ROI: How After-Hours Contrast Imaging Improves Access, Satisfaction, and Health Outcomes

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Expanding imaging hours to include evening and weekend appointments is a major vector for imaging centers looking to increase patient volume, improve access, and enhance care quality. In addition to the financial upside, there are significant patient-centric benefits that after-hours contrast enables. Many patients face barriers to scheduling during traditional hours, whether due to work schedules, transportation challenges, or family responsibilities.

Offering after-hours contrast-enhanced imaging not only helps capture a broader patient base but also reduces no-shows, improves patient satisfaction, and leads to earlier diagnoses. With remote contrast supervision solutions like Tether Supervision, imaging centers can extend service hours safely and efficiently, ensuring compliance while optimizing workflow and revenue.

Here's how after hours can improve the patient care at your imaging centers:

Increased Utilization by Underserved Populations

• Reduce Barriers for Care - After-hours appointments increase accessibility for individuals with fixed work schedules, transportation barriers, and language barriers.
• Underserved Populations Benefit Most - Studies show that racial minorities, non-English speakers, and lower-income patients are significantly more likely to utilize evening and weekend imaging appointments.
• Expand Patient Base - Expanding hours allows centers to capture a patient base that otherwise might delay or forgo essential imaging, reducing the risk of missed diagnoses and worsening clinical outcomes.

Access to essential medical imaging can be a major challenge for many individuals, particularly those with fixed work schedules, transportation barriers, and language differences. Expanding the availability of after-hours imaging appointments—during evenings and weekends—can significantly improve access for these populations and help prevent delayed or missed diagnoses.

Studies have consistently shown that racial minorities, non-English speakers, and lower-income patients are more likely to take advantage of imaging appointments offered outside traditional business hours. Research by Rossi et al. (2023) and Miles et al. (2022) found that these groups disproportionately rely on evening and weekend imaging, underscoring the need for more flexible scheduling to ensure equitable access to radiology services.^1,2 Without these expanded options, many patients may forgo essential imaging due to work constraints, lack of transportation, or other logistical challenges, leading to worsened health outcomes.

Lung cancer screening serves as a powerful example of this disparity. A 2023 study by Maki et al. revealed that almost double the number African American individuals reported difficulty scheduling lung cancer screenings, compared to White individuals.³ Similarly, transportation barriers were reported by 11.1% of African American respondents, compared to only 3.6% of White respondents. These disparities suggest that individuals from underserved communities face greater structural barriers to timely care, which can contribute to late diagnoses and poorer prognoses. By offering after-hours cancer screenings, healthcare providers can make it easier for patients to schedule crucial tests at times when family members or friends may be available to assist with transportation and support.

Multiple other studies have found that minority populations and individuals with public insurance are disproportionately more likely to miss or cancel outpatient imaging appointments scheduled during regular business hours.^4–7 Authors in these studies cited obstacles such as lower income, job insecurity, and workplace policies that do not provide flexibility for medical appointments. When essential imaging is inaccessible due to rigid scheduling, the consequences can be severe, potentially delaying critical diagnoses and interventions.

Ultimately, the data suggest that extending outpatient imaging hours is a practical and effective way to improve healthcare access, particularly for underserved populations. By accommodating the realities of patients’ lives—whether that means offering appointments outside standard work hours or addressing transportation challenges—healthcare systems can reduce disparities in medical imaging utilization and help ensure that all patients receive timely, essential care. Given the persistent inequities in healthcare access, implementing after-hours imaging services is a meaningful step toward closing the gap and improving health outcomes across diverse communities

Heightened Patient Satisfaction

• After-Hours Imaging Enhances Satisfaction – Offering after-hours imaging appointments improves patient satisfaction by increasing accessibility and accommodating those with rigid schedules.
• Satisfaction Correlates with Higher Patient Volume – Higher patient volumes in imaging centers correlate with improved satisfaction scores.
• Logistical Convenience is Key - Studies highlight logistical convenience, including flexible scheduling and helpful staff, is a key driver of patient satisfaction in radiology settings.

