Download Medical Imaging Landscape Report - MidCentral District Health Board

NOVEMBER 18, 2013
MEDICAL IMAGING LANDSCAPE REPORT
WHANGANUI AND MIDCENTRAL DISTRICT HEALTH BOARDS
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Document Control
Title:
Medical Imaging Landscape Report
Status:
FINAL
Subtitle:
Whanganui and MidCentral District Health Boards
Rev Number:
Key Words:
Publish Date: 14/11/2013
Save Date:
27/03/2014
File Name: Landscape Report (18Nov13) FINAL
3:46:00 p.m.
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CONTENTS
1
2
3
4
Executive Summary ......................................................................................................................... 6
The Role of Medical Imaging in The Health System ........................................................................ 7
DHB Funding Philosophies ............................................................................................................ 10
Regional Demographic Profile ....................................................................................................... 12
4.1
Projections ............................................................................................................................ 13
4.2
Equity of Access .................................................................................................................... 14
5 Modality Descriptions and Observations ...................................................................................... 15
5.1
Where Services are Provided ................................................................................................ 15
5.2
Breast Imaging ...................................................................................................................... 16
5.2.1
Modality Description..................................................................................................... 16
5.2.2
Key Issues ...................................................................................................................... 17
5.2.3
Potential Opportunites.................................................................................................. 17
5.3
MRI ........................................................................................................................................ 19
5.3.1
Modality Description..................................................................................................... 19
5.3.2
Key Issues ...................................................................................................................... 20
5.3.3
Potential Opportunites.................................................................................................. 22
5.4
CT .......................................................................................................................................... 23
5.4.1
Modality Description..................................................................................................... 23
5.4.2
Key Issues ...................................................................................................................... 24
5.4.3
Potential Opportunites.................................................................................................. 25
5.5
Ultrasound............................................................................................................................. 26
5.5.1
Modality Description..................................................................................................... 26
5.5.2
Key Issues ...................................................................................................................... 28
5.5.3
Potential Opportunites.................................................................................................. 29
5.6
Digital Subtraction Angiography (DSA).................................................................................. 30
5.6.1
Modality Description..................................................................................................... 30
5.6.2
Key Issues ...................................................................................................................... 32
5.6.3
Potential Opportunites.................................................................................................. 32
5.7
General X-Ray ........................................................................................................................ 34
5.7.1
Modality Description..................................................................................................... 34
5.7.2
Key Issues ...................................................................................................................... 34
5.7.3
potential opportunites .................................................................................................. 35
5.8
Nuclear Medicine and PET/CT ............................................................................................... 36
5.8.1
Modality Description..................................................................................................... 36
5.8.2
Key Issues ...................................................................................................................... 37
5.8.3
Potential Opportunites.................................................................................................. 37
5.9
Bone Densitometry ............................................................................................................... 38
5.9.1
Modality Description..................................................................................................... 38
5.9.2
Key Issues ...................................................................................................................... 38
5.9.3
Potential Opportunites.................................................................................................. 38
5.10 Medical Photography ............................................................................................................ 40
5.10.1 Modality Description..................................................................................................... 40
5.10.2 Key Issues ...................................................................................................................... 40
5.10.3 Potential Opportunites.................................................................................................. 41
5.11 Radiology Information System (RIS) / Picture Archiving & Communication System (PACS) . 42
5.11.1 Description .................................................................................................................... 42
5.11.2 Key Issues ...................................................................................................................... 42
5.11.3 Potential Opportunites.................................................................................................. 43
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6
Workforce Descriptions and Observations ................................................................................... 44
6.1
Radiologists ........................................................................................................................... 45
6.1.1
Description .................................................................................................................... 45
6.1.2
Key Issues ...................................................................................................................... 45
6.1.3
Potential Opportunites.................................................................................................. 46
6.2
Medical Radiation Technologists........................................................................................... 47
6.2.1
Description .................................................................................................................... 47
6.2.2
Key Issues ...................................................................................................................... 47
6.2.3
Potential Opportunites.................................................................................................. 49
6.3
Nursing .................................................................................................................................. 50
6.3.1
Description .................................................................................................................... 50
6.3.2
Key Issues ...................................................................................................................... 50
6.3.3
Potential Opportunites.................................................................................................. 51
7 Indicative Financial Comparisons .................................................................................................. 52
8 Next Steps for the Development Plan ........................................................................................... 53
9 Appendices .................................................................................................................................... 54
9.1
Annual Plan Initiatives with a Medical Imaging Impact ........................................................ 54
9.2
Population Projections .......................................................................................................... 56
9.3
European or Other Population Projections ........................................................................... 58
9.4
Maori Population Projections ............................................................................................... 60
9.5
Asian Population Projections ................................................................................................ 62
9.6
Pacific Population Projections ............................................................................................... 62
9.7
Whanganui Access Equity ..................................................................................................... 63
9.8
Ministry of Health Funded PET CT Examinations .................................................................. 65
9.9
Imaging Services.................................................................................................................... 66
9.9.1
Hospital Based Services................................................................................................. 66
9.9.2
Patient Type – All Modalities......................................................................................... 69
9.9.3
Normal Hours Of Operation – All Modalities ................................................................ 71
9.9.4
Day Of Examination – All Modalities ............................................................................. 71
9.9.5
Hour Of Examination – Ct.............................................................................................. 73
9.9.6
Hour Of Examination – Us ............................................................................................. 76
9.9.7
Hour of examination – MRI ........................................................................................... 78
9.9.8
Out-Of-Hours Activity In Detail – Ct .............................................................................. 79
9.9.9
Out-Of-Hours Activity in Detail – Us ............................................................................. 80
9.9.10 Out-Of-Hours Activity in Detail – MRI ........................................................................... 81
9.9.11 DHB Provided Facilities ................................................................................................. 81
9.9.12 DHB Provided Current Equipment, Hours of Operation, Volumes and Staffing ........... 82
9.9.13 Private Provided Current Equipment, Hours of Operation, Volumes and Staffing ....... 88
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TABLES
Table 1: Breast Imaging Future Developments .................................................................................... 18
Table 2: MRI Future Development ....................................................................................................... 22
Table 3: CT Future Development .......................................................................................................... 25
Table 4: Ultrasound Future Development ............................................................................................ 29
Table 5: Digital Subtraction Angiography (DSA) Future Development ................................................. 33
Table 6: General X-ray Future Development ........................................................................................ 35
Table 7: PET-CT Volumes ...................................................................................................................... 37
Table 8: Nuclear Medicine/PET-CT Future Developments ................................................................... 37
Table 9: Bone Densitometry Future Developments ............................................................................. 39
Table 10: RIS/PACS Future Developments ............................................................................................ 43
Table 11: Radiologist Future Developments ........................................................................................ 46
Table 12: MRT Future Developments ................................................................................................... 49
Table 13: Nursing Future Developments .............................................................................................. 51
Table 14: Services; DHB provided......................................................................................................... 87
Table 15: Privately provided services ................................................................................................... 91
FIGURES
Figure 1: Location of Services............................................................................................................... 15
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1
EXECUTIVE SUMMARY
This is the second paper, in a series of three, to progress the 2012/13 Annual Plan centralAlliance
initiatives to review Medical Imaging services. The paper reflects work done to date with many
areas remaining work in progress. The next steps are to explore the key issues further, test current
assumptions and determine a final Plan to be endorsed by key stakeholders.
The final plan will define the need for imaging services for both DHB populations taking into
consideration not only current demand but also the inevitable impact of government targets and
strategies. It will identify opportunities to work differently as well as highlighting those areas to
consolidate, where it is important to strengthen rather than change current arrangements.
Opportunities for improvement include:
 To provide better and faster services for referrers and patients
 To ensure value for money from both current expenditure and future investment
 To identify and fast track development opportunities
 To think differently about and address historic problems
 To contribute to future clinical strategies and facilities design
 A focus on succession planning and workforce
 To strengthen the public system as part of the centralAlliance and wider central region
Work on this plan runs in parallel with, and interfaces to, the Central Region Radiology project, the
Central Regional Information Services Plan (CRISP) and the Master Health Services Plan for
MidCentral DHB (MDHB).
In July 2013 a paper was presented to the Committees of both boards to provide a strategic context
for the presentation of more detailed papers in future meetings. That paper set the scene for the
project work underway to develop a plan for Medical Imaging Services. It outlined some key areas
of focus such as ultrasound access and the development of teleradiology services in Palmerston
North to address increasing out of hours demand for computed tomography (CT).
This paper outlines the landscape of service provision and access for both DHBs. The purpose of
this interim step, prior to a final plan, is to take the opportunity to more fully describe the current
state, and potential steps forward, and to seek feedback from the Committees on both these
aspects as they relate to future imaging services.
It is divided by modality area and identifies some potential opportunities for future development
shown at the end of each section. There are also separate sections, following the modality areas, to
describe the landscape for radiologists, MRTs and Nurses. The current operational performance of
both hospital departments is included and various comparisons between the two DHBs have been
completed.
The paper also highlights that further work is required to better understand and to gain agreement
on the clinical and strategic direction. Importantly further engagement with clinical staff is needed
to crystallise, and prioritise, the items before the final development plan is endorsed by the Project
Team. This paper will form the basis for these discussions in a series of clinical forums.
While a number of opportunities have been raised, there are issues for some work streams that will
be a priority in the next financial year and will take precedence for the immediate term. These are:





Breast Imaging Services for Whanganui
The model of service for CT in Palmerston North
An urgent focus on the model of service for ultrasound for both DHBs
Radiologist and MRT capacity and capability for both DHBs
A focus on equity of access for both DHBs
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2
THE ROLE OF MEDICAL IMAGING IN THE HEALTH SYSTEM
The current health environment is characterised by Health Targets and Standards of Practice,
increasing regionalisation and new Models of Care. These measures are the basis of better
outcomes for patients and are reflected in the DHB’s Annual Plan. A review of both DHBs’ Annual
Plans has shown that effective and efficient access to imaging is a shared necessity. This access is a
key enabler, and also a key risk, in determining the likely success of many initiatives. Fifty Annual
Plan strategies are either entirely or partly reliant on the use of imaging. These strategies include
specific targets, such as for CT and MRI wait times, or wider goals such as improving cancer
pathways. Other areas relying on imaging services include plans to strengthen primary care
through GP access to diagnostics or supporting systemic improvement in patient flow through the
use of technology, such as RIS/PACS. A full list of Annual Plan strategies that have a Medical
Imaging component, are shown in section 10.1.
The Role of Medical Imaging
Medical Imaging is the technique and process used to create images of the human body for clinical
purposes, including the diagnoses of disease, in order to recommend treatment options for
patients. It serves the needs of referring clinicians and is influenced by developments in all areas of
medical practice. Similarly technological developments in medical imaging provide greater options
for clinical management that is incorporated in best practice pathways.
Due to resource constraints, imaging services in the public sector, need to prioritise patients with
different acuities ranging from acute ED trauma patients to routine GP referrals. The services are
funded from a range of sources including CWD discharges, ED attendances, and Community
Referred contracts, health insurers including ACC, maternity s88 payments, national screening
contracts, and private individuals. Services are delivered by both public and private providers.
One of the tensions to be managed is the need to minimise unnecessary examinations, in an
environment where the benefits and accessibility of information continues to improve. Global
issues affect both public and private medical imaging providers and addressing these is
fundamental for the healthcare system of the future. These challenges are:







Ensuring that there are the right services, in the right place to meet the needs of referrers.
Ensuring there are sufficient radiologists employed, and in training, to undertake not only
the viewing and reporting of images, but also to deliver and develop interventional services,
to foster special interest areas, to support training, participate in clinical rounds and
multidisciplinary meetings, and to be key decision makers in healthcare strategies and to
provide opportunities for positive engagement with referrers in both primary and secondary
care.
Ensuring that regional plans for implementing technology, maintaining equipment and
growing staff keep pace with the needs of the health sector.
Ensuring strong networks exist and are maintained between imaging services and referrers
so resources are used effectively and radiologists can actively guide best practice in using
imaging services.
Utilising technology to strengthen services in and out of hours.
Providing a compelling case for change for longstanding problems and thinking differently
about how services are resourced, delivered, and developed.
Providing a sustainable practice environment for ultrasound services that supports more
successful recruitment and retention of sonographers.
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Whanganui DHB Annual Plan
Whanganui DHB funds its Hospital Medical Imaging Department for all imaging required in the
region. In turn the hospital based service provides a range of examinations and purchases from
other suppliers those aspects they are unable to provide. This includes arrangements to access
complex investigations such as interventional radiology, mammography and PET/CT and currently
shorter term contracts to meet wait times, mostly in ultrasound.
The largest outsourced arrangement is in the provision of a radiologist reporting service from
Pacific Radiology in Wellington. This contract, for ongoing service provision and to support to the
sole radiologist in Whanganui, ensures timely reporting and the availability of a broad range of
examination types locally. The funding model strengthens the public sector which is critical in this
small population.
The DHB is relatively well placed to meet the initiatives of its Annual Plan with a well-functioning
service for plain film, CT and MRI. General Practice has access to all modalities except MRI and
while some pathways such as breast imaging have been fragmented, the DHB has implemented
both short term and long term alternatives to manage inequities.
The recently implemented RIS/PACS system has provided clinicians with improved access to
information and improved internal data collection. As the initial implementation site of the
regional RIS, this investment is expected to improve operational flexibility within the region’s
radiology services in the future.
However, ultrasound services are currently less than optimal, with the service unable to meet
service needs due to staffing challenges. Contingencies are in place to support service delivery
however these are temporary ad hoc arrangements requiring a number of patients to travel
outside the region for this service. Acute arrangements are less than ideal due to inconsistency of
options across the week. Addressing the service issues is now a priority and will be fast tracked
through the development.
MidCentral DHB
The MDHB region is supported by four imaging providers, with the two largest being Palmerston
North Hospital (PNH) and Broadway Radiology. The MDHB funding division purchases services
from all providers.
As a result the initiatives of the MDHB Annual Plan reflect the influence of all providers in the
region. This disseminated model creates competition, offers choice and is responsive to
progressing new strategies however there are inequities between providers and their readiness to
participate in the market.
PNH’s Medical Imaging Department has been constrained for many years due to lack of radiologist
resources. Radiologists are central in the development of any imaging service and as a consequence
shortages in this group have limited the development of other staffing groups, technologies and the
ability of the service to play a role in new strategies. Notwithstanding these constraints MidCentral
has developed a capability for interventional work that is greater than other similar sized facilities
and has maintained a reputation for the quality of work undertaken.
In 2013 radiologist staffing for the hospital has improved considerably as a result of active
recruitment and improved retention over the past three years. There has been considerable
investment over the past 18 months in replacement equipment, providing in many cases a step
change in capability.
Investment will be required if more radiologists are to be employed over historical levels, to
support sustainable levels of staffing and in recognition of service growth and to move the PNH
service forward.
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The impact of new models of care, such as both the attendance and preparation for
multidisciplinary meetings is also significant, with Radiologist capacity not simply a factor of the
volumes of images reported.
The role of this service within a more integrated health system, local and regionally, is changing.
Good relationships, acknowledgement of interdependencies and agreement that strong suppliers in
public and private are needed, and in fact complement each other, will provide certainty and
confidence for the community in the health sector overall.
Initiatives for primary care and implementing collaborative pathways are well supported by a
philosophy to move imaging services to the community, making these easily accessible in a
timeframe that facilitates better patient management outside of the hospital setting. The range of
suppliers available to MDHB provides opportunities in this regard, which could be further enhanced
by the development of community based publicly provided capacity, in a similar fashion to the
community based Breast Imaging Service for example.
The expected pace of the Faster Cancer Treatment programme is yet to fully appreciated, but will
impact on CT services in the future. The current model of service for CT was discussed in the July
update, with consideration being given to investment in teleradiology services and additional CT
staff to better manage out of hours and weekend CT work.
Ultrasound services continue to be constrained, mostly through a global shortage of public sector
sonographers. Staffing in this area does fluctuate and PNH continues to train a number of
sonographers each year; however a large private market does have an impact on retention.
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3
DHB FUNDING PHILOSOPHIES
DHBs have a responsibility to fund access to community referred radiology services. There are
differences between MidCentral DHB and Whanganui DHB in their funding approach. These
differences are neither right nor wrong (and indeed there are significant variations between DHBs
of all sizes and localities across the country). They are approaches that have evolved to meet the
needs of the DHB’s primary care referrers given the capabilities that have existed over time in each
DHB’s public and private provider markets.
Primary Care Diagnostics
Both DHBs support primary care having an increased responsibility for ordering diagnostics and
acting on the reported results to maintain care for the patient in the community setting, if that is
appropriate.
This is now increasingly supported by greater standardisation, through the use of clinical pathways
that require access to diagnostics, along with documentation of the patient history, and the clinical
assessment to progress referral of the patient. These standardised clinical pathways are also now
better supported by Primary Care information systems. This is reflected in the increasing use of the
Map of Medicine, which can systematically guide the primary care clinician through the appropriate
diagnosis and treatment decisions.
The increased use of community referred diagnostics has also been enabled by the move to
integrated family health centres (with a broader range of on-site diagnostic services; including x-ray
and ultrasound) supporting the Better, Sooner, More Convenient approach.
The two DHBs enable community referred radiology services in different ways. MidCentral has
been influenced by the availability of a mature private provider market and in Whanganui by the
relative lack of private providers and the need to retain sufficient volume within the hospital
system to provide economy of scale.
MidCentral DHB
The Funding Division has, for a number of years, looked to support primary care to better exercise
the decisions to order radiology diagnostics through giving it the responsibility for managing the
availability, quality and appropriateness of radiology as a diagnostic tool. To this end the DHB has
contracted the Central PHO to provide plain film x-ray and non-maternity ultrasound for the Otaki,
Horowhenua and Tararua populations. The contract for this service has a number of quality
requirements including that the PHO maintains an active radiology oversight committee chaired by
a primary care referrer. The contract has a set number of Relative Value Units (RVUs) per locality
and a price per RVU which in effect sets the community referred radiology budget within which the
PHO is expected to operate. In effect the PHO (i.e. the primary care referrers) hold the budget.
The PHO is able to have as few or as many radiology providers as appropriate to encourage services
to be provided as locations convenient to each community.
Limited contracts for specific purposes have been issued directly to the private providers for
services such as Renal, Ultrasound DVT, CT colonoscopy, CT Heads and Transient Ischemic Attack
(TIA) diagnostics.
Palmerston North Hospital provides all other community referred radiology services including plain
film x-ray. It is the DHBs intention to transition Feilding and Palmerston North to the same PHO
contract once integrated family health centres are established in those locations.
MidCentral has also demonstrated preparedness to contract radiology diagnostic services from
private providers in situations where the hospital provider cannot provide the timeliness, volume
or quality required.
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Whanganui DHB
Whanganui DHB provides community referred radiology for plain film x-ray, maternity, CT and MRI
services through the Wanganui Hospital Provider. There is no budget holding of volumes by the
PHO in this process. Private x-ray and ultrasound services are limited in Whanganui and are
probably not sustainable. This arrangement provides economies of scale as it allows for the
employment of additional staff to support out of hours rosters.
The contract for community referred radiology is included in the Service Level Agreement between
the WDHB Funder and Provider and is agreed annually. The Provider bears the risk of any over
delivery of volumes against this contract. Plain film x-rays, ultrasound, and CTs are all included in
this contract.
Funding for community referred MRI is specifically excluded, however historically access has been
given by the hospital provider to consultants to refer their patients from private for MRIs. The
value of this unfunded work is approximately $150K annually. Ideally the cost of private referred
MRI would be covered by health insurers and the DHB has initiated discussions to see how the
barriers to this occurring could be overcome. Currently, insurers do not reimburse for services
provided by public hospitals.
As a provider, Whanganui DHB does not charge co-payments on any community radiology,
including ACC. However, co-payments are applied by private providers of radiology services.
In 2011/12 the WDHB Provider over-delivered against the community referred radiology contract,
which was increased at the beginning of the 2012/13 financial year. The Funder purchases relative
value units per modality as per the table below.
Community Referred Radiology
Plain Film
CT
Ultrasound (excluding maternity)
Mammography
Other - Bone Density scans, Nuclear Med Scans, GP
referred interventional radiology and floroscopy
MRI
Maternity Ultrasound
Contracted
RVUs 12/13
9,200
11,000
3,700
1,600
Actual
RVUs 12/13
12,188
11,106
3,272
959
472
25,972
82
4,156
31,763
7,833
7,679
Whanganui DHB also purchases community radiology from MidCentral DHB through inter-district
flows. For the 2012/13 year this amounted to 1,941 RVUs with a funding value of $134,783.
Total DHB Public Funding Levels
Analysis of Whanganui‘s and MidCentral’s total funding of public and private providers shows that
Whanganui is funding at approximately $44,500 per 1,000 population while MidCentral is funding
at $72,500 per 1,000 population.
The differences may, in part, be explained by MidCentral’s provision of more complex examinations
and procedures. However the mature private market in MidCentral’s should also be considered in
order to get a complete view of the relative position of each DHB.
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4
REGIONAL DEMOGRAPHIC PROFILE
The current and future model of service for Medical Imaging, including predictions on issues of
access and supply, is significantly influenced by the profile of the populations the service is
designed to support. This section reviews the sources and correlation of current populations
counts (the census), the population projections and DHB Medical Imaging patient and examination
volumes. The data sources and analysis are shown in section 10.2.
The purpose of this analysis is to identify and understand any differences in access for particular
population groups (in the context of their relative health need) and provide a view on the likely
impact of population change generally. The analysis also considers the impact of ethnicity as a
proxy for health disparity and age as a proxy for likely health care intensity.
Statistics New Zealand publishes data sets to provide insight into the profile of the population of
each DHB, by DHB region and territorial authority. Census 2013 data is not yet available and
therefore 2006 data is used for this report. As this data is both outdated, and reported for the
territorial authorities within each DHB but not the DHB areas themselves, it is only a convenient
guide to the information, and is not to be considered absolutely correct.
The most recent census data is due for imminent release, and should be reviewed against the
indications considered in this section of the paper.
The latest population estimate for DHB boundaries shows that at 30 June 2012 Whanganui DHB’s
population was estimated to be 62,600 while MidCentral DHB’s population was estimated to be
169,300.
Given the correlations between health outcomes, age, family support, ethnicity and poverty the
following key factors will influence the Medical Imaging Landscape.

The residents of Whanganui DHB area, to a greater degree, and MidCentral to some degree,
have higher levels of socio-economic deprivation and higher percentages of the population
identified as Maori than the New Zealand average.

Whanganui DHB has significantly more people identified as Maori (23%) than New Zealand
overall (14%) and MidCentral DHB (17%). However MidCentral has the greater number of
Maori and both DHBs have similar number of Maori living in their rural areas.

More Whanganui males and females identified themselves as smokers (24% respectively)
compared to 20% and 18% for New Zealand males and females and 22% and 21% for
MidCentral.

