Radiology in Europe: A Snapshot

Key Points

Today, European radiology lies atthe centre of the healthcare chain.Nevertheless, we don’t know verymuch about how this profession mayevolve: what will it be in the future?What is the European perspective? Inthis era of economic restraints as wellas rapidly evolving geo-political factors,what viewpoints are there in differentEU countries? For this article, the firstauthor designed a questionnaire, whichHealthManagement sent to membernational associations and societies of theEuropean Society of Radiology (ESR), togauge the state of health of the radiologicalworld, providing details as to thetrends of medical imaging services inforthcoming years. What is likely to bethe impact on this profession of newscenarios, such as teleradiology, outsourcing,robotic technologies and otherprofessional competitors?

HealthManagement Survey

HealthManagement sent a 15-question survey to all institutional member societies of the European Society of Radiology, as well as to the radiological society in Iceland.

Fifteen national associations returned the survey: Belgium, Bosnia-Herzegovina, Bulgaria, Iceland, Ireland, Israel, Italy, Netherlands, Norway, Romania, Serbia, Slovak Republic, Slovenia, Spain, and the United Kingdom.

Results

The range of radiologists working in each distinct country varies from a minimum of 1 radiologist to 23,501 inhabitants in Bosnia-Herzegovina, up to a maximum of 1 radiologist vs. 3,972 inhabitants in Romania (see Figure 1).

2. (Un)Employment

The majority of the interviewed associations replied that there are no unemployed radiologists in their countries: in Bulgaria, moreover, they claim a shortage of radiologists. Unemployment was mentioned in Romania (less than 1%), in Spain (1-3%), in Italy (4%), in Belgium, and in the Netherlands (about 10%).

3. Demand for Medical Imaging Services

All the associations, except for Belgium, replied that there is a significant increase in demand.

4. Teleradiology

Teleradiology is widely used in the UK and in Belgium, whereas it has limited use in the remaining countries. Ranschaert and Barneveld published a survey in 2013, which looked at how teleradiology is used in Europe (see Table 1).

Our questionnaire asked if teleradiology was regulated by specific laws. The answer was no, there is a lack of specific laws in all of the involved countries. In a few cases (Belgium, Ireland and Italy), general guidelines have been provided. This appears to be a critical weak point.

5. Outsourcing

Outsourcing is performed only to a small extent in all the countries. In all the enrolled countries, public hospitals use radiology services outside the hospital very seldom. Private hospitals are inclined to use more often radiology services outside the hospital (particularly in countries such as Bosnia-Herzegovina, Israel and the UK, where this percentage exceeds 50%, but also in other places such as the Slovak Republic and Slovenia the range is quite high, between 33 and 50%). There are only a few national laws regulating the outsourcing practice: in Bosnia-Herzegovina, radiologists can have only 30% overtime working hours; in Bulgaria some restrictions apply; in Spain there are some regional and national laws on this matter.

Reasons for outsourcing to teleradiological services have recently been included in the survey by Ranschaert and Barneveld (2013) (see Table 2).

6. Competition

Asked if radiologists in their country were currently threatened by other competitors, the large majority of the interviewed associations replied that radiologists feel currently threatened by other competitors, represented by vascular surgeons, cardiologists, gynaecologists, gastroenterologists, and less frequently by neurosurgeons, emergency physicians, urologists, paediatricians, rheumatologists, neurologists, general physicians, and nuclear physicians. Moreover, in Italy, there is also a turf battle with radiographers.

Who Performs Ultrasound Examinations?

Respondents were asked what percentage of the overall ultrasound examinations is performed by certified radiologists in their country. Here the range is very wide. The peaks are seen in Belgium and in Spain, where about 80% of overall US exams are performed by radiologists. On the other hand, in other countries such as Italy and Bulgaria, only about 40% of US exams are carried out by radiologists (this means that competitors handle the majority of the US workload). Table 3 shows responses to a survey by the ESR Working Group on Ultrasound.

Who Performs MRI Examinations?

Respondents were asked what percentage of the overall MRI exams is performed by certified radiologists in their country. MRI remains a radiological domain everywhere. In Spain and in Italy less than 5% of the exams are performed by nonradiologists. In the large majority of the respondent countries the percentage performed by radiologists rises up to 100%. Finally, the overall number of MRI exams that were performed in 2011 is shown in Figure 2.

Automation

Respondents were asked if robotisation/ automated scanning systems are being used in their country. These innovative systems are seldom used in Europe at the moment. There is limited use in Belgium, Israel, the UK and in Italy (as an example, computer-aided diagnosis (CAD) in mammographic screening).

Future Trends

The questionnaire asked for the respondents' thoughts about the future trends of the radiological profession in Europe as well as in their own country. In general there is an optimistic view about the future of this discipline. In the last few decades, the radiological world has dramatically changed after the introduction of the Radiological Information System (RIS) and Picture Archiving and Communication System (PACS). Thus we have to perform an important role within different multidisciplinary teams. In order to succeed, a high scientific profile has to be kept, together with the ability to understand the evolving needs of the referring physicians.

Acknowledgements

Appendices