Necessity provided breeding ground for international teleradiology

December 1, 2004

Dr. William G. Bradley Jr. was lecturing in China in 2000 when he received a call from his Southern California office asking for help with a difficult emergency neuro case. He found an Internet cafe, downloaded the image, and was providing an interpretation, when it suddenly hit him: He was reading the case with a fresh perspective during daylight hours. Back in California, it was early morning, and the interpreting radiologist may have been bleary-eyed and a little off-kilter because of the unreasonable hour.

Dr. William G. Bradley Jr. was lecturing in China in 2000 when he received a call from his Southern California office asking for help with a difficult emergency neuro case. He found an Internet cafe, downloaded the image, and was providing an interpretation, when it suddenly hit him: He was reading the case with a fresh perspective during daylight hours. Back in California, it was early morning, and the interpreting radiologist may have been bleary-eyed and a little off-kilter because of the unreasonable hour.

When Bradley returned home, he conferred with Dr. Paul Berger, a fellow radiologist, and the two formed Nighthawk Radiology Services, setting up offices in Sydney, Australia. The business was based on the idea that reads by fresh eyes during the daytime could provide an alternative to unpleasant night call or expensive night services for radiology practices.

Today, Nighthawk Radiology Services has offices in Sydney and Zurich, Switzerland, and serves 500 hospitals, Bradley said during a plenary session on international teleradiology. Other organizations have established similar services, all of which take advantage of time zone shifts to solve night call woes.

The international solution was actually the culmination of a long series of attempts by Bradley and his colleagues in the Memrad Medical Group to find a better way to provide night call. Initially, the radiologists had to drive to the hospital to provide night interpretations. Later, they tried "cameras on a stick," which captured the radiology images and allowed them to read from home.

By 1994, the partners were taking turns with night call. In checking his log, Bradley found a note in which he had described one of his turns as "the worst night of my life since internship." That system gave way to another that awarded an extra $1000 per night to those who took call.

By 1997, the practice was using a dedicated staff for night call, but it was expensive, involving premium payments and shorter hours for the nighthawks. In 2000, when Bradley had his revelation, the added expense of nighthawk coverage was costing each of the practice partners $30,000 per year.

Today, offshore teleradiology services are a growing part of the practice picture, and Nighthawk Radiology Services has been joined by competitors in the U.K., Paris, Israel, and other locations.

Nighthawk Radiology provides preliminary wet reads that are followed by formal reads by the requesting practice, so Medicare restrictions on payments are not invoked, he said. The service employs 35 radiologists who earn $300,000 per year for half-time work.

Bradley presented facts and figures that suggest the pressure for night reads will not decrease any time soon.

Emergency room visits generate 50 million imaging studies per year, more than half acquired between 5 p.m. and 8 a.m., he said. CT studies, once dominated by head scans, now include more complex body and abdominal studies, and their volume increased by 24% between 1997 and 2001. The technology to facilitate international nighthawk reads is well established.

Finally, there are human factors. Once, night call went to the junior members of a practice. That's less attractive for them today.

"Younger radiologists want a life," Bradley said.