On April 13, Franklin & Seidelmann Subspecialty Radiology Inc, Beachwood, Ohio, announced the addition of Richard D. White, MD, FACC, FAHA, professor of radiology and chairman of the Department of Radiology at the University of Florida College of Medicine, Jacksonville, to its staff; White’s role will be to develop and expand the company’s subspecialty cardiac teleradiology program and provide interpretation services to F&S clients. Advisor spoke with Scott Seidelmann, president and CEO of F&S, about the emerging field of cardiac teleradiology.

IEA: First of all, what was the motivation behind starting up the cardiac program?

Seidelmann: We see cardiac as an extension of subspecialty; musculoskeletal, neuro, body, cardiac—it’s just a natural extension. We see it as sticking to our mission, which is to continue to deliver quality radiology. We’re approaching cardiac as a true subspecialty.

IEA: Could you explain the new business structure?

Seidelmann: It’s very similar to the rest of our business. Essentially clients with 64-slice CT scanners that are producing CTAs will be charged a per-study fee and we’ll deliver them a subspecialty interpretation, and we’ll pay the radiologist accordingy. It’s literally exactly the same as if we were reading a musculoskeletal MRI. The one difference from a business perspective is that cardiac studies, like several other 3D studies, require 3D reconstruction. Unlike an MRI where the tech performs a study and then the radiologist views and manipulates the original data, a cardiac study, like a virtual colonoscopy, has to go through the middle step of reconstruction. We approached cardiac as another subspecialty on the market. We found a leading preeminent subspecialist in the field, and the person we added was Rick White, who’s one of the foremost international cardiac imagers. He formally led the program at the Cleveland Clinic, and before that he was at Georgetown. He’s really been a cutting edge cardiac imager. We found Rick first, and we said, how should we do cardiac? The easy thing to do was just send a bunch of our radiologists to Level 1 training programs. But that’s not the way we approached any of our other subspecialties, and it’s certainly not the way we decided to approach cardiac. Rick White has read hundreds of thousands of cardiac images, and so he’s really going to lead. He’s defining what the backgrounds are of the cardiac imagers that we want, what’s the proper degree of expertise. Everybody should be a Level 2 or Level 3, but how do you tell a qualified reader from an expert? That’s where Rick will lead for us. There aren’t yet too many readers with the experience to truly understand how to interpret these CTAs. It’s really the role of the subspecialist to get involved with the image acquisition and the 3D reconstruction.

IEA: How many cardiac readers are you hoping to add, and over what time frame?

Seidelmann: I think that the plan right now is to have five by midsummer and to see where it goes from there, but based on what we’re seeing from demand, we could have up to 10 by the end of the year. I think cardiac is a really interesting area. You’re really seeing how radiology’s evolving, because we’re adding in cardiologists as well. They both need to do some training. The cardiologist needs some training in cross-sectional imaging, and the radiologist needs some training in diseases processes.

IEA: A lot of teleradiology practices are getting into CTA right now. How will you differentiate yourselves from the competition?

Seidelmann: We’re going to offer the highest quality service that we can. We want standardized and repeatable interpretations—that’s key. And I think a major differentiator here is that we’re not having techs in some third party location do the 3D reconstruction and then send it off to a radiologist for interpretation. Image acquisition is such an important piece of this. Our radiologists will be directly involved in the 3D reconstructions themselves, and no other telerad business is doing that. But again, that’s all sticking with the theme of quality. Our view is that one of the great advantages of teleradiology is that you can take advantage of this distributed expertise. You really can deliver the highest quality possible product.

IEA: Any further plans for expansion?

Seidelmann: We’re always expanding. Teleradiology’s changing so fast, and we’re listening to our customers and reacting to them. And there’s certainly a need for a full-service product differentiated by quality. We’re big believers in the idea that in radiology, every portion of the field is specialty-driven. Every radiologist is a specialist, and we’re looking for areas of this market where we can add quality through specialization. You’ll see us broaden our product quite a bit. Teleradiology’s becoming increasingly “enterprise.” Buyers are making a second teleradiology decision now. You’re seeing a lot of turnover, and they’re getting very smart. They’re asking questions, and what we’re hearing a lot of is you need to offer a breadth of services.