Adoption of large-scale medical equipment: the impact of competition in the German inpatient sector

Radiology Access in Rural Germany: A Nationwide Survey on Outpatient Imaging and Teleradiology

Background/Objectives: This study examines the role of teleradiology and outpatient imaging in addressing gaps in rural radiology, analyzing the perspectives of referring physicians and radiologists. Methods: An online survey was conducted with a primary focus on evaluating the perspectives of referring physicians, including practicing surgeons, internists, and general practitioners. Their responses were then compared with those of radiologists. The survey consisted of multiple sections covering demographics, attitudes toward teleradiology, and outpatient imaging. It employed Likert scales, semantic differential scales, multiple-choice questions, and weighted ranking systems. Results: A total of 171 participants were included in the survey, consisting of 50 internists, 40 surgeons, 48 general practitioners, and 33 radiologists. A total of 79.2% of referring physicians rated teleradiology positively (at least 4 out of 5 stars), although its adoption in Germany remains limited, with 80.4% of referring physicians and 55.6% of radiologists reporting minimal to no use in their regions. Key concerns among referring physicians included the "lack of communication of teleradiologists with requesting physicians" (50%) and "lack of diagnostic consultations of radiologists with patients" (26.7%). In contrast, radiologists expressed significantly greater concern about technical failures (28.6% vs. 3.3%, p < 0.05). Additionally, 59.5% of referring physicians identified teleradiology as a crucial factor for improving access to radiology in rural areas. With regard to outpatient imaging, referring physicians valued continuity of care most highly, while radiologists prioritized minimizing wait times. Conclusions: Referring physicians view teleradiology and outpatient imaging as promising solutions for bridging the gap in radiology access between urban and rural areas. Addressing concerns like communication barriers and ensuring technical reliability are critical to its broader adoption and implementation.

99m Tc bone scintigraphy does not affect preoperative workup for patients with potentially resectable esophageal squamous cell carcinoma

Background

^99mTc bone scintigraphy (BS) is the mainstay and most widely used technique in evaluation of bone metastasis (BM) in China. This study aimed to investigate the value of ^99mTc BS in preoperative workup for patients with potentially resectable (cT_1−4aN₀₋₃) esophageal squamous cell carcinoma (ESCC).

Methods

This prospective cross‐section clinical trial (ChiCTR1800020304) enrolled a total of 385 patients with ESCC diagnosed at thoracic surgery clinic from October 2018 to September 2020. All patients were diagnosed with stage cT_1−4aN₀₋₃ and were potential candidates for surgical resection. BS was performed preoperatively and the treatment strategy was changed after confirmation of BM. The primary endpoint was the rate of change of the treatment regimen because of BM, while the secondary endpoint was the rate of positive BS findings.

Results

Out of the 385 patients, only two (0.5%) changed their treatment regimen because of BM. The rate of positive BS findings was 1%, while two patients (0.5%) had false‐positive or false‐negative results. The BS diagnostic performance for BM was sensitivity 50%, specificity 99.5%, positive predictive value 50%, negative predictive value 99.5%, and accuracy 99.0%. There was no significant difference in BM in relation to age, sex, tumor location or clinical stage.

Conclusion

Our data demonstrated that ^99mTc bone scintigraphy does not significantly affect the preoperative workup in patients with potentially resectable ESCC, especially in early clinical stage patients.