[The digital patient journey in radiological emergencies : Massive hemoptysis as a stress test of interoperability]

Massive hemoptysis is a life-threatening emergency in which the risk of asphyxiation predominates over blood loss. The situation becomes particularly challenging when a patient must be transferred from an external facility and clinically relevant information is incomplete.

The initial diagnostic workup already begins prior to transfer to a specialized center. Initial priorities are oxygenation, correct patient positioning, and early airway protection. Depending on the local infrastructure, computed tomography (CT) angiography and bronchoscopy are the preferred modes of imaging. Structured, digital transfer of information, results, and imaging data without loss of data is paramount.

In peripheral or systemic bleeding, bronchial artery embolization is the first-line therapeutic option and should be performed at a specialized center. A superselective technique, strict nontarget prevention, and adherence to established standard operating procedure (SOP) principles are essential. Massive hemoptysis is an example for the digital patient journey in radiological emergencies: when preliminary diagnostics are performed at an external hospital and definitive treatment is provided at a specialized center, the structured and rapid transfer of clinical information to that center is critical for quality of treatment.

Emergency datasets on the electronic health card, the electronic patient record, and technical standards (FHIR, DICOM, and DICOMweb) are clinically relevant. European infrastructures (MyHealth@EU, European Health Data Space) may support the future of structured access to key clinical information and direct exchange of imaging data; however, they have not yet been fully integrated into routine emergency radiological practice.

In radiological emergencies, interoperability is not merely a technical feature but a safety-relevant infrastructure component. It improves data triage, reduces media discontinuity, and may help prevent unnecessary repeat imaging.

In radiological emergencies, it must be assessed at an early stage whether further treatment in an interventional center is necessary. In these cases, relevant data and clinical information should be transferred in a structured and fully digital manner without loss of information.