Deaconess Health System

Katie Warren

When people talk about “best practice” in medical imaging, the conversation often centers on large academic hospitals with deep benches of subspecialists and the latest technology. But in rural America, especially in communities facing high poverty and significant health disparities, best practice looks different. And it has to.

For those of us leading imaging services in rural settings with Medicare and Medicaid payer mixes approaching 70 percent, best practice is not about matching urban capabilities. It’s about delivering safe, timely and clinically meaningful imaging that truly serves the community.

In rural healthcare, best practice means access. It means a patient with stroke symptoms can receive a CT immediately, not hours later after a transfer.

One of the physicians who has most profoundly shaped my leadership is neurologist Dr. Alejandro Hornik, who often says, “Think of us as a long hallway to a tertiary care center.” That mindset matters. It means doing everything we can to keep patients close to home when transfer is not necessary. Imaging is the critical tool that allows our clinical teams to make that determination confidently and safely.

Best practice also means imaging that supports real-time decision-making for emergency physicians and primary care providers who are often managing complex cases with limited specialty backup. And it means doing this consistently, day after day, with small teams and finite resources.

Scaling imaging capabilities in smaller hospitals is one of the hardest challenges we face. Workforce shortages are constant. Recruiting and retaining technologists and radiologists is difficult and losing even one team member can threaten service continuity. Capital dollars are limited and aging equipment must often be stretched far longer than ideal. At the same time, reimbursement pressures from a predominantly government payer mix leave little margin for reinvestment, even though community need is often greater, not less.

Volume variability adds another layer of complexity. Some days are quiet. Others are overwhelming. Staffing models that work well in urban systems simply don’t translate to rural environments, where flexibility is essential and redundancy is rare.

“Best practice rural imaging is not about doing more. It’s about doing what matters most, exceptionally well, for the people who depend on us.c.”

Yet rural imaging leaders don’t lower clinical standards; we adapt them. We standardize protocols to reduce variability and improve safety. We prioritize modalities that have the greatest impact on outcomes, particularly CT and ultrasound. We cross-train staff to build resilience without compromising quality. And we establish clear escalation pathways so patients who need higher levels of care can be transferred efficiently and appropriately.

Technology has become our greatest ally. Teleradiology allows us to provide 24/7 coverage and subspecialty expertise that would otherwise be impossible. Cloud-based PACS and image sharing reduce delays and prevent unnecessary repeat exams. AI tools and clinical decision support help ensure imaging is appropriate and timely. In many cases, technology enables rural hospitals to leapfrog traditional barriers and deliver care that rivals much larger systems.

But technology alone isn’t enough. The heart of rural imaging is the people.

Supporting imaging teams in rural settings requires intention. These professionals often work in isolation, carrying significant responsibility with limited backup. Retention depends less on compensation alone and more on feeling valued, supported and connected. Investing in education, offering clear career pathways and ensuring a strong clinical leadership presence make a measurable difference. When teams feel respected and aligned with the mission, they stay and they thrive.

There are important lessons here for healthcare leaders working to improve rural imaging care. First, equity does not mean equal distribution of resources. Rural communities often require greater investment to achieve comparable outcomes. Second, reliability matters more than perfection. Consistent access to safe, timely imaging saves more lives than sporadic access to advanced technology. Third, partnerships are essential. Regional health systems, academic centers and vendors must collaborate with rural hospitals, not compete with them.

Finally, we must remember why this work matters. Imaging in rural healthcare is not a cost center; it is a lifeline. It reduces unnecessary transfers, supports local clinicians and ensures patients can receive care close to home. In high-poverty communities, it can mean the difference between early diagnosis and delayed treatment, between stability and crisis.

That mission is at the heart of my work with Deaconess Illinois as Regional Imaging Director. Serving the community where my friends and family seek care is not just a job; it’s a calling. Best practice rural imaging is not about doing more. It’s about doing what matters most, exceptionally well, for the people who depend on us.