Fewer Whanganui women aged 15 years and over had no children (21%) compared to New
Zealand over all (28%) and MidCentral women (27%).

More Whanganui and MidCentral women had 4 or more children (18% and 16%
respectively) than for New Zealand over all (13%).

More Whanganui and MidCentral people had no qualifications (30% and 27% respectively)
compared to New Zealand overall (22%).

79% of MidCentral people had personal incomes less than $50,000 for the year ended 31
March 2006 compared to 73% for New Zealand overall and 78% for Whanganui people.

More Whanganui and MidCentral people were on unemployment, sickness or domestic
purposes benefits than for New Zealand overall. 19% of Whanganui people were on NZ
Superannuation or veterans pensions compared to 14% for New Zealand overall and 17% for
MidCentral people.
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
A similar number of people in New Zealand overall, MidCentral and Whanganui DHB areas
were identified as not being in the workforce (30-33%) and in full time employment (4548%).

Slightly more people in MidCentral and Whanganui were a couple with no children (42%
and 41% respectively) compared to New Zealand overall (40%) but more Whanganui
families identified as having a single parent (22%) than did MidCentral families (19%) and
New Zealand families overall (18%).

Slightly fewer Whanganui people were in a one family household (65%) compared to New
Zealand overall (68%) and MidCentral (67%) and more Whanganui people were in oneperson households (28%) compared to 25% in MidCentral and 23% in New Zealand overall.
4.1
PROJECTIONS
For WDHB the projected change over the period from 2006 to 2031 is a decrease to 89% of the
2006 census count. Significantly the 65+ age group change is 170% while the other age groups are
in the 73% to 78% range.
For MDHB the projected change over the period from 2006 to 2031 is an increase of18,250 people
or 112% of the 2006 census count. Significantly the 65+ age group change is 192% while the other
age groups are in the 94% to 105% range.
For WDHB the number of Maori will increase by 2021, for all ages, to 109% but that the 65+ group
show a change of 180%. Other age groups changes range between 102% and 111%.
While for MidCentral the change for all ages is 126% and 267% (1500 people) for the 65+ group.
The 40-64 group changes by 142% while ages below that approximately 115%.
By 2021 territorial authorities within the Whanganui DHB area will have, compared to the 2006
Census:



6,350 fewer people but 4,450 more in the 65+ age group
1,700 more people identifying as Maori of which 800 more will be aged 65+
Rural populations will decline
By 2021 territorial authorities within the MidCentral DHB area will have, compared to the 2006
Census:


11,900 more people of which 10,650 more will be 65+
Palmerston North City will have an additional 2,800 Asian and 1,900 Pacific Island people of
which 900 and 200 respectively will be 65+
While the total population changes are the single largest influence on capacity needed, the impact
of the aging population and the greater number of people aged 65+ is less certain. There are
various theories in respect to aging, health need and health resources. One view is that utilisation
of health resource is a constant no matter what age people live to, and that those who live longer
simply do so due to better health. The counter view is that as an aging population will be greater
users of health service due to our increased risks of age and the longer term effects of lifestyle
factors.
Specifically medical imaging market analysis (data from the major equipment suppliers) is
forecasting continued growth in developing countries driven by economic growth and population
aging but diminishing growth in developed countries due to budget constraints.
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4.2
EQUITY OF ACCESS
As part of the review of the regional demographics a high level analysis of imaging techniques and
access, relative to age and ethnicity, was undertaken. This work requires further expert
interpretation before publication, however there is variability noted between Maori and non Maori
population access to imaging that requires further explanation. An analysis of this area, with a
view to considering where change may be required, will be completed for the final plan.
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5
MODALITY DESCRIPTIONS AND OBSERVATIONS
This section explores in greater detail the various modality areas. Each area is described with a focus on
how the area works and the differences between the various providers. Key linkages with major health
priorities are also described where relevant. Potential opportunities, originating from key issues, have been
developed through consultation and research and are noted for each area. These will form the basis upon
which final development steps to be agreed and presented. This section also highlights where further work
is required to better understand or to gain agreement on the clinical and strategic direction.
Further detail on these services (including service volume, equipment, staffing and hours) are included in
section 10, Hospital Based Services, page 65.
5.1
WHERE SERVICES ARE PROVIDED
The adjacent map of medical imaging service
locations shows that general x-ray services are
quite wide spread across the combined DHB
districts including facilities at both Turoa and
Whakapapa.
Fixed ultrasound services are provided in
Dannevirke, Palmerston North and Wanganui
with portable services provided in Levin and
Feilding.
Fluoroscopy, CT and MRI are provided in both
Wanganui and Palmerston North while
Angiography, Bone Densitometry, Nuclear
Medicine and Medical Photography services are
provided only in Palmerston North.
Mammography and screening are provided
from fixed locations in Palmerston North and
Wanganui with all the smaller centres covered
by the Mobile Breast Screening Service.
Numbers in the map colour code refer to the
number of service providers at each location.
FIGURE 1: LOCATION OF SERVICES
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5.2
5.2.1
BREAST IMAGING
MODALITY DESCRIPTION
Breast cancer is a significant health issue for New Zealand and is the leading cause of cancer death in nonsmoking New Zealand women. The incidence of both female and male breast cancer has increased in
recent years however reassuringly the mortality rate has reduced by 19% over the last decade. This
reduction is generally attributed to earlier detection and the greater use and effectiveness of adjuvant
treatment. The majority of breast cancers are detected through breast x-rays or mammograms.
There are three pathways for breast cancer diagnosis. These are:
1. Diagnosis via the BreastScreen Aotearoa programme
2. Diagnosis made in the private sector and referred to secondary or tertiary care or
3. Referral from primary care for breast symptoms or at risk mammography to secondary services,
either surgical or imaging
The BreastScreen Aotearoa programme, for women 45-69 years, is a diagnostic pathway for the detection
of breast cancer. The National Screening Unit (NSU), as part of the National Health Board, is responsible
for coordinating all population screening activities including BSA. The NSU contracts eight regional ‘Lead
Providers’ to deliver breast screening services nationally.
The Lead Provider for the Whanganui and MidCentral regions is MDHB. The providers have their own
unique brands with the service across the central North Island known as ‘BreastScreen Coast to Coast’ or
BSCC.
BSCC operates from a central hub in Amesbury St in Palmerston North. This site provides screening services
for the MidCentral region, and assessment services to facilitate diagnosis (further views, ultrasound and/or
biopsy) for those women found to have an abnormal screening mammogram. This site also administers the
programme and leads health promotion activity.
A mobile breast screening unit travels the region on a two yearly basis and there are nine mobile sites in
the region. These are in Otaki, Levin, Foxton, Dannevirke, Feilding, Marton, Gonville, Taihape and Ohakune.
The mobile unit is popular with women and is a key factor in providing remote and rural access to the
programme.
Screening mammograms are available year round at Progressive Medical Imaging, a private site in
Whanganui, which offers mammograms services only. Whanganui women with an abnormal screening
mammogram go to Palmerston North for further investigation and diagnosis.
Diagnostic breast imaging, in comparison to breast screening, is for those patients presenting with a
specific breast symptom or for those on a planned programme of follow up post breast cancer. These
patients, both male and female, are referred from both primary and secondary services.
A diagnostic work up or ‘triple assessment’ includes a mammogram, a targeted breast ultrasound and/or a
biopsy of a suspicious lesion.
MidCentral DHB
In Palmerston North the symptomatic and surveillance, or diagnostic mammograms are also taken in
Amesbury St, under the name of the MDHB Breast Imaging Service. Triple assessment is offered for all
symptomatic women and in the majority of cases this means one visit for women, and men, to complete a
diagnostic work up. This service has only recently combined with BSCC and the process continues to be
embedded. In addition, the introduction of a map of medicine pathway from General Practice to specialist
care, via the imaging service is planned for the next six months.
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Whanganui DHB
BSA is responsible for the delivery of a screening service for the women of the Whanganui region. The
service provided for symptomatic women is the responsibility of the WDHB and is delivered via referrals to
the Radiology Department. As the WDHB outsourcers mammography but provides ultrasounds this has led
to a disjointed service for woman and extended waiting times between examinations. It also requires
significant monitoring to ensure delays to diagnosis do not occur. Currently discussions are underway with
Broadway Radiology to provide both mammography and ultrasound services in an attempt to reduce
waiting times for symptomatic women. Streamlining of breast imaging to one event, and potentially one
site, minimises the risk of unnecessary delays and will improve waiting times required by the national
programme for faster cancer treatment.
5.2.2
KEY ISSUES
Equipment
The National Screening Unit requires all BreastScreen providers to have digital equipment by the end of
2013. This directive has instigated a nationwide upgrade of services and the implementation of a central
national PACS for all BreastScreen images. The breast imaging service in Palmerston North has effectively
completed a digital upgrade and aims to have this fully implemented by year end, with the delivery of a
new digital mobile unit.
For mammography services in Whanganui, both screening and diagnostic, the local provider is contracted
until June 2014. This site is not digital and continues to assess the feasibility of whether it is financially
viable to upgrade to a digital platform.
Faster Cancer Treatment
In October 2011, the Minister of Health outlined a programme of work to provide Faster Cancer Treatment
with a focus on improving the quality of care. Key components of the programme include early recognition
and reporting of symptoms and rapid access to investigations and treatment.
Effective management of the diagnosis and treatment of breast cancer is long established internationally,
and in New Zealand. Dedicated and well organised breast care teams are essential for the rapid assessment
and diagnosis of breast problems including cancer.
At a minimum, this includes a multidisciplinary team of surgeons, radiologists, pathologists, breast
care/breast cancer nurses and medical radiation therapists with access to onsite mammography and
ultrasound, preferably with stereotactic facilities and ready access to magnetic resonance imaging (MRI),
nuclear medicine and computed tomography (CT) scanning.
MidCentral has made a number of steps to improve breast services in the past two years and as a
consequence is well placed with new equipment and a comprehensive model of care for breast diagnosis to
meet the expectations of the Faster Cancer Treatment programme.
5.2.3
POTENTIAL OPPORTUNITES
The current model of care for Whanganui does not meet the requirements of faster cancer treatment, and
with the current technology being used, does not meet the national requirements for screening
mammograms.
A workshop, held in May 2013 with stakeholders across the breast pathway, proposed that there is one
centralAlliance breast care service, subject to approval of a business case. If implemented, the service
would be led from the Breast Imaging Service in Palmerston North, but with multiple sites delivering
screening and diagnostic services (mammograms, biopsies and breast ultrasounds) across the region.
Triple assessment models are traditionally offered on one physical site capitalising on the one location of
equipment and specialist staff. This is extremely effective in metropolitan regions that densely populated
and well served by public transport, yet relatively small geographically.
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In this region however, which is geographically large and sparsely populated, a single facility model would
create as many barriers as it would minimise. Challenges of geography and access to effective transport
does not preclude rural and provincial regions from enjoying the same level of clinical excellence
experienced in larger centres, but simply requires solutions that understand and meet the needs of the
population rather than the population trying to adapt to a one size fits all model.
The one service will operate with consistent imaging pathways for all aspects for breast imaging and
diagnosis, will arrange the annual imaging of women post breast cancer and provide overarching
governance and clinical leadership, in partnership with the surgical and oncology specialties in both
regions, for the ongoing care and management of breast disease.
The one service model builds on an already well-established specialist team and through a function of
organic growth, rather than duplication; this team could expand to encompass the wider region.
This model is pre-existing in some circumstances with the BSCC programme operating at two fixed
screening sites and eight (8) mobile unit sites already. Diagnostic services in MidCentral already operate a
triple assessment approach and are planning to improve this model before the end of the year.
A future model would therefore consolidate what is currently available, enhance it where needed and
design any local variations, including the expansion of a site offering mammograms, ultrasound and
Radiologist services, in consultation with community and local health providers.
The model would include:



Eight mobile breast screening sites, as currently scheduled.
A lead site in Palmerston North from which all clinical activities would be managed. This site will
provide screening for the MidCentral region, BSA assessment services for both regions, reading of
mammograms for both regions, stereotactic biopsy and all administration including bookings.
A permanent outreach site in Whanganui offering screening mammograms and triple assessment of
diagnostic patients on a routine basis, with the opportunity for Whanganui clients to travel to
Palmerston North between pre planned sessions should they wish to, or if their clinical presentation
requires a swifter pathway to diagnosis.
Benefits of this model include:







Opportunities for improved communication and the development of effective relationships through a
multidisciplinary patient centred approach to care provision along the complete patient cancer
pathway.
Reduced anxiety for patients, family and whānau through increased trust in a more effective,
consistent and accessible system.
Better control and survival benefit for some cancer patients.
Effective use of specialist staff and equipment.
Dedicated breast nurses to act as a coordinator of care to facilitate the treatment pathway and to
provide guidance and support from symptoms to diagnosis through to follow-up.
Improved strategic decision making through consistent information, data collection and clinical
governance.
Value for money through reduced duplication and consolidation of skills and equipment in one
structure.
OPPORTUNTIES FOR FUTURE DEVELOPMENT

MDHB and WDHB to explore the development of an outreach dedicated breast imaging facility in
Whanganui, maintaining breast screening and diagnostic service provision locally in the region.
TABLE 1: BREAST IMAGING FUTURE DEVELOPMENTS
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5.3
MRI
MRI is a rapidly growing and evolving medical imaging technology which is increasingly being requested by
clinicians as the established standard for accurate and definitive diagnoses. There have been significant
technological leaps forward which reduce examination times, improve image quality and the patient
experience, particularly with the introduction of a wider bore.
5.3.1
MODALITY DESCRIPTION
Two MRI scanners are located in the Whanganui and MidCentral region; one in Whanganui Hospital and
one located on the Palmerston North Hospital campus, owned and operated by Broadway Radiology.
Broadway Radiology provides all MRI services for MDHB via a fee for service contract. The service provided
is well regarded however as demand grows increased volumes have created cost pressures for the hospital
services.
The Wanganui hospital has had MRI since December 1993. The current MRI scanner is a Siemens 1.5 Tesla
unit, which is 9.5 years old and currently operating a 4 receiver channel system. Peripheral equipment
includes an MR compatible automatic injector and pulseoxymeter (heart rate and oxygen saturation
monitor). A planned upgrade in the near future will increase the number of receiver channels to 18.
The Broadway Radiology MRI scanner in Palmerston North is a GE 1.5 Tesla unit, commissioned in October
1999 sited on the MDHB campus. About four years ago it was upgraded to an 8 channel system. Broadway
Radiology MRI has access to full MRI compatible anaesthetic monitoring equipment. This anaesthetic
monitoring equipment is owned by MDHB but is stored in the Broadway MRI scanner room. Broadway has
an MRI compatible pulseoxymeter, but do not have an automatic injector. Consideration to technological
improvements in three (3) tesla machines should also be considered when MRI machines are replaced.
Wide bore technology has been developed, which enables obese patients to be scanned with greater ease.
These patients are often not able to be scanned because they do not fit in the regular sized scanners. The
wider bore also means a drop in the number of patients needing sedation to undergo scans, and has made
scanning shoulders on even relatively normal sized patients much better tolerated from the patient’s
perspective. Neither WDHB nor Broadway Radiology currently have wide bore magnets, and is something
to be considered in futures years as part of the asset replacement cycle.
Both scanners provide a similar range of examinations. These include musculoskeletal, neurological,
abdominal and vascular imaging. The capabilities of the scanners are very comparable, with the only
difference between them being that Broadway Radiology scanner has the equipment and software to
perform Non Contrast Angiography, Breast MRI, Tempero-mandibular Joint MRI and MRI examinations
under anaesthetic. Broadway Radiology also performs Spectroscopy of the brain, although this is seldom
used.
There is a good level of access to MRI in Whanganui. The MRI scanner is available 5-days per week
between 08:00 and 16:00 on Mondays and Fridays, and 08:00 to 21:00 Tuesdays, Wednesdays and
Thursdays. Access to outpatient and community referred MRI is being measured monthly and reported to
the Ministry of Health via the Faster Access to Diagnostics Reporting. The following table shows access for
these referral types in Whanganui.
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MRI Faster Access to Diagnostics
400
100.0%
% of referrals done within
6-weeks
350
90.0%
80.0%
300
70.0%
Referrals
250
60.0%
Target - 50% of referrals
seen within 6-weeks
200
50.0%
New Referrals Accepted in
the month (axis 1)
150
40.0%
30.0%
100
20.0%
50
Referrals reported within 6weeks (axis 1)
0
10.0%
0.0%
This table shows that from June 2013 over 95% of MRI referrals from outpatients and the community are
seen within 6-weeks. The minority waiting longer have probably been referred to another provider as the
WDHB does not have the equipment or resources to sedate patients. In reality the waiting list is currently
around 2-weeks. Reporting of MRI images takes an average of 2-days from the time of examination till the
report is verified and released.
MRI volumes have been growing in the past 5-years. A small number of these volumes are outsourced to
providers who are able to sedate patients. Volumes have grown further in 2013/14 following the
introduction of extended hours three days per week.
2008/09 2009/10 2010/11 2011/12 2012/13
2,308
2,267
2,163
2,422
2,678
At the end of October there were 144 patients waiting for an MRI. 54 of these patients were planned.
There were only 4 patients waiting longer than 42-days for an MRI scan.
5.3.2
KEY ISSUES
MRI is a fundamental tool for any major hospital, and appropriate access to this modality is not only
essential for patients / referrers but also for Radiologists who wish to remain current in this field. The
MDHB service model is somewhat unusual without an MRI in Radiology, which in other hospitals would be
part of the routine roster for Radiologists. While philosophically this is not insurmountable and shared
staffing arrangements do exist, logistically there are challenges with staff working across different
providers. As radiologist staffing improves access to MRI and involvement in how it used is now an
important issue to address and an equally vital factor for the future recruitment.
Similarly post graduate training opportunities in MRI need to be carefully planned, with the majority of
technicians taking two years to be fully qualified. The workforce is small, and the lead in time required
needs to be considered alongside any planned increases in equipment regionally.
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Analysis of Whanganui’s and MidCentral’s cost per examination shows that for the 2012/13 year
Whanganui DHB has a cost per MRI examination 35% lower than that of MidCentral DHB. Given the
different arrangements that exist for the delivery of the service further work is required to fully understand
how the two cost structures influence future decisions. This current contractual arrangement for
MidCentral continues until 2015/16.
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5.3.3
POTENTIAL OPPORTUNITES
OPPORTUNTIES FOR FUTURE DEVELOPMENT

Development of an approach to future procurement of MRI services that ensures provision of the
best clinical, operational and business outcomes including better analysis of cost differences and
structures.
 Active, local, training programme for MRI Medical Radiation Technologists.
 Shared MRI service development across the Whanganui/MidCentral DHBs.
 Wanganui DHB would like to explore the option of insurance payments / private funding for
private patients currently accessing MRIs, on the basis that the hospital is the only local provider
of this service.
TABLE 2: MRI FUTURE DEVELOPMENT
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5.4
5.4.1
CT
MODALITY DESCRIPTION
A Computed Tomography (CT) scanner combines a series of x-ray data from multiple angles and processes
these to form sets of cross sectional imaging. It is a precise and versatile technology and a fundamental
tool for any imaging service.
CT is the preferred method of imaging for many major conditions and is crucial in the management of
patients due to its accuracy and speed. It has key applications for trauma patients, the management of
acute symptoms such as chest or abdominal pain, management of spinal conditions, vascular anomalies,
neurological defects and cancer treatment. CT is also used in interventional work such as guided biopsy. CT
units are staffed by a multidisciplinary team of MRTs, radiologists, radiology registrars and nurses. The
roster covers 24 / 7 and is heavily relied upon by a significant number of specialties across the hospital both
in and out of hours. CT is a complex technology and the MRTs require training and ongoing access to
remain current and competent in this area.
The volume of data obtained in a single examination can be extensive and, as a consequence, requires time
to review, reconstruct and draw conclusions. The reporting of CT is therefore complex and time consuming
for Radiologists.
Whanganui Hospital
Whanganui DHBs CT department operates from 08:00 to 16:00 Monday to Friday with a 24/7 on-call
service. Two MRTs operate the scanner together with the radiology nurse cannulating and injecting
contrast. There is currently the equivalent of 4 FTE able to cover the on call roster; this is being increased
to 5 FTE following a decision made in May 2013. There is an agreed plan with staff to extend the current
operating hours to 5pm on weekdays. This has not yet been implemented due to staff shortages.
Wanganui hospital provided some 4,400 examinations in the 2012/13 year. Whanganui accepts referrals
from outpatients, inpatients, emergency department (ED), GPs and private providers. There are no charges
to any patient group.
Wait times for CT are currently minimal with 97% of community referred and outpatient referrals being
seen within six weeks. The table below shows performance against the faster access to diagnostics targets.
Inpatients and ED patients are generally seen on the day of referral.
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CT Faster Access to Diagnostics
500
100%
% of referrals done in
6-weeks
450
400
90%
80%
Target 75% of referrals done
in 6-weeks
350
70%
Referrals
300
60%
New referrals accepted
during the month (axis 1)
250
200
50%
Referrals reported within
6-weeks (axis 1)
40%
150
30%
100
20%
50
10%
0
0%
Reporting times for Whanganui is an average of 26 hours from the date of the examination till the verified
report is released. Cases identified as being ‘urgent (identified by the MRTs and requiring urgent results)
are reported, typed and verified immediately.
Whanganui DHB is able to assist neighbouring DHBs with providing CT scans for their patients in order to
reduce waiting lists and provide faster access to diagnostics.
Palmerston North Hospital
CT is provided 0800-1630 Monday to Friday and on call at other times. In 2012/13 Palmerston North
Hospital performed 9,529 scans, 16% above the previous year. Wait times for CT in September exceed the
target with 87% of patients seen within six weeks.
The service is for specialists referral with most GP work referred to the private provider at the patient’s
expense. The only exception is a small contract for the management of headaches via an arrangement
between the MDHB funder and primary care.
A new machine was installed in September 2013 and allows for faster and more complex procedures to
take place. The updated scanner will enable examinations that have not previously been undertaken to
occur. The replacement CT is of benefit to not only the Medical Imaging service, but also to
Gastroenterology for colonoscopy patients, potentially relieving some of the pressure on these waiting
times.
5.4.2
KEY ISSUES
CT procedures are one of the fastest growing modalities. Effective access to the technology is a key priority
and impacts on the DHB’s ability to meet not only the national wait times for CT, but also the ability of the
hospital to manage patient flow effectively (impacting on the six hours waiting times in ED) and the
imminent faster cancer treatment programme.
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The modality is under significant pressure to manage demand, not only during the working day, but out of
hours. The current staffing arrangements in Palmerston North are inadequate to support the level of
services being provided.
Whanganui has only one scanner in their region which can put pressure on neighbouring DHBs in the event
of a breakdown. This also necessitates the transfer of acute patients and carries a significant clinical risk, as
CT is often the modality used for trauma patients.
Clinically the use of CT is expanding as well as being impacted upon by increasing pressure to see patients
faster. Greater volumes and surges in demand, resulting from faster access target create pressure for this
technology that exceeds current capability.
5.4.3
POTENTIAL OPPORTUNITES
OPPORTUNTIES FOR FUTURE DEVELOPMENT
This area of focus is multifaceted and requires further review. It is influenced by a number of
organisational, and sector wide, priorities. To agree the final development opportunities a clinical forum
is needed to discuss, prioritise and agree the direction for service development for this area. Areas of
consideration may include but are not limited to:



