Census highlights UK dependency on European experts

With less than six months to go before the UK is set to leave the European Union, the latest Royal College of Radiologists (RCR) census, published in September, illustrates the extent to which British hospitals are reliant on European radiology talent.

The report shows that in 2017 about one in 10 UK radiologists came from other parts of European Economic Area (EEA). A further 22% came from outside Europe.

The UK’s reliance on European radiology experts was highest in Northern Ireland, where 13% of radiologists were from the EEA.

The census notes that the UK National Health Service was already feeling the effects of brexit. “The proportion of European doctors gaining a licence in the UK has fallen from 25% of the total in 2014 to just 16% in 201,” it says.

The RCR also says the UK is working to improve international recruitment, but efforts so far have been inconclusive.

“There seems to be little evidence that the number of consultant clinical radiologists recruited from outside the UK will change over the next few years, despite current workforce shortages in radiology,” it warns.


Radiology lives: cheesy fMRI study bags an Ig Nobel

Functional magnetic resonance imaging (fMRI) is rightly celebrated as being an important tool in medical diagnostics.

In September, though, the technology also gained the dubious honour of gaining an Ig Nobel prize, a parody of the Nobel Prize which is awarded every autumn to celebrate unusual or trivial achievements in scientific research.

Specifically, the scientific humour magazine Annals of Improbable Research, which hands out the awards, this year decided the medicine Ig Nobel should go to a paper titled ‘The Neural Bases of Disgust for Cheese: An fMRI Study’.

FMRI “reveals that the internal and external globus pallidus and the substantia nigra belonging to the basal ganglia are more activated in participants who dislike or dis-want to eat cheese than in other participants who like to eat cheese,” said the authors.

The research seems likely to attract debate over the possible uses now being found for MRI machines that can cost up to several million dollars apiece.

The fMRI study is far from the most trivial piece of research to appear in this year’s Ig Nobels, though; the peace prize, for instance, went to a team that showed how the regular playing of a didgeridoo is an effective treatment for obstructive sleep apnoea and snoring.

AI: still early days

Frenzied reporting of the potential impacts of artificial intelligence (AI) would lead any radiologist to fear a robot revolution is just around the corner. However, the reality is much more mundane, according to Claudio Silvestrin, head of the AI Centre of Excellence at Unilabs.

While AI undoubtedly has the potential to help transform radiology in the future, as it stands “there is no widespread adoption,” he says.

The Centre of Excellence is evaluating promising AI technologies, but at present the state of the art is hardly ground breaking.

Instead, when AI starts to enter radiology practice it is likely to be in the form of unobtrusive productivity- and quality-enhancing tools, such as applications that highlight potential areas of concern in CT scans, rather than big-bang innovations.

Narrow AI applications are hitting the market. But Silvestrin says Dr Bradley Erickson of the Mayo Clinic in Rochester, Minnesota, was probably right last year in predicting it would take up to three years for deep-learning algorithms to create full preliminary reports for mammography.

They would still need to be checked by humans, however.

Based on Erickson’s estimations, it could be a decade before AI is able to create full preliminary reports on CT scans of the head, chest, abdomen and pelvis, MR images of the head, knee and shoulder, or ultrasound views of the liver, thyroid and carotids.

The point when deep-learning algorithms can produce full reports for most diagnostic imaging studies, meanwhile, could be up to 20 years away. That doesn’t mean AI won’t see progress in the near future, though.

On the contrary, units such as the AI Centre of Excellence are likely to be very busy. “There are thousands of potential applications in radiology alone,” Silvestrin says; the issue, for now, is finding the ones that make most sense.

“Common sense is a superpower”

“Common sense is a superpower.”

This throwaway remark, by an Australian academic general practitioner during a seminar at the Preventing Overdiagnosis conference in Copenhagen in August this year, really got me thinking.

I’m sure he says it often at such meetings, and most listeners ignore it, but for me it was a light-bulb moment. To a proportion of my radiology colleagues, it is a good estimate that at least 50% of the imaging we do in the UK is unnecessary.

To a proportion of the clinicians who refer cases to us, meanwhile, it is clear that too many scans are being done.

So when I receive what I think is a dodgy referral and phone the clinician responsible, I appreciate that often, in the absence of any good evidence base for not doing a particular test, I am appealing to their common sense. I’ve been doing this for many years.

There are colleagues, senior and junior, who immediately get what I’m saying, agree with my point before I’ve even finished, and cancel the pointless test.

There are others who will justify their request based on some misguided notion that they must rule out the tiny possibility of some rare and life-threatening condition, with huge medicolegal ramifications if they get things wrong.

With these people, we might as well be speaking a different language. We are never going to agree, and they will forever view me as being unnecessarily difficult.

Similarly, there are radiologists who, as I do, despair about the 10% annual increase in scanning demand and the huge rise in out-of-hours scanning. Yet others seem not to question whether what we’re doing makes any sense.

