From software solutions to outsourcing reads to portable imaging equipment, radiology departments across the country have geared up to maximize efficiency.

Spending less time and money, and at the same time increasing throughput, is the universal measure of success for radiology departments. And while the equation is the same no matter the context, the variables differ.

For some departments, being able to have a study read day or night without interruption is the key to being efficient. For others it is having a suite of software tools that can centralize workstation operations. And for others it is imaging equipment that is easier to use, involving less FTEs and greater patient safety.

The result, no matter the means, is a department that is both cost-effective and able to deliver high-quality care to its patients.

The human factor is perhaps the primary way to create efficiency in the radiology department. Since computer technology can only help make a finding, the work of the radiology department falls to the flesh-and-blood expertise of the radiologist. There must be a pair of fresh eyes at the ready day and night.

Advantages of Outsourcing

The reality of today's radiology practice is that many physicians do not want to work nights. It was because of this that Salem Radiology in Salem, NH, turned to Nighthawk in 2005 to cover its off-hours emergent radiology interpretations. "We were kind of forced into it," said Brian Hannon, director of IT and practice development. "We didn't want to do it. But now we're saying 'thank God' we did. It's just the cost of doing business."

The nine-radiologist group provides services to Merrimack Valley MRI in Methuen, Mass, and the 220-bed Caritas Holy Family Hospital. It also has its own imaging center in Salem where the group sees about 130 patients per day.

The Nighthawk physicians typically take eight to 10 trauma calls per night. Hannon said that these radiologists usually see higher utilization than the practice's own physicians did when they took night calls. There is less of a concern by the emergency department physicians to send them a case at 2 am, so they will ask the Nighthawk radiologists to read as many studies as necessary.

There are a few reasons for this. The Nighthawk radiologists do not have a personal relationship with the emergency department physicians, so there is less hesitancy to continue sending cases late into the night. It also is a reflection of the Nighthawk system, which has them in time zones that are in daytime hours when New Hampshire is still covered by night.

All of the Nighthawk radiologists are America-trained and board certified. According to Scott Giordanella, director of marketing for Nighthawk, the radiologists come from all demographics from the new grad to those ready to retire. About half of the company's 122 radiologists are in the United States, headquartered in San Francisco. The remaining ones are situated in Zurich, Switzerland, and Sydney, Australia. They handle both emergent and nonemergent readings, and are available 24 hours per day—the benefit of being distributed around the world. The company currently services 1,500 hospitals and 750 radiology groups.

Giordanella notes that with Nighthawk services, which can be scheduled in advance or as an overflow situation occurs, departments can become more efficient. "If you're in an overflow situation, you can do more work with the same number of radiologists," he said. All the department has to do in this situation is use the company's order-entry program and arrange for a Nighthawk radiologist to help out.

Salem Radiology uses Nighthawk exclusively for nighttime reading, and this has made the group much more efficient. "If you had to take night calls, we used to let you take the next day off," Hannon explained. "With Nighthawk we got that day back."

Hannon described the service the group receives as high quality. "We started with Nighthawk because it is the 'Kleenex' of the industry," he said. "It is very, very high end."

The Nighthawk radiologists, who receive and return their readings virtually, have had findings that, during the retrospective readings by Hannon's father, group founder Robert C. Hannon, MD, were described as "very impressive catches," according to his son.

This is not surprising, considering the way Giordanella describes the company's commitment to quality and efficiency. "We have to be as efficient, if not more so," he said. "Our accuracy rate is so high because of the sheer number of readings we do."

The numbers do not exist in a vacuum. It is a result of the human factor—highly trained and high-quality radiologists. "We hire really good radiologists—and we don't have any recruiting challenges," Giordanella said. "And we want to keep our doctors happy."

The human factor is only part of what makes Nighthawk successful. The other is the technology. Hannon notes that the online system that is used to send and retrieve images is excellent and reliable.

Vitally Important

While the human eye and brain are the most important pieces of "equipment" in the radiology suite, computer software makes the biological work more efficiently.

Vital Images offers a variety of radiology solutions that can be customized to the needs of the radiology department. The software runs on a Windows platform—the company is a Microsoft Gold Partner. So it is intuitive, easy to use, and compatible with any system that can use Windows.