Managing national wait time targets for CT
Improving certainty over resources for CT inclusive of all staff groups
Seeking innovative solutions to enhance the use of CT in clinical pathways and patient
mapping initiatives.
TABLE 3: CT FUTURE DEVELOPMENT
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5.5
ULTRASOUND
Access to ultrasound is an urgent and significant issue. The current situation in the public hospitals needs
to be strengthened to ensure its future sustainability. The public environment, having a reputation of
working with long waiting lists, lower remuneration and short staffing, cannot recruit and this has reduced
hospital based employees over time to unsustainable levels. In turn hospital providers have looked to the
private sector for assistance in the provision of ultrasounds continuing this cycle. The longevity of the issues
and the fragmented philosophies over how to deliver ultrasound indicates that the service model needs to
be redesigned to determine the future of this modality.
5.5.1
MODALITY DESCRIPTION
Ultrasound technology is portable, relatively inexpensive and not restricted by the legislation governing
radiation protection. This has meant that as a clinical tool it has migrated beyond the Medical Imaging
Department and is embedded in a number of clinical practice settings.
Ultrasound can be accessed in public hospitals and private radiology providers as well as in other specialties
such as gynaecology, cardiology and emergency medicine.
The current system is fragmented with scans occurring in an ad hoc fashion through a combination of
privately and publicly funded arrangements that are characterised by waiting lists, surcharges and a level of
uncertainty about how to access and deliver this modality.
Sonographer resources are inequitably distributed across the region with many more sonographers
employed privately than in public. Access to training programmes for staff varies and a national approach
through Health Workforce NZ is under development. Palmerston North Hospital is the only long term
training site in our region and the majority of sonographers now employed privately were trained publicly
at MDHB. Traditional models of training are also in question with new academic approaches being
considered to change the training model and deliver it in New Zealand.
How ultrasound use differs between specialties
Ultrasound in Medical Imaging
Ultrasound scanning, as part of a Medical Imaging Department, is a comprehensive service offering a range
of specialist scanning types. The scans are mostly performed by a qualified sonographer, traditionally post
graduate to a Medical Radiation Technology qualification, who undertakes the scans, documents a series of
required images which are in turn interpreted and reported by Radiologists. Radiologists also scan patients
as required.
Women’s Ultrasound
Ultrasound is the diagnostic imaging examination of choice for women’s services; it is a safe method in
antenatal assessment and for views of the uterus and ovaries, at all stages of life. As a specialty
Obstetricians and Gynaecologists have undertaken the use of ultrasound in their own practice and some
have an equivalent qualification in its use for diagnosis and reporting as their Radiologist colleagues.
Ultrasound as an aid to decision making
In recent years ultrasound has been incorporated in emergency and a number of other settings to make
simple clinical decisions, mostly to determine next steps or to guide the placement of lines, catheters or
drains. Clinicians who use ultrasound, other than Radiologists or specialists in O&G, vary in skills and
experience, as determined by its use. Short courses, targeted at the area of need are available, and at
MDHB these are well attended. There are requirements for ongoing review of practice and audit of use of
ultrasound in this clinical setting that requires support from Radiologists or possibly experience
sonographers, however due to staffing constraints this is not common.
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Ultrasound Services
Whanganui Hospital
Whanganui Hospital ultrasound service has two general machines in radiology and one echocardiology
machine, one general machine was purchased in 2013 and the other is due for replacement. Three
sonographers are employed although all work less than 40 hours per week. Current staffing constraints due
to injury have led the WDHB, to outsourcing ultrasounds to Broadway Radiology and Manawatu Ultrasound
in order to deliver urgent and semi-urgent diagnostic referral requests.
In 2012/13 Whanganui radiology department delivered 5,978 ultrasound examinations to 5,727 patients.
Due to current resource constraints the WDHB is not accepting routine referrals, giving patients an early
indication allowing them to pursue the option of a private examination if they so choose. Semi-urgent and
Urgent referrals are either done in the radiology department or outsourced to Broadway Radiology or
Manawatu Ultrasound after they are triaged. The WDHB monitors reporting quality and patient waiting
times. At the end of October there were 388 patients waiting for an ultrasound, 60% of these had been
waiting shorter than 6-weeks.
WDHB also has portable ultrasound machines in various departments. One of these is in the emergency
department (ED) and is available for use in the critical care unit when required. Other machines are located
in the peri-operative unit, women’s and children’s services and two in outpatients. The machine in ED is
the first one requiring replacement which is due for 2014/15.
Access to ultrasound in Whanganui is current less than ideal. Access to outpatient and community referred
ultrasound is being measured monthly using the Faster Access to Diagnostics methodology. The following
table shows access for outpatient and community referred referrals.
1000
Ultrasound Faster Access to Diagnostics
100.0%
900
Referrals
800
90.0%
% of referrals done within
6-weeks
80.0%
700
70.0%
600
60.0%
Target 50% of referrals seen
within 6-weeks
500
400
40.0%
New referrals accepted in
the month
300
200
50.0%
30.0%
20.0%
Reported examinations
waiting less than 6-weeks
100
10.0%
0
0.0%
This table shows that patient waiting times have improved since June following the use of outsourced
providers to delivery some of these images. The total number of reports are dropping as routine referrals
are currently not being accepted due to capacity constraints.
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Ultrasound volumes have been growing over the past 5-years as shown below.
2008/09 2009/10 2010/11 2011/12 2012/13
5130
5636
5216
5924
5752
At the end of October there were 767 patients waiting for an ultrasound. 58 of these patients were
planned. There were only 55 patients waiting longer than 42-days for an ultrasound scan.
Reporting times for ultrasound are currently 28-hours from the time the scan is completed until the verified
report is released.Palmerston North Hospital (PNH)
MidCentral Health has 13 ultrasound machines, with a total purchase value of $2 million. These are used
across the hospital in Women’s Health (2), Medical Imaging (3), Emergency (1), Cardiology (1), Surgical (2),
Breast Centre (1) and Medical Services (3).
A 08:00 – 16:30 Monday to Friday diagnostic ultrasound service is provided in Medical Imaging, with on call
provided by Registrars and Radiologists. On call is approximately 1% of all departmental call outs.
Currently the service has 1.7 FTE qualified sonographers and three student sonographers. Approximately
8,000 examinations are undertaken per annum, although this increased in 2013 to 9,600 due to a period of
improved staffing. All examinations are reported with 24 hours.
Currently there are 1,571 patients waiting for appointments, 317 of which are advanced appointments.
195 patients are waiting longer than 6 months which has increased from 105 in September 2013.
Broadway Radiology
Broadway Radiology is the largest provider of ultrasound services in the region. In 2012, over 15,000
ultrasound scans were performed across their sites. Nine sonographers work for the private practice. They
operate seven machines in four sites, Monday to Friday 08:00 – 17:00.
Scanning through Broadway Radiology is funded privately. MidCentral DHB’s Funding Division and the
MDHB and Whanganui Provider Divisions subcontract scans they are unable to deliver internally due to
challenges with capacity or capability. They also provide a service to ACC patients, patients referred from
private specialists and the maternity patients through the section 88 claiming system. Patients are often
expected to pay a surcharge above ACC or Section 88 maternity funding.
Other non-hospital based Providers
Tararua Health Group at Dannevirke Community Hospital has one ultrasound machine. They scan as a
private entity three days a week and through an MOU share resources with Palmerston North Hospital on
the remaining two days, with MCH Radiologists reporting all their Ultrasound (US) imaging.
Horizon Radiology at The Palms also owns one machine and offers private and maternity appointments.
Breast ultrasound is predominantly delivered by the Breast Imaging Service in Amesbury St in conjunction
with a mammogram in the assessment of breast symptoms, although this is fragmented with some scans
still undertaken at PNH.
Ultrasound scans are also undertaken by private specialists in their consulting rooms.
5.5.2
KEY ISSUES
Whanganui DHB
The service has been significantly affected by staff health issues of late and operates one machine four days
per week to manage only the most acute work.
The lack of a consistent service is sub-optimal, and over time there is a risk that further resources are
attracted away. WDHB is also aware of a new private provider which is planning to set up a Whanganui
based practice to deliver ultrasound scans.
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Access to ultrasound in Whanganui is currently less than ideal. Access to outpatient and community
referred ultrasound is being measured monthly using the Faster Access to Diagnostics methodology.
Waiting times have improved since June following the use of outsourced providers to delivery some of
these images.
Projections for the Whanganui region estimate that 8,500 – 9,000 scans per annum are needed. This is a
combination of what is currently achieved in the hospital service, alongside scans that have been
performed privately and at Palmerston North Hospital (PNH), as well as an estimated unmet need that will
be inevitably present in a constrained environment.
The sonographers report that inconsistent cover day to day, mainly through staff injury, is the most
significant challenge in maintaining the service. Fluctuating levels of supply create variable backlogs in the
number of patients waiting. Multiple strategies are needed to triage patients, select patients for
outsourcing or for scanning locally and to manage concerns from referrers and patients. Whanganui would
benefit from the commitment to a sonographer training programme, either WDHB based or alongside
MidCentral with students working across both sites.Clinical leadership arrangements have changed and
there is a leadership opportunity within both teams. This role is required not only to oversee the patient
flow through this service but to take a role of clinical leadership, in partnership with a radiologist, to
monitor quality, training and development as well as foster a cohesive culture for this specialty in the
clinical community.
Palmerston North Hospital
The current issues with the provision of ultrasound are:
1.
2.
3.
4.
5.5.3
Long wait lists for access to diagnostic ultrasound
Sonographer shortages in the public hospital
Lack of certainty for Women’s Health patients in the provision of ultrasound
Insufficient systems to oversee and support the use of ultrasound for other specialties
POTENTIAL OPPORTUNITES
The current situation in the public hospitals is unsustainable. Each provider needs to continue to focus on
recruitment, staff health and retention recognising that this workforce is vulnerable to not only market
forces but from injury. Clinical leadership at each site is critical and key leadership gaps need to be filled.
The future environment for ultrasound will need to reflect collaboration between not only the two DHBs
but also between the DHBs and their private partners. With so many providers it is critical that the
landscape for ultrasound is characterised by clinical collaboration, ensuring consistent outcomes for
patients regardless of the scan provider.
A clinical network is recommended, either for each DHB or combined across the region, to focus on
improving outcomes for patients and to provide clinical governance. The network, to be established now,
will take responsibility for the final recommendations for ultrasound under the Medical Imaging
Development Plan, their implementation, as well as provide guidance and quality control for all ultrasound
activity in the future.
OPPORTUNTIES FOR FUTURE DEVELOPMENT
 Implement a centralAlliance clinical network, of public providers, to provide clinical governance for
the use of ultrasound and to make collaborative decisions about service provision in the future.
TABLE 4: ULTRASOUND FUTURE DEVELOPMENT
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5.6
DIGITAL SUBTRACTION ANGIOGRAPHY (DSA)
5.6.1
MODALITY DESCRIPTION
Digital Subtraction Angiography (DSA) is an imaging technique that uses x-rays and special dyes (contrast
media) to show blood vessels in the body and with image processing can eliminate any anatomical
structures that overlay the vessels. In the MCH region, this service is provided only at Palmerston North
Hospital.
The DSA equipment is essential for minimally invasive therapeutic procedures such as angioplasty where a
special balloon is introduced into a blood vessel that has been narrowed by disease, it is then inflated to
widen the vessel and improve blood flow. DSA is also used for other therapeutic procedures (such as stent
and catheter insertions into not only vascular systems but biliary, gastrointestinal and urinary systems as
well.
The availability of this technology, and the specialist staff to operate it, has significant benefits. Patients are
not only imaged, but treated, without the need for operating theatre time or an overnight stay, minimising
the recovery time.
The DSA equipment was replaced in August 2013. Newer technology has allowed for improved image
quality with less radiation dose to both patients and staff and a wider range of examinations are now
possible. The new unit also allows less complex interventional work currently carried out in Computed
Tomography and Ultrasound to be performed in this room by a number of Radiologists. This will have a
positive impact on both diagnostic waiting and faster cancer treatment times and enable increased
throughput with biopsies previously only carried out in CT that can now be completed in DSA.
Interventional services for PN Hospital include:

Angiography, or the imaging of blood vessels, is used both in cardiology, to assess the coronary
arteries, and in radiology to assess all other blood vessels but commonly the abdominal and lower
limb vessels. Angiography assesses the patency of vessels, accurately identifies where disease is
located and is an aid to further intervention such as angioplasty or stenting to restore vascular
function. It is a relatively straightforward procedure and the vessels are accessed through a small
puncture in either the arm or groin.

In Palmerston North a comprehensive range of angiography procedures are performed with the
exception of head and neck imaging. Those examinations not able to be undertaken in Palmerston
North are transferred to Wellington.

Angiography procedures, including cardiac angiography, can also be performed with CT and MRI.

Angioplasty is the technique of mechanically widening narrowed or obstructed arteries through the
use of balloon catheter. The angiogram guides the placement of the catheter and assesses the
relative success of the procedure once the balloon is deflated. In PN angioplasty is a common
procedure and can be used to restore and improve blood flow to most main vessels. Vascular stents
can also be placed during these procedures.

Image guided drainage of abscess or fluid and image guided biopsy provides greater certainty over
needle placement and sampling reducing unintended harm and targeting the exact area of disease.
This is a routine radiological procedure and image guided biopsy is undertaken on DSA in PN and
ultrasound and CT in both DHBs.

DSA also guides the placement of various catheters and lines. The service then has an important
part to play in checking the ongoing patency and placement of these items, which are generally
used for longer term vascular access.
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The service operates 0830-1630 Monday to Friday with an on-call service outside of these hours. The unit
requires a multidisciplinary team for operation, including radiologist, nursing and MRT expertise. Due to
the invasive nature of the work undertaken patients often require pre admission and post care.
Preadmission
A preadmission assessment is essential for interventional patients. These can be complex and invasive
procedures and an opportunity to discuss the procedure, the risks, answer questions and provide social
support is important to both staff and patients.
In 2011, in response to facility and resource constraints in the surgical pre operative assessment clinic, PN
Medical Imaging was requested to find alternative arrangements for the pre assessment of interventional
patients. As a consequence nurse led preadmission clinics were identified as a service priority and
delivered within existing resources.
For those patients not able to be seen at this clinic, who are having less complex procedures, Medical
Imaging nurses undertake comprehensive phone interviews.
On the day of procedure, patients report to the Transitory Care Unit. Their medical notes are reviewed to
ensure all the necessary information has been collated, cannulae are inserted; baseline observations and
any pre medication or fluids are given.
The implementation of a PN Medical Imaging preadmission clinic has been very successful and has
minimised this previous barrier to timely access, however as demand grows subsequent growth in clinic
resources is required to keep pace and ensure that patient flow continues seamlessly from referral to
treatment.
Post Procedure Care
Following an interventional procedure patients recover in the Transitory Care Unit (TCU) and are discharged
four to six hours later or are transferred to a ward if the procedure is more complicated.
Workload
For Medical Imaging capacity has been limited by the availability of a single interventional radiologist,
however an additional radiologist has been recruited to arrive in November 2013. A part time
interventional radiologist is rostered 2-3 sessions per week currently, and with the new appointment this
will increase capacity to 5-6 sessions per week.
Other departments within MCH are directly reliant on the DSA equipment to enable service provision for
patients in their care. Gastroenterology has one session per week and Cardiology has up to four sessions a
week. These specialties also require MRT time for their sessions. Cardiology also requires one Medical
Imaging nurse for all their sessions.
881 examinations including cardiology and gastroenterology were undertaken in 2012 / 13. Service volume
has increased year on year over the past three years with a 16% increase in volumes in 2010 / 11 to 2012 /
13.
An on call service is in place however this is dependent largely on the availability of one radiologist for
complex cases after hours. Where this individual is not available work is diverted to other DHBs for acute
patients and to ensure routine waiting times remain appropriate. In turn additional hours are then needed
to address the backlog on this staff members return. Along with the impact of staff leave, the availability of
pre and post admissions beds in the Transitory Care Unit also have an impact on waiting times.
Notwithstanding the challenges the interventional service in Palmerston North has developed a capability
for interventional work that is greater than other similar sized facilities and has maintained a reputation for
the quality of work undertaken. This provides a strong platform for growth in the work undertaken in
Palmerston North and also the service able to be provided to other DHBs.
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5.6.2
KEY ISSUES
The main constraint in this area is the shared nature of the facility. This is an excellent use of resources
from an organisational perspective; however it does require a relatively rigid schedule to accommodate all
parties which in turn limits flexibility for all specialties. In turn this affects the ability to offer flexible
training arrangements for registrars and or expand sessions, with two interventionists now employed.
Preadmission clinics are held once a week and four patients are seen. This number does not meet the
demand for the number of interventional procedures that take place and is limited by availability of nursing
staff and space to hold the clinic within the department.
Transitory Care Unit capacity is a significant constraint as it services many specialties. Capacity is allocated
for each service, and is therefore limited in the number of bed spaces in order to accommodate all areas
needs. Medical Imaging patients, as elective rather than acute patients, are given lower priority and
interventional procedures are cancelled in response to the needs of acute patients. TCU also closes at 6pm
meaning for patients needing six hours bed rest only a morning appointment is possible.
This is a known risk and it is proposed that Medical Imaging expand its patient care service to include both
pre and post care for all day patients, streamlining the patient journey to the one area. This process would
apply for the following procedures:





5.6.3
Biopsies, needle aspirations and drainages
All Angiograms – Radiology and Cardiology
All day stay interventional procedures
Paediatric patients for urinary studies who require sedation
Insertion of Haemodialysis catheters and endoscopic retrograde cholangiopancreatography (ERCP)
POTENTIAL OPPORTUNITES
This modality has considerable scope for clinical future development. The opportunities offered by the
technology and the ability to provide a standard of care that eliminates general anaesthesia, reduces length
of stay and fast tracks recovery, make this area of significance important in health services planning.
The technology also offers significant scope to consider role extension for Nurses and MRTs, and the
potential options for radiographic assistants in procedural work. These areas are further explored under
the workforce section of this document.
Growth in demand is anticipated as chronic conditions, such as diabetes and renal failure continue to have
an impact on the health of the population requiring greater needed for intervention. The impact of
smoking on the peripheral vascular system, even though significant gains have been made in smoking
cessation, will continue to manifest for some years to come.
Opportunities to support other services exist, such as stenting in gastroenterology, and with improved
Medical Imaging capacity these could be explored. The focus on Faster Cancer Treatment and National
Tumour Standards continues to be key priority for health. The Regional Cancer Treatment Service (RCTS) is
a tertiary provider, and the opportunity to improve and enhance support to the RCTS has wide benefits for
the MDHB as an employer and provider of services.
Interventional oncology is a growing field providing new and expanded opportunities to use imaging
technology to diagnose and treat localised in targeted and minimally or non-invasive manner. It has an
application for the administration of both chemo and radiation therapy.
The Cardiology Landscape project has considered the future for the Cardiac Angiography service and plans
are in place for a standalone cardiac lab. A business case is being prepared for presentation in early 2014.
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OPPORTUNTIES FOR FUTURE DEVELOPMENT
To agree the final development opportunities a clinical forum is planned to discuss, prioritise and agree
the direction for service development for this area. Areas of consideration may include but are not
limited to:





