Advancing Access and Efficiency in Modern Medical Imaging

Courage Osagie is an experienced imaging leader with nearly three decades of experience in medical imaging, including about 20 years in leadership roles. As System Director of Imaging Services at Scotland Health Care System, he focuses on improving access to imaging, expanding diagnostic services and strengthening operational efficiency as demand continues to grow. His career began as a radiology technologist before advancing into nuclear medicine and PET imaging, building a strong clinical foundation that informs his leadership across imaging and cardiology operations.

Building a Career in Imaging Leadership

My first director role was in Maine at Northern Light Inland Hospital, where I served as Director of Imaging Services for about four years. I later became Director of Cardiology before transitioning into Administrator for Physician Practices, where I worked for another four years.

Although I enjoyed my work in Maine, the winters were difficult for my family, which led us to relocate to Louisiana. At Louisiana Heart Hospital, I served as Director of Imaging Services and Outpatient Services, overseeing imaging and outpatient services such as physical therapy and outpatient lab collection.

I later moved to northeast Georgia, where most of my family lives, serving as System Director of Non-Invasive Cardiology and overseeing four hospitals. Just before COVID, I shifted into contract leadership roles with organizations such as B.E. Smith and IRE. During that time, I worked with health systems including AdventHealth in Orlando, Dignity Health in California and Ascension in Wisconsin, typically serving as Director of Imaging Services or Director of Cardiology.

In those assignments, my role focused on assessing operational challenges and implementing improvements. I spent the first few months identifying issues related to patient satisfaction, employee morale, recruitment challenges or imaging volumes. After identifying priorities, I developed a plan with senior leadership and led implementation over the following six months to a year.

I came to Scotland Health about a year ago to help address accelerated growth and recruitment challenges. Since then, my focus has been improving access while scaling imaging operations to meet rising demand.

When I arrived, MRI services operated Monday through Friday from eight to five. Today, MRI runs Monday through Sunday, with weekday outpatient hours extending until 9:30 in the evening. We also now offer weekend imaging, including mammograms on Saturdays, while CT and ultrasound are available on weekends and into the evening. As volumes have grown, we have worked closely with a new radiology group and implemented tools such as Rad AI to help radiologists complete dictation more efficiently.

Staffing Pressures in Imaging Services

One of the biggest challenges facing imaging services today is staffing, particularly the shortage of technologists and radiologists. Recruiting radiologists has become increasingly difficult because many new graduates prefer to work off-site rather than in hospitals.

"It is important to continue to educate yourself, join the society and look out for mentors who can help guide you as you move forward."

This shift has required changes in workflow and closer coordination with IT to ensure the infrastructure supports remote work. Fast and reliable internet is essential for radiologists reading studies from off-site locations.

At Scotland Health, we typically have five or six radiologists. A physician assistant is on-site to assist with fluoroscopy cases, and we also have interventional radiologists. Most other radiologists covering breast imaging, MRI, CT, ultrasound and general X-ray work off-site. Because Scotland Health serves a rural area, internet service can be challenging, requiring additional focus on infrastructure and cybersecurity.

To strengthen the workforce pipeline, we are working closely with three local community colleges, whose biggest challenge is securing enough clinical sites. To help address that need, we have opened more locations, created imaging tech assistant roles for senior students and expanded opportunities for clinical training, making it easier for students to transition into full-time roles after graduation. I encourage my managers to see students not only as learners, but also as an important part of long-term recruitment.

Expanding Access to Strengthen Patient Care

Improving access remains a priority in medical imaging. Since COVID, imaging volumes have grown significantly. I often remind my staff that access is quality because every delay in imaging also delays diagnosis and the next step in care.

That belief has shaped several of our recent initiatives at Scotland Health. In addition to expanding service availability, we have implemented a mobile mammogram program that travels to underserved communities to improve access to screening. Together, these efforts are designed to expand appointment availability and bring imaging closer to patients who might otherwise face barriers to timely care.

AI Driving Better Care and Faster Imaging Workflows

I am excited about the potential of AI in medical imaging. Tools such as Rad AI have already made our radiologists about 10–15 percent more efficient, and as we evaluate additional applications, those gains could grow further. AI is also improving workflows in areas such as MRI and CT, particularly in post-processing where automation can accelerate turnaround times. A year ago, I was more skeptical about AI, but seeing its impact firsthand has changed my perspective.

More broadly, medical imaging has become one of the most cost-effective ways to support patient care and clinical decision-making. In the 1990s, exploratory surgery was more common because clinicians often had limited visibility into what was happening inside the body. Advances in CT scans and MRI have made diagnosis far more precise and reduced the uncertainty that once shaped many clinical decisions.

I also see AI emerging as a valuable tool for helping clinicians order the right study. As imaging demand grows, determining the appropriate exam remains a challenge for many physicians. I would like to see more attention from AI companies on helping ordering providers, including primary care providers and specialists, identify the most appropriate imaging study so it is done right the first time. Taken together, these developments will play a significant role in shaping the future of radiology practice and patient care.

Leading Boldly through Mentorship and Continuous Growth

My advice for future imaging leaders is to lead boldly. I have been fortunate to have mentors who helped guide me along the way. Some came from within imaging, while others were outside the field, including vice presidents and directors who helped shape my perspective on leadership and career development.

Another important step is joining AHRA, the organization for radiology administrators. AHRA offers programs that support new leaders, established leaders and supervisors who want to continue growing into leadership roles.

As I often say, it is important to continue to educate yourself, join the society and look out for mentors who can help guide you as you move forward.