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CASE STUDIES IN CLINICAL PRACTICE MANAGEMENT
Integrating a Community Hospital-Based
Radiology Department With an Academic
Medical Center
Cheryl R. Croft, RN, MBA, Richard Dial, BS, RT(R), Gary Doyle, RT(R), Jennifer Schaadt, MBA, MS,
Linda Merchant, BS
PROBLEM IDENTIFICATION
AND BACKGROUND
The growing trend in US health care
continues to be consolidation. Sixty
percent of hospitals are now part
of health systems, up 7 percentage
points from a decade ago. In fact,
between 2007 and 2012, 432 hospital merger-and-acquisition deals
were announced, involving 835
hospitals [1]. This article outlines a
5-year imaging asset plan and radiology workflow observation from
the integration of a small community hospital in Waycross, Georgia
(Satilla Regional Medical Center
[SRMC]) with the Mayo Clinic in
Florida. SRMC is a 231-bed community hospital with an outpatient
imaging center. Waycross’s service
area is in rural southeastern Georgia
and does not overlap with that of
the Mayo Clinic in Florida. The
Mayo Clinic is a nonprofit medical
practice and research group with
locations in Rochester, Minnesota;
Scottsdale, Arizona; and Jacksonville, Florida. The practice specializes in managing difficult cases
through tertiary care. In March
2012, leaders from SRMC and the
Mayo Clinic signed an agreement to
integrate SRMC with the Mayo
Clinic in Florida. On May 1, 2012,
SRMC became the Mayo Clinic
Health System in Waycross.
300
The type of radiology practice
influences equipment selection on
the basis of capital availability, the
presence of subspecialties (vascular, diagnostic, neurologic, nuclear,
pediatric), education and research
affiliations, advances in digital
technology and IT-enabled teleradiology coverage 24/7/365, and
access to subspecialists (ie, neuroradiology and breast imaging).
Smaller, geographically isolated
hospitals benefit from teleradiology,
but this often requires advanced
equipment, data-transfer capabilities, and imaging quality, particularly for specialist interpretation and
expertise [2]. These factors must
be considered at both institutions
when merging radiology departments. Decisions regarding continued outsourcing of teleradiology
services or hiring radiologists into a
shared radiology service will shape
the recruiting, hiring, and equipment decisions for the radiology
department. A distinct benefit of
the shared service is the ability
to use radiologists within the system for subspecialty interpretations,
building camaraderie with radiology
and other clinical staff members.
Equipment standardization is an
important component in asset planning, as are training and education.
Technologists must be trained and
comfortable on all equipment, as this
affects their workflow and efficiency,
as well as the quality of the images
radiologists must interpret.
WHAT WE DID
Mayo put together a team of clinicians and workflow consultants to
review inpatient and outpatient radiology equipment, portable equipment
(C arms, portable radiography, and
point-of-care ultrasound), cardiac
catheterization laboratory angiography, injectors, and echocardiography. For strategic planning, the
consultants ran an econometric report
using primary and secondary service
areas provided by Waycross. Econometrics uses statistical modeling on
current population statistics, age,
gender, race, economic indicators,
payer mix, risk factors, chronic disease
incidence, outpatient imaging utilization, and inpatient service-line
trends to assist with forecasting and
asset management. Current information regarding Waycross’s inventory,
including manufacturer, serial and
model numbers, equipment description, acquisition date, equipment
location, service provider, and
coverage and end-of-support status,
were put into a spreadsheet (see
online Table 1). An on-site visit
validated the inventory and provided
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ª 2016 American College of Radiology
http://dx.doi.org/10.1016/j.jacr.2015.07.026
the opportunity to interview stakeholders. Approximately 14 staff
members were interviewed, including
radiology managers, lead technologists,
department leaders (operating room,
emergency department, intensive care
unit), and schedulers. The interviews
were informal, designed to ascertain
equipment preferences, service issues,
hours of operation, and staffing. Interviews were conducted in the
respective departments to better understand equipment location, facility
layout, and patient and staff workflow.