"One of the ways we sell the solution is the ease of use," said Susan Wood, executive vice president of technology and marketing. "It's intuitive, and that's a key thing because there are so many different, varying skill sets in a radiology department." The company offers training as part of its service.

The software also can be integrated with a wide variety of PACS systems, offering a seamless, centralized viewing system. "The way we customize the package really depends on the requirements of the end user," Wood said.

Gary Wendt, MD, MBA, and his colleagues at the University of Wisconsin, Madison, Department of Radiology have been using Vitrea and ViTALConnect for the last 5 years. During that time, the way the solution has been deployed has changed and has made the department more efficient. "Originally, we used it for stand-alone viewing," he said. "The benefit of that is with the floating licenses we could put stations wherever radiologists were. We then integrated Vitrea with our PACS—now we can have them both everywhere on the same workstation and load it on the PACS system, which allows us to restore the model anywhere."

"With a lot of other 3D systems, the only way to restore the image is that you have to be on the same workstation that created it," Wendt said.

Vitrea software is a visualization solution that creates 2D, 3D, and 4D images of human anatomy from CT and MR image data. The Vitrea has a variety of specialty options for cardiac, colon, vessel probe, and other applications. In addition, Vitrea software utilizes an intuitive clinical workflow and automatic settings to improve speed and simplicity.

ViTALConnect is a Web-based tool that allows access to the 2D, 3D, and 4D medical images. Because of its Web connectivity, the solution helps with the use of common advanced visualization tools and allows radiologists, cardiologists, and referring physicians to collaborate from anywhere in real time. Integrated with Vitrea, ViTALConnect helps customers extend the value of the former's interactive snapshots and advanced capabilities.

Vital Images offers a full service to its clients from site planning prior to installation to 24/7 support (mostly remotely) after installation. The solution is not vendor specific, so it can be used with a wide variety of computer and medical imaging hardware. The company provides the specifications to the client, and, in most cases, the hardware can be an off-the-shelf purchase.

The goal with Vital Images' solution is efficiency. "The solution has anticipatory automation and can be automated before the end user needs it," Wood said. "The solution computes the mundane tasks and automates that using comparative information. It gives the end user all the practical information to make a determination."

Wendt has found that the Vital Images' solution saves time and—thus—money. "It basically reinvented the wheel," he said. "For patient outcomes, it enables us to get data more quickly in about 30 to 45 minutes."

Efficiency comes not only from around-the-clock reading and time-saving computer solutions. It also comes from improving on the old. That is what Eric M. Bailey, co-founder of Neurologica, did with the Ceretom.

Building a Better Modality

Bailey, who has designed numerous CT systems and CAT scanners over the past 2 decades, was inspired to create the Ceretom after the death of his brother, who had a brain injury as result of a car accident. The small hospital to which he was transported had no scanner, and he died because of a subdural hematoma.

The Ceretom is a portable battery- or line-operated eight-slice CT scanner for the head and neck in adults and the whole body in infants and small children. The company has delivered about 100 of the low-cost units, mostly to neuro-ICUs. It recently supplied its first one to the US Army.

According to Bailey, the images are good particularly for emergent situations. "We didn't give up image quality to be portable. What I sought here was the same as a high-end CT," he said.

The machine, which weighs about 700 pounds and is fully portable, is designed for one technologist to do everything. Scanning is done while the patient is in his or her own bed, eliminating the need and complications—including code situations and infections due to removal of ventilator tubing—associated with transporting the patient to the imaging suite. A scan using the Ceretom takes about 20 minutes, compared to about 50 minutes for a conventional, nonportable CT, according to a study conducted by the Cleveland Clinic.

Not only is the Ceretom good for patients, improving outcomes and avoiding any additional trauma to them, but it is good for the bottom line as well. The Cleveland Clinic study found that the department saved more than $54,000 in personnel costs using the scanner for 4 months. The break-even point for the capital investment was estimated at a little more than 6 months, with a total economic benefit of more than $2 million in 5 years.

While the bottom-line numbers are impressive, Bailey is focused on the patient. "In the last year and a half we've saved a lot of lives," he said.

C.A. Wolski is a contributing writer for Medical Imaging. For more information, contact .