More angioplasty and complex vascular stenting
Consider an Oncology Intervention service
More timely service for renal patients in particular haemodiaylsis catheter insertions
Implement a new model of care for preadmissions and post procedural recovery
Strengthen this area as a regional service exploring the potential to grow new area of work as a
service to other DHBs
 Provide role extension opportunities prime in this area for nursing, MRTs and Radiographic
Assistants
TABLE 5: DIGITAL SUBTRACTION ANGIOGRAPHY (DSA) FUTURE DEVELOPMENT
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5.7
5.7.1
GENERAL X-RAY
MODALITY DESCRIPTION
General x-ray services are the most widespread medical imaging service across the MidCentral and
Whanganui areas with services provided in Raetihi, Taihape, Whanganui, Palmerston North, Levin,
Dannevirke and on Mount Ruapehu.
Both hospitals provide community referred services, with further community referred services available in
Levin and Dannevirke under DHB contracts. Whanganui provides plain film imaging at Taihape and Raetihi.
Privately provided services are available in Whanganui and Palmerston North (two locations) and the other
rural centres.
Whanganui
Whanganui Hospital provides services between 08:00-21:00. The main x-ray department is open from 8am
until 4.30pm Monday to Friday. The ED room is open from 8am until 9pm Monday to Friday and 10.30pm
until 6pm Saturday and Sunday. A 24/7 on call service is provided.
There is open access to x-rays in Whanganui with patients presenting with their referral when it is
convenient for them. This can lead to long waiting times for patients, which puts pressure on MRTs
providing general x-rays. An innovative solution has been found in using the fluoroscopy machine to
provide some of these images.
Whanganui had approximately 16,500 community referred examinations and 11,500 inpatient/outpatient
examinations in 2012/13.
Reporting times for general x-ray images in Whanganui are on average 30 hours from the time the image is
taken to the time the final report is distributed to the referrer.
MidCentral
Palmerston North provides a 24 hour service with normal services provided 08:00-13:60 Monday to Friday.
MidCentral has six general x-ray rooms (including rooms adjacent to ED) and has just upgraded their
analogue X-Ray equipment to digital. Palmerston North provided 58,000 examinations in 2012/13 (above
their target) of which 45% were ED, 37% were inpatient and outpatient and 19% were community referred.
5.7.2
KEY ISSUES
This work stream requires further investigation to draw conclusions on areas for development. Adequate
staffing is a key issue while this area faces the conflicting needs of a 24/7 roster, backfilling other
modalities, flexing services to accommodate outpatient clinics and responding to high acuity and urgency
from emergency and inpatient services.
The equipment is in transition from computed radiology to direct digital technology in some areas which
provides opportunities to streamline workflow and increase volumes without additional capital. How these
opportunities are used, and the impact on staff and floor space, is also a platform for moving forward.
In Whanganui service delivery options for the delivery of plain film x-rays in Taihape and Waimarino need
to be reviewed. The equipment in these regions is due for replacement, yet patient volumes are low.
There are also issues with bandwidth for the digital transmission of images from these regions to our PACS
software.
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5.7.3
POTENTIAL OPPORTUNITES
OPPORTUNTIES FOR FUTURE DEVELOPMENT
This area of focus is multifaceted and requires further review. It is influenced by a number of priorities
and impacts on a large number of staff. Change for general x-ray ranges from addressing immediate
issues for rostering and staffing, to more innovative solutions in supporting hospital wide patient flow. A
full review of this area will be included in the final development plan.
TABLE 6: GENERAL X-RAY FUTURE DEVELOPMENT
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5.8
NUCLEAR MEDICINE AND PET/CT
5.8.1
MODALITY DESCRIPTION
Palmerston North Hospital provides a Nuclear Medicine service Monday to Friday 0800-1600 and on call
outside of these hours. The unit staffing includes a Nuclear Medicine Physician, with the primary
equipment being a dual head gamma camera combined with a CT scanner. The CT scanner provides a back
up to the Radiology department’s main CT scanner.
Nuclear medicine imaging scans are performed to:








evaluate bones for fracture, infection, joint diseases, tumours and other conditions not evident on
X-rays or MRI;
detect disorders of coronary artery blood flow and cardiac function with Rest/Stress myocardial
perfusion scans;
measure cardiac function (mostly an urgent scan performed for chemotherapy patients);
evaluate thyroid structure and function;
lung scans, mainly for blood clot detection, especially in younger patients in whom the radiation
dose from CT angiography may be an issue, patients with iodine allergy, or in patients with renal
problems for whom contract CT studies are contra-indicated;
identify problems of the biliary tract and gallbladder;
detect some uncommon cancers by way of specific tumour-seeking agents; and
identify the source and nature of bleeding into the bowel where other investigations have not
succeeded.
The number of examinations has been consistent over the past three years with 2,352 in the 2012/13 year.
Referrals are sourced from outpatient and inpatient services, community referred examinations and ACC
volumes.
Nuclear Medicine is a regional service. It is the service provider for Whanganui for all Nuclear Medicine,
and the provider of therapeutic treatment for Taranaki, Wairarapa and Hawke’s Bay to align with the
Regional Cancer Treatment Service. Patients need to travel to the department for scanning and treatment,
and the service has systems in place to ensure that this is managed with the individual needs of patients in
mind to minimise the impact of these more complex journeys.
Benchmarking surveys of Nuclear Medicine show MDHB compares well with other public providers and an
annual referrer survey confirms that Nuclear Medicine is a critical part of clinical practice for MDHB
referrers.
The recent purchase of a new SPECT/CT gamma camera, installed in June 2013 is a welcomed addition to
the service and a second older camera will remain in service for a limited number of examinations, as
clinically appropriate, to manage surges in demand.
NM will be impacted on by the Faster Cancer Treatment requirements increasing the number of ‘suspicion
of cancer’ scans. Changes in practice, such as new chemotherapy protocols and clinical trials also increase
volumes for NM.
Average waiting times for semi-urgent scans had been increasing but these have lessened with the
installation of a new camera and are expected to continue to improve. Although in recent years the
volumes in NM have decreased this is thought to be a factor of access and dated technology, rather than an
indication that the technology is becoming less needed. Discussion with clinicians would also support the
value of NM within their practice.
During the 12/13 financial year, Whanganui DHB sent 166 patients to MidCentral for nuclear medicine
scans. Whanganui records show that patients wait an average of 9 weeks from the time of their referral to
the time their examination has been reported.
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Positron Emission Tomography (PET) is a medical imaging technique which uses radioactive isotopes to
diagnose, locate and assess a disease process, especially cancers. This is a relatively new technology which
was first offered in Wellington in 2008 using isotopes flown directly from Melbourne.
In 2010 a cyclotron, which is used to make the isotopes, was built in Wellington by Pacific Radiology. Since
then private providers have invested in PET scanners in Auckland (2), Hamilton, and Christchurch, using
isotopes from Wellington. Over time the price of PET scans and competition in the market place has
resulted in a more economical service. Whanganui and MidCentral patients are currently referred to Pacific
Radiology for PET however as numbers grow in this area the opportunity to formally review the market for
PET / CT could be undertaken.
The Ministry of Health supports the use of PET scans for patients who meet specific criteria. Scans for
conditions not mandated on this list can be obtained following approval from a Regional PET Committee
located in Palmerston North. Currently volumes are small, and it is unlikely that either MidCentral or
Whanganui will have the economies of scale to consider investing in this equipment in the next five years.
PET-CT Volumes
2009/10
Wanganui
2
MidCentral
No data
TABLE 7: PET-CT VOLUMES
5.8.2
2010/11
17
No data
2011/12
21
61
2012/13
24
102
KEY ISSUES
Nuclear medicine (NM) physicians, who offer both therapeutic and diagnostic services, are relatively rare
and while MDHB has one in post now it may prove difficult to replace like with like in the future. The work
currently done by this individual could be divided between various specialties such as cardiac evaluation to
the Cardiology Department, therapeutic thyroid to the Radiation Oncologists and interpretation of Nuclear
Medicine imaging to radiologists with an interest in Nuclear Medicine. These opportunities are being
explored as part of succession planning.
Periods of medical leave are covered mostly by PNH radiologists and by MRT-led reporting. There is also a
longstanding telereporting arrangement with Oceanic Radiology based in Perth, Australia. An MOU with
Hawke’s Bay DHB for reporting also exists.
The service has four technicians, working across 3 FTE. The training of technicians is internationally
uncertain and there is no NZ training programme for NM technicians. MDHB does not have a dedicated
training position, instead training technicians as part of the established staff.
Training takes two to four years, as often combined with working in general radiology, and without a
dedicated ‘training role’ this can mean long gaps between one staff member leaving and another being
trained.
5.8.3
POTENTIAL OPPORTUNITES
OPPORTUNTIES FOR FUTURE DEVELOPMENT

A focus on workforce succession planning for the MDHB based Nuclear Medicine physician and
training opportunities, within national frameworks for Nuclear Medicine technicians.
 Consideration of an appropriate procurement process to evaluate the PET / CT providers
nationally.
TABLE 8: NUCLEAR MEDICINE/PET-CT FUTURE DEVELOPMENTS
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5.9
BONE DENSITOMETRY
5.9.1
MODALITY DESCRIPTION
A bone density scan, also known as DEXA scan, is an imaging test to measure ‘bone strength’. There are a
number of factors that accelerate loss of bone density which include age, lifestyle and certain medications
or treatments.
Dual-energy x-ray absorptiometry machines (DEXA) use a minimal radiation dose to evaluate the calcium
content of bone. As a consequence of the low dose the equipment does not necessarily need to be
operated by a registered Medical Radiation Technologist (MRT) however these machines are mostly located
in the Medical Imaging sector and operated by the MRT staff.
The operator scans and produces a report that quantifies bone mineral in relation to the average for a
patient’s size and weight. The tests are designed to:




detect low bone density before a fracture occurs
confirm a diagnosis of osteoporosis
determine the rate of bone density change, through serial studies
monitor the effect of any treatment to improve bone density
For MDHB and Whanganui all bone density scanning occurs at Broadway Radiology for both publicly and
privately funded patients. At this stage there are no plans to upgrade this technology, or for it be provided
in house.
Four to five scans are undertaken per day leaving spare capacity on the current machine. The unit is
operated by registered MRTs who attend training courses and specialise in this work.
Whanganui data shows that patients wait an average of 8-weeks for a bone density scan from the time of
referral to the time the report is completed. Whanganui DHB purchased 77 scans from Broadway Radiology
during the 12/13 financial year.
5.9.2
KEY ISSUES
No significant issues noted to date.
5.9.3
POTENTIAL OPPORTUNITES
The National Standard for post breast cancer care1 recognises that all post-menopausal women receiving
hormone inhibitors, and women experiencing premature menopause as a result of treatment, are at
increased risk of bone loss. These patients require access to a baseline DEXA scan and two-yearly repeat
scans as part of their routine follow up.
Respiratory services also require bone density scanning as part of the standard model of care for patients
with chronic conditions on long term steroid treatment.
Osteoporosis NZ reports that fragility fractures exert a tremendous burden on older New Zealanders. Not
only does this impact financially on the health sector but half of all hip fractures require long term care and
a quarter of patients suffer early death2.
Bone density ‘screening’ with DEXA scanning is available in Australia but only for those over 70 years. In NZ
there is no government funding for screening however Osteoporosis NZ are lobbying for this to occur.
Research shows that half of patients presenting with a hip fracture have presented prior to this with a more
minor fragility fracture3. As a result, in 2013, DHBs have been asked to establish fracture liaison services to
1
National Tumour Standards for Breast Cancer; MOH; 2013
Bone Care 2020, A systematic approach to hip fracture acre and prevention for NZ; Osteoporosis NZ
3
Bone Care 2020, A systematic approach to hip fracture acre and prevention for NZ; Osteoporosis NZ
2
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better manage patients who present with low impact fractures. MDHB is in the process of implementing
these services.
While not every patient presenting with complications of osteoporosis will require imaging, with many
having treatment simply based on risk factors, the correlation between better bone health and reducing
the burden of hip fracture is well demonstrated. The use of imaging is therefore a key tool in the early
identification and prevention of poor health outcomes in this area.
Volumes of bone density scans have reduced in recent years following the discontinuation of free scans
under the Fosamax drug trial. However as work continues to minimise the burden of fractures in older
persons and the survival rates from breast cancer continue to improve the need for effective assessment of
bone density continues to be an important service.
OPPORTUNTIES FOR FUTURE DEVELOPMENT

Monitor changes in the model of care and/or volumes for post breast cancer survivorship and
strategies to reduce the impact of osteoporosis on the health sector.
TABLE 9: BONE DENSITOMETRY FUTURE DEVELOPMENTS
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5.10 MEDICAL PHOTOGRAPHY
5.10.1 MODALITY DESCRIPTION
Medical Photographers are required to produce accurate and objective images to record injuries and
diseases, as well as the progress of some medical procedures and general photography services. Images are
used for measurement and analysis, as well as to accompany medical or scientific reports, articles or
research papers. They are also used for educational purposes, and to demonstrate the effects of a range of
diseases and/or medical conditions.
Medical Photographers may also be required to take medico-legal photographs for solicitors' reports,
industrial accidents or other investigations and can also specialise in more technical forms of photography,
such as ophthalmic or forensic photography.
Ophthalmology imaging is a highly specialised form of photography, using dedicated equipment, to
document parts of the eye. Optical coherence tomography or OCT is a growing photography field and is a
routine in the standard of care for ophthalmology services. Retinal angiography, or the imaging of the eye
with a contrast agent or dye, is used to assess the vascularity of the eye.
Medical Photography also has a role in the mapping, and tracking, of skin lesions. This work is currently
offered privately.
Training and Experience
Medical Photographers require knowledge of photography, basic medicine, the regulatory environment
relating to confidentiality and copyright and skills in working with patients in what can be intimate or
emotional circumstances. Recruitment to Palmerston North has historically come from other government
organisations with similar requirements (particularly the police and armed forces).
Palmerston North Hospital has a professional medical photography service providing clinical and general
photography, and ophthalmology imaging services. The service is well resourced with good facilities and
modern equipment and is staffed by 1 FTE with a contract for service in place to provide leave cover.
Approximately 450 clinical photography sessions were undertaken in 2012/13 with 20 general photography
sessions. 3,000 ophthalmology examinations are estimated to be done each year. All images are stored on
the PACS system and readily available for clinical use.
Clinical photography is undertaken in situ i.e. theatre, ward or clinic and in a dedicated studio located in the
Medical Imaging Department. No services are provided to the mortuary.
Retinal angiography clinics are held in the medical imaging department one day per fortnight, seeing
approximately four patients during that afternoon. The clinic is staffed by a doctor and a nurse alongside
the medical photographer.
Whanganui Hospital has no professional photography services but does provide digital cameras in theatre
and the Emergency Department for clinical use by staff. MidCentral Health also has digital cameras across
the organisation.
5.10.2 KEY ISSUES
These issues were raised specifically by the PNH based photographer, however the wider aspects of privacy
and the ease with which images or videos can now been taken, both by DHB staff and patients, are relevant
for both regions.
There is an increasing use of a range of digital equipment for clinical photography in the health setting. The
ease, with which these items can be used not only by health professionals but also by patients, raises
confidentiality and quality issues for each service to consider.
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Hospital policy does prohibit the use of personal equipment to take images but many services own a range
of cameras and portable devices that when used as cameras create complications for the identification and
storage of images.
There are also concerns about the increasing number of patients requesting to have images of their
hospital experience. This is a particular issue for obstetric ultrasound services.
There are concerns regarding the risks associated with the use of a ‘lesser’ photographic technique, where
images may be incorrectly compressed, stored or labelled, and as a consequence images are unable to
submitted as evidence.
The focus on the impact of melanoma in New Zealand is also an emerging area with the development of
National Tumour Standards, and locally a skin cancer pathway for MDHB. As these standards are finalised
and introduced increased clinical photography services will be required for both primary and secondary
care clinicians.
The ophthalmology service in Palmerston North is a walk in service, providing excellent access for patients
and a ‘one stop shop’ for those attending the Eye Clinic. The variable nature of this approach however, and
that this is a sole practitioner service, does mean that the level of flexibility required supporting a walk in
service, can at times compromise availability for other work. As the potential demand for medical
photography increases these historic practices may require review in order to manage demand effectively
within existing resources.
The reliance on a sole photographer at Palmerston North requires MidCentral to have succession planning
in place.
5.10.3 POTENTIAL OPPORTUNITES
OPPORTUNTIES FOR FUTURE DEVELOPMENT

Determine the clinical photographic service requirements required with introduction of the
Melanoma tumour standards.
 Review of the existing policies and guidelines (and compliance to their use) relating to the use of
digital imaging devises, patient privacy, photographic standards and image storage.
 Review of outpatient ophthalmology imaging services at Palmerston North Hospital with respect
to patient scheduling, provision of the service within the medical imaging department and
image/reporting storage.
TABLE 10: MEDICAL PHOTOGRAPHY FUTURE DEVELOPMENTS
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5.11 RADIOLOGY INFORMATION SYSTEM (RIS) / PICTURE ARCHIVING & COMMUNICATION SYSTEM
(PACS)
5.11.1 DESCRIPTION
The introduction of a digital image environment has been a significant advancement for MDHB and WDHB.
As part of the RIS and PACS installations, high spec hardware was purchased for radiologist reporting,
modalities were upgraded / configured to receive and process digital images and clinical reading
workstations and monitors were distributed throughout the hospitals. A Central Regional PACS Archive
which incorporates CCDHB, HVDHB, WaiDHB, HBDHB, MDHB and WDHB has just recently been
installed. The Whanganui PACS system is fully integrated with this Regional Archive and Palmerston North
Hospital is soon to follow.
The benefits overall have been:










Reduction in Examination and Reporting Times – due to improved monitoring of waiting times
Reduction in patient radiation dose due to prior images being available from the regional archive
Easier clinical consultations and faster diagnosis
Reduction of health and safety issues as images are now digital and chemicals are no longer required
for the processing of films except in Taihape and Waimarino
Assisted with improved patient/workload management, although workload has been increasing
Improves staff recruitment and retention
Decrease in operating costs
Reduced risk of medical misadventure
Security of patient information is retained due to the PACS archive
Provides the opportunity to move towards a total electronic health record.
While the RIS implementation at Whanganui had initial difficulties the issues that could be immediately
resolved have been so and the remaining issues are included in the Central Regional build which is now
largely complete and due for testing and implementation.
A RIS Working Group has been established and the solutions requirements are well underway for a Regional
RIS. An instance of a Regional RIS ready for review is expected to be available in April 2014.
The Central Regional Build of the RIS system includes agreed standards for coding, which when
implemented by each DHB will allow for significantly improved comparative reporting and clinical
information sharing across the region.
It is well recognised that systems and systems administration support of the RIS and PACS systems for each
DHB is essential for the effective and efficient use of the systems. This includes management of the
systems, user training, compliance with standards and maintenance of the systems change requirements.
Both MidCentral and Whanganui are fortunate to have strengths in this area and a growing level of
cooperation between the two support people involved. The regional RIS build will result in some system
administrative functions being centrally provided for the region but will still require strong local support.
There are opportunities for Whanganui and MidCentral to collaborate to support one another in this area.
5.11.2 KEY ISSUES
The Carestream product has one critical residual issue that has not been resolved. The product does not
fully support the more recent versions of Microsoft Office adopted by the New Zealand Government which
results in reports from third parties not necessarily being able to electronically being incorporated into the
record. This is a problem for all DHBs that use this system.
Images which are specifically excluded from the Central Region Information Systems Plan (CRISP) are
echocardiographs, ophthalmology images, ECGs and medical photography. Alternative storage solutions for
these images will be required.
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The CRISP project has been designed to enable radiologists to report images from anywhere within the
central region, enabling additional out-of-hours reporting options.
5.11.3 POTENTIAL OPPORTUNITES
OPPORTUNTIES FOR FUTURE DEVELOPMENT

Complete implementation of the Central Regional PACS archive, in particular the connection of
MidCentral to the system which is expected to be completed late November 2013.
 Continue to actively participate in the Central Regional RIS project.
 Work together to support RIS/PACS administration across both DHBs.
 Consider opportunities for alternative out-of-hours radiologist reporting rosters.
 Link up with other DHBs in central region for specialist radiologist advice.
 Regional approach to reporting of images in public and or private.
 Electronic referrals and access to images for referrers.
TABLE 10: RIS/PACS FUTURE DEVELOPMENTS
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6
WORKFORCE DESCRIPTIONS AND OBSERVATIONS
This section explores in greater detail the various professions working within Medical Imaging. Each area is
described with a focus on each professions works and the current staffing arrangements. Key linkages with
major health priorities are also described where relevant. Potential opportunities, originating from key
issues, have been developed through consultation and research and are noted for each area. These will
form the basis upon which final development steps to be agreed and presented. This section also
highlights where further work is required to better understand or to gain agreement on the clinical and
strategic direction.
The Medical Imaging professional workforce is supported by a team of administration and support staff.
These roles are a vital component of the infrastructure that supports clinical practice and optimal patient
outcomes. Areas for development therefore require due consideration to the role and capacity of
administration and support staff in ensuring the final development items are successful. The impact on
administration staff and their contribution to solutions for each final area of development will be
considered in the development plan.
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6.1
RADIOLOGISTS
6.1.1
DESCRIPTION
The traditional role of a radiologist, reporting images back to a single referrer, is rapidly being replaced by
expanded roles of the radiologist collaboratively working in multidisciplinary teams. In his paper prepared
and approved by the European Society of Radiology Professor Iain McCall observed the changing role of the
radiologist in modern health care4. He noted several key influencers that are changing the face of radiology
including the increasing reliance on medical imaging for definitive diagnosis without invasive procedures.
These changes are occurring as a result of greater technology sophistication and image manipulation.
The paper argues the case for radiologist subspecialisation both within individual clinical facilities and using
high speed image transmission to sub specialists across the world. There is a view in conclusion that, “The
world of radiology is changing rapidly and radiologists have to be proactive in this process. The subject is
now too broad and complex for an individual to remain a comprehensive provider. As a result radiologists
need to consider the role of specialisation in particular systems or disease-based areas while finding a
mechanism to provide high-quality service across departments. Radiologists must also interact more
directly with patients and primary care physicians to provide a comprehensive diagnostic and advisory
service prior to the patient entering the secondary care service by managing the investigations of the
patients themselves. This will increase efficiency, clinical effectiveness of the service and speed up the
referral process. Radiologists in the teaching hospitals will also need to specialise to a higher degree in
order to provide a tertiary referral service, communicate and advise clinical experts and to conduct and
drive imaging research as true experts in their field.”
Multi-Disciplinary Meetings (MDMs) are another key driver in the modern radiologist environment and this
has become an established part of the process for planning and monitoring the care of patients. Radiology
is a key component of these planning processes which places increased workload on the radiologist in the
preparation for and the attendance at the MDMs.
The impacts mentioned in the papers referenced, and the rapid transition to MDMs, is supported in part by
the 2010 RANZCR Radiology Workforce Report where the authors conclude that consideration of the
radiologist workforce, “cannot be limited to comparison of numbers or volumes over time. It is important to
consider the radiology workforce, and its workload, in its entire context; a context in which the patient is at
the centre of a broad safety, quality and performance framework.”
6.1.2
KEY ISSUES
In short planning the future capability of and capacity required for radiologists is going to be driven by a
number of factors each undergoing change in their own right. There are a number of tools that can be used
to determine the optimal radiologist capacity (staff, contracted and provided by teleradiology) for each of
Whanganui and MidCentral which include analysis of:





Examination waiting times
Reporting times
International FTE benchmarks
New Zealand DHB benchmarks
Recent research by Canterbury DHB
Which tool or which combination of tools is to be decided however the impact on radiologist time is a
current as well as future key issue.
4
The future role of radiology in healthcare, European Society of Radiology, Professor Iain McCall, 2009.
http://www.i3-journal.org/cms/website.php?id=/en/index/read/future-role-of-radiology.htm
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As noted in the July Medical Imaging Development Plan paper to the Hospital Advisory Committees (July
2013) MidCentral is facing long reporting times due to some of the factors described above but also due to
the breadth of modalities offered at Palmerston North Hospital and the complexity of some of the
examinations and reporting. In the 2012/13 year the Palmerston North department reported just over
81,000 examinations and an ideal complement is yet to be agreed this is a large workload for staff
particular for growth in complex areas such as CT.
Whanganui has one full time staff radiologist and contracts Pacific Radiology to provide and additional FTE.
This is provided both onsite and offsite. The contract is due to expire in 2014.
6.1.3
POTENTIAL OPPORTUNITES
Several recommendations from literature are worthy of consideration in the review of imaging services for
Whanganui and MidCentral:

Ensure radiologist numbers are sufficient to meet demand and to provide the leadership,
networking and training necessary for the future environment.

Ensure there are sufficient radiologists in training.

Encourage, and support, radiologists to maintain strong networks with their clinician colleagues.

Strengthening relationships with GPs, offering diagnostic management of their patients including
referral to clinical specialists if needed or full work-up in conjunction with the GP.

Use of teleradiology services in a proactive way through local area networks under the control of
radiologists to incorporate general and sub-specialist radiologists in a comprehensive coverage of
clinical scenarios.

Look at areas of sub specialisation in imaging techniques and how to best incorporate these in the
system.