The information from the interviewees, inventory analysis, and
econometric data provided a foundation for determining the replacement priorities; other considerations
included the following:
n
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Clinical obsolescence: Newer
technology provides enhanced
features, such as digital versus
analog technology. Advantages of
digital technology include faster
turnaround times, higher productivity, faster acquisition of
images, better spatial resolution,
and reduced radiation dose to
patients and staff members.
Redundancy: The number of devices that can back up a device is
inversely proportional to its need
for replacement.
Standardization: Training hours
and the associated training costs
are reduced with equipment
standardization.
Service hours: Unscheduled service of equipment prohibits patient access.
Radiation dose: Does the equipment have lower dose capabilities
and radiation dose monitoring software as per XR-29 regulations? [3]
Utilization: Utilization is an indicator of clinical need, reflecting the
level of device sophistication and/
or clinical applicability. It is also a
direct indicator of device availability. High utilization is typically
correlated with patient wait times,
scheduling delays, and backlogs.
Utilization calculations were
calculated for all equipment (see online
Table 2). It is important to note that
utilization percentages calculated are
not synonymous with CMS utilization
rates. CMS sets a predetermined rate
(currently 90%) estimating the percentage of time imaging equipment is
used in the outpatient setting to
calculate the technical component.
The percentage is used for all modalities and is inversely proportional to
reimbursement levels (ie, the higher
the equipment utilization, the lower
the reimbursement).
Our inventory analyzed 61 devices. Online Table 3 lists the equipment to be retired, replaced, or
redeployed; various decision criteria;
as well as the associated savings in
operating costs of $452,324. An
additional potential benefit exists
because equipment can be redeployed
from the Jacksonville campus to the
Waycross campus, resulting in significant savings in capital expenditures.
After the completion of the asset
management plan, consultants examined general radiology (radiography
and fluoroscopy) workflow. The goal
was to identify areas for standardization and to prepare for the conversion
from computerized radiography, in
place at Waycross, to digital radiography (DR), used at Jacksonville.
Clinical areas observed at both facilities included outpatient-inpatient
radiology, portables, fluoroscopy,
and operating room C arm. Currentstate workflow maps were mapped at
both Jacksonville and Waycross. A
future-state radiology workflow for
Waycross was developed using DR
and integrating best practices from
both institutions. The differences
Journal of the American College of Radiology
Croft et al n Case Studies in Clinical Practice Management
from computerized radiography to
DR workflow were minor in comparison with the workflow differences
from the facility design, the patient
population, and radiology information system and PACS vendors. At
Waycross, there is uniform use of the
current technology to its full functionality, with automated quality
control mechanisms in place, and the
addition of DR will further streamline the efficiencies in the central
radiology department, with the
largest impacts on the portables, C
arms, and operating rooms.
Certain workflow practices done
in Jacksonville evolved from maximizing patient throughput. On specific days of the week, the outpatient
clinic performs in excess of 345 examinations, compared with the
average of 215 examinations. The
high variability is a result of specialty
clinic practices on certain days as well
as hospital volumes. Because many
patients travel great distances to
Mayo Jacksonville, every effort is
made to perform examinations on
the clinic days, rather than scheduling separate visits. To accommodate these patients, keep patient wait
times down, and maintain patient
satisfaction, batching of certain clinical processes is done. Such processes
would not be applicable to Waycross.
As health care focuses on efficiencies and cost containment, facilities look to standardize where
possible to improve workflow and
clinical processes. Unique to radiology is whether to standardize imaging protocols across facilities.
Imaging protocols outline in detail all
the technical aspects of examinations.
The use of standardized imaging
protocols assists physicians in developing a subjective mental calibration
for brightness and contrast levels
seen on images. The disadvantage,
however, lies in the difficulty of
301
enforcing the acquisition method
across time and different institutions.
