VIENNA, Austria — New hardware, and increasingly new software, continues to dominate the European Congress of Radiology (ECR), covering almost 280,000 square feet of exposition space at the Austria Center Vienna, and dwarfing the conference rooms and auditoriums where thousands of scientific sessions are held.

New this year is an assertive voice raised by the organizer of the annual congress, the European Society of Radiology (ESR; Vienna), to influence issues that are redefining, and even re-engineering, how the hardware and software displayed on the exposition floor will be used in a changing landscape for healthcare delivery.

Created in December, 2005, ESR is a "success story," according to President Christian Herold, MD, a start-up compared to the 41 national societies it encompasses, most of which are long-established in the leading countries that make up the Old Continent.

A European-level representation of a single voice for radiologists has become particularly important recently as the European Commission (EC) seeks to exercise an influence in the emerging area of e-health by defining a framework for telemedicine and by setting onerous rules on the use of magnetic resonance imaging (MRI).

Both topics were pushed to the top of the society's agenda for a press conference at the opening of the congress.

ECR 2010 is being held just ahead of the High Ministerial Meeting on eHealth in Barcelona where decisions will be taken and European level policy set by health ministers from 15 Member Nations of the European Union, and the society's president used the opening press conference as a bully pulpit to send a message to the ministers.

"Teleradiology was first embraced for economic reasons," he said, "and ESR has quite a different view seeing it as a medical act that needs to have quality and care standards associated with it."

"We also need very clear legal definitions," he added.

ESR is increasingly solicited by the EC for its policy discussion in Brussels, Herold said, and the EC will participate in a joint session on e-health at ECR 2010.

Radiology is the primary driver behind e-health, the digitalization and connectivity of healthcare systems, which is enabling the possibility of telemedicine and already breaking into dozens of branches of potential applications such as telehealth, telecare, telescreening and teleradiology itself.

On a global scale, the Radiology Society of North America (Oak Brook, Illinois) created, and continues to support, the open-architecture methods of Integrating the Healthcare Enterprise (IHE) upon which an increasing number of regional and national e-health programs in Europe are based.

On the local level, the University Center Hospital (Bordeaux, France), provides a best-practice case study for e-health with a network for medical records that follows a patient along any clinical care pathway by adding layers on top of the original radiology network created for the three hospitals in the hospital group.

Radiology is both a river of critical digital data for diagnosis shared among medical groups, as well as a river of money, making up of some of the largest revenue streams for any medical center, whether for reimbursement, capital expenditures or operating budgets.

The Bordeaux group, for example, progressively paid for the construction of the underlying radiology network by recapturing savings on film realized thanks to digitizing images.

While radiology forms the backbone of e-health, the public face is at-home care and patient monitoring through telemedicine, which holds the promise of increasing access to care, improving the quality of life of chronically ill patients, reducing hospital stays, shortening waiting lists, and, most critically, cutting costs for healthcare system in Europe where the monolithic, single payer systems are banked by the governments of Member States of the European Union (EU).

Despite what it calls a tremendous potential for e-health, the EC acknowledges that "most telemedicine initiatives are no more than one-off, small-scale projects that are not integrated into healthcare systems."

On the agenda at the upcoming High Ministerial Meeting on eHealth is an effort by the EC to remove legal barriers to the provision of healthcare at a distance, which beyond saving money for Member States, holds the potential to become a very profitable market for health system developers in Europe, thereby creating jobs and increasing a European expertise in this field.

"Teleradiology is a reality, is here to stay, and will expand," said Luis Donoso, MD, a member of the Executive Council of ESR at an ECR press conference presentation entitled, "eHealth: Radiology's view on telemedicine communication."

Donoso, head of radiology services at the Hospital Clinic of Barcelona, said ESR distinguishes carefully between telemonitoring of patients at a distance on the one hand and teleradiology on the other.

"Teleradiology is not equivalent to telereporting radiological images but it is a medical act in its own right," he said.

There are key differences between these two telemedical practices, he underlined, saying teleradiology is an expansion of a well-established medical practice with the secure transmission on a telematic network of acquired images and their remote interpretation.

"We would like to emphasize that the medical act is not only a report but includes evaluation of examination requests, selection of the most appropriate imaging strategy, optimization of the examination performance, customization of the imaging protocol, and integration of imaging and medical information into the report," Donoso said.

Published studies proposing that telemedicine activity increases efficiency and economics refer mainly to telemonitoring projects, according to the society.

"Cost savings for teleradiology cannot come at the expense of quality care and patient safety," he said.

Drawing a hard line in the sand on teleradiology, Donoso delivered ESR's core position that "The quality of care to the patients is improved only when teleradiology makes available a remote radiologist in cases when there is not a radiologist available at the site or a local radiologist is easily available."

"If a doctor based in Belgium provides a report in the UK, he or she must have the proper accreditation to do so in the UK," explained Donoso."There must be an agreement between the local radiologist and the teleradiologist, and the regulation of teleradiology should be the responsibility of the member state where the patient undergoes the imaging procedure."

This core position of anchoring accountability to the site of image origin is central to ESR's insistence on a legal framework and to draw boundaries around the growing trend toward "ghosting radiology," or outsourcing to distant centers for second opinions and reading of routine exams.

"The problems with ghosting is not economic but ethical, as illustrated by the case of one company that signed off on hundreds of radiology exams that the contracting firm had never reviewed," said Donoso.

According to Herold, the society is not trying to insert a gatekeeper systems in the radiology chain but to reassert a fundamental need for proper guidelines, an appreciation for quality evaluations and a concern for patient rights.