Inland Imaging LLC, which touts itself as the Inland Northwests largest provider of radiology services, is taking steps on multiple fronts to upgrade or broaden those services even further.


The Spokane-based enterprise is spending more than $1 million on equipment upgrades at its Valley Imaging Center, at 12420 E. Mission, and plans next July to open an expanded Holy Family Imaging Center on the citys North Side. It claims that the latter facility, with about 28,000 square feet of floor space, will be the largest outpatient radiology center in the Pacific Northwest.


Operationally, the company, which together with two affiliates here employs nearly 400 people, is extending its reach into the burgeoning field of interventional radiology, which involves minimally invasive, targeted treatments such as angioplasty. It also is continuing to look at possible expansion of the limited computed-tomography (CT) screening tests it began offering late last year to adult patients with no apparent health problems who want to uncover potentially early signs of heart disease, cancer, and other maladies, a hot new segment of the radiology industry.


In addition, Inland Imaging is working to connect more of the Inland Northwests physicians to a fast-growing, Web-based radiology-image-and-report-distribution system that it helped develop, and is preparing to launch a new Web site that it believes will provide added benefit to patients and doctors. Outside the Inland Northwest, it has begun talking with an undisclosed Seattle physicians group about possible collaboration, although it declines to disclose any details of those discussions.


The company had revenues of between $40 million and $50 million last year, and currently is growing at a rate of 10 percent to 15 percent annually.


I think Inland is in a good position to deal with the challenges in the future, says CEO Steve Duvoisin. Inadequate reimbursement levels and a shortage of radiologists, however, remain big areas of concern, he says.


At the end of the day, if we can keep making the patients happy, thats really going to be a big part of what were trying to do, he adds.


Inland Imaging LLC employs about 260 people, operates seven outpatient imaging centers in the Spokane area and also one in Moses Lake, the latter through a joint venture, and provides services across the Inland Northwest through affiliations with 13 hospitals.


It now is performing and interpreting about 500,000 patient studies a year, gathering internal body images using technologies such as CT, magnetic-resonance imaging, ultrasound, nuclear medicine, and fluoroscopy. It distributes about 15,000 images and 25,000 reports monthly to referring physicians offices.


Its owned jointly by the 37 radiologists of affiliate Inland Imaging Associates PS and by Sacred Heart Medical Center and Holy Family Hospital. Radiologists are medical doctors with special training in performing and interpreting radiology studies.


The other affiliate, Duvoisin & Associates LLC, was formed about six years ago and is the managing company for Inland Imaging LLC and Inland Imaging Associates PS. It employs about 85 people and occupies the entire 18,000-square-foot third floor of the Riverpoint One Building, at 501 N. Riverpoint Blvd.


Owned by the 37 radiologists of Inland Imaging Associates PS, Duvoisin & Associates LLC handles business functions such as billing, accounting, operations management, and information systems, including Web development.


In one of its latest facility upgrade, Inland Imaging LLC recently installed new digital X-ray equipment at its Valley center at a cost of about $300,000, and it expects to complete a $700,000 MRI equipment upgrade there by the end of the year. Earlier this year, it completed a $400,000 expansion of ultrasound and mammography equipment there that has allowed it to speed up its mammogram services greatly. Such expenditures, though, arent unusual; over the last several years, Inland probably has spent an average of about $5 million annually on technology, Duvoisin says.


Its most anticipated project currently is the one under way next to Holy Family Hospital. Duvoisin says Inlands expanded imaging center there will be able to accommodate growth in long-term demand as the North Sides population increases. He says he expects Inland to finalize lease negotiations soon with Holy Family, which is developing the space as part of a $29.2 million expansion and modernization project.


The value of Inlands 20-year lease there is expected to be nearly $16 million. Inland says it plans to install the latest advanced MRI scanner from General Electric there, at an anticipated cost of about $2 million, and expects to add a new $1.2 million CT scanner there later.