Protocols are static and do not
incorporate equipment or technology
changes, patient factors, or techniques. As such, the use of standardized protocols applied across
all facilities may be clinically impractical, resulting in longer scan
times and an overall decrease in
productivity [4]. The productivity,
workload, technology, and scan
complexity is inherently different in
outpatient imaging centers, community hospitals, and tertiary care centers, even within the same system or
network [5]. As such, standardization
of protocols should be based on these
considerations, providing the best
imaging in a cost-effective and timely
manner.
OUTCOMES
There is no shortage of case studies
detailing successful and failed mergers,
acquisitions, and integration. Most
address culture to some degree, stating
that attention to cultures should not be
neglected, with involvement of all staff
members, leaders, and management. A
successful merger process also depends
on attentive interactions with the
external environment and the provision of an internal dynamic environment, fostering satisfaction and
productivity of the entire staff [6]. The
patient, community, and culture
represent the external environment.
With health care reform and increased
coverage, the external environment and
patient expectations become increasingly important as patients direct their
own care, bear more responsibility for
their care costs, and have more choices.
Hospitals cannot eliminate radiology
services, and almost all physician decisions are aided by imaging. Therefore, it is important to achieve a balance
of integration to provide diagnostic
accuracy in a timely and cost-effective
manner while maintaining patient
focus care and quality outcomes.
ADDITIONAL RESOURCES
Additional resources can be found
online at: http://dx.doi.org/10.1016/
j.jacr.2015.07.026.
REFERENCES
1. Cutler DM, Morton FS. Hospitals, market
share, and consolidation. JAMA 2013;310:
1964-70.
2. Ritzer RJ. Subspecialty radiology: beyond
the debate. Radiology Business Journal.
Available at: http://www.radiologybusiness.
com/topics/business/subspecialty-radiologybeyond-debate. Accessed August 14, 2015.
3. National Electrical Manufacturers Association. New MITA Smart Dose standard
enhances dose optimization and management in CT equipment. Available at: http://
www.nema.org/news/Pages/New-MITA-SmartDose-Standard-Enhances-Dose-Optimizationand-Management-in-CT-Equipment.aspx.
Accessed April 2014.
4. Bui AT. Medical imaging informatics. New
York: Springer Science & Business Media;
2009.
5. US News & World Report. Available at: http://
health.usnews.com/helath-news/hospital-oftomorrow. Accessed October 4, 2014.
6. McGinnis RM. Merging two universities:
the Medical University of Ohio and the
University of Toledo. Acad Med 2007;82:
1187-95.
Cheryl R. Croft, RN, MBA, Richard Dial, BS, RT(R), are from the Mayo Clinic Health System in Waycross, Waycross, Georgia.
Gary Doyle, RT(R), is from the Mayo Clinic in Florida, Jacksonville, Florida. Jennifer Schaadt, MBA, MS, and Linda Merchant, BS,
are from Siemens Corporation, Malverne, Pennsylvania.
The co-authors served as consultants to Mayo Clinic Health System and received compensation for these services.
Cheryl R. Croft, RN, MBA: Mayo Clinic Health System, 1900 Tebeau Street, Waycross, GA 31501; e-mail: croft.cheryl@mayo.
edu.