They want to buy more scanners and employ more staff. Yet the most recent Royal College of Radiologists (RCR) census shows how workload has increased without a commensurate increase in staffing.

Dr Nicola Strickland, the president of the RCR, rightly bemoans the gap between the numbers of applicants and funding for radiology posts in the UK. There is an estimated £116m spent on outsourcing that could be diverted to training and employing more radiologists.

This is not to say outsourcing is bad. The position of medical leaders in UK teleradiology is and always has been that there is a demand for outsourcing, and we should try to meet that demand. However, it needs to be treated with common sense.

Some client departments know this: they have tight control of job plans, using their own radiologists and reporting radiographers flexibly to maximise productivity, and plan their outsourcing in advance.

The most sensible departments even have a radiologist whose role it is to guarantee value for money.

However, others will phone teleradiology providers the week they have a problem, wanting to throw work at us with a tight turnaround time when teleradiology capacity is also low.

Teleradiology providers have been accused of cherry picking when they turn down this unexpected workload. The truth is that the medical leadership of all teleradiology departments would welcome a common-sense approach to the use of their services.

Through the TMC Academy, Telemedicine Clinic has offered to work with the RCR to contribute to educating the radiologists of the future, helping to increase trainee numbers more cost-effectively.

With better-staffed departments, TMC would then provide strategies to balance any outsourcing against local demand and capacity, reducing dependence on its services to a responsible level and allowing it to support departments more effectively.

When I read the annual RCR census and the commentary on it which reaches the national press, I am proud of my college for collecting and publishing such robust data, but I am always disappointed that the appropriateness of this huge increase in imaging is no longer challenged.

The big message from the College is that more and more money is wasted on outsourcing, and that it could be better spent. The implication is that outsourcing companies are a financial drain preventing the appointment of local radiologists.

In contrast, I’m convinced that if client departments were encouraged by the College to work closely with teleradiology suppliers to better manage their own capacity and control demand, as we already do out-of-hours, we could reduce dependence on outsourcing reports.

If we can harness this superpower called common sense, and teleradiology companies’ wide-ranging expertise is exploited, we can reverse many of these worrying trends.

– George McInnes

Teleradiologists get an even nicer paradise to work from down under

Now that the blistering European Summer has receded into a distant memory and the Autumn chill has returned to the air, you might already be missing that warm sunshine and those blue skies. But if the great weather got you dreaming of a life of sea and surfboards, you might want to consider joining TMC’s team down under where you can put your radiology skills to work as a TMC radiologist reporting on-call cases in the UK from the warmth of Australia. TMC is always on the hunt for radiologists who are prepared to take the plunge and make the move.

If that’s got your attention, check out our short video interview with Dr. Johan Bengtsson, a Swedish radiologist who made the move a few years ago and hear how it changed his life and gave his family the chance of a lifetime to experience the Australian dream.

At Telemedicine Clinic, the chance to work in an on-call centre in Sydney, Australia, has long been a draw for professionals wanting a break from Northern Europe’s dull climes.

Now, though, the company has gone a step further by opening another on-call centre in Noosa, on Australia’s spectacular Sunshine Coast in Queensland.

Home to Queensland’s first United Nations Educational, Scientific and Cultural Organization (UNESCO) Biosphere Reserve, Noosa is surrounded by picture postcard scenery and boasts excellent homes and restaurants and amenities such as art galleries and spas.

The location is ideal for radiologists who fancy working from paradise and is especially “attractive to families,” says Telemedicine Clinic’s chief executive, Alexander Boehmcker, although pleasure seekers and adventure fans will also be wowed.

Telemedicine Clinic radiologist Dr. Rickard Bohnmark agrees. He was among the first to work from the new centre in Noosa and he’s loving the new opportunity.

“It’s a great part of the world to work from. Not only is it much more affordable than Sydney, it’s also a more relaxed way of life. Absolutely perfect for ensuring a great work life balance – and the family are really enjoying the laid-back approach that seems to be the norm in Noosa. This is one of the best moves we’ve ever made and I can highly recommend it if you like the idea of working in Australia but the bright lights of Sydney aren’t for you”, said Rickard.

The company is looking for recruits for the centre now.

  • Looking for a change of scene? Apply for a job in Australia today.


UKAS audit confirms: quality remains job one at TMC

Last year, we reported on the great news that TMC had been accredited by the UK’s accreditation body (UKAS) for the Imaging Services Accreditation Scheme (ISAS).

These audits set the professional standard and are conducted and reviewed annually. Earlier this year, we hosted the ISAS 2018 audit on-site in our UK office where our quality was independently reviewed by three independent UKAS auditors. The results were very positive and UKAS have now confirmed that not only have we maintained our original accreditation, but we’ve also successfully transitioned to the new standard version – a great step forward.

