Download Medical Imaging Services

Background paper 12: Medical imaging services
Current services
The Townsville Hospital Medical Imaging Service provides specialist diagnostic and
interventional imaging services. The service provides tele-radiology services across
six other district facilities with plans for further expansion. Specialist medical imaging
services include:
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Computed tomography (CT)
Magnetic Resonance Imaging (MRI)
nuclear medicine and ultrasound
diagnostic imaging and on site reporting services
radiology procedures including gastro intestinal studies, arthrograms and
line placements
image guided procedures (all modalities) including biopsies and drainages
imaging support for non radiology procedures for endoscopy, operating
theatres, pain clinic and other services
interventional procedures including Digital Subtraction Angiography (DSA)
consultation and specialist advice.
Medical imaging services are also embedded in the Emergency Department, Cancer
Centre and outpatients areas.
The Medical Imaging Service was a trial site for the introduction of the Radiology
Imaging System (RIS) and has fully implemented the Picture Archive and
Communication System (PACS).
Current and future demand
Current services
An analysis of patient attendances 1 in 2007/08 indicates that the referral base for
medical imaging services is largely derived from the Emergency Department (30%),
medical (23% excluding oncology) and surgical services (28%), as shown in Table 1.
The ‘other’ category relates to referrals from service providers such as general
practitioners.
The Surgical Institute is the largest user of magnetic resonance imaging, II Group
and angiography services. The Emergency Department is the largest user of CT and
plain x-ray services.
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An attendance is defined as:
A patient visit to the imaging service for which a specific request for imaging has
been referred.
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May include multiple examination requests on the same modality request.
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The attendance may include more than one return into the imaging facility.
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Page 1 of 6
Table 1: Attendance numbers by source of referral (Clinical Institutes), 2007/08.
Emergency
Department
Medicine
Oncology
9
88
6
315
0
6
<5
0
<5
<5
20
0
0
3455
71
2989
1291
2646
137
608
35
<5
523
209
473
103
77
8
0
223
<5
1608
<5
<5
156
20
677
317
1367
127
198
17
<5
1091
418
401
47
248
0
0
<5
201
0
<5
0
19,184
1053
10,300
1291
14,583
1716
1730
1198
19
2791
365
1468
4374
850
24,063
1166
18,618
4090
22,825
6497
3701
30%
1%
23%
5%
28%
8%
5%
Angiography
Breast
Imaging
CT Group
Digital
Fluoroscopy
II Group
MRI Group
Nuclear Med
PET
Plain X-Ray
Ultrasound
Total
Women’s
&
Children's
Primary
&
Mental
Health
Care
0
% of MI
attendances
Surgery
Other
Source: Queensland Radiology Information System (QRiS), The Townsville Hospital.
Note: Positron Emission Tomography (PET) images are imported from Royal Brisbane Hospital PET
service & private providers.
Total demand for medical imaging services at The Townsville Hospital indicates an
annual average growth of six per cent per annum from 2003/04 to 2007/08 (Table 2).
The greatest number of attendances over the last five years has been for mobile and
plain x-ray, ultrasound and CT services. The largest annual average growth in
services has been for digital fluoroscopy (21% per annum), CT (20% per annum) and
the angiography group (18% per annum).
Table 2: Medical imaging attendances 2003/04-2007/08
Medical imaging
service
2003/04
2004/05
2005/06
2006/07
2007/08
Average %
change per
annum
Angiography
245
229
262
327
424
18.3%
Digital fluoroscopy
774
747
903
1031
1421
20.9%
Nuclear medicine
1644
2012
2022
2378
2224
8.8%
MRI
3240
3219
3604
3081
n/a
-1.6%
CT
6195
6477
7786
9755
11,195
20.2%
Ultrasound
9007
8976
10,144
10,663
11,064
5.7%
II Group
1211
1217
1373
1658
1843
13.0%
Mobile & plain x-ray
40,735
43,354
46,871
50,438
49,854
5.6%
Total
63,051
66,231
72,965
79,331
78,025
5.9%
Source: Hospital Based Corporate Information System imaging module (2003/04-2005/06) and the
Queensland Radiology Information System (QRiS) (2006/07-2007/08), Medical Imaging Department,
The Townsville Hospital.
