Emergency radiology without the radiologist: the forensic perspective

Purpose. The aim of this paper is to describe two cases from the authors' forensic archive database in which teleradiology was related to unfavourable outcomes. Material and methods. Two patients underwent autopsy after unexpected death following road accidents. In one case, death was caused by multiple cervical fractures following minor neck injury in the presence of diffuse idiopathic skeletal hyperostosis. In the other case, death was due to delayed isthmic aortic rupture occurring after thoracic blunt trauma in a young adult. Both conditions were diagnosed at autopsy only. Results. In both cases, the lethal outcome was due to the failure to obtain radiological reports of the X-rays performed in the emergency department. Radiological diagnoses could have been established by activating the teleradiology service which, according to the hospitals' teleradiology protocols, is available on demand in cases of emergency only, as selected by the physician requesting the service. Conclusions. These cases suggest the high risk of excluding the radiologist from the management of patients whose images are transmitted via a teleradiology system.