org/10.1016/j.jacr.2022.06.012Abstract Full Text Full Text PDF PubMed Scopus (3) Google Scholar].Table 2Results of survey on remote readingVariableOverall Results, %Radiologists in Academic Settings, %Radiologists in Nonacademic Settings, %Departments with remote reading during pandemic91 (314 of 345)93 (105 of 113)91 (209 of 232)First remote reading prepandemic53 (168 of 315)30 (32 of 106)65 (136 of 209)First remote reading during pandemic44 (139 of 315)67 (71 of 106)33 (68 of 209)Proportion of reads performed remotely by radiologists, % <2537 (61 of 163)37 (19 of 51)38 (42 of 112) 25-4915 (24 of 163)20 (10 of 51)13 (14 of 112) 50-7416 (26 of 163)25 (13 of 51)12 (13 of 112) >7532 (52 of 163)18 (9 of 51)38 (43 of 112)Change in remote reads by radiologists over past year Increase41 (67 of 163)35 (18 of 51)44 (49 of 112) No change40 (65 of 163)37 (19 of 51)41 (46 of 112) Decrease19 (31 of 163)27 (14 of 51)15 (17 of 112)Departments’ current attitudes toward remote reading Allows77 (265 of 345)65 (74 of 113)82 (191 of 232) Allowed remote reading during pandemic, but now expected to return to on-site work14 (49 of 345)27 (31 of 113)8 (18 of 232) Does not allow8 (29 of 345)6 (7 of 113)9 (22 of 232) Open table in a new tab Of the respondents, 91% (314 of 345) reported their organization enabled remote reading during the COVID-19 pandemic; 53% (168 of 315) of these organizations had remote reading before the COVID-19 pandemic, and 44% (139 of 315) first implemented remote reading during the pandemic. Of academic radiologists, 30% (32 of 106) indicated their organization allowed remote reading before the pandemic, compared with 65% (136 of 209) of those working in nonacademic settings. In contrast, 67% (71 of 106) of academic radiologists’ departments began remote reading during the pandemic, compared with 33% (68 of 209) in nonacademic settings. Among radiologists who have read remotely in these organizations, 54% (134 of 247) had their remote workstation installed before the COVID-19 pandemic, and 44% (109 of 247) had their workstation installed during the pandemic. Of academic radiologists, 39% (28 of 71) had their personal remote workstation installed before the pandemic, compared with 60% (106 of 176) of radiologists working in nonacademic settings. In contrast, 61% (43 of 71) of radiologists working in academics had their personal workstation installed during the COVID-19 pandemic, compared with 38% (66 of 176) of those not working in academic settings. Of radiologists, 21% (65 of 315) reported that although their organization enables remote reading, they do not remote read themselves. Among radiologists who read remotely, 48% (78 of 163) indicated that over half of their reads this year have been performed remotely, with 32% (52 of 163) interpreting greater than 75% of remote reads. Fewer than a quarter of reads are done remotely for 37% (61 of 163) of radiologists. For 38% (43 of 112) of radiologists working in nonacademic settings, more than 75% of their reads are done remotely, compared with 18% (9 of 51) of academic radiologists. Of practice leader radiologists, 20% (17 of 84), speaking on behalf of their respective organizations, indicated that more than 50% of their organization’s reads are done remotely, and 46% (39 of 84) reported fewer than a quarter of their organization’s image interpretations are performed remotely. Of practice leaders in nonacademic organizations, 27% (17 of 64) reported that more than 50% of their organization’s reads are done remotely, compared with 0% (0 of 20) of practice leaders in academic departments. Of radiologists whose organization enabled remote reading, 41% (67 of 163) noted that their share of image interpretations performed remotely has increased over the past year, although 40% (65 of 163) described no significant change, and 19% (31 of 163) cited a decrease. Practice leaders, speaking on behalf of their respective organizations, reported similar trends, with 52% (44 of 84) indicating their organization’s proportion of remote reads has increased over the past year, although 36% (30 of 84) reported no significant change, and 12% (10 of 84) documented fewer remote reads. However, when comparing responses from practice leaders in academics versus nonacademics, 35% (7 of 20) of academic organizations decreased the amount of reads interpreted remotely over the past year, compared with 5% (3 of 64) of nonacademic practices. Among respondents who have read remotely during the pandemic, 16% (49 of 314) are now expected to return to on-site reading, and 84% (265 of 314) reported continued remote reading practice (e-only online appendix). Of academic radiologists, 27% (31 of 113) are expected to report back to on-site reading from remote work, compared with 8% (18 of 232) of those in nonacademic settings (e-only online appendix). In contrast, 65% (74 of 113) of radiologists in academic settings plan to continue remote reading, compared with 82% (191 of 232) of those not working in academics. Because academic departments are more likely to have radiologists return to on-site work, the degree of remote reading could become a factor that recently trained radiologists consider when deciding between pursuing an academic versus a private practice career. According to a recent nationwide poll, millennials are more likely than any other generation to desire a remote work option, with 84% rating remote work as important [6Fischer J. Kingson S. Millennials drive remote work push. Axios.https://www.axios.com/2022/05/24/millennials-drive-remote-work-pushDate accessed: September 13, 2022Google Scholar]. This sentiment seems to be consistent among radiology trainees, given 77% of residents with remote workstations at one residency program indicated they would be interested in a job that offers a remote work option in the future [7Bass R.Z. Smith A.D. Langston M.C. Frazier M.B. Tridandapani S. Trainee and faculty perceptions of remote PACS workstations and next steps in a large US academic medical institution.Curr Probl Diagn Radiol. 