Increase cardiac scanning capacity using training with Radiology Operations Command Center

The Hammersmith and St. Mary’s Hospital sites in the Imperial College Healthcare NHS Trust have high patient volumes, six MR scanners connected to Radiology Operations Command Center, with three command centers (two fixed and one non-fixed) and MR services that vary by site. Each site faces capacity pressures, particularly regarding cardiac MR. Workforce pressures include high staff turnover for positions, a shortage of experienced staff and inefficient use of medical and non-medical staff time.

Radiology Operations Command Center is a multi-vendor, multi-modality, multi-site, virtualized imaging support solution. It is backward-compatible, safe and secure and can smoothly connect imaging experts in a command center or workspace with technologists at scan locations across their organization. A technologist at a scanner console can receive guidance from a senior or more experienced colleague (expert user) in real time even if they are on separate floors or in entirely different locations. Less experienced colleagues can also receive training from an instructor at the Radiology Operations Command Center command center itself.

In conducting a pilot study of Radiology Operations Command Center, Imperial was hoping to reduce training time, increase radiographer capabilities and increase the proportion of radiographers trained in cardiac MR. Imperial was interested in assessing if the virtual training experience is effective and scalable across the Trust and across its integrated care systems. Metrics included the ability to reduce the average scan time for cardiac MR scans and the number of recalls, rescans and repeated sequences.

Use of Radiology Operations Command Center for training at Imperial College Healthcare NHS Trust led to a 100% increase in cardiac MR training capacity. Average MR scan time decreased by approximately two minutes per scan. For cardiac MR, scan duration decreased by 11% (seven minutes) and for cardiac stress MR it decreased by 9% (six minutes). During the pilot 40% of the exams involved removal of unnecessary sequences.

In addition, Radiology Operations Command Center enabled training of twice as many radiographers in the same period of time (10 radiographers trained in 10 weeks, when usual training would have required 20 weeks). This training increased facility capacity, allowing for a 91% increase in cardiac patients scanned in the 17:00-20:00 shift (271 cardiac patients scanned during this shift in 2023 vs 142 in 2022).

The pilot demonstrated a 0% exam recall rate when Radiology Operations Command Center was utilized. Historically, all cardiac patients have been scanned on two out of four scanners at the sites. The use of Radiology Operations Command Center during the pilot allowed an additional 50 patients to be scanned on a third scanner from July through December 2023. This was made possible by a higher percentage of staff trained in cardiac MR.

Philip Gregory is a practice educator, facilitating postgraduate education and training, in addition to developing an imaging academy for NHS England. He notes the need to be sure that the NHS radiographers are taught to the highest possible degree to be able to get the most from the equipment and achieve the best outcomes for patients. He says his challenge is how to introduce education, training and support in busy environments and how to make best use of the most skilled radiographers of NHS. He has seen the value Radiology Operations Command Center brings across scanning, particularly in cardiac MRI. “Because we’ve been able to essentially duplicate our control room, it means we can have our expert sitting at the command center, and then rather than having one trainee sitting at the control panel itself at the scanner, you can have two trainees.”

Radiology Operations Command Center is also worthwhile for expert radiographers because it promotes their expertise and gives them new opportunities to effectively share their knowledge with colleagues in the sector, in the region and around the country. It’s valuable to patients because time saved during a scan is less time spent inside the scanner. Gregory points out the benefit of staff retention as well. “It means that all radiographers have the opportunity to upskill,” he says. Because Radiology Operations Command Center is vendor-neutral, it can be used to efficiently train radiographers on different systems in different locations, which aids workforce mobility within NHS.

Clinical Services Manager, Imaging, Imperial College Healthcare NHS Trust, David Tao was managing an MRI department at Imperial during the pilot program. “Radiology Operations Command Center allows NHS to train in a way that allows radiographers to be independent so they’re able to flourish and unlock their potential professionally.” “The quality and the standard are the same,” he says. “What is different is the speed at which we train, and the efficiency.”

Katie Pantling, Practice Education Facilitator, works with undergraduate students across sites at Imperial College Healthcare NHS Trust. Her goal is finding ways to facilitate training and placements to accommodate the increase in the number of students across the universities. Because undergraduate training tends to focus on plain film X-ray, she is interested in enhancing training in MRI to help meet the need of the Trust. She values the use of Radiology Operations Command Center in helping the Trust create an environment outside of the clinical environment where she can effectively train students in the complex modality of MRI.

Pantling says, “I’ve been able to sit with three different scanners in the background and I can help three different colleagues as they go through their scans. I do think it has a positive impact on the confidence of the radiographers that are training. Because I've got three different screens, there could be a metallic artifact on one of my patients. Then I can say, ‘OK, have a look at this. Now tell me what's on this image. Let's have a talk about it. Have a look at my three scanners. One of these patients is moving. Tell me which one and tell me how you know.’”

“We can talk about the physics, and we can talk about the weightings because there's almost guarantee between three different screens that there will be a T2 on one of them, a T1 on one of them and if there isn't there'll be another one in 30 seconds. So, it's quite good as a teaching tool where in real time there's enough that's changing and enough for me to talk about, so that we can really get into what can be a very difficult modality for them to understand. In terms of the technology, the physics and the anatomy, it's just so different than plain film.”

Pantling values the richness of the content that is available when she is teaching while scanning is happening in real time. She says, “I find--both from my point of view and the students' point of view—that they're quite dynamic teaching sessions. It's not me in front of a PowerPoint presentation, going through structured notes. It feels a lot more genuine, it feels a lot more exciting, it feels a lot more, ‘Oh, look at this, this is interesting, have a look, there's a pathology here, tell me what you think is unusual. Okay, we've got a really nice image that's just come up. Let's talk about the anatomy.’ And I think that's really helped with their engagement.”

Use of Radiology Operations Command Center has allowed Imperial College Healthcare NHS Trust to greatly increase its cardiac scanning capabilities, while benefitting less experienced radiographers, radiographers with a great deal of experience and—most of all—patients.