MRI / CT utilization in hospitals

[fedor]

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Do most hospitals utilize their CT scanners and MRI machines on a 24/7 basis?

I would assume that many hospitals would try to schedule as many scans as possible because of the very high fixed costs associated with the equipment (especially with MRI).

So how realistic is it to say that at most hospitals MRI would be available from around 7am to 11pm for elective scans and emergency scans, and from 11pm to 7am it would be available for emergencies w/ the techs and rads on call (or nighthawking).

 

[Docxter]

Do most hospitals utilize their CT scanners and MRI machines on a 24/7 basis?

I would assume that many hospitals would try to schedule as many scans as possible because of the very high fixed costs associated with the equipment (especially with MRI).

So how realistic is it to say that at most hospitals MRI would be available from around 7am to 11pm for elective scans and emergency scans, and from 11pm to 7am it would be available for emergencies w/ the techs and rads on call (or nighthawking).

That's how it's been at the hospitals I've worked at. Except, that the overnight MRI service will be totally abused with nonemergent requests if the service is provided. "We need a stat MRI at 3 AM for this patient who has left leg pain for two months, an MRI three days ago which showed a disc but I don't know why he still has pain. No urinary symptoms or weakness, we just want to check the status of the disc", or "we need a stat liver MRI tonight at 3 AM to further assess this 1cm liver mass found incidentally on ultrasound this evening on a kidney ultrasound" or "stat requests to rule out meniscal tear on someone injured last week" or "I want to stage this cancer tonight so I can look like a goody-goody tomorrow for morning rounds". Some smaller centers have therefore chosen not to provide the service at night.

Almost all large hospitals have 24/7 CT with techs in house. Smaller and less busy centers have the tech take call from home. Places that have a residency, there is a resident in-house. Places without residency have a radiologist in-house till 11 or midnight or so, and then take call either from home and either come in or have teleradiology for midnight to 7:00AM.

 

[fedor]

That's how it's been at the hospitals I've worked at. Except, that the overnight MRI service will be totally abused with nonemergent requests if the service is provided. "We need a stat MRI at 3 AM for this patient who has left leg pain for two months, an MRI three days ago which showed a disc but still has pain. No urinary symptoms or weakness, we just want to check the status of the disc", or "we need a stat liver MRI tonight at 3 AM to further assess this 1cm liver mass found incidentally on ultrasound this evening on a kidney ultrasound" or "stat requests to rule out meniscal tear on someone injured last week". Some smaller centers have therefore chosen not to provide the service at night.

Almost all large hospitals have 24/7 CT with techs in house. Smaller and less busy centers have the tech take call from home. Places that have a residency, there is a resident in-house. Places without residency have someone in-house till 11 or midnight or so, and then take call either from home and either come in or have teleradiology for midnight to 7:00AM.

Would the CT techs who are already on 24/7 be able to scan patients on the MRI machines or is that an entirely different skillset and employee?

 

[Docxter]

Would the CT techs who are already on 24/7 be able to scan patients on the MRI machines or is that an entirely different skillset and employee?

Almost always a different person with different skill set and training.

 

[tiredmom]

Our UH does the inpatient MRIs at night, and outpatient ones during the day. Sounds like an efficient plan right? Except when your inpatient who's plan of care depends on the result of the MRA that has been bumped several times for different emergencies has to wait 6 days without any other intervention... inpatient. Talk about wasted health care dollars! Also, they don't do nonemergencies on the weekends - he happened to get admitted on a Thursday. CT runs pretty much 24/7 - with the amount of trauma, they are always busy.

 

[blue2000]

Our UH does the inpatient MRIs at night, and outpatient ones during the day. Sounds like an efficient plan right? Except when your inpatient who's plan of care depends on the result of the MRA that has been bumped several times for different emergencies has to wait 6 days without any other intervention... inpatient. Talk about wasted health care dollars! Also, they don't do nonemergencies on the weekends - he happened to get admitted on a Thursday. CT runs pretty much 24/7 - with the amount of trauma, they are always busy.

this is the experience (and frustration) that I have. You order a semi-urgent MRI on someone, it's supposed to get done overnight, gets bumped three nights in a row for true emergencies, and you've got a patient sitting on their ass, because they won't do inpatient during the day because they can get paid a lot more for the scheduled outpatient scans.

 

[fedor]

Do radiologists have any training in the functions of a radiographer/radiology tech? Would they be able to do the role of a tech if needed?

I could see a need for it if a rad resident is taking overnight in-house call while the MRI tech is doing home-call or generally unavailable.

 

[f_w]

We had a third shift MRI tech for a while. But as 'Docxter' so eloquently predicted, it opened the door for abuse even further. Also, the techs who welcomed the additional $$ from the third shift work grew tired of it after a while (one reason for techs to do the MRI training is the prospect of working 9-5). The third shift also turned out not to be terribly productive. The bottleneck (as in every hospital on earth I know of) was transport. Getting the inpatients down for their 2 am MRI turned out to be so slow that it wasn't worth the effort in the end. Also, for historical and technical reasons, MRI suites are often located outside of the main hospital. It was a bit scary to have the tech alone in a remote and unpopulated corner of the hospital with sometimes less than stable inpatients.

 

[f_w]

Would the CT techs who are already on 24/7 be able to scan patients on the MRI machines or is that an entirely different skillset and employee?

The MRI and CT scanners of the major manufacturers nowadays share the same software platform. As a result, it is a lot easier to cross-train a CT tech to do limited MRI than it was 10 years ago.

It is entirely possible to cross train a good CT tech to do basic MRI's such as heads for stroke or 'r/o compression' spines. The problem is that an MRI scan will take the overnight CT tech away from CT for at least 30 minutes (including getting the patient on an off the table). In the meantime the ED attending screams himself hoarse because his bogus 'r/o everything' abdominal CTs are piling up.

 

[f_w]

Do radiologists have any training in the functions of a radiographer/radiology tech? Would they be able to do the role of a tech if needed?

There was a time I could have done that. But this would certainly not be a worthwhile use of my time today. Doing the scans involves practice, in order to maintain that skill you would have to do it on a regular basis.