Strengthen the role of radiologists in decision making for imaging services.
AREAS FOR FUTURE DEVELOPMENT
Review the recommendations and agree a method for determining radiologist numbers now and in the
future that allows time for all facets required of this role in the future.
TABLE 11: RADIOLOGIST FUTURE DEVELOPMENTS
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6.2
6.2.1
MEDICAL RADIATION TECHNOLOGISTS
DESCRIPTION
Role of a Medical Radiation Technologist (MRT)
MRTs require a high level of knowledge, expertise and independence. They provide information to patients
about what will happen during their examinations, prepare patients and equipment for these examinations,
produce diagnostic images to help with diagnosis of injuries or possible diseases, check the quality of
images taken and complete managerial or administrative tasks that contribute to patient care.
MRTs in New Zealand are registered with the MRT Board and are required to maintain an expert level of
competence with evidence submitted annually to maintain a current practicing certificate. MRTs in the
public health sector usually undertake shift work, including weekends and evenings or are on routine
call rosters. They also work in private practice.
Training
In the central region MRT training is provided by UCOL in Palmerston North. A level 7 degree program is
offered and students are placed at both Palmerston North and Whanganui Hospitals. A clinical tutor,
employed by UCOL, is placed at each teaching site to support students and UCOL staff also complete
clinical hours at Palmerston North Hospital to maintain their own registration.
Clinical Placements are required to blend practical application with the theory provided in blocks at UCOL;
students are also rostered to private practice. Practical training is undertaken by the qualified staff in
apprentice like model. There are currently (21) students in training in the region.
The programme is well regarded and completion rates are 96 - 98%. New graduates are of a high standard,
however there is still the need for a new graduate programme in the clinical setting post employment to
assist and support them in the transition from student to qualified MRT.
Post graduate qualifications
MRTs have post graduate pathways in ultrasound, nuclear medicine, mammography and MRI.
Role of a Radiographic Assistant (RA)
A Radiographic Assistant is a staff member employed to aid the workflow and assist patients in and around
the imaging department. There is no pre requisite qualification for the role and the RA’s are trained by the
department to undertake a range of supportive duties relevant to each area. Palmerston North Hospital
has four of these roles. The addition of these assistants, with the introduction of RIS/PACS, has been an
extremely positive change and increases efficiency and provides improved patient flow. The RA’s relieve
the MRT of a number of time consuming activities that would otherwise reduce throughput in the
department. They also provide excellent patients care, supporting and navigating patients while in the
department.
Whanganui Hospital does not have these roles.
6.2.2
KEY ISSUES
Recruitment and retention
MRT turnover is currently in line with the global low turnover, due to the economic downturn. Trans
Tasman flow has significantly reduced and New Zealand is enjoying high retention rates. Historically, during
better economic times, the MRT workforce is transient and departments have struggled to recruit and
retain in the global market.
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Workload is a recurring issue for staff in particular for Palmerston North staff. Growing volumes in all
modalities, along with the specific pressures on the CT on call service, have left staff with the sense that
capacity has been exceeded. A review of the roster in underway and additional staff is planned as a
consequence. Two positions are already in place to support roster requirements and enable staff to take
annual leave.
There is no agreed single method to determine MRT numbers however a key factor in managing growth is
to understand how changes in the health system flow onto the MRT capacity. While the introduction of
new shifts or faster equipment is an obvious trigger the wider changes in the hospital system, such as the
appointment of a new consultant position, also impacts capacity and capability. The wide reaching nature
of Medical Imaging, across all specialties, means that only small changes often made in isolation from
Medical Imaging, but in many areas, can make a relatively large impact on the workforce.
Increased workload also limits the level of teaching that can be given by the qualified staff to students.
Supervision is time consuming and slows efficiency in patient flow however it remain an essential
component of sustainable services for New Zealand.
Ongoing competence and post graduate training
With the implementation of the Health Practitioners Competency Act (2003) there has been recognition of
the MRTs need to participate in on going continuing professional development to prove competency. This
is also a requirement of the MRTB in order to hold an Annual Practicing certificate. The programme
predominantly used is the NZIMRT programme, where participants are required to gain points or to
produce a portfolio of evidence. This proof comes from a variety of sources including education
programmes, learning days and post graduate education. There are very few CPD programmes available
and generally most MRTs are enrolled in NZ based programmes. Study days held on weekends are a
popular form of CPD with all staff and these are well attended on a regional and local basis.
CPD is seen to be a joint responsibility between the employer and the employee. The employer supports
the staff in the form of time and financial assistance and the employee is responsible for the direction and
content of their CPD.
There are issues with continuing development as a factor of the scarcity of local programmes along with a
limited budget to be spent across a number of staff. Qualified staff also have a significant training
obligation to student MRTs which does require support in order to support students appropriately and to
the required standard.
MRTs can also train to a specialist level in different modalities, through an ‘in house’ training process.
While their student years do include exposure to all aspects of imaging, on qualification they need further
training, but not necessarily qualifications, to be rostered in some more specialised areas. These areas
include CT, DSA and diagnostic mammography. This training is provided on the job and needs to be
accommodated within the normal staffing levels. As these modalities become more complex and
technically challenging the training model has limitations, particularly for staff working shifts amongst
training blocks, which fragments learning and prolongs the training period.
Recruitment and retention of sonographers continues to be problematic nationally and a regional and
national approach is being undertaken to improve this. Training is occurring however this is Australian
based and reliant on an apprentice model similar to MRT training. With sonographer shortages nationally
this in turn limits sonographer training positions.
Nuclear Medicine training is also tenuous with no consistently available programme in New Zealand at
present. Auckland University are introducing a suitable programme starting in 2014 but taking on board
just four trainees per annum which has the expected financial risks seen with any low volume educational
programme.
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6.2.3
POTENTIAL OPPORTUNITES
OPPORTUNTIES FOR FUTURE DEVELOPMENT

Develop and agree a model for matching workload and workforce, consistent with changes in
demand, for the future.
 Improve matching staffing capacity with demand in Palmerston North.
 Work with the NZIMRT/HWFNZ to develop a scope for Radiographic Assistants including the
opportunity for training, ongoing development and progression.
 Work with UCOL to develop short courses to assist with continued professional development.
 Continue to work address issues with post graduate training.
 Work with the clinical network for ultrasound services to address known shortages, and issues, for
sonographers.
 Consider the opportunity for supernumerary training in DSA and CT.
TABLE 12: MRT FUTURE DEVELOPMENTS
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6.3
6.3.1
NURSING
DESCRIPTION
Role of a Medical Imaging Registered Nurse (RN)
Medical Imaging RN’s require a high level of knowledge, expertise and independence in order to care for a
wide variety of patients who have diverse needs, and about whom information may be limited.
Their work focuses on a range of tasks including patient assessment, both prior to and during procedures,
the management of intravenous lines, administration of medications and working alongside radiologist to
support the performance of interventional procedures. Nurses also have a key role on the workflow of CT,
cannulating those patients requiring contrast, supporting patient care and assisting with the physical
transfer of patients.
These nurses also care for the patients while in transit between the Medical Imaging department and
inpatient wards or day stay areas. This is an important support for the inpatients wards where nursing
capacity may not be sufficient to transfer patients to Medical Imaging and for the Imaging service itself
where patient flow is not impacted by lack of access to a transfer nurse.
Nurses have a key role in education for staff and patients and are central in ensuring the needs of the
patient and their whanau are understood and met. This is a challenging and diverse area where high
quality nursing care is required for a largely transient group of patients of all ages and nurses need to be
skilled in identifying and meeting patient need in a relative short timeframe.
MidCentral DHB
The nurses in PNH Medical Imaging Department provide specialised nursing care, supporting the patients in
having interventional radiological procedures such as renal biopsies, angiograms/plasty (vascular/cardiac),
renal catheter insertions, breast biopsies, lung biopsies, incisions and drainage procedures, pre admission
assessments, CT scanning with intravenous contrast, and an MDHB nurse led initiative, the insertion of
peripherally inserted central catheter or PICC lines. The nurses are linked professionally with the operating
theatre nurses and supported by the Charge Nurse in this area. Operationally the MI nurses report through
the MRT clinical leadership.
Whanganui DHB
Whanganui Imaging Nurses are an integral part of the decision making team within the medical imaging
department who focus on quality patient nursing outcomes. Currently there is one FTE Registered Nurse
position shared between two staff.
The nursing role is to support the CT, MRI, Ultrasound and Fluoroscopy services and undertakes similar
functions to their counterparts in Palmerston North. Interventional procedures are provided on an acute
and booked basis determined by radiologist availability. The interventional work load is steadily increasing
in Whanganui, which does put extra demands on the sole department nurses.
Similar to the PNH department, this is a small team of nursing who share one role.
There are also a number of casual nurses that work around the hospital who are trained up to cover
radiology if one of the nurses is sick or on leave.
There are no medical imaging nurses based in private practice in either DHB.
6.3.2
KEY ISSUES
Interventional procedures have increased over recent years in both departments. With the introduction of
the latest technology in CT, the time to complete a scan will decrease. This is a significant benefit for
managing increasing demand; however this means that the time between patients also decreases impacting
on the capacity for nurses to mange patient care and support good workflow.
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Medical Imaging Nursing is an increasingly complex and emerging opportunity for nurses. As the numbers
of staff in this professional specialty grows, in response to increasing demand and complexity, there is a
need to explore the educational and leadership opportunities available, in line with the growing workforce.
Clinical practice development opportunities are increasing and specialist post graduate programmes are
available for medical imaging nurses through Australia. Imaging nurses also require Advanced Adult Health
Assessment (level 8) qualifications in order to operate a nurse led assessment service. Planning for how to
best use these opportunities for development in nursing and the service overall is needed.
The transfer function is currently shared between all nurses in PNH and while the provision of a transfer
service is essential, the current model may not best utilise the specialised skills of the workforce.
Nursing is very supportive of the plan to redesign pre and post admission functions, including the
development of a new model of care for this area as described within the areas for development in DSA.
6.3.3
POTENTIAL OPPORTUNITES
OPPORTUNTIES FOR FUTURE DEVELOPMENT
Medical Imaging Nurses are a key component of the patient journey, they have specialised skills that are
clearly required within the medical imaging department.




Consideration of a nursing leadership or education role, including regional opportunities, to keep
pace with the growing specialisation and expertise in this field
Review nursing resource to ensure anticipated areas of growth or new initiatives, such as post
recovery activity deliver the expected benefits
Explore enhanced opportunities for nursing professional development
Reconsider the model of care for patient transfer and the nurse role in CT
TABLE 13: NURSING FUTURE DEVELOPMENTS
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7
INDICATIVE FINANCIAL COMPARISONS
Management accountants at Whanganui and MidCentral DHB have evaluated costs for each of the major
modalities for their respective imaging departments.
There are differences in the application of the chart of accounts at each DHB (that reflect how indirect costs
are managed and the extent to which it is allocated or not to departments. These differences are material
when undertaking any departmental analysis across the two DHBs.
The age of the capital equipment, plus ownership versus lease, makes a material difference to this analysis.
The costs used in the analysis are 2012/13 actuals and predate the installation of the new CT scanning
equipment.
Differing coding standards will also have an impact on the ability to make direct DHB comparisons. Coding
standards are being discussed at a Central Regional level and will allow for more direct comparisons.
The analysis does not provide any insight to community referred volumes or costs.
However the work completed to date indicates that on a cost per examination basis the following:



General X-Ray, Ultrasound and CT scanning and reporting costs, per examination are within 6%
difference between the DHBs and probably within the margin of error
General X-Ray costs account for approximately 1/3 of each department’s costs. This is a material
issue if plain film volumes decline and is replaced by other modality volumes
MidCentral MRI costs per examination are 35% higher than the costs shown at Whanganui
Value for money decisions in relation to high capital cost equipment (particularly MRI) where the
explanation for the high differential between Whanganui and MidCentral’s per examination MRI cost is
Whanganui’s ability to move into the marginal cost increase area; where volumes have increased and fixed
costs remained static making the additional MRI volumes cheaper on a cost per examination basis.
As explained in that section the value for money decisions are appropriate at a given time but change as
through the volume increase/decrease cycles and the equipment lifecycles.
The opportunity for Whanganui and MidCentral DHBs is to undertake joint planning where investment in
high capital cost equipment is involved to ensure that the decisions to buy, lease or contract out are taken
in the context of the greater joint volume and the ability to even out the peaks and troughs that inevitably
occurs through the service delivery cycle.
Ensuring value for money decisions are optimised will be part of every proposal within the Medical Imaging
Development Plan.
AREAS FOR FUTURE DEVELOPMENT


Actively participate in Central Regional coding standards discussions and implement agreed
standards
The costing comparisons between the two DHBs to be refined to support collaborative efforts to
manage costs where there are opportunities to do so.
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8
NEXT STEPS FOR THE DEVELOPMENT PLAN
The purpose of the Medical Imaging Development Plan is to focus on collaborative and connected
solutions, inclusive of all factors that contribute to the patient journey, that align with the wider pathways
and obligations of the DHB to their communities.
Improving integration is a vital component for how Medical Imaging positions itself for the future and how
it can support the wider aims of the health services. A more patient centred and responsive model is
needed that plans well for the future and provides quality service where and when it is needed.
The purpose of this paper, an interim step, prior to a final plan, is to describe the current state for Medical
Imaging, and potential steps forward as they relate to future imaging services. It explores potential
opportunities that have been developed through engagement and research and seeks to show the
connections between the various providers of imaging, their referrers and the importance of these services
in the wider aspirations of each DHB.
Key themes for future development include:






The development and implementation of new model of services
Increasing the complement of staff to meet growing service demands now and in the future
Taking opportunities to work regionally
Using technology to solve problems, and provide opportunities for the future
Thinking differently about how resources and staffing are used
Strengthening the roles of clinical leaders to be the key drivers of change and development
These themes now require further consultation and discussion to crystallise, and prioritise, the key items for
development. This paper will form the basis for these discussions in a series of clinical forums.
The final development plan, to be presented in 2014, will outline the proposed development steps,
presented after consultation with staff and stakeholders, for the Boards consideration and endorsement.
The plan will confirm the need for imaging services for both DHB populations taking into consideration not
only current demand, as experienced in both the public and private sector, but also the inevitable impact of
government targets and strategies, and the influence of best practice models and research. It will then
confirm the areas of development, along with an analysis of options, including their potential impact. This
plan will include those areas that require investment over time.
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9
9.1
APPENDICES
ANNUAL PLAN INITIATIVES WITH A MEDICAL IMAGING IMPACT
Whanganui DHB
MidCentral DHB
 Improve the timely management of patients under the
Faster Cancer Treatment pathway through fast access to
medical imaging.
 Reducing wait times especially for ultrasound.
 Reducing avoidable hospital admissions.
 Improving Primary Care Capacity and Infrastructure through
the emerging Integrated Family Healthcare Centre projects.
 Implementing the Better Sooner More Convenient Business
case through better management of acute and unplanned
care.
 Eliminating unnecessary delays in admission, discharge or
transfer.
 Reducing presentations to emergency department and
avoidable admissions by supporting people to stay healthier,
identifying problems earlier and reducing risk factors.
 Implementing the regional and sub-regional plans for
radiology.
 Developing better systems to prevent and/or manage the
impact of long term conditions out of the hospital setting.
 Strengthening equity of access to community referred
radiology.
 Living within the resources available, building capacity and
strengthening the workforce.
 Adopting a systematic framework to address changes in
workforce, IT and capital investment.
 Fostering clinical leadership through involvement and
influence in key decision making.
 Ensuring women experience safe and effective obstetric
service.
 Implementing the maternity quality safety programme.
 Promoting the use of General Practice for primary
appropriate conditions.
 Improving appropriate direct access to diagnostics for
primary care.
 Supporting the regional stroke network to implement actions
to improve outcomes for people who have had a stroke.
 Developing Clinical pathways in the care of people with long
term conditions.
 Increasing hospital capacity, to achieve shorter waits for
elective services, through integrated care, provided in
primary, with ready access to the diagnostic tools needed to
support the emerging collaborative clinical pathways.
 Supporting quality improvement for maternal health services
through a review of the funding model and community
referred process to access ultrasound scans.
 Improving the health of older persons through a redesign of
systems, focusing on what can be achieved in primary care
and implementation the dementia pathway requiring
community access to Head CT.
 Implementing the Faster Cancer Treatment programme and
as a consequence faster turnaround times for diagnostic and
biopsy services to ensure treatment is delivered within 62
days of referral to secondary care.
 Improving population health outcomes for women 50-69
years through increased breast screen coverage for Maori
women.
 Reducing wait times wait times for CT, MRI and ultrasound.
 Establishing a sub-regional service development model
under the centralAlliance programme for diagnostic imaging.
 Strengthening primary management of community referred
radiology through the Radiology Oversight Committee.
 Increasing the numbers of people with chronic conditions to
better manage their own health.
 Implementing the diagnostic elements from clinical
pathways.
 Implementing a clinical pathways tool in primary care.
 Ensuring equitable and timely access to intensive assessment
and treatment.
 Implementing the diagnostic elements of clinical pathways.
Implementing the recommendations of the local cardiac
project.
 Applying best practice in dementia care locally.
 Supporting whānau ora collectives to transform to whānau
centred integrated approaches.
 Manage the bottlenecks identified in the achievement of the
Shorter Stays in ED target.
 Improving waiting times for CT, and MRI.
 Improving internal data collection.
27 March 2014
 Increasing elective surgery, reducing wait times, meeting
shorter stays and better matching the capacity of hospital
reassures to meet demand.
 Improving pathways for women through better management
of gynaecological presentations.
 Improving access to information and integration of this
information reducing gaps and supporting better interactions
for patients with healthcare services, regardless of location
or speciality.
 Living within the resources available, building capacity and
strengthening the workforce.
 Enhancing cardiology capability and capacity in response to
the cardiology landscape paper, acute coronary syndrome
pathway, cardiac catheterisation facilities and
echocardiography.
Medical Imaging Landscape Report
Page 54 of 91
Whanganui DHB
MidCentral DHB
 Considering new booking systems to reduce DNA’s providing
flexibility for patients and their whānau.
 Supporting nurse led clinics in primary care with appropriate
access to diagnostics.
 Supporting the acute stroke service with timely access to CT.
 Supporting orthopaedic initiatives and theatre productivity
initiatives through availability of mobile imaging.
 Releasing radiologists to support the development,
implementation and monitoring of national tumour
standards for cancer and multidisciplinary support for all
specialities, including primary care.
 Improving asset and facility management.
 Implementing a regional PACS solution.
 Meeting the requirements of emergency management
planning.
27 March 2014
Medical Imaging Landscape Report
Page 55 of 91
9.2
POPULATION PROJECTIONS
Projected population age structure and components of change5
Territorial authority areas
1996–2031 (2006-base, October 2012 update), medium projection
(2)
Territorial
(1)
authority area
Population by age group (years),
at 30 June
Year
0–14
15–39
40–64
65+
Total
Components of population change,
five years ended 30 June
(3)
Births
(4)
Deaths
Natural
(5)
increase
Net
(6)
migration
Median
(7)
age
(years)
at 30
June
Ruapehu district
1996
2001
2006
2011
2016
2021
2026
2031
4,950
4,050
3,500
3,100
2,650
2,500
2,250
2,050
7,000
5,300
4,600
4,150
3,750
3,550
3,350
2,900
3,950
4,200
4,450
4,500
4,050
3,550
2,950
2,700
1,400
1,450
1,500
1,650
1,950
2,250
2,550
2,700
17,300
15,000
14,050
13,400
12,400
11,800
11,150
10,350
...
1,400
1,100
1,150
950
900
850
750
...
500
500
500
500
500
500
500
...
900
600
650
500
400
350
200
...
-3,200
-1,600
-1,300
-1,500
-1,000
-1,000
-1,000
28.8
32.3
34.8
36.4
38.1
38.8
39.6
41.6
Wanganui district
1996
2001
2006
2011
2016
2021
2026
2031
11,000
10,300
9,400
8,800
8,300
8,200
7,800
7,500
15,800
13,800
12,800
12,500
12,000
11,900
11,800
10,900
12,400
13,300
14,100
14,400
13,800
12,700
11,600
11,200
6,900
7,000
7,500
7,900
8,900
10,200
11,500
12,500
46,000
44,400
43,800
43,600
43,100
42,900
42,700
42,100
...
3,200
2,800
3,100
2,800
2,700
2,600
2,400
...
2,300
2,300
2,300
2,300
2,300
2,400
2,500
...
900
500
800
500
400
200
-100
...
-2,500
-1,200
-1,000
-1,000
-500
-500
-500
34.5
37.0
39.5
41.0
42.6
43.7
44.3
45.3
Rangitikei district
1996
2001
2006
2011
2016
2021
2026
2031
4,500
3,900
3,400
3,100
2,850
2,750
2,600
2,450
5,950
4,850
4,450
4,250
4,050
3,900
3,700
3,200
4,400
4,750
5,100
5,050
4,600
4,100
3,550
3,250
1,900
2,000
2,200
2,450
2,850
3,200
3,550
3,850
16,750
15,500
15,150
14,850
14,350
13,950
13,450
12,800
...
1,250
950
1,050
950
900
850
750
...
650
600
600
600
650
700
700
...
550
350
450
350
300
200
50
...
-1,800
-750
-750
-800
-700
-700
-700
32.5
35.8
38.6
40.5
42.0
42.6
43.1
44.4
1996
2001
2006
2011
2016
2021
2026
2031
Change
20,450
18,250
16,300
15,000
13,800
13,450
12,650
12,000
74%
28,750
23,950
21,850
20,900
19,800
19,350
18,850
17,000
78%
20,750
22,250
23,650
23,950
22,450
20,350
18,100
17,150
73%
10,200
10,450
11,200
12,000
13,700
15,650
17,600
19,050
170%
80,050
74,900
73,000
71,850
69,850
68,650
67,300
65,250
89%
5,850
4,850
5,300
4,700
4,500
4,300
3,900
3,450
3,400
3,400
3,400
3,450
3,600
3,700
2,350
1,450
1,900
1,350
1,100
750
150
-7,500
-3,550
-3,050
-3,300
-2,200
-2,200
-2,200
Sum of
projections for
WDHB
5
Statistics New Zealand
27 March 2014
Medical Imaging Landscape Report
Page 56 of 91
Manawatu district
1996
6,800
9,600
7,300
3,000
26,700
...
...
...
...
32.9
2001
2006
2011
2016
2021
2026
2031
6,400
6,000
5,900
5,900
6,100
6,000
6,000
8,500
8,100
8,100
8,200
8,300
8,600
8,400
8,200
9,000
9,500
9,300
8,800
8,300
8,200
3,200
3,600
4,100
4,900
5,800
6,700
7,500
26,300
26,800
27,600
28,300
29,000
29,600
30,000
1,800
1,600
1,800
1,700
1,800
1,800
1,700
900
1,000
1,000
1,000
1,100
1,200
1,300
800
700
800
700
700
600
400
-1,300
-200
0
0
0
0
0
35.8
38.0
39.3
40.2
40.3
40.6
41.7
1996
2001
2006
2011
2016
2021
2026
2031
16,100
16,200
16,300
16,500
16,700
17,100
17,100
17,100
35,100
32,200
32,500
33,600
34,800
35,800
36,800
37,000
18,100
20,400
22,800
24,200
24,500
24,800
24,700
25,200
7,800
8,400
9,200
10,200
12,100
13,900
16,300
18,500
77,100
77,100
80,800
84,600
88,100
91,500
94,900
97,900
...
5,500
5,300
6,000
5,800
5,900
5,900
5,800
...
2,500
2,700
2,700
2,800
2,900
3,100
3,300
...
3,100
2,700
3,300
3,000
3,000
2,800
2,600
...
-3,100
1,000
500
500
500
500
500
29.2
31.2
32.2
32.5
33.0
33.8
34.8
36.0
Tararua district
1996
2001
2006
2011
2016
2021
2026
2031
5,200
4,700
4,300
4,000
3,750
3,700
3,650
3,600
6,700
5,600
5,300
5,000
4,800
4,800
4,800
4,450
5,350
5,650
6,000
6,000
5,700
5,150
4,650
4,450
2,350
2,400
2,500
2,750
3,150
3,700
4,200
4,600
19,500
18,350
18,050
17,700
17,400
17,350
17,300
17,100
...
1,400
1,250
1,350
1,200
1,200
1,250
1,150
...
750
750
700
750
750
800
850
...
600
550
650
500
450
450
300
...
-1,800
-800
-1,000
-800
-500
-500
-500
33.2
36.1
37.8
39.5
40.9
41.0
41.1
42.3
Horowhenua district
1996
2001
2006
2011
2016
2021
2026
2031
7,300
7,000
6,500
6,100
5,600
5,500
5,300
5,100
9,800
8,700
7,900
7,500
7,200
7,100
7,100
6,600
8,500
9,400
10,100
10,200
9,700
9,000
8,000
7,400
5,200
5,600
6,100
6,900
7,900
8,700
9,600
10,400
30,800
30,600
30,600
30,700
30,400
30,300
30,000
29,500
...
2,200
1,800
2,000
1,800
1,800
1,700
1,600
...
1,900
1,900
1,800
1,800
1,900
2,000
2,100
...
300
-100
300
0
-100
-300
-500
...
-500
0
-200
-200
0
0
0
36.2
39.2
42.1
44.8
47.4
49.5
50.9
51.5
1996
2001
2006
2011
2016
2021
2026
2031
35,400
34,300
33,100
32,500
31,950
32,400
32,050
31,800
61,200
55,000
53,800
54,200
55,000
56,000
57,300
56,450
39,250
43,650
47,900
49,900
49,200
47,750
45,650
45,250
18,350
19,600
21,400
23,950
28,050
32,100
36,800
41,000
154,100
152,350
156,250
160,600
164,200
168,150
171,800
174,500
10,900
9,950
11,150
10,500
10,700
10,650
10,250
6,050
6,350
6,200
6,350
6,650
7,100
7,550
4,800
3,850
5,050
4,200
4,050
3,550
2,800
-6,700
0
-700
-500
0
0
0
96%
105%
94%
192%
112%
Palmerston North
city
Sum of projections
for MDHB
Change
27 March 2014
Medical Imaging Landscape Report
Page 57 of 91
9.3
EUROPEAN OR OTHER POPULATION PROJECTIONS
Projected 'European or Other' population structure and components of population change6
Selected territorial authority areas, medium series
1996–2021 (2006-base update)
Projected components of population change,
five years ended 30 June
Population by age group (years) at 30 June
Territorial authority
area
Year
0–14
Ruapehu district
Wanganui district
Rangitikei district
Sum of projections
for WDHB
Manawatu district
Palmerston North
city
6
15–39
40–64
65+
All
ages
Births
Deaths
Natural
increase
Net
migration
Interethnic
mobility
1996
2001
2006
(base)
2011
2016
2021
3,500
2,700
5,000
3,600
3,100
3,200
1,200
1,200
12,800
10,700
...
...
...
...
...
...
...
...
...
...
2,300
2,200
2,100
2,000
3,200
2,900
2,600
2,400
3,400
3,400
3,100
2,700
1,200
1,300
1,600
1,800
10,200
9,800
9,400
8,900
...
800
700
600
...
400
400
400
...
500
400
300
...
-900
-800
-800
...
0
0
0
1996
2001
2006
(base)
2011
2016
2021
9,000
8,100
13,100
10,800
11,000
11,600
6,600
6,700
39,700
37,200
...
...
...
...
...
...
...
...
...
...
7,300
6,900
6,700
6,600
9,900
9,500
8,900
8,500
12,100
12,300
11,800
10,600
7,100
7,300
8,000
8,900
36,400
36,100
35,400
34,600
...
2,300
2,100
2,000
...
2,000
2,000
2,100
...
300
0
-100
...
-600
-700
-700
...
0
0
0
1996
2001
2006
(base)
2011
2016
2021
3,700
3,200
4,800
3,900
3,800
4,100
1,800
1,800
14,100
13,000
...
...
...
...
...
...
...
...
...
...
2,700
2,500
2,300
2,200
3,600
3,300
3,100
2,800
4,300
4,300
4,000
3,600
2,000
2,200
2,600
2,900
12,600
12,400
12,000
11,600
...
800
700
700
...
500
500
500
...
400
200
200
...
-600
-600
-600
...
0
0
0
1996
2001
2006
(base)
2011
2016
2021
Change
16,200
14,000
22,900
18,300
17,900
18,900
9,600
9,700
66,600
60,900
12,300
11,600
11,100
10,800
-1,500
88%
16,700
15,700
14,600
13,700
-3,000
82%
19,800
20,000
18,900
16,900
-2,900
85%
10,300
10,800
12,200
13,600
3,300
132%
59,200
58,300
56,800
55,100
-4,100
93%
3,900
3,500
3,300
2,900
2,900
3,000
1,200
600
400
-2,100
-2,100
-2,100
0
0
0
1996
2001
2006
(base)
2011
2016
2021
6,700
6,200
9,600
8,200
7,500
8,300
3,000
3,300
26,800
26,100
...
...
...
...
...
...
...
...
...
...
5,900
5,900
5,900
6,000
7,900
7,800
7,700
7,800
9,200
9,700
9,600
9,100
3,600
4,100
4,900
5,800
26,700
27,400
28,100
28,600
...
1,800
1,700
1,700
...
1,000
1,000
1,100
...
800
600
500
...
0
0
0
...
0
0
0
1996
12,900
28,900
15,700
7,400
65,000
...
...
...
...
...
Statistics New Zealand
27 March 2014
Medical Imaging Landscape Report
Page 58 of 91
Tararua district
Horowhenua district
Sum of projections
for MDHB
2001
2006
(base)
2011
2016
2021
13,000
25,500
17,100
7,900
63,500
...
...
...
...
...
12,600
12,600
12,600
12,900
24,700
25,600
26,400
27,000
18,800
19,400
19,200
19,000
8,400
9,100
10,300
11,300
64,500
66,600
68,400
70,200
...
4,500
4,500
4,600
...
2,500
2,500
2,600
...
2,100
2,000
2,000
...
100
-200
-200
...
0
0
0
1996
2001
2006
(base)
2011
2016
2021
4,500
4,000
5,800
4,700
4,900
5,100
2,200
2,300
17,300
16,100
...
...
...
...
...
...
...
...
...
...
3,600
3,400
3,300
3,100
4,400
4,000
3,700
3,600
5,300
5,300
5,100
4,600
2,400
2,500
2,900
3,400
15,600
15,300
15,000
14,700
...
1,100
1,000
900
...
600
700
700
...
500
300
200
...
-900
-600
-600
...
0
0
0
1996
2001
2006
(base)
2011
2016
2021
5,900
5,500
8,100
6,900
7,500
8,100
5,100
5,300
26,500
25,800
...
...
...
...
...
...
...
...
...
...
5,100
4,900
4,700
4,600
6,300
5,900
5,600
5,300
8,700
8,700
8,400
8,000
5,800
6,400
7,100
7,600
25,800
25,900
25,800
25,500
...
1,600
1,500
1,400
...
1,600
1,600
1,700
...
0
-200
-300
...
100
100
100
...
0
0
0
1996
23,300
42,800
28,100
14,700
2001
2006
(base)
22,500
37,100
30,300
15,500
21,300
35,400
32,800
16,600
2011
20,900
35,500
33,400
18,000
7,200
4,700
2,600
-700
0
2016
20,600
35,700
32,700
20,300
7,000
4,800
2,100
-700
0
2021
20,600
35,900
31,600
22,300
108,80
0
105,40
0
105,90
0
107,80
0
109,20
0
110,40
0
6,900
5,000
1,900
-700
0
-700
500
-1,200
5,700
4,500
97%
101%
96%
134%
104%
Change
27 March 2014
Medical Imaging Landscape Report
Page 59 of 91
9.4
MAORI POPULATION PROJECTIONS
Projected Māori population structure and components of population change7
Selected territorial authority areas, medium series
1996–2021 (2006-base update)
Projected components of population change,
five years ended 30 June
Population by age group (years) at 30 June
Territorial authority
area
Year
0–14
Ruapehu district
Wanganui district
Rangitikei district
Sum of projections
for WDHB
Manawatu district
Palmerston North
city
7
15–39
40–64
65+
All
ages
Births
Natural
increase
Deaths
Interethnic
mobility
Net
migration
1996
2001
2006
(base)
2011
2016
2021
2,600
2,300
2,800
2,300
1,100
1,200
200
200
6,800
6,000
...
...
...
...
...
...
...
...
...
...
1,900
1,900
1,800
1,800
2,000
1,900
1,900
1,900
1,300
1,400
1,300
1,200
300
300
400
500
5,500
5,400
5,500
5,400
...
700
700
600
...
200
200
200
...
600
500
400
...
-500
-400
-400
...
-100
-100
-100
1996
2001
2006
(base)
2011
2016
2021
3,500
3,600
3,700
3,700
1,500
1,900
300
300
9,000
9,500
...
...
...
...
...
...
...
...
...
...
3,400
3,500
3,600
3,700
3,600
3,700
3,900
4,000
2,200
2,500
2,700
2,800
500
600
700
900
9,800
10,300
10,900
11,400
...
1,400
1,300
1,300
...
300
300
300
...
1,100
1,000
900
...
-400
-300
-300
...
-100
-200
-200
1996
2001
2006
(base)
2011
2016
2021
1,600
1,400
1,700
1,400
800
800
100
200
4,200
3,800
...
...
...
...
...
...
...
...
...
...
1,300
1,200
1,200
1,200
1,300
1,400
1,400
1,400
900
1,000
900
900
200
300
300
400
3,700
3,800
3,900
3,900
...
500
500
400
...
100
100
100
...
300
300
300
...
-200
-200
-200
...
-100
-100
-100
1996
2001
2006
(base)
2011
2016
2021
Change
7,700
7,300
8,200
7,400
3,400
3,900
600
700
20,000
19,300
6,600
6,600
6,600
6,700
100
102%
6,900
7,000
7,200
7,300
400
106%
4,400
4,900
4,900
4,900
500
111%
1,000
1,200
1,400
1,800
800
180%
19,000
19,500
20,300
20,700
1,700
109%
2,600
2,500
2,300
600
600
600
2,000
1,800
1,600
-1,100
-900
-900
-300
-400
-400
1996
2001
2006
(base)
2011
2016
2021
1,500
1,500
1,400
1,400
600
700
100
100
3,600
3,700
...
...
...
...
...
...
...
...
...
...
1,600
1,500
1,600
1,700
1,600
1,700
1,800
1,900
900
1,000
1,200
1,200
100
200
300
400
4,100
4,500
4,900
5,300
...
600
600
600
...
100
100
100
...
500
500
500
...
-100
-100
-100
...
-100
-100
-100
1996
3,500
4,900
1,300
200
10,000
...
...
...
...
...
Statistics New Zealand
27 March 2014
Medical Imaging Landscape Report
Page 60 of 91
Tararua district
Horowhenua district
Sum of projections
for MDHB
27 March 2014
2001
2006
(base)
2011
2016
2021
3,800
5,000
1,600
200
10,500
...
...
...
...
...
4,300
4,800
5,100
5,300
5,700
5,900
6,200
6,500
2,100
2,500
2,900
3,300
300
400
600
800
12,400
13,600
14,800
15,900
...
1,900
1,900
1,900
...
200
200
200
...
1,800
1,700
1,600
...
-300
-300
-300
...
-200
-200
-200
1996
2001
2006
(base)
2011
2016
2021
1,400
1,400
1,400
1,300
600
700
100
100
3,600
3,400
...
...
...
...
...
...
...
...
...
...
1,400
1,400
1,500
1,600
1,400
1,400
1,500
1,600
800
1,000
1,100
1,100
200
200
300
400
3,800
4,100
4,400
4,600
...
500
500
500
...
100
100
100
...
500
400
400
...
-100
-100
-100
...
-100
-100
-100
1996
2001
2006
(base)
2011
2016
2021
2,400
2,400
2,400
2,300
1,100
1,300
300
300
6,100
6,300
...
...
...
...
...
...
...
...
...
...
2,400
2,500
2,500
2,700
2,300
2,400
2,600
2,700
1,500
1,700
1,900
1,900
300
500
600
800
6,500
7,100
7,600
8,100
...
900
900
900
...
200
200
200
...
700
700
700
...
-100
-100
-100
...
-100
-100
-100
1996
8,800
10,100
3,600
700
23,300
2001
2006
(base)
9,100
10,000
4,300
700
23,900
9,700
11,000
5,300
900
26,800
2011
10,200
11,400
6,200
1,300
29,300
3,900
600
3,500
-600
-500
2016
10,700
12,100
7,100
1,800
31,700
3,900
600
3,300
-600
-500
2021
11,300
12,700
7,500
2,400
33,900
3,900
600
3,200
-600
-500
Change
1,600
1,700
2,200
1,500
7,100
116%
115%
142%
267%
126%
Medical Imaging Landscape Report
Page 61 of 91
9.5
ASIAN POPULATION PROJECTIONS
Projected Asian population structure and components of population change8
Selected territorial authority areas, medium series
1996–2021 (2006-base update)
Projected components of population change,
five years ended 30 June
Population by age group (years) at 30 June
Territorial authority
area
Year
0–14
Palmerston North
city
9.6
15–39
40–64
65+
All ages
Births
Deaths
Natural
increase
Net
migration
Interethnic
mobility
1996
2001
2006
(base)
2011
2016
2021
1,000
1,000
2,500
2,600
800
1,100
100
200
4,300
4,900
...
...
...
...
...
...
...
...
...
...
1,100
1,300
1,600
1,800
3,400
3,600
3,700
3,700
1,400
1,700
2,000
2,200
300
500
800
1,200
6,100
7,200
8,000
8,900
...
500
500
500
...
100
100
100
...
400
400
400
...
700
500
500
...
-100
-100
-100
Change
700
300
800
900
2,800
164%
109%
157%
400%
146%
PACIFIC POPULATION PROJECTIONS
Projected Pacific population structure and components of population change9
Selected territorial authority areas, medium series
1996–2021 (2006-base update)
Projected components of population change,
five years ended 30 June
Population by age group (years) at 30 June
Territorial authority
area
Year
0–14
Palmerston North
city
1996
2001
2006
(base)
2011
2016
2021
Change
8
9
15–39
40–64
65+
All ages
Births
Deaths
Natural
increase
Net
migration
Interethnic
mobility
900
900
1,000
1,100
300
400
0
0
2,300
2,400
...
...
...
...
...
...
...
...
...
...
1,100
1,400
1,600
1,800
1,400
1,500
1,700
1,900
500
600
700
900
100
100
200
300
3,000
3,600
4,300
4,900
...
600
600
600
...
0
0
0
...
500
600
600
...
100
100
100
...
0
0
0
700
500
400
200
1,900
164%
136%
180%
300%
163%
Statistics New Zealand
Statistics New Zealand
27 March 2014
Medical Imaging Landscape Report
Page 62 of 91
9.7
WHANGANUI ACCESS EQUITY
<45
45-54
CT
55-64
Whanganui Unique Patient and Examination Volumes by Age Group and Ethnicity
X-Ray
Ultrasound
65+
TOTAL
<45
45-54 55-64 65+
TOTAL
<45
45-54 55-64 65+
2011/12 distinct patients
% of patients
2011/12 Procedures
% of procedures
% of population
2011/12 Maori distinct patients
% of patients
2011/12 Maori Procedures
% of procedures
% of population
765
21%
926
19%
59%
198
5%
238
5%
17%
529
14%
688
14%
14%
114
3%
156
3%
2%
613
17%
829
17%
11%
109
3%
153
3%
2%
2012/13 distinct patients
% of patients
2012/13 Procedures
% of procedures
% of population
2012/13 Maori distinct patients
% of patients
2012/13 Maori Procedures
% of procedures
% of population
855
22%
1073
20%
59%
212
25%
265
5%
17%
529
13%
733
14%
14%
114
22%
162
3%
2%
710 1,844
18%
47%
954 2,613
18%
49%
11%
16%
134
153
19%
8%
183
224
3%
4%
2%
1%
Whanganui
All men
% men
Maori men
% Maori men
All women
% women
Maori Women
% Maori women
All Whanganui
% Whanganui
Whanganui Maori
% Whanganui Maori
% of population
Page 63 of 91
1762
48%
2458
50%
16%
150
4%
216
4%
1%
3669
100%
4901
100%
100%
571
16%
763
16%
23%
36459
59%
10679
77%
17%
8754
14%
1494
11%
2%
6807
11%
939
7%
2%
9801
16%
823
6%
1%
2582
13%
3803
12%
14%
545
3%
791
3%
2%
3048
15%
4642
15%
11%
502
3%
783
3%
2%
6459
33%
10798
35%
16%
540%
0%
881
3%
1%
MRI
45-54 55-64 65+
TOTAL
19756
100%
30722
100%
100%
2973.4
15%
5327
17%
23%
3066
59%
4431
65%
59%
948
18%
1413
21%
17%
525
10%
612
9%
14%
139
3%
156
2%
2%
512
10%
584
9%
11%
100
2%
119
2%
2%
1069
21%
1203
18%
16%
106
2%
123
2%
1%
5172
100%
6830
100%
100%
1293
25%
1811
27%
23%
738
37%
833
37%
59%
148
7%
164
7%
17%
422
21%
489
21%
14%
67
3%
73
3%
2%
364
18%
426
19%
11%
41
2%
50
2%
2%
473 1,997
24% 100%
534 2,282
23% 100%
16% 100%
30
286
2%
14%
37
324
2%
14%
1%
23%
3,938
7,514 2,600 3,219
6,825 20,158
100%
37%
13%
16%
34%
100%
5,373 11,270 3,958 5,123 11,541 31,892
100%
35%
12%
16%
36%
100%
100%
59%
14%
11%
16%
100%
613
1,957
504
531
540
3,532
16%
26%
7%
7%
7%
47%
834
2,820
777
853
874
5,324
16%
9%
2%
3%
3%
17%
23%
17%
2%
2%
1%
23%
3,164
58%
4,428
63%
59%
1,012
19%
1,331
19%
17%
492
9%
592
8%
14%
108
2%
134
2%
2%
509 1,247
9%
23%
582 1,459
8%
21%
11%
16%
104
111
2%
2%
120
126
2%
2%
2%
1%
5412
100%
7061
100%
100%
1335
25%
1711
24%
23%
807
33%
944
33%
59%
146
6%
166
6%
17%
478
20%
582
21%
14%
86
4%
103
4%
2%
506
21%
605
21%
11%
52
2%
62
2%
2%
625 2,416
26% 100%
707 2,838
25% 100%
16% 100%
38
322
2%
13%
46
377
2%
13%
1%
23%
<45
45-54
55-64 65+
TOTAL
18327
4287 3342 4293
30249
61%
14%
11%
14%
100%
5167
681
420
306
6574
79%
10%
6%
5%
100%
18132
4467 3465 5508
31572
57%
14%
11%
17%
100%
5512
813
519
517
7361
75%
11%
7%
7%
100%
7667
39%
11479
37%
59%
1921
10%
2872
9%
17%
TOTAL <45
`
61821
100%
13935
100%
23%
Radiology Landscape Report (18Nov13) FINAL.docx
27 March 2014
MidCentral Access Equity
<45
45-54
CT
55-64
MidCentral Unique Patient Volumes by Age Group and Ethnicity
X-Ray
Ultrasound
TOTAL
<45
45-54 55-64 65+
TOTAL
<45
45-54 55-64 65+
65+
2011/12 distinct patients
% of patients
2011/12 Procedures
% of procedures
% of patients
% of population
2011/12 Maori distinct patients
% of patients
2011/12 Maori Procedures
% of procedures
% of population
1335
36%
985
27%
1215
33%
4273
116%
0%
17%
59%
246
7%
0%
13%
14%
176
5%
0%
16%
11%
150
4%
0%
55%
15%
208
6%
3%
14%
2%
2%
2%
1%
3%
1%
2012/13 distinct patients
% of patients
2012/13 Procedures
% of procedures
% of patients
% of population
2012/13 Maori distinct patients
% of patients
2012/13 Maori Patients
% of patients
% of population
1657
42%
MidCentral
All men
% men
Maori men
% Maori men
All women
% women
Maori Women
% Maori women
All MidCentral
% MidCentral
MidCentral Maori
% MidCentral Maori
% of population
Page 64 of 91
1,094 1,447 4,871
28%
37% 124%
0%
18%
59%
342
21%
0%
12%
14%
185
17%
0%
16%
11%
195
13%
0%
54%
16%
230
5%
3%
15%
2%
2%
2%
2%
2%
1%
7808
213%
0
0%
100%
100%
780
21%
0
10%
17%
11585
59%
4656
24%
5662
29%
16914
86%
0%
0%
0%
0%
59%
2348
12%
14%
740
4%
11%
683
3%
15%
863
4%
6%
14%
2%
2%
2%
1%
2%
1%
TOTAL <45
38817
196%
0
0%
4763
92%
1163
22%
961
19%
2468
48%
0%
0%
0%
0%
100%
4634
23%
0
12%
17%
59%
793
15%
14%
188
4%
11%
130
3%
15%
130
3%
8%
14%
2%
2%
1%
1%
1%
1%
9355 830
181% 42%
0
0%
0%
100% 59%
1241 135
24%
7%
0
13%
3%
17% 14%
9,069 12,057 4,871 6,039 17,948 40,915 5,717 1,447 1,146 2,552 10862 871
230%
60%
24%
30%
89%
203% 106%
27%
21%
47% 201% 36%
0
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
0%
100%
29%
12%
15%
44%
100%
53%
13%
11%
23% 100% 17%
100%
59%
14%
11%
16%
100%
59%
14%
11%
16% 100% 59%
952
2,448
741
715
911
4,815 1,031
226
147
130
1534 154
10%
33%
10%
10%
12%
64%
19%
4%
3%
2%
28%
6%
0
8%
6%
2%
2%
2%
12%
9%
2%
1%
1%
14%
3%
23%
15%
2%
2%
1%
23%
15%
2%
2%
1%
23% 15%
Nuclear Medicine
45-54 55-64 65+
TOTAL
706
56%
1116
117%
0%
0%
14%
7%
11%
140
7%
15%
140
7%
2%
2%
3%
1%
3%
1%
109
2334 4,986
117% 250%
0%
0%
100%
524
26%
11%
17%
819 1,098 2,465 5,253
34%
45% 102% 217%
0%
0%
0%
0%
16%
21%
47% 100%
14%
11%
16% 100%
161
148
79
542
7%
6%
3%
22%
3%
3%
2%
10%
2%
2%
1%
23%
<45
45-54
55-64 65+
TOTAL
42,916 10,254 8,130 9,635
70935
61%
14%
11%
14%
100%
10,694
1,155
618
468
12935
83%
9%
5%
4%
100%
44,316 10,722 8,616 12,345
75,999
58%
14%
11%
16%
100%
9,378
1,215
699
543
75999
602%
146% 117% 168%
1032%
87,232
59%
20,072
81%
14%
20,976 16,746 21,980
14%
11%
15%
2,370 1,317 1,011
10%
5%
4%
2%
1%
1%
146,934
100%
24,770
100%
17%
Radiology Landscape Report (18Nov13) FINAL.docx
27 March 2014
9.8
MINISTRY OF HEALTH FUNDED PET CT EXAMINATIONS
Cancer
Colorectal
Clinical Indication

