Follow-up Examination Recommendation and Clinical Effectiveness of On-Site Versus Teleradiology Interpretation for Outpatient Abdominopelvic CT.

RATIONALE AND OBJECTIVES: To compare follow-up examination recommendation behavior, adherence, and oncologic clinical effectiveness (OCE) between on-site radiologists and teleradiologists for outpatient abdominopelvic CT (APCT). MATERIALS AND METHODS: This retrospective single-center study included consecutive outpatient APCT from February 2023 through January 2024, randomly assigned to interpretation by either on-site radiologists or teleradiologists. Key metrics were: recommendation proportion (RP; reports recommending additional exams among all examinations), adherence proportion (AP; recommended examinations subsequently performed), and OCE (oncologically positive cases among those recommended for follow-up). Differences in RP, AP, and OCE between on-site radiologists and teleradiologists were evaluated using population-averaged regression models accounting for clustering. Inter-radiologist variability in RP was evaluated using mixed-effects models, with variability quantified by random-effect variance and intraclass correlation coefficients (ICC). Subgroup analysis was performed for liver MRI recommendations. RESULTS: A total of 24,146 APCT interpretations from 14,871 patients were analyzed. Teleradiologists issued significantly more follow-up imaging recommendations than on-site radiologists (odds ratio [OR], 3.91), with recommendation proportions (RPs) of 5.5 and 1.5%, respectively. Inter-radiologist variability in RP was more pronounced among teleradiologists than on-site radiologists, as reflected by higher ICC (0.24 vs. 0.16). Recommendations made by teleradiologists showed significantly lower AP (OR, 0.42) and lower OCE (OR, 0.36) compared with those made by on-site radiologists. Similar findings were observed in the subgroup analysis of liver MRI recommendations. CONCLUSION: Teleradiologists issued more follow-up examination recommendations than on-site radiologists for outpatient abdominopelvic CT examinations, with greater inter-radiologist variability, and these recommendations were accompanied by lower adherence and lower malignancy-related clinical effectiveness.