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Emergency Department activity
Demand for medical imaging services from the Emergency Department indicates an
average annual growth of 5.9 per cent per annum since 2003/04; however over this
period MRI services have increased by an annual average of 74 per cent and CT
services by an annual average of 23 per cent (Table 3).
Table 3: Emergency Department attendances for medical imaging, 2003/04-2007/08
Medical imaging
services
2003/04
2004/05
2005/06
2006/07
2007/08
% change
average
per annum
16,263
18,083
19,495
18,739
19,068
4.3%
1780
1879
2442
3227
3438
23.3%
38
45
94
124
150
73.7%
1157
1078
1467
1454
1194
0.8%
XF-fluro procedures
23
15
21
25
29
6.5%
Nuclear medicine
94
111
107
54
16
-26.4%
19,355
21,211
23,626
23,623
23,895
5.9%
Plain and mobile x-ray
CT Scan
MRI
Ultrasound
Total
Source: Hospital Based Corporate Information System imaging module (2003/04-2005/06) and the
Queensland Radiology Information System (QRiS) (2006/07-2007/08), Medical Imaging Department,
The Townsville Hospital.
Projection methodology
Details of the projection methodologies, data sources and assumptions are included
in Appendix 1: Projection methodology and assumptions.
Projected demand
Future demand for medical imaging spaces was estimated using projected
separations through aIM and Victorian Normative Benchmarks, which assume 1.5
attendances per separation and 1.2 examinations per attendance (Table 4).
Table 4: Projected requirements for medical imaging services, 2011/12 and 2016/17
2011/12
2016/17
Total separations*
56,210
70,794
1.5 attendances per separation
84,315
106,190
101,177
127,428
5,500 examinations per room
18.4
23.2
Rooms at 85% productivity
21.6
27.3
1.2 examinations per attendance
*aIM projection of separations. Note: 5,500 examinations/ year/ room is based on an average 30 mins
per examination, 50 weeks per year, 55 hours per week.
Table 5 presents the projected demand for all medical imaging service spaces,
including all embedded services, CT and x-ray.
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Table 5: Projected total medical imaging space requirements to 2016/17
Current
space 2008
Projected
spaces
20011/12
Additional
to existing
2011/12
Projected
spaces
2016/17
Additional
to existing
2016/17
CT#
2
3
1
4
2
SPECT/CT
2
3
1
4
2
PET
0
1*
1*
1*
1*
MRI
1
2
1
2
1
X-ray
4
9
5
10
6
Fluoroscopy
1
1
0
1
0
Ultrasound
4
6
2
8
4
OPG
1
1
0
1
0
Digital Subtraction
Angiography
1
2
1
2
1
Bone densitometry
0
1
1
1
1
16
27
11
33
17
Description
TOTAL
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Includes Cancer Centre CT. *Service to be developed with private sector, site to be determined.
Of the medical imaging spaces in Table 5, 1 CT facility will be required for immediate
access by the Emergency Department, and two x-ray spaces will be required in the
Emergency Department (Table 6). Associated holding bay and recovery spaces will
be required to support these services.
Table 6: Recommended medical imaging spaces for the Emergency Department
2016/17.
Projected
20011/12
demand
Emergency
Department
Hours of
operation
Plain x-ray
24 hr/7 day
17,520
22,089
CT scan
18 hr/7 day
11,680
5352
Benchmark
Projected
20011/12
spaces
Projected
2016/17
demand
Projected
2016/17
spaces
1
25,222
2
1
7684
1
Source: Planning and Coordination Branch Data, Analysis and Resources Team 2008.
Service issues and strategies
Medical imaging service issues
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Additional medical imaging facilities will be required to support the projected
activity to 2016/17 including two CTs, six x-rays, four ultrasounds, an MRI,
digital subtraction angiography and a bone densitometry facility.