 The UKAS audit report confirmed that: “It’s clear from our review that TMC’s strong focus on quality and its existing (and well-embedded) quality management system means that it is well prepared for any eventuality.”

 And Ida Anderman, TMC’s Quality Officer added: “We’re delighted to have received such positive feedback from UKAS alongside their practical and positive suggestions for improvement. While the UKAS experts were here, we were able to share with them detailed insight into a variety of topics including our coaching system, general HR policies, risk registers, reporting processes, peer feedback, incident management, training and health and safety. They were particularly impressed with our Optemis system and all the new functionality that has been added since the last audit.”

 “A huge thank you to all the UK team for the work they put in to supporting this audit. The general consensus is that we do things right at TMC, so while we can never be complacent, we can be very proud of these results and remain confident in the high quality of service that we provide our clients.”

TMC Academy announces Autumn schedule: sign up now


TMC Academy’s Fellowship programme is designed for the individual radiologist embarking on a subspecialised path. The Fellow will work with a subspecialised radiologist with extensive experience in radiology reporting and teaching.

The purpose of the Fellowship is to learn through daily lectures, reporting from individual workstations and subsequent group discussion. The programme is flexible and adaptable to your needs. Choose from:


Live streaming webinars offer you access, every two weeks, to a different online conference delivered by a recognised expert. Interact directly with the lecturer, ask questions once the talk has concluded and access webinars on demand, whenever and wherever you want.

Upcoming sessions include Richard de Villiers on rotator cuff MRI (Aug 14-18), Andras Palko on kidney space-occupying lesions (Aug 30-18), Fausto Labruto on head injuries (Sep 13-18) and Astrid Schweitzer on temporomandibular joints (Sep 27-18).

Sign up now for the full-year 2018 schedule of 2018 and get all the sessions for €300.


TMC Academy offers on-site Continuing Medical Education-accredited radiology courses several times a year, with prominent speakers on subspecialised topics.

The courses are for basic and advanced level and give you the knowledge you need to get to the next level in radiology. Choose from:

Coming soon

TMC Academy is launching two completely new online training services later this fall built around an innovative web based platform allowing students to report on real anonymized cases directly in their browser while getting immediate feedback through structured reports. Check out Diagnostic Imaging e-Training and Online Mini-fellowships and learn what makes them unique.

AI and the UK’s breast screening fiasco

Another setback to the UK’s beleaguered National Health Service could point to how artificial intelligence (AI) could help with radiology workloads in future.

The setback, widely reported on in the British press, involved an error in which around 450,000 women failed to get a breast cancer screening reminder. Health secretary Jeremy Hunt said up to 270 women may have died as a result.

Besides making sure such glitches do not crop up again, one of the priorities in any incident such as this is to get screening programmes back on track. In the UK, where radiologists are already stretched, that won’t be easy. However, there are two developments that might help.

The first, which is available today, is teleradiology. Being able to tap into clinicians in other countries, connected via collaborative diagnostic networks, could help national healthcare providers to spread the load when there is an unexpected increase in radiology requirements.

Even teleradiology services, though, might be strained by a mammogram screening backlog, since these usually require full double reading. This is where AI could help, though.

AI tools could, for example, pre-sort exams so radiologists only have to review mammograms where there appear to be signs of a problem. Another option would be for AI systems to fully replace subspecialists for one of the readings.

In the latter case, the profession would effectively move from double reading to single reading with AI support. This is not far off the computer-aided detection used routinely with mammography in the US.

Naturally, for AI to work in this way there needs to be full confidence in its capabilities. It must be allowed by regulators and the tools need to be certified. All this means it may not be an option for some time to come. Nevertheless, the technology offers much promise.

Thus, while AI may never be able to stop mistakes from happening in national health services, it may at least help them to deal with the aftermath.

Clinical practice: it’s true that many scans aren’t needed

Research has confirmed what most radiologists already know from intuition: many scans that are ordered simply aren’t needed. That is the finding from research shown at the European Congress of Radiology this year.

The study, by a team led by Dr Rusha Sarhan of the Department of Radiology & Medical Imaging at King Fahad Armed Forces Hospital in Saudi Arabia, found that “no valid clinical indication for the study” was the biggest cause of inappropriate CT and MRI requests.

“Poor awareness of the appropriateness criteria for radiological exams must be tackled and more efforts should be dedicated to encourage the healthcare community to develop and adopt criteria for appropriate use of CT, MRI and other radiological procedures,” the authors said.

TMC’s new Head of Academy is here and he has plans

TMC’s new Head of Academy, Ricard Robledo has arrived at an exciting time for TMC – and for The Academy in particular.

Our courses are continuing to prove a popular way of gaining experience, expertise and qualifications in a way that fits with the busy and demanding lives of radiologists. Our e-learning platforms are proving very popular and our Fellowships are growing in strength and stature.

