Diagnostic Imaging Utilization Following Teleconsultation Versus In-Person Care: A Real-World Comparative Study

In modern healthcare, a doctor's visit is no longer limited to a physical office. Patients can now connect with specialists through video calls, a practice known as telemedicine. This approach offers convenience and broader access, but it comes with a fundamental trade-off: the doctor cannot physically touch the patient or perform a hands-on examination. This limitation raises a critical question for health systems: does the inability to touch a patient change the way doctors decide to order medical tests? Specifically, when a patient needs to see inside their body, does a virtual visit lead to different choices than an in-person one? Two common types of scans are central to this decision. One is a standard X-ray, a quick and low-radiation image that shows bones and some internal structures. The other is a computed tomography, or CT scan, which creates detailed, cross-sectional images of the body but involves significantly higher radiation exposure. Understanding whether the method of consultation influences which of these tools gets used is vital for ensuring patients receive the right care without unnecessary exposure or cost.

Researchers in Peru set out to examine this exact dynamic within a large, national health system. They looked at a massive collection of medical records from a single month, focusing only on the moments when a consultation had already led to a completed scan. They compared two groups: patients who saw a doctor face-to-face and those who saw a doctor through the National Telemedicine Center. The study did not try to guess how often doctors decided to order a test in the first place; instead, it analyzed the tests that actually happened. The goal was to see if the type of consultation changed the mix of tests performed. The findings revealed a distinct pattern. Among the nearly 26,000 completed scans in the study, the vast majority followed in-person visits, while a smaller but significant number followed virtual visits. When the researchers looked at what kind of scans were performed, the difference was stark. For patients who saw a doctor in person, about 18 percent of the scans were CT scans, with the rest being standard X-rays. In contrast, for patients who consulted via telemedicine, only 8 percent of the scans were CTs, while more than 91 percent were standard X-rays.

This shift toward simpler imaging in virtual visits held true even after the researchers carefully adjusted for many other factors that could influence the results. They accounted for the patient's age, gender, the specific medical specialty of the doctor, the part of the body being examined, where the patient lived, and whether the patient was referred from another clinic. Even with these adjustments, the data showed that a virtual consultation was strongly linked to a lower likelihood of receiving a CT scan compared to an X-ray. The pattern was particularly noticeable in older adults. For patients under 40, the difference in CT usage between the two groups was small, but for those aged 40 to 64 and those over 65, the gap widened significantly, with in-person visits leading to many more CT scans than virtual ones. The study also noted that the types of doctors involved differed between the two groups, with virtual care seeing more family medicine and neurology specialists, while in-person care involved more general medicine and orthopedics. Despite these differences in who was being treated and by whom, the trend toward fewer CT scans in the virtual group remained consistent.

Crucially, the study found that this difference in test selection did not appear to result in missed diagnoses. When the researchers looked at the final results of the scans, they found that the proportion of tests showing a medical problem was almost identical for both groups. Roughly 39 percent of the scans from in-person visits showed a pathological finding, and 39 percent of the scans from virtual visits did the same. This suggests that the doctors using telemedicine were not simply skipping necessary complex tests; rather, they seemed to be selecting a different diagnostic path that relied more heavily on standard X-rays. The researchers noted that this could be because virtual visits are often used for conditions where an X-ray is the appropriate first step, while patients with more complex needs might be directed to in-person care. However, the study could not confirm this because it did not have access to the specific reasons why a test was ordered or the severity of the patient's symptoms.

The research provides a clear picture of how diagnostic imaging is utilized in a real-world setting, showing that the method of consultation shapes the tools doctors choose. While virtual care led to a profile of testing that was dominated by X-rays and avoided CT scans, it did not appear to compromise the rate of finding medical issues in the scans that were performed. The authors caution that these results describe the composition of completed tests rather than the overall probability of a patient receiving any test at all, as the data did not include consultations where no scan was ordered. They also emphasize that the study reflects a specific time and place, and that the reasons behind these choices remain partly a hypothesis. What is clear, however, is that the shift to virtual care is not just a change in location, but a shift in the diagnostic landscape, favoring a more conservative approach to imaging that relies less on high-radiation scans while still capturing a similar rate of abnormal findings.