R&E 2: Radiology Efficiency from a Radiology COO—Interview with Maria Budhwani

How Private Centers Drive 4X ROI and Maximize Every Scan

In this installment of the Radiology & Efficiency (R&E) Series, Maria Budhwani shares a clear, data-driven view of how Georgia Health Imaging, a single independent imaging center, has remained profitable, stable, and innovative in a consolidated market. Her perspective is shaped by 20+ years of technical and operational leadership inside one of the few remaining private centers in metro Atlanta.

Her themes are consistent:
Optimize payer mix, extract more value from every scan, and build a workforce that rarely turns over.

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Financial Velocity

A Deliberate Shift Toward Higher-Return Cases

Maria describes the most visible financial change: traditional commercial insurance no longer supports the cost of doing business.

• Typical return for a basic lumbar MRI: ~$125 after administrative overhead.
• Return on PI, workers’ compensation, and self-pay cases: 3–4× higher.

Since 2021, the center has intentionally moved toward these higher-yield categories. The metric she watches most closely is revealing and straightforward:
What percentage of monthly scans fall into PI/self-pay vs. commercial insurance?

This shift funds the practice’s technology upgrades without relying on shrinking insurance margins.

Operational Efficiency

One Scan. Five+ Clinical Outputs.

Georgia Health Imaging is implementing a protocol strategy that maximizes the diagnostic value of every CT scan.

From a single low-dose chest/abdomen/pelvis study, the team can now derive:

• Lung screening
• Bone density (with accuracy exceeding traditional DEXA)
• Liver health metrics
• Cardiac chamber volumetry
• Coronary calcium scoring

Impact:

• Fewer individual visits
• Less total radiation exposure
• Elimination of standalone equipment (and its footprint)
• More actionable information per encounter

Maria frames it: “Reduce the number of exams. Increase the amount of information. Improve the accuracy.”

This approach has revealed incidental—but clinically significant—findings, such as severe cardiac calcification in a patient who presented for an unrelated lung evaluation.

Workforce Stability

Long-Tenured Teams and Quantifiable Quality Checks ensure Radiology Efficiency

While turnover and burnout dominate national headlines, Maria reports a stable team with long tenure across radiologists, technologists, and front-office staff.

The model is straightforward:

• Primary radiologist on staff for ~20 years, with consistent backup coverage
• Quarterly dual-read quality checks (Radiologist A vs. Radiologist B)
• Administrative staff trained to identify mismatches before they become report errors

The culture emphasizes respect, accuracy, and follow-through.
A recent case reinforces this: within minutes of reviewing a CT head, their radiologist identified a near-rupture intracranial aneurysm—leading to emergency surgery and a saved life.

The Administrative Constraint

The Largest Bottleneck Is Not Clinical

Maria is direct about the most significant operational drag: the administrative friction tied to authorizations, coding mismatches, and payer delays.

Examples she cites:

• Incorrect ICD-10 codes submitted by third parties
• Authorization errors (e.g., left vs. right side)
• Slow insurer corrections that delay patient care

AI tools help flag mistakes faster, but the underlying problem remains structural:
AI can only validate the rules it is given—and many of those rules are rigid, granular, and error-prone.

Radiology-specific administrative AI still lags behind clinical AI in usefulness.

Technology That Drives Return

PACS Upgrades, Advanced Protocols, and Accessible 3D Visualization

Two investments stand out:

1. Modernized PACS
   • Fully digital, patient-accessible images
   • Simple, shareable links for referring providers
   • Patients can generate their own 3D renderings, increasing comprehension and engagement
2. Protocol-Level Innovation
   • Expanded MRI and CT capabilities on existing hardware
   • New high-level DTI protocols for stroke, TBI, MS, and neuro evaluations
   • No new scanner purchase required—keeping advanced care affordable and local

Patients have responded to both. Many review their images at home and return with informed questions, improving clinical conversations.

Looking Ahead

Human + AI as the Practical Path Forward for Radiology Efficiency

Maria’s outlook is pragmatic:
AI is most valuable as a second set of eyes—never the sole authority.

She expects continued gains in:

• Cardiac AI for CT
• MRI DTI protocol expansion
• Automated extraction of multi-organ analytics from standard scans

The future advantage will belong to practices that combine experienced radiologists, structured quality checks, and AI-accelerated insights—all without burdening patients with more visits, higher costs, or confusion.

Get in touch with us at Imorgon

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Andy Milkowski CEO

I am proud to have made a meaningful impact on many lives by improving the utility of diagnostic ultrasound worldwide. For over 20 years, I have been part of the diagnostic ultrasound community in various corporate roles, including leadership roles in sales, product management, and research.  Working with both committed clinicians and extremely talented scientists, we have brought new capabilities to ultrasound.  We have enabled ultrasound to provide more information and across a large habitus of patients to Radiologists – allowing for a diagnosis without follow-up exams using contrast agents or radiation.  I have been thankful for my early training and education in statistics and engineering, which has allowed me to see the ‘signal from the noise.’  

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