Bringing the procedure to the patient: Fusion and point-of-care procedural imaging

Every hospital has people whose whole job is moving patients from one place to another. The work is essential, and few hospitals fully measure what it costs. Call it the trip everyone sees but few fully count.

That trip looks different in critical care. Picture a ventilated ICU patient who needs a line placed under fluoroscopic guidance. Before they can leave the room, a nurse switches them to portable monitoring, and a respiratory therapist takes over the airway. Then the patient crosses the hospital, waits, has the procedure, waits again, and comes back. For a few minutes of fluoroscopy, a small team is gone from the unit for well over an hour.

This patient isn’t one specific case, but the numbers come from published studies and hospital workflow data.

Ask anyone who has worked in critical care, and they’ll tell you transport is one of the riskier moments in a patient’s day. Fanara and colleagues made the case that it should be treated as a complex clinical procedure in its own right, one that needs planning, the right equipment, continuous monitoring and trained people.¹ 

More recently, Murata and colleagues pooled the evidence in a systematic review and meta-analysis and found that adverse events during transport are still common, even as monitoring technology and transport protocols have improved. The list reads like an ICU nurse’s worry list: cardiovascular instability, respiratory compromise, monitoring that drops out, equipment that fails, and catheters or other devices that get dislodged along the way.²

Many transports are completed without incident. Each one still carries some degree of risk, and each one takes staff time away from patient care.

Time is the easier cost to measure, and the totals tend to surprise people.

In a clinical feasibility study at the University of Rochester Medical Center (URMC), moving a patient from the room to the IR suite took an average of 39 minutes, and the return trip took another 33. That works out to roughly 72 minutes of transport per patient.³

A Carestream workflow analysis at a large academic medical center in the Southeast found a heavier burden. It covered 467 ICU-to-IR transports over 16 months, and it only looked at procedures that had already been screened on duration, radiation dose and complexity as reasonable candidates for mobile fluoroscopy. Transport to IR averaged 50 minutes and the return averaged 40, which puts the total near 90 minutes per patient before the procedure itself is counted.⁴

What often surprises people is how much of the burden falls outside the transport itself. At the same Southeast academic medical center, patients arrived in IR an average of 66 minutes before their procedure began, and the return trip started about 37 minutes after it ended.⁴ That’s where the prep work, the wait for a room, the staff coordination and the handoff back to the ICU all happen. None of them are in the 90 minutes.

There’s a second cost that’s easy to miss if you only look at the ICU side. In workflow conversations at that site, clinicians pointed out that many ICU patients skip the usual pre- and post-procedure holding area and go straight into a procedure room.⁵ The room has to sit open while the patient is on the way, and the cases behind it wait.

In a department that’s already tight on room time, a low-complexity ICU case can end up holding a room that a higher-acuity patient needs.⁵

So the real question is whether some of these trips need to happen at all. For selected procedures, mobile fluoroscopy makes it possible to bring the equipment and the provider to the bedside and keep the patient where they are, with their monitoring and care team in place.

A scientific poster presented at the American College of Radiology 2026 Annual Meeting reported initial experience at URMC, in collaboration with Carestream Health.³ Interventional radiologists working in the IR suite used an investigational mobile fluoroscopy device for commonly performed procedures, including vascular catheter checks, drainage catheter procedures, biliary procedures, genitourinary tube procedures and feeding tube procedures. They reported adequate image quality across all procedures, and no case had to switch to standard IR equipment.

Early as it is, the result points somewhere important: selected procedures can be guided with mobile fluoroscopy without giving up image quality, which opens the door to doing them where the patient already is.³

Bedside procedures aren’t free, and any economic case that pretends otherwise won’t survive a conversation with finance. A technologist still has to bring the system to the room and get it positioned. The physician, interventional radiologist or advanced practice provider still has to make their way to the bedside. Procedure time happens either way, so the model leaves it out and compares the cost of moving the patient against the cost of moving the equipment and the provider.