302
Journal of the American College of Radiology
Volume 13 n Number 3 n March 2016
Journal of the American College of Radiology
Croft et al n Case Studies in Clinical Practice Management
Table 1. Asset management inventory
302.e1
Building
Main/OIC
Main/OIC
Main
Department
RAD
RAD
US
Location
RAD
RAD
Main
RAD
Main
Echo
Main
Echo
Main
Echo
OIC
US
Main
Cath lab
Main
Cath lab
Main
Cath lab
CCL1
Main
Cath lab
CCL2
Main
CT
Main
CT
OIC
CT
Main
Main
OIC
OIC
CT
CT
CT
DEXA
CCL2
Device Type
Computed radiography
PACS
Radiofrequency ablation
systems
Radiographic units,
mobile
Scanning systems, US,
cardiac
Scanning systems, US,
cardiac
Scanning systems, US,
cardiac
Scanning systems, US,
general purpose
Injectors, contrast
media, angiography
Injectors, contrast
media, angiography
Radiographic/
fluoroscopic systems,
cardiovascular
Radiographic/
fluoroscopic systems,
cardiovascular, UPS
Injectors, contrast
media, CT
Injectors, contrast
media, CT
Injectors, contrast
media, CT
Scanning systems, CT
Scanning systems, CT
Scanning systems, CT
Densitometers, bone
DK2077
Acquisition
Date
12/10/2008
8/1/2004
1/1/2008
Age
(y)
6.6
11.0
7.6
Service
Provider
Provider 1
Provider 2
Provider 3
Coverage
Parts/labor
Support
Vendor E
503-5400
4/1/2009
6.3
Provider 4
Parts/labor
Vendor H
V77626
6/1/2006
9.2
Provider 4
Vendor H
V77623
6/1/2006
9.2
Provider 4
Vendor H
VI3330
1/1/2011
4.6
Provider 4
Vendor H
116625435
4/1/2013
2.3
Provider 4
Warranty
Vendor A
IH-525501-001
6/1/2011
4.2
Provider 5
Parts/labor
Vendor O
61318
1/1/1995
20.6
Provider 5
Parts/labor
Vendor T
4888270
4/1/1989
26.3
Provider 5
Parts/labor
Vendor Y
91002117
10/1/2011
3.8
Provider 5
Warranty
Vendor O
32279
4/1/2009
6.3
Provider 5
Parts/labor
Vendor O
35152
2/24/2006
9.4
Provider 5
Parts/labor
Vendor O
300703220968
2/24/2006
9.4
Provider 5
Parts/labor
3041
10120
6283
2600
4/22/2009
8/22/2009
12/1/2010
9/30/1995
6.3
5.9
4.7
19.8
Provider
Provider
Provider
Provider
Gold
Gold
Gold
Parts/labor
OEM
Vendor B
Vendor C
Vendor
Vendor
Vendor
Vendor
T
T
T
Q
Serial
No.
EOS
5
5
5
5
(continued)
302.e2
Table 1. Continued
Journal of the American College of Radiology
Volume 13 n Number 3 n March 2016
Building
Main
Department
Mammo
Location
OIC
Mammo
Room 1
OIC
Mammo
Room 2
Main
Mammo
Main
MRI
MRI
Main
MRI
MRI
Main
NM
Main
NM
Main
NM
Main
NM
Main
NM
Main
NM
Office
Main
Main
RAD
RAD
RAD
Main
RAD
Office
Main
RAD
RAD
Room 6
OR
RAD
Device Type
Radiographic units,
mammography
Radiographic units,
mammography
Radiographic units,
mammography
Biopsy image-guided
stereotactic systems
Injectors, contrast
media, MRI
Scanning systems,
MRI
Scanning systems,
gamma camera
Scanning systems,
gamma camera,
SPECT
Scanning systems,
gamma camera,
SPECT
Workstations, gamma
camera/SPECT
Workstations, gamma
camera/SPECT
Workstations, gamma
camera/SPECT
Radiographic units
Radiographic units
Radiographic units,
mobile
Radiographic units,
mobile
Radiographic units
Film scanner
OEM
Vendor J
Serial
No.
