Overview

The Imaging Service manages the complete diagnostic imaging workflow from order entry through image acquisition, radiologist interpretation, and report delivery.

Imaging Modalities

X-Ray (Radiography)

• Chest X-ray
• Bone X-rays
• Abdominal X-rays
• Dental X-rays

Computed Tomography (CT)

• CT Head (stroke protocol)
• CT Chest (PE protocol)
• CT Abdomen/Pelvis
• CT Angiography

Magnetic Resonance Imaging (MRI)

• MRI Brain
• MRI Spine
• MRI Joints (knee, shoulder)
• MRI Abdomen

Ultrasound

• Abdominal ultrasound
• Obstetric ultrasound
• Vascular ultrasound
• Echocardiography

Other Modalities

• Mammography (breast imaging)
• Fluoroscopy
• Nuclear medicine (PET/CT)
• Interventional radiology

Workflow Steps

1. Order Entry

• Provider orders imaging study
• Clinical indication required
• Pregnancy screening for females
• Contrast allergy checking
• Prior authorization (if required)

2. Scheduling

• Outpatient: Schedule appointment
• Inpatient: Portable imaging or transport
• Prep instructions (fasting, hydration)
• Contrast consent if needed

3. Image Acquisition

• Technologist performs study
• Images sent to PACS (DICOM)
• Quality check before release
• Radiation dose recorded

4. Radiologist Interpretation

• Worklist prioritized (STAT > URGENT > ROUTINE)
• Comparison to priors
• Structured reporting templates
• Critical findings identified

5. Report Delivery

• Report sent to EHR (HL7 ORU)
• Ordering provider notified
• Critical findings: Immediate notification
• Patient access via portal

PACS Integration

Picture Archiving and Communication System

• DICOM Standard: Medical imaging format
• Image Storage: Long-term archive (7-10 years)
• Image Viewing: Web-based viewer and thick client
• Hanging Protocols: Specialty-specific layouts
• Comparison: Prior studies automatically retrieved

Critical Findings

Immediate Notification Required

• Pulmonary Embolism (PE): Blood clot in lungs
• Pneumothorax: Collapsed lung
• Aortic Dissection: Life-threatening
• Stroke (Acute): Time-sensitive treatment
• Bowel Perforation: Surgical emergency
• Fractures: In trauma cases

Notification Process

1. Radiologist identifies critical finding
2. Provider paged immediately
3. Direct phone call to provider
4. Read-receipt required
5. Escalation if not acknowledged (15 min)
6. Documentation in report and chart

Technology Stack

• PACS: Enterprise imaging platform
• DICOM: Medical imaging standard
• HL7 v2: Order and result messaging
• RIS: Radiology Information System
• Worklist: Modality worklist (MWL)
• Viewer: Web-based zero-footprint viewer

Radiation Safety

ALARA Principle

• As Low As Reasonably Achievable
• Dose monitoring and tracking
• Pediatric protocols (lower dose)
• Pregnancy screening
• Alternative modalities considered (ultrasound, MRI)

Dose Tracking

• Cumulative radiation exposure recorded
• Alerts for high cumulative dose
• Dose reduction techniques
• Regular equipment calibration

Contrast Safety

Iodinated Contrast (CT)

• Allergy history screening
• Premedication protocol (steroids, antihistamines)
• Renal function check (creatinine)
• Hydration protocols

Gadolinium (MRI)

• Nephrogenic systemic fibrosis risk (renal failure)
• Dose minimization
• Patient screening

Standards & Compliance

• DICOM: Digital Imaging and Communications in Medicine
• ACR: American College of Radiology standards
• Radiologist Board Certification
• Quality Assurance: Peer review programs
• Accreditation: ACR accredited facilities

Performance Metrics

• Report Turnaround Time:
  • STAT: < 1 hour
  • URGENT: < 4 hours
  • ROUTINE: < 24 hours
• Critical Finding Notification: < 15 minutes
• Image Quality: < 2% repeat rate
• Patient Satisfaction: > 85%