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A new Mediterranean triangle is forming in Europe with the cooperation of the French, Italian and Spanish societies of radiology, to improve awareness of radiology and advance patient care. Prof. Asunción Torregrosa Andrés, president of the Spanish Society of Radiology (SERAM), explained why such an alliance makes sense and where.

SERAM, the French Society of Radiology (SFR) and the Italian Society of Radiology (SIRM) are working on a joint statement to better regulate the radiologist’s contribution to multidisciplinary committees, Torregrosa told Mélisande Rouger ahead of ECR 2024.

‘Multidisciplinary committees are an issue everywhere,’ she said. ‘Such meetings are very time consuming for radiologists since everything in healthcare begins with an image. However, other specialists don’t always take seriously the work we do. They tend to ask us to evaluate new images onsite immediately, when nobody would ask, for example, an endoscopy in such a short time.’

While shortage of staff is increasing everywhere, multidisciplinary committees are additional workload that radiologists have to carry on top of their daily, busy work list. For a referral center, receiving patients with very complex pathologies means significant extra work, as the pathway of these patients is usually complicated and previous imaging studies are not always available.

Prof. Asunción Torregrosa Andrés, president of the Spanish Society of Radiology (SERAM)

‘Preparing such a patient takes us 20 to 30 minutes, so we can’t work on the spot on a case that a specialist decides to add spontaneously,’ she said. ‘Our job is to evaluate the patient and many previous imaging scans that this patient brings to the hospital, correlate with clinical symptoms, and give a professional opinion. Other clinicians have to understand that we have zero tolerance for this kind of behavior. It’s also not safe for the patient if I look at an image for just 30 seconds, there is a risk that I might be wrong in my evaluation.’

SERAM recently conducted a survey to find out how much time Spanish radiologists invested in multidisciplinary committees. The document will be published in Radiología as soon as possible, and will serve as the basis for a joint statement from the SIRM, SFR and SERAM to help improve radiologists’ visibility and access to adequate tools, such as the ability to connect with different PACS.

‘If a patient comes from another center with whom I have no connection in the PACS, where do I get the information from? An interconnected PACS is one of the tools we need to improve our work in the multidisciplinary setting,’ she said.

When it comes to PACS or equipment, the situation is very heterogeneous in Europe. ‘It depends on where you work. Some hospitals provide you with network access and workstations with digital screens and adequate image resolution, while in other hospitals, you have to bring your own laptop and find yourself a screen.’

Unity is strength

Teleradiology is another battle that France, Italy and Spain have vowed to fight together. ‘‘We want to unite the countries of southern Europe to establish a consensus document to serve as guidelines for those who have to provide us with these tools listen to us,’ Torregrosa said.

SFR, SIRM and SERAM are thus working on an agreement on minimum bases of quality, tools, time worked for radiologists, working conditions in the teleradiology setting. The situation between the three countries is, here again, extremely heterogeneous, with big differences between private and public hospitals.

The recent Covid crisis has, however, accelerated the trend of remote work. ‘Teleradiology has developed in Spain,’ she said. ‘They made it easier for us to set up teleradiology and it is here to stay. Even if our work is not only to do reports, we continue to use it when we are at home to keep doing reports.’

In Italy, teleradiology is only allowed in special emergency cases, but this may change seeing what can now be done in Spain and France, Torregrosa believes. ‘SIRM has a lot of power in terms of the health ministry consulting them, so they might be able to influence things.’

Italy and France both have dedicated trade unions for imaging professionals, something that Spain should imitate. ‘Without a doubt, we should have a union,’ she said. ‘SERAM is a scientific and professional society that issues consensus, collects the issues of professionals, but we are not yet interlocutors with the ministry for certain professional issues.’

Torregrosa is also in favor of homogenizing radiological practice throughout the country, which has 17 healthcare systems, one in each of its 17 autonomous communities following the country’s almost federal organization.

‘We should have national baselines that guarantee that the management of a patient from one province to another is comprehensive, so that we don’t have to start from scratch when a patient moves to another city or region,’ she explained.

Another agreement should be reached regarding extra work hours’ remuneration, which differs from one region to another but is generally far too low, Torregrosa insisted.

‘The Valencian community has just issued the new extra care activity rates and it’s a shame,’ she said. ‘They treat us as fourth row specialists. Looking at what they want to give us in terms of remuneration, they just don’t consider us. But we are indispensable and at the core of a hospital. Without imaging you can’t operate, you can’t continue attending patients. The regional government wants us to work practically for free to reduce waiting lists. It’s indecent.’

More globally, Torregrosa deplores a lack of consideration towards the medical community and fears that young specialists might be driven to leave the country. ‘When you look at salaries, there is a continuous mistreatment of healthcare professionals here. It takes a minimum of 11 years to prepare someone to become a radiologist. It costs the state so much money to train specialists, and they arrive on the labor market the only thing they find is mistreatment. They have to build loyalty and prevent the leakage.’

The new cooperation with Italy and France may help advance local issues as well. ‘It’s very important that countries with such a high number of radiologists are united and cooperate to deal with professional issues that are common and very similar,’ she concluded.