Joseph K.T. Lee, MD

With state-of-the-art technology, it definitely can be a profit center. When a department has the most up-to-date systems, this facilitates improved return on investment (ROI). It also improves work flow and, thereby, achieves greater cost efficiencies. These, in turn, pave the way for profitability. Our experience at UNC Hospitals, Chapel Hill, NC, illustrates this effect.

North Carolina’s Research Triangle area, which constitutes our primary market, began growing dramatically in population more than 20 years ago. Steadily, UNC Hospitals have seen demand for services (and for radiology services, in particular) increase manyfold. In 1991, UNC Hospitals authorized intensive improvement of its radiology capabilities in order to meet current and future demand, based on expected procedural volumes. The measures undertaken at that time included a top-to-bottom reorganization of the radiology department, a complete redesign of work flow, and implementation of a full picture archiving and communications system. Later, there was an ingathering of our far-flung array of imaging services to the basement of the newly built UNC Women’s and Children’s Hospitals, into which we moved early in 2002. Some modalities and services remain decentralized for the strategic advantages that this produces; these include a CT, one MRI, mammography, ambulatory care radiology, and vascular interventional services.

Michael A. DeGennaro, MBA


We began acquiring new systems in 1991. Although we invited a number of vendors to submit proposals, we ultimately standardized, to the extent that this was possible, around a single vendor. We chose the one that offered us the best value, in terms of advanced performance, high-quality engineering, and price. In this instance, the manufacturer was Siemens Medical Solutions, Malvern, Pa.

The investment in state-of-the-art technology undertaken by UNC Hospitals brought the radiology department a pair of 16-slice CT scanners, a positron emission-tomography/CT scanner, two additional MRI units, four fluoroscopy devices, nine radiography rooms, three mammography units, seven gamma cameras, and five ultrasound systems.

We are particularly pleased with our CT systems. They have provided exquisite imaging, along with exceptionally fast scanning and reconstruction. The specialized software sold with each machine has been proven versatile and powerful. The improved imaging that we have obtained has led to better patient care. For example, a trauma surgeon requested a dental study for a suspected mandibular fracture in a child. The fully three-dimensional images that we produced were available almost in real timeso rapidly, in fact, that the young patient needed significantly less sedation for the procedure than might have been the case if we had still been employing our outdated helical CT scanner.

Another improvement is that our new MRI units are capable of full-range imaging and spectroscopy. Among its uses are the detection of spina bifida in utero using half-Fourier single-shot turbo spin echo, or HASTE, imaging. These units also are well suited for cardiac imaging, and this permits us to offer less invasive diagnostic procedures for heart-disease patients.

Not only are we performing imaging procedures of greater sophistication that are, at the same, time more easily tolerated by patients, we are also performing more procedures with greater efficiency. In 1991, our department performed 135,000 examinations per year. Today, the annual figure is in excess of 300,000 examinations. During the past 3 years alone, we have seen imaging volume grow by 35%. Our CT scanners are among the busiest in the United States. In a recent national benchmarking survey, the UNC Hospitals radiology department ranked in the 90th percentile in productivity and supply expense management.

This increase in volume involves more than increased referrals or growth in the number of walk-in patients. Our chosen CT scanners have made it possible for us to be more productive. Included with the equipment purchases was the new Syngo software platform; among many other things, it has helped us reduce our scan times by 35%. Our throughput on our new scanner has risen from 45 patients to 65 patients per day, and 65 patients is hardly the limit of our capabilities.

We expect to be able to see more patients, but we must first address the challenge of patient logistics. That, and not equipment capability, is what now limits our throughput. At present, we are attempting to improve patient logistics by improving patient transport, preparation for examinations, and image processing, as well as by using meticulous tracking to fine-tune the speed with which patients gain access to our services.


As might be imagined, referring physicians have reacted very favorably to the changes made by the radiology department, since improved radiology capacity and efficiency mean greater clinic and inpatient efficiency for them.

Meanwhile, we are finding that the presence of cutting-edge technology is, for prominent academic radiologists, a strong inducement to join our team. Several of the internationally known and respected radiologists that we have recruited since 1991 (including Mauricio Castillo, MD; Richard Simelka, MD; Paul Molina, MD; and Julia Fielding, MD) expressed an eagerness to come aboard that was due, in large measure, to our ability to offer them an environment in which their work could most readily advance to the next level.

Recruitment of radiology technologists has been similarly supported by our complement of equipment. This is no small feat, considering the severity of the shortage of technologists being seen across the United States.

Over time, having fewer technologist vacancies to fill means that we have less difficulty in offering such a wide variety of services and in performing so many sophisticated procedures. Nonetheless, certain economic realities still apply, with adequate staffing or without it. One of those is that offering more services leads to performing more studies and, therefore, to incurring more costs. These costs are minimized, of course, by maximizing efficiency, and that is precisely what we have been able to do because of our investments in state-of-the art technology.

We invested substantial sums in order to obtain the latest and greatest equipment. Was it worth the expense? Absolutely. Without this technology, we would have missed a fantastic opportunity to serve our patients better, both within the hospital and beyond its walls. We are riding a wave of growth, and enjoying a remarkable return on our investment.

Joseph K.T. Lee, MD, is E.H. Wood distinguished professor and chair of radiology, School of Medicine, University of North Carolina, Chapel Hill, and radiologist in chief, UNC Hospitals, Chapel Hill, NC.

Michael A. DeGennaro, RT(R), MBA, is administrative director of radiology services, UNC Hospitals.