Patient satisfaction plays a crucial role in healthcare, influencing both patient retention and the overall success of medical facilities. When it comes to radiology and outpatient imaging, accessibility and convenience are key factors in shaping a positive patient experience. Research shows that offering after-hours imaging appointments—during evenings and weekends—can significantly enhance patient satisfaction by providing greater flexibility and reducing logistical barriers.

A survey conducted at the C.T. Scanning Unit at the Royal Infirmary in Edinburgh, Scotland, demonstrated that a notable 20% of patients expressed a preference for evening appointments between 6:00 PM and 8:00 PM.⁸ Additionally, 78% of those surveyed stated they would accept an evening appointment if offered. As shown in other studies, this preference may be larger in certain populations as well.^1–6 This early insight into patient preferences underscores the demand for extended imaging hours, particularly among individuals with rigid work schedules or other daytime commitments.

More recent studies further confirm this trend. North et al. found that nearly a quarter (24.4%) of self-scheduled imaging examinations took place after normal business hours or on weekends, emphasizing the strong demand for non-traditional appointment times.⁹ This growing preference for flexible scheduling reflects a broader shift in patient expectations, where convenience is a driving factor in healthcare decision-making.

Interestingly, an imaging center’s patient volume also correlates with satisfaction levels. A 2022 retrospective study analyzing MRI outpatient visits in a university-affiliated hospital system found that facilities with increasing patient volumes experienced significant improvements in satisfaction scores.¹⁰ These improvements spanned multiple domains, including facility experience, staff responsiveness, ease of registration, and overall quality of care. This suggests that offering more appointment availability—including after-hours slots—may not only enhance accessibility but also boost patient satisfaction metrics, ultimately strengthening an imaging center’s reputation.

Logistical convenience plays a critical role in satisfaction. A study by Ajam et al. analyzing Press Ganey survey data from over 69,000 respondents found logistical elements, such as the ease of scheduling and the helpfulness of registration staff, were major determinants of patient satisfaction in radiology settings.¹¹ Given these findings, expanding imaging hours can further improve patient experiences by accommodating diverse schedules, reducing stress associated with appointment access, and ensuring a smoother, more patient-centered care experience.

Ultimately, the availability of after-hours services can significantly enhance patient satisfaction by offering greater flexibility and convenience.^9,10,12,13 Patients who cannot attend appointments during regular hours due to work or other commitments may find after-hours services particularly valuable. This increased accessibility can lead to higher patient satisfaction, as it addresses their specific needs and preferences. As satisfaction increases, so does the likelihood of higher patient volume, as satisfied patients are more likely to choose and recommend these services.^10,11,14 The convenience of after-hours availability can thus attract a broader patient base, contributing to increased utilization of imaging services.

Improved Health Outcomes:

• Timely Imaging Improves Patient Outcomes – Faster access to diagnostic imaging enables earlier detection, reduces unnecessary specialist referrals, and decreases emergency department visits, ultimately improving overall patient care.
• Early Detection Saves Lives – Advanced imaging technologies like CT and MRI play a crucial role in detecting cancers such as lung, breast, liver, and prostate cancer at earlier stages, significantly improving survival rates and treatment outcomes.
• Expanding Imaging Access Reduces Healthcare Strain – Increasing imaging availability, including after-hours services and physician coverage for contrast studies, enhances health equity, prevents late-stage disease, and alleviates pressure on emergency departments and specialists.

Timely access to diagnostic imaging plays a crucial role in improving patient outcomes by enabling earlier detection, reducing unnecessary specialist referrals, and minimizing emergency department (ED) visits. Research has shown that when health systems have direct access to outpatient imaging, diagnoses are made more quickly, hospital referrals decrease, and overall patient care quality improves ^15–17. A streamlined referral system not only enhances efficiency but also helps patients receive the right care at the right time.

Studies indicate that direct access to imaging is both cost-effective and effective in diagnosing health conditions earlier.¹⁸ Faster imaging access reduces delays in treatment initiation, improving disease management and long-term health outcomes. In particular, research has demonstrated that after implementing direct imaging referral pathways, the number of patients sent to emergency departments dropped significantly, highlighting the role of early diagnosis in preventing medical crises and hospital overcrowding.¹⁹

Cancer detection is one of the most critical areas where improved access to imaging has a direct impact on survival rates.