6210
Acquisition
Date
7/29/1999
Age
(y)
16.0
Vendor J
6540
1/1/1996
Vendor J
6795
Vendor K
1201099
Vendor O
Service
Provider
Provider 5
Coverage
Parts/labor
19.6
Provider 5
Parts/labor
1/1/1997
18.6
Provider 5
Parts/labor
1/1/2000
15.6
Provider 5
Parts/labor
10/31/2005
9.7
Provider 5
Parts/labor
EOS
Vendor T
110498
4/22/2004
11.3
Provider 5
Gold
Vendor T
3035
1/1/2005
10.6
Provider 5
Parts/labor
Vendor T
4000649
1/1/2012
3.6
Provider 5
Parts/labor
Vendor T
453560824741
1/1/2012
3.6
Provider 5
Parts/labor
Vendor T
4/22/2009
6.3
Provider 5
Parts/labor
Vendor T
8/22/2009
5.9
Provider 5
Parts/labor
Provider 5
Parts/labor
Provider 5
Provider 5
Provider 5
Parts/labor
Parts/labor
Parts/labor
Vendor T
FW00420540
1/1/1999
16.6
Vendor D
Vendor H
Vendor H
912287R608
279439WK4
1/1/2011
1/1/2008
1/1/1999
4.6
7.6
16.6
Vendor H
954543WKJ
6/22/2005
10.1
Provider 5
Parts/labor
Vendor H
Vendor L
912283R209
12/1/2008
8/1/2004
6.7
11.0
Provider 5
Provider 5
Parts/labor
Parts/labor
2000
Journal of the American College of Radiology
Croft et al n Case Studies in Clinical Practice Management
Main
RAD
Surgery
Main
RAD
Main
RAD
Room 5
Main
RAD
Surgery
Main
RAD
Surgery
Main
RAD
Room 3
Main
RAD
Room 4
Main
RAD
Surgery
Main
RAD
Surgery
OIC
RAD
Main
Main
Surgery
US
Main
US
Main
US
Main
US
Surgery
Surgery
Radiographic/
fluoroscopic systems,
urologic
Image digitization
systems
Radiographic/
fluoroscopic systems,
general purpose
Radiographic/
fluoroscopic units,
mobile
Radiographic/
fluoroscopic units,
mobile
Radiographic/
fluoroscopic systems,
general purpose
Radiographic/
fluoroscopic systems,
general purpose
Radiographic/
fluoroscopic units,
mobile
Radiographic/
fluoroscopic units,
mobile
Radiographic units
Beta/gamma detector
Scanning systems,
US, general purpose
Scanning systems,
US, general purpose
Scanning systems,
US, general purpose
Scanning systems,
US, general purpose
Vendor M
c11207h306
1/1/2008
7.6
Provider 5
Parts/labor
Vendor N
4411-A0200
3/1/2003
12.4
Provider 5
Parts/labor
109
1/1/1992
23.6
EOS
Provider 5
Parts/labor
Vendor R
69-2242
3/28/2000
15.3
07/01/1997
Provider 5
Parts/labor
Vendor S
69-3427
3/28/2001
14.3
07/01/1997
Provider 5
Parts/labor
Vendor T
84936
1/1/1993
22.6
Provider 5
Parts/labor
Vendor T
84949
1/1/1993
22.6
Provider 5
Parts/labor
Vendor T
867
>17 yrs
Provider 5
Parts/labor
Vendor T
4716270
>17 yrs
Provider 5
Parts/labor
Vendor X
8/31/2005
9.9
Provider 5
Parts/labor
Vendor P
Vendor H
PA470-0704040701
13751827
196333YM9
1/1/1998
1/24/1999
17.6
16.5
Provider 5
Provider 5
Parts/labor
Parts/labor
Vendor H
66401US1
12/1/2007
7.7
Provider 5
Parts/labor
Vendor H
77501US5
2/1/2005
10.5
Provider 5
Parts/labor
Vendor H
113113US5
9/1/2012
2.9
Provider 5
Parts/labor
NA
EOS
302.e3
(continued)
302.e4
Table 1. Continued
Building
Main
Department
US
Location
OIC
US
Main
US
ICU
Main
Cath lab
CCL1
Main
US
Main
Cath lab
CCL2
Main
Main/OIC
Mammo
Mammo
Room 1
Main
US
ED
Device Type
Scanning systems,
US, general purpose,
laptop
Scanning systems,
US, bone sonometry
Scanning systems,
US, general purpose
Injectors, contrast
media, angiography
Scanning systems, US,
vascular
Radiographic/
fluoroscopic systems,
cardiovascular
Table, stereotactic biopsy
Computer-aided
detection systems,
mammographic
Scanning systems, US,
general purpose
OEM
Vendor H
Serial
No.