Let’s do the math.⁵ We put mobilization at roughly $50 a procedure in a lean workflow, about $100 in a typical academic hospital and $150 to $200 in a large, spread-out facility. On the transport side, Hurst and colleagues measured an average cost of $452 per transport in 1992.⁶ Bring that forward to today’s dollars and it lands somewhere between $1,050 and $1,450, depending on which inflation index you use.⁵ We used $1,000 in the model on purpose: a conservative figure that gives the analysis a credible foundation without overstating the case.

Two assumptions had to be estimated because published benchmarks don’t exist: how many ICU-to-IR transports a hospital does each day, and what share of procedures are suited to the bedside. We modeled both as scenarios, with bedside eligibility from 10% to 40%. The results below assume 20% (modeled by Barski⁵)

Scenario	Avoided transports per year	Net annual savings
5 transports per day	365	$292K–$347K
10 transports per day	730	$584K–$694K
20 transports per day	1,460	$1.17M–$1.39M

Staff time follows the same curve. At roughly 90 minutes per avoided transport, the high-volume scenario gives back about 2,190 hours a year, a little more than one full-time equivalent.⁵. We’re deliberate about how we frame that. Those hours are capacity a hospital can redeploy to direct patient care and higher-acuity work, and they shouldn’t be read as positions to eliminate. Nursing leadership will hear the difference right away, and they should.

Fusion* is in development to be a mobile fluoroscopy system that provides real-time fluoroscopic guidance and full general radiography on a single platform. It is designed to support minimally invasive image-guided procedures at the bedside. Bedside means wherever the patient is, whether that’s the ICU, the emergency department, the trauma bay or a step-down unit. The same unit carries the full portable radiography workload, so it stays productive every day rather than only on procedure days.Fusion Mobile RF SystemCarestream Health

For the care team, that changes where the work happens. Real-time fluoroscopic guidance arrives with the system, and the physician and technologist come to the patient. The patient stays connected to their own monitoring; the nurse and respiratory therapist stay on the unit, and the trip, along with the waiting on either side of it, is no longer part of the procedure.

*Fusion is pending FDA 510(k) clearance and is not available for sale in the United States.

Fusion is built to take some of the friction out of a workflow many hospitals have simply learned to accept. Today, moving the patient to a procedural suite is the default for nearly all of this volume, and it is a cost many organizations have absorbed for so long that it rarely gets a second look.

The answer may be different at every hospital. The two numbers the literature can’t provide, daily transport volume and bedside eligibility, are ones any ICU and IR team can pull for themselves. Look at your own transport volumes, procedure mix, staff time and workflow impact, and you may find that what has long been accepted as routine carries a larger operational burden than expected.

Which leaves the question this piece started with: who is ultimately paying for it?

The full white paper, with every model assumption, is available here. David Ruiz will present this work at RSNA 2026 in two Innovation Park sessions in the South Hall: Sunday, Nov. 29 at 11 a.m., and Monday, Nov. 30 at 4 p.m. You can also find Carestream in the South Hall at Booth 2165.

References

1. Fanara B, Manzon C, Barbot O, Desmettre T, Capellier G. Recommendations for the intra-hospital transport of critically ill patients. Crit Care. 2010;14(3):R87. doi:10.1186/cc9018

2. Murata M, Nakagawa N, Kawasaki T, et al. Adverse events during intrahospital transport of critically ill patients: a systematic review and meta-analysis. Am J Emerg Med. 2022;52:13-19. doi:10.1016/j.ajem.2021.11.021

3. University of Rochester Medical Center / Carestream Health. Initial experience with novel mobile fluoroscopy device for simple interventional radiology procedures. American College of Radiology 2026 Scientific Poster.

4. Carestream Health. Transport workflow analysis, anonymous academic medical center. Data on file.

5. Carestream Health. Reducing ICU-to-IR transport through bedside fluoroscopic interventions: clinical, operational, and economic value for large health systems. White paper. 2026.

6. Hurst JM, Davis K Jr, Johnson DJ, Branson RD, Campbell RS, Branson PS. Cost and complications during in-hospital transport of critically ill patients: a prospective cohort study. J Trauma. 1992;33(4):582-585.

David Ruiz, R.T.(R)(T)(ARRT) is Director of Commercial Strategy and Product Marketing at Carestream Health, and Lori Barski is Senior Principal Imaging Scientist at Carestream Health.