• Lung Cancer: As the leading cause of cancer-related deaths in the United States, lung cancer claims nearly 150,000 lives each year. While chest X-rays can detect tumors, by the time a tumor reaches a detectable size, the disease is often already in an advanced stage, reducing the effectiveness of treatment. Increased accessibility and utilization of CT scans have significantly improved early detection, allowing doctors to identify tumors as small as a grain of rice. Compared to traditional chest X-rays, CT screening reduces lung cancer deaths by 20%, and the American Cancer Society estimates that widespread adoption of this technology among high-risk populations could save 12,000 lives annually.²⁰
• Breast Cancer: The National Breast Cancer Foundation reports that when detected early, the survival rate for breast cancer patients is 98%. However, for some women—particularly those with dense breast tissue—standard mammography alone may miss tumors. Contrast enhanced MRI can help identify small breast cancers that may be difficult to see on conventional imaging.²¹
• Liver Cancer: Contrast-enhanced CT scans are essential for detecting liver tumors and assessing their spread to surrounding blood vessels. These scans allow for better tumor characterization and help guide treatment decisions, such as liver resection or transplant eligibility.²² Early detection of hepatocellular carcinoma (HCC) through contrast-enhanced imaging significantly improves prognosis by enabling timely intervention.²³
• Prostate Cancer: Contrast-enhanced MRI is often used to accurately assess the size and location of prostate tumors. This provides greater sensitivity for detecting clinically significant prostate cancer and helps distinguish aggressive tumors from slow-growing ones, reducing unnecessary biopsies.²⁴ Early prostate cancer detection with MRI has been shown to improve treatment outcomes and reduce overtreatment of indolent tumors.

Ultimately, increasing access to advanced imaging services leads to earlier disease detection, better treatment outcomes, and reduced strain on emergency departments and specialist services. Expanding imaging availability—through after-hours services, or increasing physician coverage for contrast studies—plays a critical role in saving lives and improving health equity. By prioritizing timely and convenient access to diagnostic imaging, healthcare systems can significantly enhance patient outcomes and reduce the burden of late-stage disease treatment.

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References:

1. Miles RC, Lehman CD, Chou SHS, et al. Patient Sociodemographic Characteristics Associated With Saturday Breast Imaging Clinic Utilization. J Breast Imaging. 2022;4(4):378-383. doi:10.1093/jbi/wbac035

2. Rossi J, Mullen LA, Oluyemi ET, et al. Patient Utilization of Weekend and Evening Appointments for Screening Mammography: An 8-Year Observational Cohort Study. J Am Coll Radiol. 2024;21(10):1657-1667. doi:10.1016/j.jacr.2024.04.029

3. Maki KG, Talluri R, Toumazis I, Shete S, Volk RJ. Impact of U.S. Preventive Services Task Force lung cancer screening update on drivers of disparities in screening eligibility. Cancer Med. 2023;12(4):4647-4654. doi:10.1002/cam4.5066

4. Mieloszyk RJ, Rosenbaum JI, Hall CS, Hippe DS, Gunn ML, Bhargava P. Environmental Factors Predictive of No-Show Visits in Radiology: Observations of Three Million Outpatient Imaging Visits Over 16 Years. J Am Coll Radiol. 2019;16(4):554-559. doi:10.1016/j.jacr.2018.12.046

5. Glover M, Daye D, Khalilzadeh O, et al. Socioeconomic and Demographic Predictors of Missed Opportunities to Provide Advanced Imaging Services. J Am Coll Radiol. 2017;14(11):1403-1411. doi:10.1016/j.jacr.2017.05.015

6. Moses RA, Dagrosa LM, Hyams ES, Steinberg PL, Pais VM. Failing to follow up: predicting patients that will “no-show” for medically advised imaging following endourologic stone surgery. Can J Urol. 2013;20(5):6939-6943.

7. O. AlRowaili M, Ahmed AE, Areabi HA. Factors associated with No-Shows and rescheduling MRI appointments. BMC Health Serv Res. 2016;16(1):679. doi:10.1186/s12913-016-1927-z

8. Gavan DR, Moore J, Best JK. A survey of patient attitudes towards an evening out-patient appointment. Health Bull (Edinb). 1995;53(2):94-98.

