Telereporting of PET/CT Scans in India: Are We Ready for Bridging Expertise, Expanding Access and Defining Standards?

The expansion of PET/CT imaging in India has been rapid and transformative, mirroring global trends in oncologic care. However, unlike high-income countries where workforce scaling has kept pace with technological adoption, India faces a persistent mismatch between infrastructure and expert manpower. In this setting, tele-reporting has emerged as a critical enabler. Importantly, insights from Western teleradiology systems—where the model is more mature— offer valuable benchmarks to guide its evolution in India.

Western literature consistently demonstrates that teleradiology is not merely a stopgap solution but an efficient, scalable, and clinically reliable model. Large European datasets, including analyses of over 10,000 examinations, report mean turnaround times as low as 34 minutes for CT studies, reflecting highly optimised workflows and dedicated reporting networks.^[1] By contrast, PET/CT tele-reporting, owing to its complexity, naturally demonstrates longer turnaround times. A multi-country analysis published in this journal comparing India and Western settings reported a mean turnaround time of approximately 31.9 hours in the United States versus ~20 hours in India for PET/CT reporting.^[2] While this may appear counterintuitive, it reflects differences in workflow prioritisation, case complexity, and reporting models rather than inefficiency alone.

Equally important is the question of diagnostic accuracy. Concerns regarding the reliability of remote reporting have historically limited acceptance; however, contemporary Western evidence provides reassurance. A large prospective study evaluating over 7,000 CT examinations found clinically significant discrepancy rates of approximately 5.8% in teleradiology versus 6.1% in in-house reporting, demonstrating non-inferiority of remote interpretation.^[3] This parity in performance highlights that quality is less a function of location and more dependent on training, standardisation, and system design.

These data have direct implications for PET/CT tele-reporting in India. First, they reinforce that high-quality remote reporting is achievable, provided there is adherence to structured workflows. Second, they highlight the importance of infrastructure, particularly high-speed data transfer, advanced visualisation software, and integrated information systems, which underpin the efficiency observed in Western models. Third, they emphasise the need for robust quality assurance mechanisms, including discrepancy audits and peer review, which are standard practice in many Western teleradiology networks.

However, the transplantation of Western models into the Indian context is challenging, and systems are often compromised for profit maximisation. The Indian healthcare ecosystem presents unique challenges, including variable access to clinical information, inconsistent availability of prior imaging, and heterogeneity in reporting standards. PET/CT interpretation, more than most imaging modalities, is highly context-dependent; the absence of clinical correlation can significantly diminish diagnostic accuracy. The onus is more on the delivery of findings rather than the actual clinical relevance of those findings.

Another key lesson from Western experience is the centrality of standardisation. Structured reporting, incorporation of established criteria, and clear communication of uncertainty are hallmarks of high-quality teleradiology systems. In India, variability in reporting formats remains a significant limitation. The development of national guidelines potentially led by professional bodies such as the Society of Nuclear Medicine, India could harmonise practices and align them with global standards.

The regulatory and medico-legal landscape surrounding tele-reporting needs to catch up with the pace at which its utility is growing with each passing day. While the acquisition and handling of radiopharmaceuticals are governed by the Atomic Energy Regulatory Board (AERB), the act of reporting falls under the purview of professional and legal standards applicable to medical practice. Therefore, the presence of an on-site Nuclear Medicine Physician is non-negotiable. The responsibility for the report rests unequivocally with the interpreting physician, irrespective of physical location. This underscores the need for clear documentation, credentialing, and adherence to established reporting standards. Data privacy, governed by the Information Technology Act and emerging digital health frameworks, further necessitates stringent safeguards.

Achieving parity in remuneration for PET/CT tele-reporting in India requires addressing a fundamental issue: the service is currently valued as a commodity rather than a high-impact clinical expertise. As long as reporting is priced per scan without accounting for complexity or clinical impact, disparities will persist.

First, there must be a shift from volume-based to value-based compensation. PET/CT is not equivalent to routine CT or Magnetic Resonance Imaging (MRI); it directly influences oncologic decision-making, including staging, therapy selection, and response assessment. Compensation models should reflect this by introducing tiered pricing— for example, higher remuneration for therapy response assessments (e.g., PERCIST-based reporting), comparison with prior studies, or complex post-therapy scans. This aligns payment with cognitive effort and clinical relevance rather than sheer volume.

Second, the development of national benchmark pricing guidelines is critical. Professional bodies such as the Society of Nuclear Medicine, India (SNMI) should establish recommended minimum tariffs for PET/CT reporting. Even if not legally enforceable, such benchmarks can prevent undercutting and provide a reference for fair negotiation. Similar frameworks in other specialities have helped stabilise compensation and maintain quality standards.

Third, reducing dependency on intermediaries is essential. Many teleradiology companies function as aggregators, capturing a significant share of revenue while radiologists perform the core intellectual work. This has led to trivialising the role of Nuclear Medicine Physician, which has led to suboptimal standards not just in reporting but also in the quality of PET/CT scans.

Fourth, and perhaps most importantly, PET/CT reporting must be integrated into the clinical care pathway. In many Western systems, radiologists participate in tumour boards and multidisciplinary discussions, reinforcing their role as clinical decision-makers rather than report generators. In India, tele-reporting is often isolated from clinical interaction. Enabling access to electronic medical records, prior imaging, and direct communication with oncologists will elevate the role of the reporting physician. Once integrated into decision-making, the perceived and actual value of reporting increases, naturally supporting better remuneration.

Finally, professional alignment is necessary. Individual negotiation has a limited impact in a fragmented market. A collective stance where practitioners decline unsustainably low compensation can gradually correct pricing distortions and help achieve fair valuation.

‘Tele reporting’ needs to emerge from being a point of debate to a point of healthy discussion. There needs to be a redefinition of the service from a transactional task to a value-driven clinical function. Through standardised pricing, value-based models, disintermediation, quality incentives, and deeper clinical integration, a more equitable and sustainable compensation framework can be established in India.

In conclusion, tele-reporting of PET/CT scans in India stands at a pivotal and critical juncture. For India, the challenge is not whether to adopt tele-reporting, but how to refine it—through investment in infrastructure, commitment to standardisation, and integration of clinical data. If these elements are addressed, tele-reporting will not only bridge existing gaps but also define the future architecture of nuclear medicine practice in the country.