Nationally, the subspecialty of Emergency Radiology has developed from four major trends in emergent care: increased ED utilization by patients and their physicians; technological and medical advancements leading to greater reliance on advanced imaging for acute medical decision-making in emergency departments; the maturation of emergency medicine and trauma surgery as medical and surgical specialties in need of coordinated subspecialty radiology services; and the expectation of contemporaneous interpretation of all emergent imaging by attending radiologists at all times of the day. Emergency radiologists specialize in imaging of acutely ill or injured patients, and thrive in a fast-paced environment where their imaging expertise and consultation is vital in guiding acute patient care decisions. Emergency Radiology is now one of the most rapidly growing subspecialty areas in radiology, as hospitals throughout the country recognize the value of a service-line approach to ED imaging and seek solutions to provide high quality and consistent ED imaging services 24/7.
Throughout its history, the Brigham and Women’s Hospital Emergency Radiology section has been a leader in the field. It was one of the first dedicated emergency radiology sections to be established in 1999, and in 2004 was one of the first academic centers in the country to incorporate 24/7/365 on-site attending staffing. There is at least one attending emergency radiologist immediately available in the reading room at all times, with a second attending present between approximately 6 pm and 3 am. We train two Emergency Radiology fellows each year, and two to three radiology residents train on our service at any time, with shifts distributed throughout the 24 hour cycle.
The depth and breadth of Emergency Radiology services is unique since it spans all imaging modalities and organ systems within the department. Our facility is a state of the art level-one trauma center and tertiary/quaternary care referral center, and our Emergency Radiology team performs and interprets all imaging needed to diagnose and guide management for the broad range of acutely ill emergency and trauma patients. Our imaging spans the modalities of CT, ultrasound, radiography, and MRI. We image all organ systems including neurologic, thoracic, vascular, gastrointestinal, genitourinary, musculoskeletal, gynecologic, and obstetric. We have strong collaborative relationships with the other subspecialty radiology sections at BWH and have launched a number of joint efforts designed to standardize approach throughout the department.
Our service is efficient and well organized, and is designed to operate robustly at any time of day on every day of the year. We play an active role in optimizing and streamlining all emergent imaging. Our on-site presence immediately within the ED enables unique patient-centric imaging approaches, for example by monitoring our most urgent CT scans (for trauma, aortic dissection, and stroke) in real time as they are being performed in order to reduce radiation exposure to only what is needed, and to provide nearly instantaneous results to the patient care teams.
During our 2004 transition to 24/7 attending coverage, we created the Brigham NightWatch program, which provides emergency teleradiology services to multiple other emergency rooms, hospitals, and urgent care centers in Massachusetts. Since that time, our section has grown from 5 to 12 radiologists (10 FTE’s), making us one of the largest clinical services in the radiology department. NightWatch has enhanced the collaborative reputation of BWH Radiology within the Massachusetts imaging community by providing a highly regarded service with a very stable customer base since 2004.