Optimizing pediatric radiology workflow amidst workforce shortages: A single-center experience reducing off-hours...

Pediatric radiology is facing an escalating workforce crisis, fueled primarily by a constrained fellowship pipeline and rising imaging volumes. This imbalance has created difficulty providing and maintaining off-hours fluoroscopic services, which require on-site radiologist presence. The resulting burden on the existing labor force exacerbates burnout, challenges radiologist retention and recruitment, and risks undermining the long-term sustainability of pediatric radiology practice. There is a shared imperative to seek alternative, creative strategies to alleviate these issues while achieving comparable diagnostic performance and maintaining credibility and trust with our referring providers. This Learning From Experience article outlines a practical, protocol-based approach to reducing fluoroscopy dependence through alternative imaging modalities while maintaining diagnostic accuracy and patient safety. These include midgut ultrasound as the first-line imaging modality for bilious emesis workup, low-dose CT of the esophagus for impacted esophageal foreign bodies instead of fluoroscopic esophagram, and technologist-performed contrast studies for percutaneous feeding tubes to reduce on-site radiologist-performed fluoroscopy. In addition, an advanced practice provider-supported fluoroscopy model is discussed to improve resource utilization. Lastly, potential delay of intussusception reductions overnight is discussed as a future direction that has not been implemented. Following implementation of the three examination-specific pathways at our institution, off-hours fluoroscopy utilization decreased by 64%, from approximately three to one examination per week; much of the remaining off-hours fluoroscopy volume involved intussusception reduction. In our experience, these alternative imaging pathways and systematic changes can meaningfully reduce after-hours procedural burden while maintaining diagnostic quality and patient safety.