- The Washington Times - Thursday, March 20, 2008

Hospitals that take in just a few radiological images at night do not have to staff a night shift, thanks to companies like Advanced Radiology that use teleradiology — the virtual transmission of radiological images for off-site readings.

Advanced Radiology, an imaging provider in Baltimore, supplies nighttime remote readings for seven hospitals in Maryland, serving five of those hospitals with in-house staff during daytime hours to provide round-the-clock services. The company uses a software program developed by NightHawk Radiology Services, an Idaho-based provider of radiology services to hospitals and radiology groups in the United States.

“There’s no way we can manage the volume and complexity of cases we have now without moving them intelligently,” says Dr. Robert Stroud, radiologist and president of Advanced Radiology. “It’s efficient, allowing radiologists to manage an increasing number of images and studies.”

Advanced Radiology uses a software program developed by NightHawk called Talon Clinical Workflow Solutions to manage the various images — magnetic resonance images (MRI), computed tomography (CT) scans, mammograms, bone-density measurements, nuclear medicine and X-rays — coming in from its hospital clients.

The work-flow system identifies the radiologists at Advanced Radiology who can, based on their availability, specialization and qualifications, conduct a preliminary reading of the images, Dr. Stroud says. The radiologist who does the reading manually types or uses voice-recognition software to produce a preliminary report that identifies any immediate needs for patient care to send back to the hospital.

The next day, radiologists who come in for the morning shift file the final reports, which are more detailed and point out any additional care needs, Dr. Stroud says. The final reports are not conducted for the two hospitals that do their own readings during the day shifts, he says.

“You don’t have to have a doctor travel to a site. You can have the image travel to a doctor,” says Scott Giordanella, director of marketing for NightHawk Radiology Services.

NightHawk provides 24/7 teleradiology services to hospitals and radiology groups in the United States that are short on radiologists or are located in rural areas and need few readings during nighttime or off hours, Mr. Giordanella says. NightHawk, which opened in 2001, gives preliminary, final and subspecialty interpretations from central reading facilities in Sydney, Australia; Zurich, Switzerland; and San Francisco, along with a three-dimensional imaging center in Austin, Texas, he says.

(Virtual Radiologic Corp. in Minneapolis is another teleradiology company that provides similar services. The company did not return phone calls.)

Teleradiology helps address the nationwide shortage of radiologists, technological advances in imaging and the increased demand for more sophisticated scans to make diagnoses, metro-area radiologists say.

“We can improve patient care by being able to give interpretations from an alert doctor who’s well-rested,” Mr. Giordanella says.

A 20-year-old report that predicted a surplus of radiologists in the year 2000 led to the American Board of Radiology reducing the number of slots on its board and to smaller radiology programs closing, says Dr. James Jelinek, chairman of radiology for the Washington Hospital Center. However, emergency rooms increasingly are using imaging as a primary diagnostic tool, escalating the need for more radiologists to be on staff, he says.

Dr. Paul Berger, a radiologist serving as chief executive officer and chairman of NightHawk, responded to the gap with his business idea, using the term “nighthawk” — which refers to pilots who flew helicopters in Vietnam — to define off-hour teleradiology services.

Dr. Berger chose Australia, an English-speaking country, to open the first central reading facility to take advantage of the time zone there, enabling U.S. board-certified, state-licensed and hospital-privileged radiologists to work during the day in Australia to cover the night in the United States, Mr. Giordanella says.

The hospital and radiology groups contracting with NightHawk send in their images, which NightHawk’s work-flow software distributes to the most appropriate radiologist to do a preliminary reading, Mr. Giordanella says. The final reading is conducted the next day either in-house at NightHawk or by the radiologists who are on shift at the group or hospital, he says.

The Association of Alexandria Radiologists (AAR) is evaluating the need for contracting with a teleradiology service for overnight coverage, says Dr. Monjari Gillian, a radiologist at Inova Mount Vernon Hospital. Inova Health System contracts with AAR and Fairfax Radiological Consultants for radiological services at its Northern Virginia hospitals.

Washington Hospital Center in Northwest is a 900-bed facility that performs nearly 1,000 radiological exams a day, too high a volume to transmit electronically and to obtain the needed level of expertise, Dr. Jelinek says.

“The NightHawk services work for very small hospitals when they don’t have a frequent demand and the intensity of what they’re doing isn’t that complex,” he says.

Teaching hospitals such as Georgetown University Hospital and the University of Maryland Medical Center also do not use teleradiology services. Radiologists on staff work with fellows and residents to teach them how to read the images, a lesson that would be hard to conduct off-site, says Dr. Reuben Mezrich, chairman of radiology at the University of Maryland School of Medicine in Baltimore.

“It’s very much a guild or apprenticeship right there at the workstation,” Dr. Mezrich says. “While it’s still fresh in everyone’s minds, the teaching goes on, even at two o’clock in the morning.”

Georgetown University Hospital in Northwest does not use an outside service for quality reasons.

“We haven’t chosen to use an outside service because we have no control over knowing the quality of their physicians,” says Dr. James Spies, chairman of the department of radiology. “We’re a big-sized group providing care in all of the subspecialties.”

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