Catawba Valley Medical Center

Robin Cox

Rural Imaging Authority

In rural communities, access to imaging care is shaped by far more than the availability of equipment. Geography, workforce shortages, limited modality capacity, and delays in obtaining specialist interpretation can all stand between a patient and a timely diagnosis. These barriers can postpone treatment decisions and compound risk when findings require prompt specialty consultation. For healthcare leaders, improving rural imaging access requires more than capital investment. It requires deliberate redesign of the systems that determine how, when, and where patients receive care.

How care is delivered depends on clear referral pathways, streamlined authorization and scheduling processes, and reliable safeguards to ensure patients receive the appropriate examination the first time. When care is delivered depends on appointment availability, effective use of modality capacity, prioritization of urgent studies, and timely report turnaround. Where care is delivered is equally consequential. When clinically appropriate, imaging and specialty expertise should be brought closer to patients through local services, mobile or shared resources, teleradiology, virtual specialty consultation, and partnerships with larger health systems.

Operational Redesign: Expanding Access with Existing Resources

Many of the most immediate opportunities to expand imaging access do not require new equipment or additional physical space. They begin with a disciplined review of how work moves through the imaging continuum from order entry and referral through scheduling, examination, interpretation, and followup. Small inefficiencies at each point can accumulate into delayed care, unused capacity, staff frustration, and a poor patient experience.

Scheduling is often the highest impact starting point. Leaders should assess demand patterns, appointment types, no-show and cancellation rates, modality utilization, and backlog by service line. These data can inform practical changes, such as protecting capacity for urgent studies while preserving routine access, simplifying rescheduling, and using reminder and outreach workflows to reduce unused appointment time.

"Expanding rural imaging access is not a single-project effort. It is a leadership strategy that combines operational redesign, workforce investment, responsible technology adoption, and intentional partnerships."

These improvements should not be viewed solely as productivity initiatives. Their purpose is to make access more reliable. By reducing friction in scheduling and care coordination, rural imaging programs can serve more patients, shorten time to diagnosis, and reduce the logistical burden borne by patients and families.  

Using AI to Extend Clinical Capacity—Not Replace It

After foundational workflows have been improved, artificial intelligence can provide another avenue for expanding imaging access. The most valuable applications are those that reduce administrative burden, support clinical decision-making, improve image quality, or help imaging teams work more efficiently. AI should be positioned as a capability that extends clinical capacity—not as a substitute for clinical judgment, accountability, or human connection.

For example, AI-enabled scheduling and workflow tools may help identify unused capacity, prioritize urgent examinations, reduce manual tasks, and flag patients who need followup. Within imaging, AI may support faster acquisition or reconstruction, assist with image-quality checks, and prioritize examinations with potential urgent findings for radiologist review. These capabilities may be particularly valuable when rural facilities have limited staffing or when radiologists interpret studies across multiple locations.

Leaders should evaluate AI investments not only on technical performance, but also on demonstrated impact on access, turnaround time, staff workload, quality, equity, and total cost of care. AI is most likely to create value when it is integrated into a broader operational strategy. When implemented responsibly, it can reduce delays, improve consistency, and allow clinicians and staff to devote more attention to the work that requires their expertise.

Partnering to Bring Specialty Expertise Closer to Home

Partnerships with tertiary health organizations can help rural health systems expand access to specialty expertise without requiring every patient to travel for initial evaluation or followup. These relationships can support teleradiology coverage, virtual specialty consultation, shared protocols, clinician education, and streamlined referral pathways for patients who need a higher level of care.

The maternal-fetal medicine program at Catawba Valley Health System illustrates this model. Catawba Valley identifies its maternal-fetal medicine partner physicians as being from Atrium Health Wake Forest Baptist; these specialists work with local sonographers to support high-risk obstetric care. This type of partnership helps connect patients with specialized consultation and coordinated care closer to home while leveraging the resources of a larger system. It can reduce unnecessary travel, support local obstetric and imaging teams, and help ensure patients with complex pregnancies are identified and connected to the appropriate level of care efficiently.

The larger leadership lesson is clear: partnerships should be designed not merely as referral arrangements, but as integrated care models that strengthen local capability while providing access to specialty expertise that would be difficult for a rural organization to sustain independently.

Expanding rural imaging access is not a single-project effort. It is a leadership strategy that combines operational redesign, workforce investment, responsible technology adoption, and intentional partnerships.