*Purpose: To evaluate the benefits and challenges of remote diagnostic breast imaging and propose strategies to optimize its use for radiologists, technologists, and patients.
*Methods and Materials: As part of a larger 43-question survey on remote breast imaging, breast radiologists with experience or knowledge of remote diagnostic breast imaging answered 11 multiple-choice and free-response questions. The survey was distributed to Society of Breast Imaging members (July 6-August 2, 2023). Descriptive statistics were used for multiple-choice responses, while free responses were systematically coded based on the thematic similarities.
*Results: Among 424 respondents (response rate: 13%, 424/3244), 40% (169/424) had experience with remote diagnostics. Of those with experience, most believed patients were either unaware of an in-person alternative (32%, 54/169) or preferred in-person exams (15%, 25/169). The majority (60%, 101/169) felt less effective at establishing patient rapport remotely, citing video calls (41%, 36/88) as the best communication method (Note: denominators vary due to skipped questions). Nearly half (48%, 81/169) felt remote work weakened rapport with technologists, suggesting strategies such as frequent communication (30%, 28/93), periodic in-person interactions (24%, 22/93), and strong communication skills (23%, 21/93). Most (63%, 74/117) relied on technologists to report physical exam findings, and when real-time scanning was needed, 53% (61/116) had patients return when a radiologist was on-site. Despite concerns—some calling it “malpractice” or “substandard care”—others saw remote diagnostics as valuable for improving patient access to fellowship-trained breast radiologists.
*Conclusions: Remote diagnostic breast imaging remains controversial; while some radiologists view it as a valuable tool to expand access to fellowship-trained breast radiologists, others raise concerns about patient care quality, liability risks, and reduced effectiveness in building patient and technologist rapport. Respondents recommended strategies to optimize remote breast imaging, including frequent communication with technologists, periodic in-person interactions, strong interpersonal skills, and having patients return for real-time scanning when needed. Standardized guidelines incorporating these elements may improve outcomes for radiologists, technologists, and patients.
*Clinical Relevance/Application: Remote diagnostic breast imaging can expand access to specialized care but presents challenges in communication and clinical assessment. Enhanced training for technologists and strong collaborations between technologists and breast radiologists can optimize patient care in the setting of remote reading.

Lisa A. Mullen MD

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