So, we thought we’d spend a few minutes chatting with Ricard to ask him the big questions: What it is that makes him tick? Why is continuing education so important? What exciting plans does he have for The Academy over the coming years.


And this is what he said:

Tell us a little about yourself?

My name is Ricard. I am a biochemist and I’ve been working in digital healthcare since 2005. Before that, I worked in Neurobiology in Germany, playing with Hippocampus and mice brains! Two lives in one. However, I’ve always had an entrepreneurial streak within me, which is one of the reasons that TMC appealed to me. It’s already been a great start and I’m positive that this is just the beginning of an exciting journey!

What are you looking forward to most in your new role?

For me, I’m really looking forward to provide the highest quality of training to as many clinicians as possible, beginning with radiologists and pathologists. I think the TMC Academy approach can have a real impact on their clinical practice and can really help to keep their quality standards up in a way that doesn’t take too much time from their already busy lives.

What did you do before TMC?

I’m experienced in driving digital transformation/acceleration strategies aimed at improving healthcare organisations’ commercial efficiency. I’ve created, led and managed large scale healthcare marketing initiatives all the way from strategy development to execution at both and international and local market level. I’ve done this in major companies such as Brystol-Myers Squibb, where I worked to develop the multi-channel strategy.

I also worked for Elsevier Health Science where I looked after the e-Pharma business holding both local and international roles and before that, I was at Novartis, where I was e-Marketing Manager for Spain and a member of the Global Digital Transformation team. Immediately before joining TMC, I headed up the Global Digital Healthcare professional area for Nutricia’s international team in Holland.

What are the best/most unique advantages of TMC Academy?

The TMC Academy was born from the mission and the core purpose of TMC: to bring quality healthcare to all people.

TMC is uniquely placed to create and deliver compelling training experiences, partly due to the sheer volume of cases that we handle each year and the depth of knowledge held by the many expert radiologists and pathologists that we have in house. All that experience allows us to deliver some of the best training in the sector and to find innovative ways of delivering it to maximise the benefit and minimise the time commitment – something that we know is important for all busy radiologists.

Why is continuous education so important for teleradiologists?

We all know that quality is job one. Any mismatch diagnosed by the radiology team could have a direct impact on patient outcomes and that can have very serious consequences. Also, since the majority of radiologists are general radiologists, it’s vitally important to support and help them throughout their sub-specialisation training journey. That’s what we are here to do and that is why we are gathering some of the leading international experts in their fields to lead our courses. We’re working to use technology to make our courses as easy and as accessible as possible so that they can keep learning and get better at what they do. This sub-specialist expertise is vital to keep up the highest standards of clinical practice.

How is technology influencing the way you deliver courses?

Technology is critical. It allows us to create and simulate real clinical environments through things like structured reporting integrated with PACS. This enables us to develop Learning by doing training environments, which we believe is the most effective approach for training. [more here]

What are the highlights of the year ahead for TMC Academy?

We’re really excited about the prospects for the year ahead and I can’t wait to build on the great work that has already been done on Academy over the last few years. One of the things we’re most excited about is rolling out our brand new Online Diagnostic Reporting solution – but I’ll tell you more about that in another article…

What is your ambition for Academy?

Our ambition is simple: we want to be the first-choice medical education hub for telediagnostic clinicians. That’s what we work for every day and we’re confident that our plans will enable us to achieve that goal.

What are your impressions of TMC and the Academy team so far?

I love working for TMC. I’m really proud of what the team have achieved so far and the potential is enormous. There is a good, positive culture in the company and I look forward to coming to work each day. While we’re still a small team, I think we’re already doing really well and delivering on some big projects. We’re all really excited about taking this to the next level.

Any interesting things you’d like to share with us about yourself?

I’ve always had a bit of an attraction to anything entrepreneurial, so this is why I am really enjoying myself at the Academy and can’t wait to get stuck in. Outside of work, I love music – everything from Laurent Garnier to Brad Mehldau. I also love hanging out with family and friends. There is nothing better than being around good people.

For more information or to sign up for one of our courses, please contact: academy@telemedicineclinic.com

Coming up at The Academy:

TMC Academy offers on-site Continuing Medical Education-accredited radiology courses several times a year, with prominent speakers on subspecialised topics.

The courses are for basic and advanced level and give you the knowledge you need to get to the next level in radiology. Choose from:


TMC Academy’s Fellowship programme is designed for the individual radiologist embarking on a subspecialised path. The Fellow will work with a subspecialised radiologist with extensive experience in radiology reporting and teaching.

The purpose of the Fellowship is to learn through daily lectures, reporting from individual workstations and subsequent group discussion. The programme is flexible and adaptable to your needs. Choose from:

For more information or to sign up for one of our courses, contact: academy@telemedicineclinic.com