GEL196542
Acquisition
Date
10/1/2008
Age
(y)
6.8
Service
Provider
Provider 5
Coverage
Parts/labor
Vendor I
3123
1/1/1997
18.6
Provider 5
Parts/labor
Vendor V
030WNL
12/1/1995
19.7
Provider 5
Parts/labor
Vendor A
IH-531212-011
11/1/2009
5.7
Provider 1
Parts/labor
Vendor Z
mls2l1111
4/1/2010
5.3
Provider 6
Parts/labor
Vendor Y
11D422U
10/31/2011
3.7
Vendor F
Vendor G
96121608
1/1/1999
2/1/2009
16.6
6.5
Vendor U
308
1/1/2013
2.6
EOS
10/01/2016
Warranty
Parts/labor
Warranty
Journal of the American College of Radiology
Volume 13 n Number 3 n March 2016
Note: Cath ¼ catheterization; CCL1 ¼ cardiac cath lab 1; CCL2 ¼ cardiac cath lab 2; DEXA ¼ dual-energy x-ray absorptiometry; Echo ¼ echocardiography; ED ¼ emergency department; EOS ¼ end of
support; ICU ¼ intensive care unit; Mammo ¼ mammography; NM ¼ nuclear medicine; OIC ¼ outpatient imaging center; OR ¼ operating room; RAD ¼ radiology; SPECT ¼ single-photon emission
computed tomography; US ¼ ultrasound.
Table 2. Utilization rate calculations
Facility
Main
Main
Main
Main
OIC
OIC
Main
Main
Main
OIC
OIC
Main
Main
Main
Main
Main
Main
Main
Main
Main
Office
OIC
Main
Main
Main
Main
Main
Main
Main
Main
Main
Main
OIC
Main
Main
Main
Main
Main
Department
Cath lab
Cath lab
CT
CT
CT
DEXA
Echo
Echo
Echo
Mammo
Mammo
Mammo
Mammo
Mammo
MRI
MRI
NM
NM
NM
RAD
RAD
RAD
RAD
RAD
RAD
RAD
RAD
RAD
RAD
RAD
RAD
RAD
US
US
US
US
US
US
Location
CCL2
CCL1
Room 1
Room 2
MRI
MRI
Room 6
Surgery
Surgery
Surgery
Surgery
Room 3
Room 4
Room 5
Surgery
Surgery
Device Type
Radiographic/fluoroscopic systems, cardiovascular
Radiographic/fluoroscopic systems, cardiovascular
Scanning systems, CT
Scanning systems, CT
Scanning systems, CT
Densitometers, bone
Scanning systems, US, cardiac
Scanning systems, US, cardiac
Scanning systems, US, cardiac
Radiographic units, mammo
Radiographic units, mammo
Radiographic units, mammo
Biopsy image-guided stereotactic systems
Table, stereotactic biopsy
Scanning systems, MRI
Injectors, contrast media, MRI
Scanning systems, gamma camera, SPECT
Scanning systems, gamma camera, SPECT
Scanning systems, gamma camera
Radiographic units
Radiographic units
Radiographic units
Radiographic/fluoroscopic units, mobile
Radiographic/fluoroscopic units, mobile
Radiographic/fluoroscopic units, mobile
Radiographic units, mobile
Radiographic units, mobile
Radiographic/fluoroscopic systems, general-purpose
Radiographic/fluoroscopic systems, general-purpose
Radiographic/fluoroscopic systems, general-purpose
Radiographic/fluoroscopic systems, urologic
Radiographic/fluoroscopic units, mobile
Scanning systems, US, general-purpose
Scanning systems, US, general-purpose
Scanning systems, US, general-purpose
Scanning systems, US, general-purpose
Scanning systems, US, general-purpose, laptop
Scanning systems, US, vascular
Utilization (%)
58
32
61
61
39
25
81
17
0
31
31
8
2
2
66
8
79
78
30
81
52
48
30
30
30
29
29
16
16
4
3
2
44
40
40
40
40
9
Note: Using a standard utilization rate or benchmark (ie, the number of procedures per year for all equipment is misleading). Best practice is to
determine utilization for each individual piece of equipment using procedure volumes, scan times, and procedure types, as there can be large
differences in specific equipment utilization due to staff availability, scan type, number of systems, equipment capability, location, and patient
variables (ie, obesity, age, acuity, patient status). Abbreviations as in Table 1.
