"It's a difficult challenge to market quality. People see imaging as a commodity. They don't know that the image is not as good, and will go to wherever the doctor will send them," says Rose.
But there are a couple of imaging-related quality issues that make patients take notice. Most may not have the expertise to distinguish between the resolution of different images or understand how that can affect their ultimate diagnosis, but they do pay attention to issues like radiation exposure.
In 2009, Cedars-Sinai Medical Center in Los Angeles came under investigation for inadvertently exposing 260 patients to overdoses of radiation eight times above expected levels during CT scans for detection of stroke. The exposure may have increased the patients' likelihood of developing cataracts, and Cedars-Sinai offered to pay bills for related medical care after some of the patients filed a class-action lawsuit.
While the Cedars-Sinai episode was a rare case of extreme overexposure, patients and regulators are becoming more aware of the potential dangers of imaging overutilization. That opens an opportunity for hospitals—by investing in low-dose imaging equipment and emphasizing other safety measures—to both improve clinical quality and create a marketing message that will move patients.
Nowhere is that opportunity riper than in children's imaging. As part of its "imaging gently" campaign, Sanford Children's Hospital in Sioux Falls, SD, purchased Adaptive Statistical Iterative Reconstruction (ASIR) technology that worked with its existing 64-slice CT scanners to reduce radiation levels by 30% to 40% while still providing quality images.
The change has been popular with parents concerned about the long-term effects of radiation on children who sometimes require multiple tests over the course of an episode of care, says Annie Roggenbuck, radiology/CT supervisor with Sanford USD Medical Center, a 545-licensed bed hospital in Sioux Falls, SD. "There's more of a public awareness about radiation and making sure we're doing all we can to make it as low as possible," she says.
But the low-dose option is also popular with physicians. A pediatric surgeon initially approached hospital and physician leadership about the benefits of low-dose technology. Although the hospital markets the low-dose technology and works to educate patients about the potential effects of radiation exposure, the biggest impact is on referrals from physicians, says Jan Haugen-Rogers, vice president of children's services, Sanford USD Medical Center.
"Where the rubber meets the road, so to speak, is when you have a radiologist who specifically works with families and technicians to maximize what they can see for diagnostic purposes, but at the same time is saying, 'How do we make sure . . . the long-term impact is minimized?'" she says.
Success Key No. 3: Restart capital spending, smartly
Because so many hospitals froze capital expenditures for economic reasons in the past couple of years, there's a chance that 2010 could see a boom in imaging investment as organizations finally have the capital to make the purchases that they put off in 2008 and 2009.
"From an organizational perspective, we have certainly been conservative. We established a budget that focused on those things we believe are necessary for improved patient care," says Haugen-Rogers.