Radiology practices and departments that intend to offer coronary CT angiography (CCTA) need to consider how the additional exam volume and time commitments created by CCTA studies will affect their operations and their staffing models. Will they need to hire additional radiologists, nurses, and/or technologists to manage the extra workload? Who will perform the necessary volume renderings and reconstructions, and how long will it take to perform them?
Some radiologists who interpret these exams may insist on performing their own reconstructions before interpreting the studies. If so, how much of their time will this require? Informal surveys indicate that this step could call for as few as 10 extra minutes per case—or as long as an hour. That hour might be difficult to justify, and this possibility of extreme variation in time requirements, in many cases, makes accurate operational planning difficult.
If additional personnel must be hired to interpret CCTA exams and/or to perform reconstructions, this will obviously increase overhead costs significantly, and any such increases should be factored into the practice’s financial analysis of the merits of offering CCTA services. This additional overhead expense could mean that the practice will have to accept lower margins for CCTA on a per-case basis.
In addition to evaluating overall changes in staffing needs that might be made necessary by CCTA, practices must should consider how to provide after-hours coverage for these studies. Since patients who present to the emergency department with chest pain are common candidates for CCTA, it is unlikely, in many settings, that the performance of these exams can be limited to the hours of the day shift.
Who will perform these studies at night? Who will perform the reconstructions after hours? If your practice is based at an academic hospital, it is important to determine whether residents or fellows will have time to perform reconstructions and interpret exams at night as part of your decision to evaluate staffing needs.
For private radiology practices, it is necessary to decide whether external after-hours services or local night-coverage staff will perform reconstructions for CCTA. Companies specializing in after-hours radiology coverage have already begun to fill this niche; for example, they may offer processing and preliminary interpretation of CCTA and of triple–rule-out CTA as needed, around the clock. They may also provide images of all the major coronary arteries and a preliminary reading that indicates disease in any of those vessels.
Those practices intending to offer CCTA exams must determine carefully whether this kind of external after-hours service is necessary, as well as whether the practice can afford it—and whether it is wise to purchase such services. Will outsourcing only commoditize radiologists’ services?
Some practices may consider having the CCTA source images sent to the home teleradiology units of their radiologists for after-hours interpretation. Because there is the potential for data overload, however, they should consider four questions. First, how long will it take to send all the axial images to a radiologist’s home unit? Second, can the radiologists involved perform reconstruction or volume rendering at home? Third, if they can, how long will that take? Fourth, are reconstruction and volume rendering necessary in all cases? The provision of CCTA studies may necessitate rethinking the need for 24-hour in-house attending coverage.