2022; 51: 146-151https://doi.org/10.1067/j.cpradiol.2021.09.003Crossref PubMed Scopus (7) Google Scholar]. Academic radiology departments must balance the advantages of remote reading with its potential drawbacks, perhaps most importantly because of the impact on radiologic training. At one academic institution, 81% of first- and second-year radiology residents reported that remote work during the pandemic had either a negative or very negative effect on their education [7Bass R.Z. Smith A.D. Langston M.C. Frazier M.B. Tridandapani S. Trainee and faculty perceptions of remote PACS workstations and next steps in a large US academic medical institution.Curr Probl Diagn Radiol. 2022; 51: 146-151https://doi.org/10.1067/j.cpradiol.2021.09.003Crossref PubMed Scopus (7) Google Scholar]. According to 84% (208 of 247) of radiologists who have read remotely, remote reading will be a permanent change to their organization’s workflow postpandemic in some capacity (many radiologists likely will do hybrid readings), with no significant differences between radiologists in academic and nonacademic settings. Overall, radiologists’ predictions for the proportion of reads done remotely over the next year are similar to the proportion of reads done remotely from the previous year. The most attractive features of remote reading include improved lifestyle (279 of 345 [81%] indicating a primary or important factor), no commute to work (261 of 345 [76%]), and fewer interruptions and distractions (237 of 345 [68%]) (Fig. 1). However, a decreased sense of camaraderie with colleagues and referring physicians was the biggest drawback of remote reading (184 of 345 [54%]), followed by lack of consultation with colleagues (152 of 345 [44%]) and increased isolation (143 of 345 [41%]) (Fig. 2). Among radiologists who read remotely, 87% (142 of 163) reported a positive impact on job satisfaction, and 8% (13 of 163) and 5% (8 of 163) noted a neutral and negative impact, respectively.Fig. 2Perceived drawbacks of remote reading.View Large Image Figure ViewerDownload Hi-res image Download (PPT) The lack of interpersonal contact inherent with remote reading has little to no impact on the patient-physician relationship for 80% (131 of 163) of respondents who remote read In addition, 75% (122 of 163) and 63% (103 of 163) of radiologists indicated remote reading has little to no impact on their relationship with referring physicians and technical staff, respectively. Finally, 57% (93 of 163) reported remote reading has little to no impact on their relationship with other radiologists. For a summary of results from the survey, see Table 2.Table 1Respondent demographicsVariableNo. of Respondents (%)Gender Male254 (74) Female73 (21) Prefer not to answer18 (5)Age, y 25-3433 (10) 35-44107 (31) 45-54109 (32) 55-6475 (22) 65+18 (5) Prefer not to answer3 (1)Primary job responsibility Practicing physician309 (90) Resident or fellow36 (10)Practice setting∗ACR practice setting classification. AcademicsAcademic setting113 (33) NonacademicsIndependent private practice113 (33)Hospital, hospital system, or hospital-affiliated physician practice group71 (21)National radiology practice or entity22 (6)Uniformed services7 (2)Teleradiology7 (2)Non-hospital-affiliated physician practice group or multispecialty entity7 (2)VA or other government practice1 (0.3)Other4 (1)Leadership status Practice or department leader95 (28) Not a practice or department leader243 (70) Not sure7 (2)Region Urban150 (43) Suburban162 (47) Rural27 (8) Not sure6 (2)VA = US Department of Veterans Affairs.∗ ACR practice setting classification. Open table in a new tab VA = US Department of Veterans Affairs. There are several limitations to our study. Our data are susceptible to response bias. Additionally, the survey does not query in what situations remote reading is used most frequently, such as during evening, weekend, or overnight shifts. Finally, our survey has a relatively small sample size and low response rate. In conclusion, the COVID-19 pandemic catalyzed the implementation of remote reading, especially in academic departments that were less likely to have remote reading before the pandemic. Remote reading likely has become a permanent part of radiology workflow. Supplementary Figure 2Distribution of responses regarding the policy/behavior towards remote reading by respondents’ organization, comparing radiologists working in academic versus non-academic settingsView Large Image Figure ViewerDownload Hi-res image Download (PPT)