Procedures Service Operations

To increase the efficiency of the Body Imaging Section by:

Facilitating the logistics of scheduled and add-on interventions through improved communications with the section
Streamlining processes related to interventions, such as setting up new procedures and their protocols, new devices, equipment, etc.
Decompressing the reading teams in CT and US by performing all BI interventions except tumor ablations (to be done by qualified attendings only)

To increase patient throughput by optimizing:

To improve the teaching mission of our division and enhance the procedure skills of our trainees

To improve QA of Body Imaging Procedures

To increase and facilitate academic output related to procedure topics

Procedures Service Workflow

All BI procedures, except tumor ablations, are performed by the procedure service team (fellow and resident, supervised by one attending radiologist) on duty. These procedures include US and CT. OR procedures are performed by the attending on duty only.
On days when the PS fellow is on academic leave (one half day per week), the procedures resident will run operations. This will mostly include approval and database related responsibilities, since usually no elective procedures are scheduled during this time (currently Tuesday a.m.)
Morning procedures will be performed by the fellow only, since the resident is assigned to body CT at this time. Cases in the afternoon should be done predominantly by the resident, ideally at least one sedation and one non-sedation procedure.
Tuesdays are the exception, where the resident will perform all morning procedures while the fellow is on academic time. Afternoon cases are predominantly done by the fellow on that day.

Hours of operation are 8 a.m. to 6 p.m.
Time slots for procedures are 90 minutes each, with a 30-minute transition time for post-procedure responsibilities, reporting, consenting the next patient, etc.
There are up to 6 scheduled procedure time slots per day; however, workload may vary in either direction.
The first and third morning slots and the first afternoon slot are preferably used for conscious sedation procedures (e.g., liver and lung biopsies), since possible complications can be better monitored during working hours.

Friday p.m. will be kept blocked for the frequent Friday add-ons
Thyroid FNA´s are scheduled every 2nd and 4th Monday. Thyroid FNA hours of operation are 8:00 a.m. – 2:30 p.m. Time slots are 45-60 minutes each, depending on number of lesions; the number of lesions will be noted on the approval or requisition form. Exams are scheduled in 30 minutes increments, so that patients overlap. Two sonographers and one pathologist support the service in two rooms connected to each other, in order to expedite the workflow. The last thyroid appointment is 2:15 p.m.

On these Mondays other procedures may be scheduled at 3:00 p.m. only.
If thyroid FNA´s are scheduled on other days, check the “in room path” box on the approval sheet. 3:30p.m. is the last minute the histopath tech would come in.

Tumor ablations are independent from the time slots and will be covered by one qualified attending only, preferably Dr. Kolokythas, or, in his absence, other attendings will alternatively cover in IR or OR.
All add-on procedures of the day will be approved by the PS fellow, after discussion of the request with the PS attending. Scheduled procedures will be primarily approved by the same, but can be also approved by the PS fellow in conjunction with the US or CT attending. If the added-on procedures exceed the capacity of the time slots provided above, they would have to be approved in consultation with the reading teams, who then would help out if necessary.
PS fellow academic days (half day per week) are on Tuesday a.m.. No elective procedures are scheduled for these two time slots. Add-on / stat procedures would be allowed with the PS attending's approval only.