You have been asked to serve on a group to recommend a location for imaging after identifying and evaluating the positives and negatives of the two locations within ED or adjacent to ED.

When preparing your analysis, consider the following additional facts:

• The imaging space available in both locations is 1,500 square feet (SF). The overall cost (excluding fees) for construction in the ED is 1,500 SF $525/SF = $787,500.
• Capital costs for equipment are $1,020,000 (CT = $650,000; wireless diagnostic unit = $250,000, and ultrasound unit = $120,000).
• Because of concerns regarding excessive radiation exposure from CTs, EDs are beginning to utilize ultrasonography when appropriate. Ultrasound studies can visualize soft tissue and tendon and muscle complaints, and they are particularly useful in diagnosing inflamed appendixes and kidney stones.
• Use of electronic medical records, digital film in imaging, and the expansion of an IT infra- structure and high-resolution screens to the ED and radiologists offices and homes make rapid interpretation and consultation available 24/7.
• Flexible credentialing of imaging staff permits using them for all modalities except ultrasonography. Radiology technologists receive 2 years of training and supervised practice in an American Medical Associationapproved program. This is followed by a national registry examination and award of a state license covering both diagnostic and CT modalities. Ultrasound technicians (sonographers) receive additional training and are examined by a different registry prior to receipt of a state license. Often, however, they have a basic radiology technologist license as well.
• It is not unusual for hospitals to concentrate their nighttime imaging workload in the ED. Use of ED equipment for all studies at night justifies capital and operating costs incurred in a second location.
• The primary concerns of ED physicians are the availability of medical and nursing supervision of acute patients and turnaround time for interpretation of imaging studies. For example, stroke therapy must be initiated within 20 minutes of diagnosis, and, therefore, transport time, scanning speed, and interpretation results are critical.
• The hospital must have a high volume of ED imaging to justify the additional equipment, space, and staff.