9. North F, Nelson EM, Buss RJ, Majerus RJ, Thompson MC, Crum BA. The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison. JMIR Med Inform. 2021;9(12):e27072. doi:10.2196/27072

10. Ajam AA, Lang EV, Nguyen XV. Does Patient Satisfaction Drive Volumes in Outpatient Magnetic Resonance Imaging? Curr Probl Diagn Radiol. 2022;51(4):497-502. doi:10.1067/j.cpradiol.2021.09.005

11. Ajam AA, Berkheimer C, Xing B, Umerani A, Rasheed S, Nguyen XV. Topics most predictive of favorable overall assessment in outpatient radiology. Jakovljevic M, ed. PLOS ONE. 2023;18(5):e0285288. doi:10.1371/journal.pone.0285288

12. Offman J, Wilson M, Lamont M, et al. A randomised trial of weekend and evening breast screening appointments. Br J Cancer. 2013;109(3):597-602. doi:10.1038/bjc.2013.377

13. Huppe AI, Loving VA, Slanetz PJ, Destounis S, Brem RF, Margolies LR. Optimizing the Patient Experience in Breast Imaging Facilities: AJR Expert Panel Narrative Review. Am J Roentgenol. 2024;223(3):e2329995. doi:10.2214/AJR.23.29995

14. Lucas C, Ethan C. Evaluating the Pros and Cons of Evening and Weekend Outpatient Medical Imaging: Implications for Patients and Radiology Professionals. J Radiol Oncol. 2024;8(2):078-084. doi:10.29328/journal.jro.1001069

15. Ní Shúilleabháin A, O’Kelly M, O’Kelly F, O’Dowd T. Limited options: a report on GP access to services. Ir J Med Sci. 2007;176(1):27-32. doi:10.1007/s11845-007-0006-1

16. Smith CF, Tompson AC, Jones N, et al. Direct access cancer testing in primary care: a systematic review of use and clinical outcomes. Br J Gen Pract. 2018;68(674):e594-e603. doi:10.3399/bjgp18X698561

17. Van Den Berg MJ, Van Loenen T, Westert GP. Accessible and continuous primary care may help reduce rates of emergency department use. An international survey in 34 countries. Fam Pract. 2016;33(1):42-50. doi:10.1093/fampra/cmv082

18. Rua T, Mazumder A, Akande Y, et al. Management of chronic headache with referral from primary care to direct access to MRI compared with Neurology services: an observational prospective study in London. BMJ Open. 2020;10(10):e036097. doi:10.1136/bmjopen-2019-036097

19. Rutten MH, Smits M, Peters YAS, Assendelft WJJ, Westert GP, Giesen PHJ. Effects of access to radiology in out-of-hours primary care in the Netherlands: a prospective observational study. Fam Pract. 2018;35(3):253-258. doi:10.1093/fampra/cmx093

20. The National Lung Screening Trial Research Team. Reduced Lung-Cancer Mortality with Low-Dose Computed Tomographic Screening. N Engl J Med. 2011;365(5):395-409. doi:10.1056/NEJMoa1102873

21. Bakker MF, De Lange SV, Pijnappel RM, et al. Supplemental MRI Screening for Women with Extremely Dense Breast Tissue. N Engl J Med. 2019;381(22):2091-2102. doi:10.1056/NEJMoa1903986

22. European Association for the Study of the Liver. EASL Clinical Practice Guidelines: Management of hepatocellular carcinoma. J Hepatol. 2018;69(1):182-236. doi:10.1016/j.jhep.2018.03.019

23. Forner A, Reig M, Bruix J. Hepatocellular carcinoma. The Lancet. 2018;391(10127):1301-1314. doi:10.1016/S0140-6736(18)30010-2

24. Ahmed HU, El-Shater Bosaily A, Brown LC, et al. Diagnostic accuracy of multi-parametric MRI and TRUS biopsy in prostate cancer (PROMIS): a paired validating confirmatory study. The Lancet. 2017;389(10071):815-822. doi:10.1016/S0140-6736(16)32401-1

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