Journal of the American College of Radiology
Croft et al n Case Studies in Clinical Practice Management
302.e5
302.e6
Table 3. Equipment to be retired, replaced, or redeployed
Recommendations
C arm OR main (3)
Cath lab, main (1)
CT main
DEXA bone density, OIC
Echo, main
Portable x-ray, main (3)
US main
MRI main
NM
Mammo main
Stereotactic breast BX system
Mammo OIC (2)
Rad fluoro, main (2)
Rad fluoro, main
Age or
Average
Age (y)
17
10.9
4.7
18
2.8
15
8.8
9.6
9
18
14
18
21
22 (EOS)
Average
Replacement
Cycle (y)*
NA
11
8.3
NA
7.5
NA
8
8.7
12.8
8.5
NA
8.5
13.6
13.6
Utilization of
Replacement
Unit
30%
32%
61%
25%
0%
29%
40%
66%
30%
8%
2%
31%
8%
4%
OP Market
Growth %
Demographic
and Linear
NA
10%, 29.1%
10%, 26.7%
3.3%, 27.3%
NA
NA
5.5%, 55.7%
6.7%, 32.7%
9.1%, 1.5%
4.6%, 8.7%
NA
4.6%, 8.7%
6.5%, 24%
6.5%, 24%
Redundancy
Yes
Yes
Yes
No
Yes
Yes
Yes
No
Yes
No
No
Yes
Yes
Yes
Operational
Efficiencies
[
[
Strategic
Service
Line
Growth
Vascular
Vascular
Dose
Reduction
[
[
[
[
[
[
Neuro, ortho
[
[
[
[
[
[
[
[
[
IR
IR
[
[
[
[
Estimated Service
Cost Avoidance,
2014-2015
$9,804
$91,024
$5,940
$15,400
$4,524
$8,111
$157,310
$34,560
$57,774
$11,285
$16,008
$18,096
$22,488
$452,324
Journal of the American College of Radiology
Volume 13 n Number 3 n March 2016
Note: BX ¼ biopsy; fluoro ¼ fluoroscopy; neuro ¼ neuroimaging; IR ¼ interventional radiology; NA ¼ not available; OP ¼ outpatient; ortho ¼ orthopedic imaging. Other abbreviations as in Table 1.
*Sources: IMV 2010 Nuclear Medicine Market, IMV 2010 CT Lab Market Report, IMV 2010 MRI Market Report, IMV 2011 Interventional Angiography Lab Market, IMV 2013 X Ray/CR/DR Market Outlook
Report, and IMV 2013 Cardiac Cath Lab Market Report (IMV Medical Information Division, Inc.); US Markets for Women’s Health Imaging Systems 2012 (Millennium Research Group). Analysis of the U.S.
Medical Ultrasound Imaging Systems Market Growth to be Driven by Emerging Market Segments, 2011 (Frost and Sullivan, Aranibar R, Ruppar, D. Analysis of the U.S. Medical Ultrasound Imaging
Systems Market. Market Engineering, N9CE-50, December 2011, Available at www.imvinfo.com).