Advanced procedures


In addition to expanding or updating its facilities, Inland Imaging is trying to stay abreast of new areas of practice such as interventional radiology. Such treatments, allowing radiologists to use incisions the size of a pencil point in conjunction with tools such as catheters, wires, balloons, and coils, are an alternative to open surgical procedures. Theyre claimed to be easier on patients because they involve no large incisions, lower risk, less pain, and shorter recovery times.


Last summer, Inland was able to attract to its radiology group Dr. Brian Chong, who it claims is the first and currently only interventional neuroradio-logist practicing in the Inland Northwest. Such subspecialists are trained in the treatment of vascular diseases of the brain and spinal cord, such as aneurysms and strokes, and there are relatively few of them in the U.S. Theyre highly sought, though, and the delicate procedures they perform can be an alternative in some cases to brain surgery.


Separately, Duvoisin says Inland is continuing to move cautiously into the area of offering CT screening tests to healthy people who want to uncover or watch for potentially early indicators of disease.


Over the last year, it has begun providing such scans for coronary artery disease and lung and colon cancer to seemingly healthy patients who are referred by their primary-care doctors and are willing to pay for the tests out of pocket, since the tests arent covered by insurance. It decided not to offer the more controversial total-body CT scans that have captured national attention over the last couple of years, with some providers marketing them directly to health-obsessed consumers in shopping centers.


We continue to study those procedures for appropriateness, Duvoisin says, declining to speculate on whether or when Inland Imaging might begin offering them.


Critics contend that that the total-body scansmade possible by recent advances in CT scannerscan give those tested a false sense of security and can lead to unnecessary additional tests and invasive procedures. Sensitive to such concerns, Inland Imaging said earlier than it wouldnt begin offering the scans until there is more scientific evidence supporting their diagnostic value.


Enhanced communications


Inland also has put a lot of energy into improving electronic communications with referring physicians through the introduction of a new integrated image-and-report-distribution service.


Called the Stentor imaging suite, it provides doctors with fast access to new and archived patient images and data through a private, communitywide intranet used by Spokane health-care organizations. Long term, its expected to cut costs, improve patient outcomes, and reduce a long-standing dependence on film and paper.


Web browser-based access makes it possible for multiple physicians to view an image at the same time, such as to discuss diagnoses or treatment options or progress, and if conditions warrant it, for the images to be available for viewing the instant a patient is finished with a scan.


Inland served as a national test site for the system, after convincing two vendors, Stentor Inc., of San Francisco, and IDX Corp., of Burlington, Vt., to integrate separate radiology image and data software-based products. The melded product makes it easier for doctors to look not just at a patients images electronically, but also all pertinent written reports.


Inland Imagings history dates back to 1937 when a predecessor practice called Spokane Diagnostic Radiology was formed. The entity that later was to become Inland Imaging LLC came into being in the 1970s as Inland Radiology PS, Duvoisin says, and was at the cutting edge of introducing a number of new imaging technologies developed over about a 10-year period in the 70s and 80s.


A certified public accountant who had been working for an accounting firm here, Duvoisin joined the radiology practice in 1984 after the radiologists who owned it decided they wanted to adopt a more comprehensive business approach. That same year, the practice opened on the St. Lukes Memorial Hospital campus what Duvoisin says was just the second outpatient imaging center in the state.


Perhaps the most significant internal development in more recent years came on Jan. 1, 1998, when Sacred Heart, Holy Family, and Inland Imaging Management Inc. formed Inland Imaging LLC to take over outpatient radiology services being provided at the two hospitals and at five other locations.


The intent of the pooling of resources was to reduce duplication, use staffing more efficiently, accelerate the introduction of new services and technologies, and to allow Inlands radiologists to delve more into subspecialty fields, such as pediatric and interventional radiology, Duvoisin says.


Inland further expanded its services two years ago when it merged with Spokane Vascular Associates, bringing on four vascular surgeons, who treat diseases of the veins and arteries.