Adapt and advance care

Change is the only constant, as the saying goes. Those who are able to adapt, especially in the ever-shifting world of healthcare, will be the ones to have the most success in the future.

Take Brigham and Women’s Hospital (BWH) in Boston. This week, a review of BWH’s emergency radiology response following last year’s Boston Marathon bombings was published in Radiology and showed a number of ways that the hospital has adapted since the terrible events of that day.

While BWH was able to use an “all hands and all imaging equipment on deck” approach to speed CT exam turnaround times during the mass casualty event, x-ray turnaround times actually lagged behind typical emergency response times. The problem, it turns out, was a bottleneck created by the use of conventional radiography portable x-ray machines relying on a single x-ray plate readout device. BWH has since replaced these portable x-ray units with digital radiography equipment featuring wireless image transfer to immediately send images to the PACS.

BWH also adapted its system for handling unidentified patients. Since merely classifying a patient as “unidentified” on an imaging order led to lots of duplicate requests during the hectic hours following the bombings, a new identification system was devised that labeled patients by gender along with a unique color and number—Crimson Male 12345, for example.

Obviously, the marathon bombings were an extraordinary event, but adaptations in radiology on a smaller scale can still improve care. Say there is a late-night CT scan for suspected appendicitis, but the interpretation from the on-call radiologist is inconclusive. What’s the next step? In a pinch, it may be possible to conduct a mobile consultation using a smartphone to interpret the CT images. Researchers from Seoul National University Bundang Hospital found that a mobile interpretation offered similar diagnostic performance to in-house reports when a preliminary diagnosis of appendicitis from on-call radiologists is inconclusive.

One adaptation that radiology has yet to make, however, is to improve diversity in the specialty. While the U.S. population is changing and the percentage of Asian, Hispanic and black Americans will double or triple by 2050, progress in diversifying medicine has been disappointing, according to an article from the American College of Radiology Commission for Women and General Diversity.

Radiology lags behind many of the other specialties in this area. Of the top 20 largest Accreditation Council for Graduate Medical Education training programs, diagnostic radiology ranks 18th among trainees classified as underrepresented minorities. The specialty is ranked 17th for representation of women in the top 20 programs.

Diversity in the radiology workforce should be a top priority. Promoting increased diversity of experiences among health imaging professionals can only lead to a wider array of perspectives on the issues and would improve cultural competence, creating a more positive experience for patients.

-Evan Godt
Editor – Health Imaging