Subspecialty Reading Services: Quality Reads Peace of Mind 24/7
 ProScan radiologists and fellows discuss cases in their Cincinnati, Ohio, “West Wing” reading room.

With the emergence of advanced imaging capabilities for MRI, multidetector CT, SPECT/CT and PET/CT, the demand for subspecialty expertise for radiology reading has skyrocketed over the last few years. In fact, the use of radiology has tripled since 2003. Clinicians are now looking for more precise, high-quality, in-depth reports for better diagnoses within 24 hours.

Teleradiology service providers are shining a light at the end of the tunnel. In addition to providing “nighthawk” hours, or after-hours support, many vendors have expanded their service offerings to include fellowship-trained, board-certified radiologists in areas such as neuroradiology, CT virtual colonoscopy and orthopedics who can deliver detailed reports in a matter of minutes, rather than days or even weeks, in a multitude of subspecialties. More radiology departments and groups are turning to reading services providers for subspecialty expertise than ever before.

Demand for expertise 24/7

Radiologic Associates is a 20-radiologist group comprised of Hudson Valley Imaging, Orange Regional Medical Center and St. Luke’s Cornwall Hospital, which serves Orange County and the Hudson Valley area in New York. Two years ago, the company—which had contracted with the full-service teleradiology provider Imaging On Call (IOC) for after-hours support—determined it needed more than routine “nighthawk” coverage.

The group needed to expand their coverage to keep up with the increased demand from referring clinicians for expertise in neuroradiology cases, according to Joseph F. Yacovone, MD, president of the Middletown, N.Y.-based practice. The practice performs approximately 350,000 to 400,000 imaging procedures per year.

Offering after-hour support for that expertise, however, raised concerns over the level of quality of the reads, says Yacovone. “The bar has been raised quite a bit as to the quality of readings during off-time hours,” he says. “We have to be as accurate as possible with every single reading whether it is done at 2 p.m., 6 p.m. or 3 a.m.—we cannot afford to make a mistake.”

Yacovone says that the difficulty is that “when people are on call, obviously not every one is trained in a subspecialty area such as neuroradiology, body CT, musculoskeletal imaging or interventional imaging.” Because of that, when the practice does have a particularly difficult neuroradiology case, they have someone from IOC with  neuroradiology expertise to rely on.

“The main value [to that] is peace of mind for the people in my practice,” he says. “We know that we won’t be put on the spot in an uncomfortable situation, having to make a serious decision when we are not subspecialty trained in that area. If you have a body CT [radiologist] on call and he or she is put in the difficult position of making a decision on whether a child goes to the OR for a head or neck or neuropathology case, it is nice to know that that there is a subspecialty neuroradiologist available who can provide report within 30 minutes, depending on the study. It is that peace of mind that you can provide quality services around the clock.”

Staying ahead of the competition

The reason PremiereScan, a privately-owned single-center imaging facility in San Jose, Calif., chose teleradiology provider Virtual Radiologic for subspecialty expertise in virtual colonoscopy 24/7 was to gain a competitive position in the market. 

“We are a physician referral-based company and we noticed other imaging centers were offering virtual colonoscopy,” said Sheila Galuppo, sales and marketing director at PremiereScan. “It has the support of [clinical] studies, the medical community and the technology has improved so much over the next few years that virtual colonoscopy is going to become more mainstream, which is why we wanted to offer our community an expert on the subject.”

Galuppo says that the Minneapolis-based teleradiology provider gives the company exclusive access to one subspecialty, fellowship-trained radiologist for virtual colonoscopy—which sets them apart from local imaging centers offering the service.

“Offering exclusive subspecialty expertise makes us very marketable because we are providing a service that may not be provided by a center down the street,” Galuppo says.

The demand for quality care

Black Hills Surgery Center in Rapid City, S.D., is a 26-bed specialty hospital with seven operating rooms that offers state-of-the-art imaging services including 3T MRI and 64-slice CT.  With 10 radiologists on staff for a department that performs approximately 6,000 to 7,000 imaging studies per year, the center uses subspecialty radiologists from ProScan to deliver high-quality reads to its providers, says William May, CEO and general counsel for the center. 

“We rely on subspecialty radiologists to have specific expertise in the imaging that our referring providers are requesting,” he says. “For example, we do a lot of orthopedic procedures at our hospital and we find the subspecialty trained radiologists at ProScan have specific expertise in bone and joint disorders as well as in the spine to provide quality reporting.”

“The main value-added benefit for us is that we live in western South Dakota with close to 100,000 people, which is big for South Dakota, but is not big for a lot of other places in the country. Through teleradiology, we are able to get some of the most highly-trained radiologists in the world to read our interpretations,” says Mays. “That is the biggest benefit it has provided—getting subspecialty expertise out here in western South Dakota. We think that adds a lot of benefit in terms of the quality of care we provide.”

Since quality was the main driver for making the move to teleradiology, May says it was important to interview several different organizations before choosing ProScan. “By traveling to the company’s locations, interviewing staff and customers, we were able to get a sense of how each vendor performed. After much research and much discussion, we went with ProScan because we thought they would be able to provide us with the optimal mix of quality subspecialty interpretation and quick report turn-around that is important to us.”

May says that turn-around time for subspecialty reads depends on how a study is categorized. “It’s typically 24 hours for a routine read; if you want to do a STAT read it’s 6 to 8 minutes; a wet read is usually called back within 10 to15 minutes from the time they receive the interpretation. If any provider has questions about the study, the ProScan radiologist will get on the phone within a matter of minutes, if necessary,” he says.

For anyone considering subspecialty reading services, May says it is important to do some field research. “Make sure you have an opportunity to go to their city, see where they work and meet as many radiologists as you can. Try to get a handle on what their customer service philosophy is, find out what their turn-around times are and how often they hit their turn-around times—in other words, are they consistently delivering on their promises? And of course, interview other clients of the firm to determine their level of satisfaction by asking tough questions about how things work and how responsive the company was in fixing any problems,” he says.


As subspecialty reading services continue to gain in popularity and acceptance in response to the increasing demands from specifically trained radiologists, many hospitals and imaging centers are looking to remote reading and teleradiology providers to provide quality, in-depth expertise on their terms. Whether a radiologist is on-site or in another state will not be an issue when the focus is on competency, quality and availability.