<p>Reading colonoscopies certainly could be tele-outsourced, but performing colonoscopies cannot. Routine colonoscopies performed by a skilled endoscopist in a well-prepped patient with straight forward anatomy appear deceivingly simple. Much of the important decision making occurs during the study itself. Since biopsies, removal of appropriate lesions, and electrosurgical coagulation of bleeders are all potentially part of routine colonoscopy, this procedure must be performed by physicians, not technicians. Because some finesse, body english, dynamic patient positioning and, occasionally, force are required to manipulate the scope (without perforating the GI tract), remote or robot-assisted endoscopy remains impractical.</p>
<p>By contrast, many ultrasound studies such as transthoracic echocardiograms and "routine" pre-natal ultrasounds are performed by technicians and then later read by onsite or offsite radiologists. Of note, "high risk" pre-natal ultrasounds typically are performed and read by neonatologists in real time.</p>