LCMC Health

Dawn Miller

Care Innovation Authority

Over the years, many aspects of healthcare have changed, but one challenge continues to remain: patient access to imaging services. Common barriers include service location, equipment availability and having enough qualified staff to perform imaging procedures.

When access becomes an issue, the first request from providers, staff and patients is often to add imaging equipment. While this option should be evaluated, capital funding can be difficult to secure. Even when funding is available, planning, organising and installing imaging equipment can take months.

The National Institutes of Health (NIH) published a retrospective review of medical imaging trends involving a controlled cohort of 16-21 million patients between 2000 and 2016 and found that approximately 130 million imaging exams were performed. Given current healthcare demands, it would not be surprising if this number has continued to rise.

Across the United States, there are approximately 460,000–500,000 registered imaging technologists across modalities, including Ultrasound, X-ray, Mammography, CT, MRI and Nuclear Medicine. However, according to the American Society of Radiologic Technologists, the national vacancy rate remains between 15 and 19 percent. Although new graduates enter these fields every year, the demand for qualified technologists continues to exceed availability, a trend that has remained consistent since COVID.

This creates a significant challenge: improving patient access while managing staffing shortages, equipment limitations and increasing demand, all while maintaining quality exams. In my opinion, there are three key areas healthcare organisations should focus on to overcome these challenges.

Recruit and Retain Staff

Recruitment and retention must be the top priority because even if other solutions are implemented, organisations will continue struggling if they cannot maintain their workforce.

Potential employees need to understand why they should choose your organisation over others in a competitive recruitment market. A strong story can make a significant difference. When onboarding new employees, ask them why they selected your facility, organisation or department. Capture their feedback, take their picture and share their experiences with key stakeholders, including department leaders, radiologists, referring providers and their new work teams. These stories can also be included in presentations at recruiting events.

Developing a fact sheet with important information about your department or organisation can help build relationships with schools. Establish connections with programme directors, participate in campus visits or conduct virtual presentations to graduating students about available opportunities and what makes your department unique.

Using these techniques at LCMC Health, I have been able to recruit staff from other states and successfully fill difficult-to-recruit positions. I am fortunate to currently have full staffing in my areas of responsibility.

Retention is equally important and requires ongoing effort. Staff want fairness, accountability, communication, follow-through and trust from their leaders. One effective tool is “Purposeful Rounding” or “Rounding for Outcomes.” While organisations may use different names, the goal is the same: regularly connect with staff, understand their concerns and create a plan to address issues.

Rounding discussions may include equipment concerns, barriers affecting the team or opportunities to recognise employees for exceptional contributions. Follow-up communication can be shared through a communication board or tracking system that highlights concerns raised and what actions can be taken.

These recruitment and retention strategies, along with initiatives such as welcome letters for new hires and regular celebrations, have helped my teams consistently maintain one of the lowest needs for agency staff. It is also important to ensure the right people are on the team, as one toxic individual can negatively impact overall team morale.

Consider Non-Licensure Staff

With licensed and registered staff in short supply nationwide, organisations should consider creative approaches to completing necessary work while maintaining quality and safety.

This begins with understanding the full process involved in completing an imaging exam. Are there responsibilities currently handled by licensed staff that can safely be performed by trained non-licensed team members?

For example, one Cath Lab Director incorporated a scrub technician into the team structure. Her teams now consist of one X-ray technologist, one RN and one scrub technician. This approach allowed her to schedule more procedures because both technologists and nurses face staffing shortages nationwide. The scrub technicians received Cath Lab training and became valuable additions to the team.

Another example is the use of Tech Assistants, who can perform tasks that often prevent technologists and nurses from moving efficiently to the next patient. Tech Assistants can prepare rooms, escort patients, restock supplies, transport inpatients, remind patients about appointments, communicate delays, retrieve previous imaging and complete other responsibilities that do not require licensure.

“Focusing on recruitment and retention, effectively using non-licensed support staff and improving scheduling strategies can create meaningful improvements while maintaining quality care.”

In MRI, the ACR standard requires two MRI safety-trained staff in Zone 3 or 4. Organisations could consider staffing with an MRI technologist and an MRI Tech Assistant who is trained in MRI safety. This approach may help improve patient access while maintaining safety requirements.

However, organisations must carefully review state regulations and quality standards. In some states, DEXA (Dual Energy X-ray Absorption, also known as bone density exams) does not require a license to perform. One facility trained a PCT to perform these studies. While this can improve access, it remains a highly detailed exam where quality is critical to accurate diagnosis.

The same applies to Ultrasound, where poorly performed exams can result in incorrect or serious diagnostic consequences. If considering non-licensure options, having a strong radiologist partner who can assist with quality monitoring is essential.

Understand and Be Creative With Scheduling

The final strategy is understanding modality schedules and finding creative ways to maximise the equipment already available.

At one facility, I was told that an additional PET camera was needed because the department was at capacity. After reviewing the schedule, it became clear that only around six PET exams were being performed daily despite having two uptake rooms. With an eight-hour operating day, the facility had the potential to perform significantly more exams.

The issue was not equipment availability but scheduling efficiency. By reviewing workflow and updating the EMR template to correctly separate uptake room time from scan room time, we eliminated the backlog within a month and increased scheduling capacity to an average of 13 PET patients per day.

Other modalities can also benefit from improved workflow planning. In MRI, for example, having designated safety and preparation rooms allows patients to complete screening and preparation before entering the scan room. This reduces downtime and ensures the scanner is ready for the next patient.

Organisations should also think creatively about scheduling options. Many working patients benefit from early morning, evening or weekend appointments. At one organisation, mammography appointments were offered from 6:00 a.m. to 8:00 p.m. one day each week. These extended hours improved access for patients while also creating scheduling flexibility for staff.

Even unconventional ideas can create opportunities. Offering limited overnight appointments, targeting second-shift workers or adding occasional Saturday availability with PRN technologists can help reduce backlogs and improve access.

Overall, there is no single solution to increasing patient access to imaging services, especially with staffing shortages and challenges in acquiring capital equipment. However, focusing on recruitment and retention, effectively using non-licensed support staff and improving scheduling strategies can create meaningful improvements while maintaining quality care.