Radiology extenders significantly improve routine chest radiograph throughput at one Ivy League imaging department

Deploying radiology extenders in thoracic imaging at one Ivy League institution has helped significantly improve throughput for routine chest radiographs, experts reported Tuesday.

Interpreting such studies can require a disproportionate amount of work when weighed up against low reimbursement. With chest x-ray volume rising and an insufficient amount of resident reinforcements, the University of Pennsylvania decided to experiment. Measuring this practice change up against independent radiologist interpretation and resident-drafted cases, Penn found notable gains. Radiology extender reports were finalized more rapidly, with immaterial differences in interpretation discrepancy rates, according to an analysis published in JACR.

“The [radiology extender] job role is controversial among some who consider REs as a cost-effective replacement for radiology trainees. We respectfully disagree with their presumption,” Arijitt Borthakur, MBA, PhD, and colleagues with the Perelman School of Medicine’s Department of Radiology, wrote Oct. 13. “As an academic medical center, we hold training the next generation of radiology leaders at a higher priority than any revenue improving or cost control initiative. We are confident that the RE job function makes more business sense if REs are deployed in a strategic and meaningful manner,” the team added later.

Borthakur et al. noted that recent mergers and acquisitions in their Philadelphia service area compelled the change. Consolidation meant Penn was providing care at multiple affiliated hospitals and imaging centers across the region. Volume kept climbing and the institution had typically relied on trainees to “share the burden” of interpreting exams. “However, their supply has not kept pace with the increasing volume of work,” the team wrote.

To gauge the success of the extender program, researchers measured flow rates—or the number of interpretations finalized each hour—for four subspecialist attending radiologists. They also compared the accuracy of RE-drafted reports against those completed by junior residents. And a blinded panel of judges reviewed all reports using the RadPeer system.

Bottom line: Flow rates improved by 52% for RE-drafted cases versus 17% for those tackled by residents. And RE-handled cases generated 36% greater efficiency for attending physicians when compared to the resident variety (P < .05). The research team is now working to gauge satisfaction with this change, following concerns that the “reallocation of radiologists’ tasks would devalue their work.”

“We contend that the diagnostic responsibility remains with the radiologist in the RE-enhanced workflow while some of the technical tasks such as handling the computer software for speech recognition and text editing are taken over by support staff,” Borthakur and colleagues contended. “Our model does not reassign the intellectual contribution of the radiologist, but rather improves their professional stance by relieving them of some of the information technology tasks in a manner that fits the modern, fast-paced healthcare arena better than other methods such as tape-recording dictation models.”

Read much more on their study in the Journal of the American College of Radiology here.