Technologists and the Quest for Radiologist Efficiency

In 1986, I left UCLA, where I had done my residency and neuroradiology fellowship, to join a wonderful group of nine radiologists in San Diego. For a variety of reasons, it was one of the greatest and lowest-paid radiologist jobs in the country.

Within five years, it became one of the highest-paid radiology groups and an even better job. What happened? We focused on growing our own cross-sectional imaging business, we aggressively adopted an early PACS (DR Systems), we eliminated all processes that did not add value to our practice or patients, and we invested in the empowerment of our technologists. Our philosophy was simple. As a physician-owned practice, WE WANTED EACH RADIOLOGIST TO BE EXPENSIVE. To achieve that end, we aimed to have the least number of the most efficient doctors and to carry that philosophy to our technologists as well.

Many of our colleagues in other groups took the fatalistic philosophy that is increasingly prevalent today: technologists are impossible to supervise and train. In contrast, long before AI, we used human intelligence to expedite radiology reports.

For example, we developed protocols for virtually all exams so that technologists had standardized ways of working. This not only improved their proficiency, but it added to their confidence, something that our patients benefited from and noticed. We developed communication systems so that technologists almost never needed to stop scanning and leave the patient's side. We employed assistants to transport patients and assist technologists in other ways. We trained our technologists about reimbursable indications and how to accurately document or obtain them from the patient's chart or referral documents, so exam indications in reports were “automatically” both accurate and codable.

For some exams, like ultrasound and mammography, we developed electronic forms that were standardized and provided information (histories, findings, meds, supplies, radiation doses) directly into the radiology report. These processes saved radiologists time when reporting.

Today, I find radiologists, especially teleradiologists remotely covering many facilities, who feel hopeless about the management of employees in hospitals and imaging centers. They say things like, “It's impossible to train an ever-changing collection of remote technologists to use protocols or complete forms in a way that will be helpful to me.” I respond with the adage, “The man who says he can't is always right.”

Training technologists and providing them the right technology is tremendously helpful to technologists and radiologists. The relationship between these two groups of professionals is vital to both. I have no doubt that in the never-ending quest for higher radiologist efficiency, technologists can play a vital role, even while being more efficient and accurate themselves. It takes a technologist less time to use a properly designed web form than to find, complete, and scan a paper document, and it provides a much higher value to radiologists and ultimately to patients. Increasingly, such web forms will be deeply integrated with medical image display, so that the work process for technologists will feel more like AI-aided image annotation than completion of a form.

When a radiologist is presented with a report template where the indications, technique, medications, contrast, supplies, measurements, and properly articulated imaging findings are already documented, time is saved and more attention can be directed at the images themselves.

In view of this, my advice to radiologists today is: don't give up on the relationship with technologists. Become the technologist's teammate and everyone will reap the benefits.