The Queensland Statewide Cancer Treatment Services Plan 2008-2017 has
recommended that a PET service be established at Townsville Hospital within
two to five years. The private sector has expressed an interest in establishing
this service. The site of the service is still to be determined.
Workforce shortages have curtailed digital subtraction angiography services.
This has resulted in an increase in patient transfers to Brisbane for this
service.
The current space for digital subtraction angiography services has very
limited recovery and preparation areas.
The gamma camera equipment required for nuclear medicine services is due
for replacement with a Single-Photon Emission Computed Tomography
(SPECT/CT).
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Cone beam CT equipment has been requested for an expansion of the faciomaxillary surgical service.
Widely used bone densitometry equipment is not available for the early
detection of osteoporosis.
A digital swallowing workstation and Kay Pentax Stroboscopy Unit has been
requested to support the speech pathology service.
The Australasian College for Emergency Medicine Guidelines for Emergency
Department Design (March 2007) indicate that a medical imaging unit be
dedicated to the imaging of Emergency Department patients.
Strategies
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Provide additional facilities for ultrasound, bone densitometry, digital
subtraction angiography service by 2011/12.
Provide additional CT service by one machine to a total of three including
oncology by 2011/ 12.
Provide additional MRI service by one machine to a total of two by 2011/12.
Upgrade the nuclear medicine service equipment with a SPECT scanner.
Ensure sufficient space is allocated for additional medical imaging services in
the revised Master Plan including space for holding and recovery bays, and
scrub areas.
Explore public private partnerships for medical imaging services, particularly
for PET service.
Move some medical imaging to the catheter lab for procedures such as
percutaneous intravenous catheter line insertion.
Explore a public private partnership for the expansion of the facio-maxillary
surgical service.
Establish a medical imaging unit with CT and X-Ray equipment dedicated to
the imaging of Emergency Department patients.
Ensure that the Emergency Department has access to MRI, ultrasound and
nuclear medicine modalities as well as use of a PACS system.
Support the northern region medical imaging services by enhancing teleradiology services at The Townsville Hospital.
Collaborate with the Short Stay Unit to plan for short stay medical imaging
patients.
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Appendix 1 – Projection methodology and
assumptions
Data sources
Projected separations were sourced from the aIM tool.
Data for attendances and examinations was provided by the Medical Imaging
Department of The Townsville Hospital, October 2008. In 2006/07, the Medical
Imaging Department replaced the Hospital Based Corporate Information System
(HBCIS) imaging module with the Queensland Radiology Information System (QRIS).
Data was sourced from both systems for this review.
Data anomalies
The changeover in systems (HBCIS to QRIS in 2006/07) resulted in some coding
changes for counting examinations at The Townsville Hospital. Examples of this
coding change:
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Significant variation in nuclear medicine data in 2007/08 which relates to new
exam catalogue, eliminating duplication of exam codes for attendances.
A number of "Multi" exam codes were introduced which incorporated three to
four individual exam codes into a single (one) code used for all studies eg Ct
Trauma = Ct Chest +CT Abdo + CT Pelvis.
Magnetic resonance imaging numbers (total) declined significantly in 2007/08
due to issues with the change over of system (see above).
Assumptions
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Medical imaging services embedded in the Emergency Department, Cancer
Centre and outpatient areas have been included in the total medical imaging
attendances for The Townsville Hospital and therefore the space projections
for the medical imaging service. (Table 5).
Plain and fixed x-ray attendances have been reported in most tables as a
combined figure.
Flow analysis and future changes to models of care have not been accounted
for within the projection methodology.
As medical imaging technology is continually changing, planning for future
services should be revised in line with major changes to practice and
technology.
Future separations for medical imaging services have been projected using
the acute Inpatient Modelling (aIM) program (Table 4).
Medical imaging spaces have been calculated using the Victorian Department
of Human Services, Capital Development Guideline 1.4, Hospital Capital
Planning Benchmarks: Volume 2 (2008). Ultrasound projections were
adjusted to reflect current activity at The Townsville Hospital.
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