When the radiologists at Laughlin Memorial Hospital say “good night,” the radiologists who come on duty say, “g’day, mate!”

Laughlin Hospital is among a growing number of hospitals nationwide that are utilizing overnight and off-hour radiology coverage from accredited teleradiology facilities outside the U.S. time zones.

In Laughlin’s case, the facility is located in Sydney, Australia.

Instead of waking an on-call radiologist in the middle of the night to read the X-ray of an emergency room patient, the digital X-ray image can be read by a “wide-awake” radiologist sitting before a computer in Australia.

Once read, a detailed report on the X-rays is then rapidly transmitted via a secure communication network back to the attending ER physician in Greeneville.

The next morning, the same X-ray images are read a second time by one of Laughlin’s radiologists, and an official report is sent to the patient’s local physician.

Dr. Phillip Marino, chief of radiology at Laughlin Hospital, calls the hospital’s participation in the service a win-win situation for everyone involved.

“It’s an excellent service. It serves us, it serves the hospital, and it serves the patients,” Marino said.

Jessie Taylor, administrative director of Laughlin’s radiology department, said the teleradiology service is a way “to enhance the service that our (local) radiologists provide and to help the hospital continue to provide full radiology service after-hours.”

Both Marino and Taylor emphasize that the service does not replace the qualified work provided by the hospital’s radiologists, but rather serves in a complimentary, relief manner during the nighttime hours.

What Is Teleradiology?

The term “teleradiology” refers to electronically transmitting radiological images, such as X-rays, CTs and MRIs, from one location to another for the purposes of interpretation and/or consultation.

The technology is not new. In fact, Dr. Marino says that teleradiology has been available for close to 20 years.

What has changed, however, is the ever-growing use of the technology and the sending of images overseas.

The radiology coverage firm that Laughlin’s radiology practice utilizes is called NightHawk Radiology Services.

The hospital has been using that particular service for about three years now.

According to NightHawk’s Web site, the firm is “the world’s leading provider of overnight and off-hour radiology coverage for hospitals, clinics and imaging centers across America.”

NightHawk is fully accredited by the Joint Commission on Accreditation of Healthcare Organizations.

The firm staffs U.S.-trained, board-certified radiologists, specializing in emergency radiology, at its reading centers located in Sydney, Australia and Zurich, Switzerland, the Web site says.

The reason for the reading centers’ locations is simple. When it’s the middle of the night in the Eastern U.S., it’s daytime “Down Under.”

When it is early morning on America’s West Coast, it is daytime in the Alps, the Web site points out.

“From the centralized reading centers, NightHawk radiologists interpret exams and report the results to attending physicians in real-time, usually less than 20 minutes,” the Web site says. “Thus, whether it’s a head trauma from an accident on a rural road or chest pains in a major metropolitan area, patients receive high-quality, rapid care from some of the country’s most accomplished — and alert — radiologists no matter where they are or when they need help,” the Web site says.

In addition to its accreditation by JCAHO, NightHawk also complies with teleradiology standards set by the American College of Radiology as well as the patient privacy standards of HIPAA (Health Insurance Portablity and Accountability Act.)

Dr. Marino said the radiologists can utilize NightHawk’s services at any time — whether during off-hours at night or during the day if he wants another read on an image.

“If I’m on call, for instance, I usually have it switched over (to NightHawk) at 11 p.m. But I’m always available,” he added.

“Say if the ER physician wants me to look at an image, the hospital will page me. But usually for all of the basic, routine stuff that comes in the middle of the night, (NightHawk) will take care of that,” Marino said.

In the morning when he comes back to the hospital, Marino said, he will look at all the images read by NightHawk the previous night, and complete the official report that is sent to the local physicians.

“So there are two readings on the images,” he said.

One of the best benefits of the service, he said, is that “you don’t have a tired radiologist in the middle of the night reading it.”

“You have a well-rested, well-trained individual who is looking at your studies, and these studies are going to be reviewed again the next day (by the local radiologist at the hospital),” Marino said.

When the radiologists in Australia have a question about a case, Marino said, they will call the attending physician or radiologist directly to discuss the study.

Hospitals that do not participate in such teleradiology services are finding it harder and harder to recruit radiologists to their staffs, Marino said.

“This is great for our practice because we know what our schedule is, and we can get a night’s sleep most of the time. That’s very important,” Marino said.

Although the radiology staff at Takoma Adventist Hospital does not transmit its radiological images overseas, the hospital does participate in a teleradiology service.

Dr. Raymond Kohne, chief of diagnostic imaging at Takoma Hospital, said the radiology practice has recently begun receiving off-hours service from the New Jersey-based Excalibur Medical Imaging.

Like Marino, Kohne said it is highly beneficial to have such a service available for overnight coverage not only in terms of patient care, but also for the radiology staff.

Teleradiology services is just one part of the technology being utilized by hospitals today.

Laughlin Hospital has been using filmless X-rays and other electronic medical technology for about five years now thanks to the Picture Archival and Communication System (PACS) that it has in place.

Without PACS, the teleradiology service that it employs would be impossible, said Glen Mitchell, the PACS administrator for Laughlin Hospital.

The hospital was one of the first in the region to successful utilize the PACS technology, Marino said.

With it, a doctor can be at home or in his clinic office and log onto the secure site to view radiological images.

“He can look at it and decide if he needs to come into the hospital now or wait until morning, for example,” Marino explained. “He can make decisions right away.”

The system, Marino said, has “really helped in patient management, care and speed.”