Preoperative evaluation for patients considered for resection of
hepatic/lung metastases in colorectal carcinoma (CRC)

Evaluation of residual structural abnormality on diagnostic imaging
following definitive treatments for colorectal carcinoma (CRC)
Lung

Staging of proven non-small-cell lung cancer (NSLC) prior to curative or
radiotherapy

Solitary pulmonary nodules not amenable to fine needle aspiration (FNA)
or which have failed pathological characterisation
Lymphoma

Restaging of residual mass for Non Hodgkin’s Lymphoma following
definitive treatment
Head and neck

Staging of early stage low grade non Hodgkin’s lymphoma

Staging of Hodgkin’s Disease

Restaging of residual neck masses in head and neck cancers following
radiotherapy/chemotherapy

Staging for metastatic squamous carcinoma in cervical lymph nodes from
unknown primary
Oesophagus

Staging of gastric/oesophageal cancer for curative treatment
Malignant Melanoma

Patients considered for definitive or adjuvant treatment of oligo-metastatic
or regional melanoma
Cervical

Staging of locally advanced cervical cancer for curative radiation
treatment
Ovarian

Restaging of recurrent ovarian carcinoma being considered for
cytoreductive surgery
Page 65 of 91
Radiology Landscape Report (18Nov13) FINAL.docx
9.9
9.9.1
IMAGING SERVICES
HOSPITAL BASED SERVICES
The following analysis reports have been provided by Central TAS as part of the Radiology Trend Analysis
(CT, US and MRI) reports of data for the 2009/10, 2010/11and 2011/12 years. These data sets are and this
analysis has been selected as it provides commonality of data extraction and analysis approach and the
resulting data and analysis has been well reviewed as part of the Medical Imaging Stream of the Central
Regional Plan. General x-ray is not covered in this series.
The paper has the following acknowledgement:
“Acknowledgement: Graham Dyer, CEO Sponsor and Co-Chair (Wairarapa & Hutt Valley DHBs), Chris Lowry,
Chief Operating Officer and Co-Chair (Capital & Coast DHB).
Liaison members who provided expertise during the project are Dr James Entwisle, Regional Radiology
Clinical Leader (Capital & Coast DHB) and Dr Nicolaas Van der Walt, Clinical Head of Department (Hutt
Valley DHB).
The project group would like to acknowledge the contribution of all members of the Regional Radiology
Group who have provided feedback during the finalisation of this report.”
Privately provided volumes are not included in this analysis and are not readily available.
Whanganui data caveats:
Nothing specific.
MidCentral data caveats:
Data is only available for three full years (2009/10 to 2011/12). MRI data is
not captured on RIS so is unavailable for this analysis.
Page 66 of 91
Radiology Landscape Report (18Nov13) FINAL.docx
WhaDHB: Patient event volumes, CT, US and MRI, 2008/09 to 2011/12
2008/09
2009/10
2010/11
MDHB: Patient event volumes, CT and US, 2009/10 to 2011/12
2009/10
2011/12
2010/11
2011/12
10,000
6,000
9,000
Number of patient events
Number of patient events
5,000
4,000
3,000
2,000
1,000
8,000
7,000
6,000
5,000
4,000
3,000
2,000
1,000
0
0
CT
US
CT
MRI
US
Modality
Modality
WhaDHB: Percentage change in patient event volumes, CT, US and MRI
US
MRI
CT
30%
15%
25%
10%
20%
5%
Percentage change
Percentage change
CT
MDHB: Percentage change in patient event volumes, CT and US
15%
10%
5%
0%
-5%
-10%
0%
-15%
-5%
-20%
-10%
US
-25%
08/09 to 09/10
09/10 to 10/11
10/11 to 11/12
08/09 to 11/12
09/10 to 11/12
08/09 to 09/10
Year/s of comparison
Page 67 of 91
09/10 to 10/11
10/11 to 11/12
08/09 to 11/12
09/10 to 11/12
Year/s of comparison
Radiology Landscape Report (18Nov13) FINAL.docx
27 March 2014
CT WDHB
CT MDHB






CT annual volumes averaged 4,050 across the four years.
Peak of 4,407 in 2011/12, low of 3,477 in 2008/09 (difference of
930).
Overall increase of 27% from 2008/09 to 2011/12
Community referrers have access to CT.
US WDHB



US annual volumes averaged 5,262 across the four years.
Peak of 5,620 in 2011/12, low of 4,951 in 2008/09 (difference of
669).
Overall increase of 14% from 2008/09 to 2011/12.

CT annual volumes averaged 7,106 across the three years.
Peak of 7,370 in 2011/12, low of 6,752 in 2010/11 (difference of
618).
Overall increase of 2% from 2009/10 to 2011/12.
US MDHB



US annual volumes averaged 8,286 across the three years.
Peak of 9,505 in 2009/10, low of 7,581 in 2011/12 (difference of
1,924).
Overall decrease of 20% from 2009/10 to 2011/12. This is due to a
significant decrease in the number of qualified sonographers.
MRI WDHB



MRI annual volumes averaged 2,210 across the four years.
Peak of 2,338 in 2011/12, low of 2,103 in 2010/11 (difference of
235).
Overall increase of 6% from 2008/09 to 2011/12, but volumes
dipped in between years.
Page 68 of 91
Radiology Landscape Report (18Nov13) FINAL.docx
27 March 2014
PATIENT TYPE – ALL MODALITIES
WhaDHB: Patient type percentages, CT, US and MRI, 2008/09 to
2011/12 combined
100%
3%
90%
17%
100%
1%
90%
37%
80%
70%
Percentage
MDHB: Patient type percentages, CT and US, 2009/10 to 2011/12
combined
59%
12%
3%
50%
40%
28%
30%
20%
37%
17%
10%
19%
CT
Community
10%
US
MRI
5%
Other DHB
60%
50%
43%
20%
19%
0%
CT




Outpatient volumes (28%) have increased over each consecutive
year to be 32% higher in 2011/12 than in 2008/09.
Inpatient volumes (19%) decreased between 2008/09 and 2009/10
by 2% then increased by 16% in 2010/11 before decreasing again
in 2011/12. Over change is an increase of 8%.
Emergency patients (33%) volumes increased between 2008/09
and 2009/10 (24%), but then decreased over the next two
consecutive years. Overall change is an increase of 6%.
Community patients (17%) increased over each consecutive year,
so over the four year period volumes increased by 90%.
ACC patients accounted for 3% of total volumes across the four
years.
Of the four main patient types, emergency patients were the only
patient type to decrease in 2010/11.
27 March 2014
US
Modality
CT MDHB

Inpatient
33%
10%
CT WDHB

Emergency
Outpatient
30%
Outpatient
Modality

Community
44%
40%
Inpatient
11%
0%
ACC
Emergency
12%
31%
70%
Hospital Other
33%
60%
23%
80%
Percentage
9.9.2



Outpatient volumes (43%) decreased by 6% between 2009/10 and
2011/12. Volumes increased the following year by 7% so that the
overall change was an increase of just 1%.
Inpatient volumes (33%) increased in 2010/11 and again in
2011/12 so that the overall increase from 2009/10 was 16%.
Emergency volumes (23%) decreased by 23% between 2009/10
and 2011/12. Volumes increased the following year by 12% so that
the overall change was a decrease of 14%.
The hospital does not routinely do community referred work for
CT. Across the three years, community referred volumes
accounted for less than 1% of total volumes. So did volumes from
other DHBs.
Radiology Landscape Report (18Nov13) FINAL.docx
Page 69 of 91
US WDHB
US MDHB







Outpatients (17%) increased in 2009/10 and 2010/11 before
holding steady in 2011/12. Overall change is an increase of 27%.
Inpatients (11%) have decreased each consecutive year so that
overall the decrease is 29%.
Emergency patients (12%) increased in 2009/10 by 13% before
decreasing by almost the same percentage in 2010/11. The
following year volumes increased by 10% so the overall change
was an increase of 8%.
Community patients (59%) are the largest patient group. Volumes
increased in 2009/10 by 11%, then decreased in 2010/11 by 7%
before increasing again in 2011/12 by 18%. Overall change is an
increase of 21%.
ACC volumes accounted for only 1% of total volumes across the
four years.
Of the four main patient types, outpatients were the only patient
type not to decrease in 2010/11.
MRI WDHB










Outpatient volumes (44%) decreased by 13% between 2009/10
and 2011/12. Volumes increased the following year by 8% so that
the overall change was a decrease of 7%.
Community patients (31%) decreased in 2010/11 by 27% before
decreasing again in 2011/12 by 11% so that the overall decrease
from 2009/10 was 35%.
Emergency patients (5%) decreased in 2010/11 by 38% before
decreasing again in 2011/12 by 27% so that the overall decrease
from 2009/10 was 54%.
Inpatients (19%) decreased in 2010/11 by 5% before decreasing
again in 2011/12 by 3% so that the overall decrease from 2009/10
was 8%.
Across the three years, Other DHB volumes account for 1% of
patients.
While all patient types decreased over the three years, inpatients
and outpatients had the smallest percentage decrease, emergency
and community patients the greatest.
ACC volumes (37%) decrease in 2009/10 and 2010/11 (3% and
31% respectively) but increased in 2011/12 by 54% so that the
overall change was an increase of 3%.
Outpatient volumes (also 37%) increased in 2009/10 and 2010/11
(by 6% and 26% respectively) before remaining relatively steady in
2011/12. Overall change was an increase of 32%.
Inpatients (10%) decreased by 12% in 2009/10 before increasing
in 2010/11 and 2011/12 (by 14% and 4% respectively) so that the
overall change was an increase of 5%.
Community patients (12%) decreased each year, with each year
seeing a larger percentage decrease than the previous. Overall the
decrease was 37%.
Emergency patients only accounted for 3% of patients in 4 years.
Page 70 of 91
Radiology Landscape Report (18Nov13) FINAL.docx
27 March 2014
NORMAL HOURS OF OPERATION – ALL MODALITIES
CT
8am to 4pm, Mon to
Fri
US
8am to 4pm, Mon to
Fri
MRI
8am to 4pm, Mon to
Fri
Normal hours of operation differ between DHBs, but in order to
standardise a component of analysis that follows, the hours of 8am to
5pm, 5pm to 11pm and 11pm to 8am have been analysed across all DHBs
and all modalities.
9.9.4
US
8am to 4.30pm, Mon
to Fri
MRI
Private
Normal hours of operation differ between DHBs, but in order to
standardise a component of analysis that follows, the hours of 8am to
5pm, 5pm to 11pm and 11pm to 8am have been analysed across all DHBs
and all modalities.
DAY OF EXAMINATION – ALL MODALITIES
WhaDHB: Day of examination (percentage), 2008/09 to 2011/12
combined
100%
90%
5%
5%
3%
6%
80%
19%
17%
18%
19%
18%
19%
18%
18%
70%
Percentage
CT
8am to 5pm, Mon
to Fri
60%
50%
40%
30%
100%
80%
19%
20%
Friday
Thursday
21%
17%
17%
19%
CT
US
MRI
0%
18%
21%
60%
50%
40%
Wednesday
30%
Tuesday
20%
Monday
10%
19%
Sunday
Saturday
20%
19%
Friday
Thursday
21%
19%
Wednesday
Tuesday
17%
20%
CT
US
Monday
0%
Modality
27 March 2014
16%
70%
Sunday
Saturday
2%
4%
4%
90%
21%
20%
10%
MDHB: Day of examination (percentage), 2009/10 to 2011/12 combined
Percentage
9.9.3
Modality
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Page 71 of 91
CT WDHB
CT MDHB




CT volumes are evenly spread Monday to Friday (17-19%).
10% of volumes were performed in the weekend.
CT volumes are evenly spread Monday to Friday (17-19%).
8% of volumes were performed in the weekend.
US WDHB
US MDHB



US volumes are evenly spread Monday to Friday (17-19%). Friday
volumes are slightly less as for several months there were no
qualified sonographers available on a Friday afternoon. Also more
urgent gaps occurred on Friday afternoons (more difficult to fill at
last minute).
9% of volumes were performed in the weekend.

US volumes are evenly spread Monday to Thursday (20-21%). Friday
has fewer volumes (16%).
2% of volumes were performed in the weekend.
MRI WDHB


MRI volumes are evenly spread Monday to Friday (19-21%).
1% of volumes were performed in the weekend.
Page 72 of 91
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27 March 2014
HOUR OF EXAMINATION – CT
WhaDHB: CT patient volumes by hour of examination and patient type,
2008/09 to 2011/12 combined (1)
Inpatient
Outpatient
Emergency
Community
MDHB: CT patient volumes by hour of examination and patient type,
2009/10 to 2011/12 combined (1)
ACC
Inpatient
2500
Emergency
Community Referred
Other DHB
3000
Number of events
2000
1500
1000
2500
2000
1500
1000
500
500
0
Hour of examination
6am -
5am -
4am -
3am -
2am -
1am -
12am -
11pm -
9pm -
10pm -
8pm -
7pm -
6pm -
5pm -
4pm -
3pm -
2pm -
1pm -
11am -
12pm -
10am -
7am -
6am -
5am -
4am -
3am -
2am -
1am -
12am -
11pm -
9pm -
10pm -
8pm -
7pm -
6pm -
5pm -
4pm -
3pm -
2pm -
1pm -
11am -
12pm -
10am -
8am -
9am -
7am -
0
8am -
Number of events
Outpatient
3500
9am -
9.9.5
Hour of examination
WhaDHB: CT patient volumes by hour of examination and patient type,
MDHB: CT patient volumes by hour of examination and patient type,
Inpatient
Outpatient
Emergency
Grand total
Percentage within each hour
25%
20%
15%
10%
5%
6am -
5am -
4am -
3am -
2am -
1am -
12am -
11pm -
9pm -
10pm -
8pm -
7pm -
6pm -
5pm -
4pm -
3pm -
2pm -
1pm -
12pm -
11am -
9am -
10am -
8am -
7am -
0%
Hour of examination
27 March 2014
Radiology Landscape Report (18Nov13) FINAL.docx
Page 73 of 91
2008/09 to 2011/12 combined (2)
Inpatient
Outpatient
2009/10 to 2011/12 combined (2)
Emergency
Community
Grand total
Percentage within each hour
25%
20%
15%
10%
5%
6am -
5am -
4am -
3am -
2am -
1am -
12am -
11pm -
9pm -
10pm -
8pm -
7pm -
6pm -
5pm -
4pm -
3pm -
2pm -
1pm -
11am -
12pm -
10am -
8am -
9am -
7am -
0%
Hour of examination
WhaDHB: CT patient volumes by hour of examination and patient type,
2008/09 to 2011/12 combined (3)
100%
90%
4%
7%
6%
80%
MDHB: CT patient volumes by hour of examination and patient type,
2009/10 to 2011/12 combined (3)
100%
3%
10%
28%
70%
92%
98%
66%
98%
96%
86%
11pm to 8am
30%
5pm to 11pm
20%
8am to 5pm
10%
Percentage
Percentage
60%
40%
7%
25%
80%
70%
50%
6%
4%
90%
60%
50%
95%
100%
40%
70%
100%
91%
11pm to 8am
5pm to 11pm
8am to 5pm
30%
20%
0%
10%
0%
Inpatient
Outpatient Emergency Community All patients
Patient type
Page 74 of 91
Patient type
Radiology Landscape Report (18Nov13) FINAL.docx
27 March 2014
CT WDHB
CT MDHB








Inpatients peak in the three hours from 9am to 12 noon (42%) and
again between 2-4 pm (22%).
Just over half of outpatients were seen in the three hours from
9am to 12 noon. Numbers then dip each hour, until 3pm, with
very few patients seen after this time.
From 8am to 2pm, between 6-7% of emergency patients were seen
each hour. Volumes peak at 11% from 3-4pm.
Community patients peak between 8-10 am (38%) and again
between 12-2pm (34%).
89% of patients (all categories) were seen between the hours of
8am and 5pm.
10% of patients (all categories) were seen between 5pm and
11pm. 28% of emergency patients were seen over these same
hours.
3% of patients (all categories) were seen between 11pm and 8am.
7% of emergency patients were seen over these same hours.
27 March 2014





42% of inpatients were seen in the three hours from 9am to 12
noon, with another 41% seen in the three hours from 1pm to 4pm.
The busiest hour for outpatients appears to be from 1-2pm, with
20% of patients seen in this time. A steady number of patients are
seen in the morning between 8am and 12 noon, and again in the
afternoon between 2-4pm.
The busiest hour for emergency patients is from 4-5pm (11%).
91% of patients (all categories) were seen between the hours of
8am and 5pm.
7% of patients (all categories) were seen between 5pm and 11pm.
A quarter of emergency patients were seen over these same hours.
2% of patients (all categories) were seen between 11pm and 8am.
6% of emergency patients were seen over these same hours.
Radiology Landscape Report (18Nov13) FINAL.docx
Page 75 of 91
HOUR OF EXAMINATION – US
ACC
Inpatient
3000
3500
1500
Hour of examination
Outpatient
Emergency
Community
6am -
5am -
4am -
3am -
2am -
1am -
12am -
11pm -
9pm -
10pm -
MDHB: US patient volumes by hour of examination and patient type,
2009/10 to 2011/12 combined (2)
Grand total
Inpatient
Outpatient
Emergency
Community
Grand total
25%
Percentage within each hour
25%
20%
15%
10%
5%
20%
15%
10%
5%
Page 76 of 91
6am -
5am -
4am -
3am -
2am -
1am -
12am -
11pm -
10pm -
9pm -
8pm -
7pm -
6pm -
5pm -
4pm -
3pm -
2pm -
1pm -
11am -
Hour of examination
12pm -
9am -
10am -
6am -
5am -
4am -
3am -
2am -
1am -
12am -
11pm -
10pm -
9pm -
8pm -
7pm -
6pm -
5pm -
4pm -
3pm -
2pm -
1pm -
12pm -
11am -
9am -
10am -
8am -
7am -
8am -
0%
0%
7am -
Percentage within each hour
8pm -
Hour of examination
WhaDHB: US patient volumes by hour of examination and patient type,
2008/09 to 2011/12 combined (2)
Inpatient
7pm -
7am -
6am -
5am -
4am -
3am -
2am -
1am -
12am -
11pm -
9pm -
10pm -
8pm -
7pm -
6pm -
5pm -
4pm -
3pm -
2pm -
1pm -
11am -
12pm -
10am -
8am -
0
9am -
500
0
6pm -
1000
500
5pm -
1000
Other DHB
2000
4pm -
1500
Community
2500
3pm -
2000
Emergency
3000
2pm -
2500
11am -
Number of events
4000
Outpatient
12pm -
Community
10am -
Emergency
8am -
Outpatient
3500
7am -
Number of events
Inpatient
MDHB: US patient volumes by hour of examination and patient type,
2009/10 to 2011/12 combined (1)
1pm -
WhaDHB: US patient volumes by hour of examination and patient type,
2008/09 to 2011/12 combined (1)
9am -
9.9.6
Hour of examination
Radiology Landscape Report (18Nov13) FINAL.docx
27 March 2014
WhaDHB: US patient volumes by hour of examination and patient type,
2008/09 to 2011/12 combined (3)
100%
2%
100%
2%
14%
90%
MDHB: US patient volumes by hour of examination and patient type,
2009/10 to 2011/12 combined (3)
70%
60%
98%
99%
86%
99%
98%
97%
11pm to 8am
30%
5pm to 11pm
20%
8am to 5pm
60%
Percentage
Percentage
9%
24%
80%
70%
40%
5%
90%
80%
50%
3%
50%
95%
99%
91%
97%
40%
76%
30%
10%
11pm to 8am
5pm to 11pm
8am to 5pm
20%
0%
10%
0%
Inpatient
Outpatient Emergency Community All patients
Patient type
Patient type
US WDHB
US MDHB









Most patient types vary up and down by hour.
Just over half of all inpatients were seen between the three hours from 14pm, with another 19% seen in the hour from 11am - 12 noon.
86% of outpatients were seen in the 6 hours from 8am to 2pm.
Emergency patients vary up and down, but 30% were seen in the two
hours from 2-4pm.
Nearly 50% of community patients were seen in the three hours between
8am and 11am.
96% of patients (all categories) were seen between the hours of 8am and
4pm.
2% of patients (all categories) were seen between 5pm and 11pm. 14% of
emergency patients were seen over these same hours.
<1% of patients (all categories) were seen between 11pm and 8am.







