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The Coming Tsunami

By Jef Williams

No one could have predicted the circumstances of early 2020. We have been experiencing a period of disruption few of us have ever experienced or had to have dealt with. During this time of uncertainty, my company has been having discussions with many health care providers around the country who are dealing with the COVID-19 crisis in various ways. In some instances, there is a direct shift in operations toward managing and treating patients, while other providers are dealing with very large reductions in volume and having to lay off staff and reduce operating hours. While much remains to be learned and evaluated related to the information we have been gathering during this time, many organizations have begun to process the impact both now and, in the future, as it relates to the pandemic at hand.

Imaging departments have already begun to consider what will happen when business reopens. The impact to business reopening will be felt across all of the functional areas of delivering imaging services. This includes patient management, clinical workflow, operations, finances and technology. In a recent conversation I had with an industry expert, we discussed many of these things and how they should be addressed even in this time of uncertainty. Her prediction is that we are about to encounter a potential tsunami of activity once the country reopens and business returns to what many are calling the new normal.


Almost every ambulatory clinic in the United States was either shuttered or has significantly reduced its operations over the last two months. Some states have begun the process of reintroducing non-emergent procedures in compliance with modified shelter in place and social distance policies. An early analysis of the numbers and types of exams that were canceled or postponed during this pandemic demonstrate that there will be a large period of catching up. This is the tsunami of which my expert was referencing. Clinics that were already busy can expect that they will need to scale to meet the demand that did not disappear, but simply was held in a queue until businesses reopened.

This means that organizations are going to need to be prepared to bring staff back and potentially fast-track orientation for new staff while considering modifications to their operating hours. This volume of exams and procedures will require longer working hours, longer operating hours, more technologists and clerical staff, and supplemental radiology reading resources. It is important for organizations to begin considering how they will ramp up to meet this demand as well as evaluating their current technology to ensure that a 20-40% increase in volume can be sustained and their technology can scale to meet that additional demand.


In addition to scaling operations many organizations are already beginning to consider staffing models that meet the COVID-19 new normal. Some organizations in the United States have already separated staff into working groups in order to ensure that at any given time there is a percentage of this population of their staff that are not exposed in the work environment to COVID patients. The staff members are working alternate periods that meet the quarantine time requirements which ensures they are not infected. These staffing populations are then alternating shifts over 14 days to ensure that any outbreak does not affect the entire organization. Even within a population of working staff members there will need to be consideration for splitting shifts in ways that allow for clinics, hospital and radiology departments to open earlier and stay open later to accommodate the volume of images that will come when business reopens.


The reopening of imaging centers and radiology departments will require a completely modified approach to patient throughput. We have lived with models that can no longer be sustained in a world where social distancing is required, and contamination can be life-threatening. Patient throughput begins with waiting rooms and it will be hard to imagine any future patient throughput model that requires people to sit within close proximity of others that could potentially be carrying the virus. This means that patient arrival will need to accommodate staggered arrival times, patients waiting in safe spaces, perhaps their cars, and awaiting a text from the front desk to notify that they are ready to be arrived into the department.

The arrival and registration process will likely no longer include clipboards and paper which should drive adoption of digital pre-registration and easily sanitized kiosks. In many cases, organizations are looking for workflow models that include patient and technologist movement that reduces any touch points within the department as well as providing for 6 feet of distance between individuals. As most clinics and departments have narrow hallways and are often busy, and certainly will become even more busy in the period of catching up, some have introduced hall monitors whose job is monitoring people’s movement throughout the department. This includes ensuring that patient and technologists ingress and egress from examination rooms provides notification to ensure that all movement maintains social distancing.


Good technology is designed to support operations and patient care delivery. Many of the systems utilized in our imaging departments are designed for general workflow and do not accommodate for radical operational disruption. Now is an important opportunity to analyze current infrastructure and consider the various components of the technology stack and how it will scale and pivot to meet new demands. Digital registration and moving away from paper entirely will likely become an important component of digital transformation in the very near future. In addition, with expectations that image volumes will grow 20-40% until the backlog has been addressed, there will be a need to analyze all components of one’s imaging solutions. From looking at the modalities and planned maintenance, to looking at PACS and viewing solutions, and addressing the amount of image sharing that will be required.

There has been a significant shift away from centralized reading and reading rooms to home and remote reading over the last two months. Expect that change to continue to be a model most organizations adopt going forward. Until there is a vaccine, many people will be reticent to enter a working area where there are multiple people speaking and breathing. With many PACS solutions providing the ability for radiologist to read remotely it makes sense this would continue with only those radiologists necessary to be on site reading locally. Any distributed reading model must be able to accommodate the scaling increase of examinations which means technical support, reading workflow, image distribution, visualization and reporting are sufficiently considered.


There is no standard that we can apply to what people are experiencing right now in medical imaging. Some have never worked harder or made greater personal sacrifices to meet the demand for treating patients. Others are struggling to ensure their organizations survive during this period of significant downturn. In any case, there is an opportunity now to begin preparing for the inevitability of a massive increase in imaging over the course of the next six months that could sustain well into 2021.

Jef Williams, MBA, PMP, CIIP, is a managing partner at Paragon Consulting Partners.



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