27 March 2014
A third of inpatients were seen in the two hours from 10am to 12 noon,
with just over half of patients seen in the three hours from 1-4pm.
Outpatients peak in the two hours from 9-11am (35%) and again in the
two hours from 1-3pm (31%).
Just over half of emergency patients were seen in the three hours from 14pm, with another 23% seen in the two hours from 10am to 12 noon.
20% of community referred patients were seen in the hour from 5-6pm.
Other peaks are between 9-11am (29%) and 1-3pm (21%).
91% of patients (all categories) were seen between the hours of 8am and
5pm. Another 7% were seen from 5-6pm, of which 85% were community
referred patients.
This peak from 5-6pm was due to the employment of a locum.
9% of patients (all categories) were seen between 5pm and 11pm. 24% of
community patients were seen over these same hours.
<1% of patients (all categories) were seen between 11pm and 8am.
Radiology Landscape Report (18Nov13) FINAL.docx
Page 77 of 91
9.9.7
HOUR OF EXAMINATION – MRI
WhaDHB: MRI patient volumes by hour of examination and patient
type, 2008/09 to 2011/12 combined (1)
Inpatient
Outpatient
Emergency
Community
WhaDHB: MRI patient volumes by hour of examination and patient type,
2008/09 to 2011/12 combined (3)
100%
ACC
80%
1600
70%
1400
60%
1200
Percentage
Number of events
3%
90%
1800
1000
800
600
50%
40%
400
100%
100%
100%
100%
100%
11pm to 8am
30%
5pm to 11pm
20%
8am to 5pm
10%
200
0%
6am -
5am -
4am -
3am -
2am -
1am -
12am -
11pm -
9pm -
10pm -
8pm -
7pm -
6pm -
5pm -
4pm -
3pm -
2pm -
1pm -
11am -
12pm -
10am -
8am -
9am -
7am -
0
Hour of examination
Patient type
WhaDHB: MRI patient volumes by hour of examination and patient
type, 2008/09 to 2011/12 combined (2)
Inpatient
Outpatient
Community
ACC
MRI

Grand total
35%
Percentage within each hour
97%

30%
25%

20%
15%

10%
5%

6am -
5am -
4am -
3am -
2am -
1am -
12am -
11pm -
10pm -
9pm -
8pm -
7pm -
6pm -
5pm -
4pm -
3pm -
2pm -
1pm -
12pm -
11am -
10am -
9am -
8am -
7am -
0%
Inpatient volumes show a sharp peak in the two hours between 24pm, with just over 50% of patients seen in this time.
Two thirds of outpatient volumes were seen in the four hours from
8am to 12 noon.
23% of community patients were seen in the hour from 8-9am,
with another 43% also seen in the morning from 9am to 12 noon.
ACC patients are also morning heavy with nearly two thirds seen
between 8am and 12 noon.
Virtually all patients (all categories) were seen between the hours
of 8am and 5pm. 94% of patients were seen between 8am and
3pm.
Hour of examination
Page 78 of 91
Radiology Landscape Report (18Nov13) FINAL.docx
27 March 2014
9.9.8
OUT-OF-HOURS ACTIVITY IN DETAIL – CT
WhaDHB: Out-of-hours CT patient volumes by time period and
percentage change, 2008/09 to 2011/12
Year and % change
5pm-11pm 11pm-8am Total out of hours
2008/09
422
275
697
2009/10
474
109
583
2010/11
384
109
493
2011/12
397
73
470
Grand Total
1,677
566
2,243
% change 2009/10 to 2011/12 (3 years)
-16%
-33%
-19%
% change 2008/09 to 2011/12 (4 years)
-6%
-73%
-33%
WhaDHB: Weekend CT patient volumes and percentage change, 2008/09
to 2011/12
Year and % change
Saturday Sunday Total weekends
2008/09
194
219
413
2009/10
215
238
453
2010/11
202
195
397
2011/12
213
193
406
Grand Total
824
845
1,669
% change 2009/10 to 2011/12 (3 years)
-1%
-19%
-10%
% change 2008/09 to 2011/12 (4 years)
10%
-12%
-2%
27 March 2014
MDHB: Out-of-hours CT patient volumes by time period and percentage
change, 2009/10 to 2011/12
Year and % change
5pm-11pm 11pm-8am Total out of hours
2009/10
682
128
810
2010/11
393
121
514
2011/12
446
88
534
Grand Total
1,521
337
1,858
% change 2009/10 to 2011/12 (3 years)
-35%
-31%
-34%
MDHB: Weekend CT patient volumes by day of referral, 2009/10 to
2011/12 combined
Day referral
Day exam Monday Friday
Saturday Sunday Grand Total
Saturday
0
33
914
0
947
Sunday
1
1
25
770
797
Grand Total
1
34
939
770
1,744
MDHB: Weekend CT patient volumes and percentage change, 2009/10
to 2011/12
Year and % change
Saturday Sunday Total weekends
2009/10
397
298
695
2010/11
256
215
471
2011/12
294
284
578
Grand Total
947
797
1,744
% change 2009/10 to 2011/12 (3 years)
-26%
-5%
-17%
Radiology Landscape Report (18Nov13) FINAL.docx
Page 79 of 91
CT MDHB
CT WDHB





WhaDHB routine hours for CT are 8am to 4pm Monday to Friday.
CT volumes performed between 5pm and 11pm ranged from 384
to 474 across the four years.
CT volumes performed between 11pm and 8am ranged from 73 to
275 across the four years. Between 2008/09 and 2011/12 (four
years) volumes in this timeframe have decreased by 73%.
CT volumes performed on a Saturday ranged from 194 to 215
across the four years.
CT volumes performed on a Sunday have ranged from 193 to 238
across the four years.
Day of referral is not available for the majority of patient events, so
weekend CT patient volumes by day of referral is not presented.
9.9.9






MDHB routine hours for CT are 8am to 5pm Monday to Friday.
CT volumes performed between 5pm and 11pm ranged from 393
to 682 across the three years. Between 2009/10 and 2011/12
(three years) volumes in this timeframe have decreased by 35%.
CT volumes performed between 11pm and 8am ranged from 88 to
128 across the three years. Between 2009/10 and 2011/12 (three
years) volumes in this timeframe have increased by 31%.
CT volumes performed on a Saturday ranged from 256 to 397
across the three years.
CT volumes performed on a Sunday have ranged from 215 to 298
across the three years.
97% of CT volumes performed on a Saturday were referred on a
Saturday.
OUT-OF-HOURS ACTIVITY IN DETAIL – US
US WDHB
US MDHB








WhaDHB routine hours for US are 8am to 4 pm Monday to Friday.
US volumes performed between 5pm and 11pm ranged from 87 to
143 across the four years. Volumes varied up and down.
US volumes performed between 11pm and 8am ranged from 13 to
63 across the four years.
US volumes performed on a Saturday ranged from 117 to 459
across the four years. The lowest volumes were in 2011/12.
US volumes performed on a Sunday ranged from 88 to 212 across
the four years. As for Saturday the lowest volumes were in
2011/12.
Day of referral is not available for the majority of patient events, so
weekend US patient volumes by day of referral has not been
analysed.
Page 80 of 91




MDHB routine hours for US are 8am to 4.30pm Monday to Friday.
US volumes performed between 5pm and 11pm ranged from 402
in 2009/10 to 1,305 in 2011/12. 83% of the 1,305 volumes in
2011/12 were performed between 5 and 6pm.
US volumes performed between 11pm and 8am ranged from 1 to 6
across the three years.
US volumes performed on a Saturday ranged from 37 to 316 across
the three years.
US volumes performed on a Sunday ranged from 19 to 25 across
the three years.
24% of US volumes performed on a Saturday were referred on a
Saturday.
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27 March 2014
9.9.10 OUT-OF-HOURS ACTIVITY IN DETAIL – MRI
MRI WDHB
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

WhaDHB routine hours for MRI are 8am to 4 pm Monday to Friday.
Fewer than 10 MRI volumes each year were performed between
the hours of 5pm and 11pm, between 11pm and 8am, and on a
Sunday across the four years.
MRI volumes performed on a Saturday ranged from 1 to 68 across
the four years.
9.9.11 DHB PROVIDED FACILITIES
Whanganui has plain film x-ray facilities in Raetihi and Taihape with the
main medical imaging services provided by Whanganui Hospital
27 March 2014
MidCentral has their main medical imaging facilities at the Palmerston
North Campus. MRI is contracted to Broadway Radiology based on the
Palmerston North campus. Community refereed plain film services
provided under contract in Dannevirke and Levin.
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9.9.12 DHB PROVIDED CURRENT EQUIPMENT, HOURS OF OPERATION, VOLUMES AND STAFFING
Whanganui
MidCentral
Breast Radiology
Nil
Nuclear Medicine and PET CT
Nil
Breast Radiology
08:00 to 17:00 Monday to Friday
Nuclear Medicine and PET CT
Nuclear Medicine Hours of operation 0800-1600 Monday to Friday. On call
outside these hours.
Staffing – 3 FTE made up of 5 staff. Two staff members have a dual SOP working
in Nuclear Medicine and Radiology on a 10 week rotation.
1 FTE Nuclear Medicine Physician
Physician cover provided by radiologist
Siemens E Cam Dual Head Gamma Camera, installed 2000
Siemens SPECT/CT Symbia T16, installed 2013
Referrals from GPs, OP, IP, ED, Wanganui, Taranaki
Throughput:
 2012/13 2352
 2011/2012 2184
 2010/2011 2300
Minimal on call
Ultrasound
 0800-1630 Monday to Friday
 Staffing: 2.69 (2.2 budget) sonographers. 1.12 administration (budget 1.0)
 Philips, iU22 iE33 Logiq E9
o 9 years old, business case has been approved to replace this
asset
 GE, IU22, 5 years old
o Good condition
 GE, Logiq E9
o 3 years old, requires upgrade
 Facilities are good
 Referrals: ED, inpatients, outpatients, GPs, midwives
 3,272 booked patients, 2,988 urgent and 229 call outs in past year. Lower
volumes than normal due to sonographer leave.
 Reporting times average 2.8 days
Ultrasound
Information below is exclusive of Cardiac US service offered which is a component
of Cardiology
 0800- 1630 Monday to Friday
 On call service provided by Registrars and radiologists
 On call work is approximately 1% of all departmental call outs
Staffing :
o 1.7 FTE Qualified sonographers
o 3 Student sonographers
o 1 FTE qualified sonographer vacant
o 1 FTE booking clerk/Receptionist
Equipment in Medical Imaging:
 Philips iu22 purchased 2013
 Philips Sparq purchased 2013
 Philips iu22 purchased 2009
Equipment in WHU
 Philips iu22 purchased 2009
 Philips Clearvue 650 purchased 2013
Page 82 of 91
Radiology Landscape Report (18Nov13) FINAL.docx
27 March 2014
Whanganui
General X-Ray
Raetihi
 Normal service 0800-1600 Thursdays
 Shimadzu equipment (plain film)
 > ten years old processor end of life and urgent need of replacement
 Facilities Ok but old
 Referrals mainly ex GPs and orthopaedic
 800 examination per year
 Reporting times approximately two weeks
Taihape
 Normal service 0800-1600 Tuesdays and Fridays
 Philips, Bucky diagnostic floor system (plain film)
 >10 years old, processor end of life and urgent need of replacement
 Facilities Ok but old
 Referrals mainly ex GPs and orthopaedic
 1568 examinations per year
 Reporting times approximately two weeks
Whanganui
 Normal service 0800-2100
 Siemens, AX multi top (2), 1 in ED and 1 in main department
27 March 2014
MidCentral
Referrals accepted from ED, IP,OP GP
O&G work in Medical Imaging for 1 session (4 hours) per week.
No leave cover available for this, radiologist fills gaps
Throughput:
 2012/13 9598 (2869)
 2011/2012 8034 (2289)
 2010/2011 8021 (2667 O&G)
- Average Medical Imaging list (4 hours) 20 examinations
- Average O&G list (4 hours) 10 examinations
- All examinations are reported during the same session or next day
- MOU with Tararua Health group. MCH has access to the US machine for 2
days per week and MCH reports THG US examinations.
- Waiting times exceed 6 months for some examinations
- DNA rate around varies between 4-7%, greatest number of DNA is O&G
examinations
General X-Ray
 0800 – 1630 Monday to Friday
 GP access Monday 11-4, Tues and Friday 0830-1600, Wed and Thurs
0930-1600. On Demand service, appointments are not made
 24 hour service offered with shifts to cover out of hours Mon to Fri
o 1200-1930hrs
o 1500-2230hrs
o 1600-2330hrs
o 2330-0730hrs
 Weekends are covered by above shifts but also:
o 0730-1500
o 0830-1630
 One person is available on back up call for all out of hours work. This can
be covered by a third year student.
 Staff rotate through all areas of general and can work in CT, Fluoroscopy
or DSA during the day as well.
 6 general x-ray rooms
 1 additional general x-ray room empty with no equipment
Equipment:
 Room 2 Philips – CR purchased 2005
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Page 83 of 91
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Whanganui
9 years old, good condition
Facilities in main department are new and Ok but starting to get scruffy.
Facility in ED is small and inadequate.
Referrals: ED, inpatients orthopaedic, GP's, Physiotherapists, osteopaths,
chiropractors, private providers
16,632 walk in community referral patients and 11,332 ED and inpatient
examinations
ACC examinations 7,648 p.a.
Reporting times average 3.4 days
CT

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Normal service 0800-1600 Monday to Friday. Urgents 24/7
GE, Lightspeed 16 slice
4 years old in good condition. Scheduled replacement 2017/18
Facility space is good with the scan room of adequate size but control
Page 84 of 91
MidCentral
 Room 3 Philips – DR purchased 2007, upgraded 2013
 Room 6 Philips – DR purchased 2013
 Room 10 Philips – CR purchased 1999 – also used for IVUs
 Mobile Image Intensifier – GE Purchased 2005
 Mobile Image Intensifier – Siemens Purchased 2007 (image quality
degrading faster than expected)
 Mobile Philips – purchased 2003
 Mobile Philips – purchased 2008
 Mobile Shimadzu Purchased 2010
Throughput:
 2012/13 Total 58020
o GP 10757
o ED 25667
o IP 9871
o OP 11713
o Other DHBs 12
 2011/2012 Total 54708
o GP 10220
o ED 23575
o IP 9692
o OP 11204
o Other DHBs 17
 2010/2011 Total 53018
o GP 9580
o ED 23015
o IP 9303
o OP 11102
o Other DHBs 18
Reporting varies month to month but routine examinations can exceed 5
working days. Average was 3 days for August 2013
CT
Service 0800-1630 hrs Monday to Friday. On call outside of these hours.
 On call service supported by Registrar, SMO and MRT
 8 MRTs participate in MRT call roster
 Siemens Somaton Definition AS Purchased 2013
Radiology Landscape Report (18Nov13) FINAL.docx
27 March 2014
Whanganui
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room too small
Staffed 4.08 MRTs who rotate through department as well. 1 nurse
shared with rest of department and 1 administrator shared with MRI
Roster: 2 MRTs 0800-1600 Monday to Friday
On call: weekdays 1600-0800, weekends 24/7
Referrals: ED, inpatients, outpatients, GP's
2,238 booked patients, 1,320 ED patients and 813 call out patients in last
year
ACC examination approx. 86 per year
Reporting times average 2.9 days
DNAs 129 in past year
MRI
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Normal service 0800-1600 Monday and Friday, 0700-2100 Tuesday to
Thursday
Siemens, magnoton mistro class
9.5 years old, good condition but due for upgrade
Facility space is good and appropriate
Staffed 4.22. 4 MRTs rotate through general as well. 1 nurse shared with
rest of department and 1 administrator shared with CT
Referrals: ED, inpatients, outpatients
Roster: 2 MRTs per shift. Mon and Fri 0800-1600 Tue-Thu early shift
27 March 2014
MidCentral
 Usually have 3 FTE MRTs rostered but this can drop to 2 FTE MRT if short
staffed and with training will be 2 qualified MRTs, 1 trainee.
 1 FTE Radiographic Assistant
 1 FTE (minimum) nursing FTE
Throughput:
 2012/13 Total 9529
o GP 63
o ED 2770
o IP 2651
o OP 4011
o Other DHBs 34
 2011/2012 Total 8090
o GP 46
o ED 1843
o IP 2691
o OP 3478
o Other DHBs 32
 2010/2011 Total 7418
o GP 15
o ED 1669
o IP 2478
o OP 3233
o Other DHBs 23
 All examinations are reported during the same session or next day
 DNA rate less than 1%.
MRI

Subcontracted to Broadway Radiology
 MCH subcontracts radiologist services (3 radiologists) to Broadway to
assist with reporting of examinations. Individual radiologists have a
direct arrangement with Broadway to provide assistance with on call out
of hours.
 Throughput:
o 2012/13 3794
o 2011/2012 3386
o 2010/2011 2904
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Page 85 of 91
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Whanganui
0700-1430 late shift 1330-2100
No on-call roster. 6 life or limb call outs ion past year.
2,428 booked patients, 195 ED referrals and 2,925 examinations p.a.
ACC examinations 1,066 p.a. but likely to increase with extended MRI
hours
Reporting times 5 days
DNAs 95 in past year
DSA
Nil
Bone Densitometry
Nil
Medical Photography
 No formal medical photography service
Page 86 of 91
MidCentral
DSA
 Service 0800-1630 hrs Monday to Friday. On call outside of these hours.
 On call service supported by SMO, MRT and Nurse
 1 interventional radiologist works 2-3 sessions per week.
 Utilised by Gastro for 1 session per week
 4 MRTs participate in the on call roster
 Equipment –Philips Allura Xper FD 20 Purchased 2013
 1 MRT usually rostered to this area, but need 2 FTE.
 Equipment shared with Cardiology 3-4 sessions per week
 Registrars participate in many examinations in this area.
• Throughput:
o 2012/13 746
o 2011/2012 685
o 2010/2011 639
Fluoroscopy
 Service 0800-1630 hrs Monday to Friday.
 Registrars carry out 1 session of Barium Examinations per week
 MRT carries out 1 Barium examination session per week
 Equipment – Philips Omnidiagnost Purchased 2003. Works well but is
old technology
 Throughput:
o 2012/13 1138
o 2011/2012 1117
o 2010/2011 929
Bone Densitometry
Nil
Medical Photography
 Clinical photography has grown from 200 patients in 2009 to over 400
Radiology Landscape Report (18Nov13) FINAL.docx
27 March 2014
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Whanganui
Digital cameras in ED and Theatre available for clinical staff use
Ophthalmology scans and photography done by nursing staff in
outpatient area
Key issues – patient confidentiality through uncontrolled use of personal
cameras and phones
RIS/PACS
 Carestream PACS/RIS
 1 year old
 0.44 MRT staffing
Staffing Non Modality Specific
 MRTs: 18.14 (18.25 budgeted)
 Nursing: 1 (1.03 budgeted)
 Administration 7.2 (5.93 budget)
 Roster: CT/MRI/US work 08-1600, General x-ray runs from 0800-2100
with only 1 MRT from 1800-2100 (extended MRI hours in 2013. 3 Long
days per week)
 On call: CT on call from 1600 – 0800, 24/7 at weekends. General call
Monday to Friday: 1st 2100 - 0800 2nd 1800 - 2100 only 1 person on
over-night. General call weekends 1800 - 0800 2nd call 24/7. U/S same as
CT but not a reliable service very adhoc
MidCentral
projected for 2013
Over 3,000 ophthalmology patients scans/photography projected for 2013
20-30 other photography jobs in a typical year
Resourced at 1.0 FTE staff photographer and 0.2 contracted photographer
Good facilities and equipment
Key issues - patient confidentiality through uncontrolled use of personal
cameras and phones and conflict in time management of unscheduled
ophthalmology work vs clinical photography work
RIS/PACS
 Carestream RIS/PACS implanted 2009
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TABLE 14: SERVICES; DHB PROVIDED
27 March 2014
Radiology Landscape Report (18Nov13) FINAL.docx
Page 87 of 91
9.9.13 PRIVATE PROVIDED CURRENT EQUIPMENT, HOURS OF OPERATION, VOLUMES AND STAFFING
Modality
Broadway Radiology
X-ray@ The Palms
Other
Palmerston North
Service Comment
Note: film read contract with an
Auckland Radiology firm.
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Breast Radiology
Nuclear Medicine and PET CT
Ultrasound General and Women’s
Mammo GE unit Broadway
Mammo GE Unit PMI
Screening Room Toshiba
Broadway
Nil
Pacific Radiology provide radiologist
service to Whanganui DHB – two days
per week and an offsite reporting
service, which complements the 1FTE
staff radiologist
Nil
Nil
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IU22 machines = 4 units
Philips CX Portables
=2
units
Nil
Tararua Health Group provide some
ultrasound services to MDHB patients
as well as Tararua private referrals

General X-Ray

Broadway
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Broadway Philips plain film
room
CR readers/units (plain &
mammo)
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City X-Ray
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Philips plain film room
CR readers/units
Mobile X-Ray
Page 88 of 91

X-Ray only (no mobile, no
fluoroscopy).
0900 - 1800 Mon - Fri 1430 1630 Sat
Phillips, Bucky v table – very
good condition, 7 years old due
for replacement 2015
Referrals: GP's,
Physiotherapists, Chiropractors
2,051 patients, 112 urgent and
166 call outs
Revenue 75% ACC, 25% patient
co-payment
Radiology Landscape Report (18Nov13) FINAL.docx
Turoa and Whakapapa

3,000 (approx.) general x-ray
(digital)
Dannevirke

General X-Ray service as part
of community referred
radiology service
27 March 2014
Modality
Broadway Radiology
X-ray@ The Palms
Other
Palmerston North
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Fuji unit
Horowhenua
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Horowhenua Philips overhead
bucky room
CR readers/units
MRTs 80 hours per week
Community referred radiology
service
1.3 MRT
Roster: 1 fulltime, 1 part time
Call: on call weekends 09001800
Progressive Medical Imaging
Wanganui
CT
27 March 2014
 Mon to Fri 0830-1700
 Small patient volume
 PMI Toshiba plain film room
 CR readers/units
 Referrals: private
 Lease renewal due
 Mon-Fri 0800 to 1700
 Staffing: 4 MRTs rotate through
 Roster dictated by radiologist
availability
 No call out
 Philips, Brilliance 16 slice CT +
console/monitor, 3 years old,
excellent condition
 Facilities excellent
 Referrals: DHB & Private. Some
ACC
 Not fully utilised
 All patients booked, no call out
 Reporting: usually same day,
Nil
Radiology Landscape Report (18Nov13) FINAL.docx
Page 89 of 91
Modality
Broadway Radiology
X-ray@ The Palms
Other
Palmerston North
max 48 hours
MRI
Central MRI
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Bone Densitometry
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Page 90 of 91
Nil
Mon -Fri 0700 to 1900
On call Mon-Fri from 1900 to
2200. Weekends & stat
holidays 0800 to 2200
MRTS 224 hours per week
GE, 1.5T, 13 years old,
excellent condition
Referrals: private, ACC, DHB,
insurance
All patients booked, no walk
ins.
2-3 urgent examinations per
day
1-2 call outs per month
Reporting: within 5 working
days for normal and same day
for urgent
DNAs are generally DHB
outpatients
Mon-Fri 0800-1700
Staffing: included in Broadway
roster
No on call
Norland EXCELL DEXA scanner
Referrals: DHB,
private/insurance
Patients all booked, no call out
Referral patterns: fickle
Reporting: 48 hours maximum
Nil
Radiology Landscape Report (18Nov13) FINAL.docx
Nil
27 March 2014
Modality
Broadway Radiology
X-ray@ The Palms
Other
Palmerston North
RIS/PACS
Staffing Non Modality Specific
PACS with PN hospital connection
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Radiologists 70 hours per week
Admin 156 hours per week
Reception 332 hours per week
MRTs 247 hours per week
Sonographers 173 hours per
week

Mini PACS with PN hospital
connection
Not applicable
TABLE 15: PRIVATELY PROVIDED SERVICES
27 March 2014
Radiology Landscape Report (18Nov13) FINAL.docx
Page 91 of 91