The role of image review at the point of care in neurosurgical decision‑making

Industry: Healthcare 

Location: Chapel Hill, North Carolina 

Hyland solution: Hyland NilRead™ 

Using Hyland’s NilRead universal viewer, Dr. Mark Attiah at UNC Health illustrates how access to imaging at the point of care supports clinical decision-making, interdisciplinary collaboration and surgical planning. His experience reflects a broader shift in contemporary neurosurgical practice, where mobility, interoperability and real-time access aren’t conveniences — they’re essential clinical infrastructure. These efficiencies have led to an estimated $405,000 in annual savings, eliminating nearly half a million dollars of wasted clinician time each year.

In neurosurgery, timing and clarity are inseparable. Patients often present with rapidly evolving neurological symptoms, and even brief delays in accessing imaging can interrupt the momentum needed to make safe, confident decisions. 

At UNC, Dr. Attiah specializes in spine surgery and peripheral nerve procedures, performing a mix of complex spine reconstructions, nerve decompressions and operative follow-up management. 

 His daily clinical objectives include:  

• Reviewing MRIs, CTs, EOS and quantitative spine balance data  

• Educating patients on imaging findings directly in the room at the time of a patient visit  

• Coordinating cross‑disciplinary case discussions  

• Making fast decisions based on real-time imaging availability  

• Reducing avoidable follow-up visits through immediate review and explanation 

Before universal, instant access, patients often needed to return for a follow-up visit once imaging was located or made available, introducing delays into clinical decision‑making. 

Quantitative spine balance metrics — critical in deformity surgery — were also more difficult to compare across systems, limiting longitudinal assessment. Preparing for conferences or cross‑disciplinary reviews required gathering studies from multiple systems and verifying that all participants had access to the correct imaging, creating friction during workflows that depend on shared visualization. 

Clinic cadence adds urgency. A typical clinic day includes 17-20 patient visits, with high‑volume days reaching 22.

Point‑of‑care image review supports several aspects of neurosurgical care. Clinical decisions are often dependent on real‑time access to imaging, particularly in spine surgery, where visual explanation of anatomy plays a key role in patient understanding. When images are available immediately, patients might not need to return for a subsequent visit, improving the clinical experience while reducing system burden. 

From a quantitative and longitudinal perspective, Dr. Attiah routinely compares progression patterns such as curvature changes, canal diameter, disc height and nerve compression. Point‑of‑care access supports faster interpretations, more effective patient education and improved preoperative planning.

With NilRead, a zero‑footprint universal diagnostic viewer, Dr. Attiah can instantly access any imaging study, directly enabling review during clinic visits, and review complex cases chairside with patients.   

During one appointment, he manipulated MRI images in real time to support planning for both a spine and peripheral nerve intervention, adjusting orientation and zoom to clarify anatomy. The patient commented on the clarity of the visuals during the discussion. 

By providing 24/7 remote access to imaging, NilRead supports continuity of care across clinical settings, including urgent and after-hours consults.   

NilRead also allows him to collaborate quickly with radiologists, OR staff, trauma teams and nurse practitioners.

NilRead supports patient care as well as resident education, interdisciplinary collaboration between radiology and neurosurgery, and preoperative planning with trainees. A unified imaging experience enables more effective spine conferences, tumor boards and multidisciplinary case reviews. When imaging studies load without delay and quantitative and longitudinal data are immediately available, teams can focus on clinical interpretation rather than manual coordination or system navigation. 

Operationally, these efficiencies extend throughout the clinic day. Faster access helps avoid unnecessary return appointments, supports consistent clinic pacing and reduces administrative overhead associated with repeat scheduling. When applied across high-volume clinic days, these efficiencies contribute to an estimated $405,000 in annual savings linked to the reduction of second appointments resulting from unavailable imaging. 

This approach supports Dr. Attiah’s philosophy: “I only operate when it’s absolutely necessary — and even then, in the safest, least invasive manner possible.” 

Real‑time imaging strengthens these conversations and reinforces shared decision‑making. 

Point‑of‑care imaging plays an essential role across neurosurgical workflows. It reduces unnecessary return visits, supports the complexity of spine imaging requirements and enables rapid action in urgent neurological conditions. Just as importantly, it provides the quantitative and longitudinal data needed for confident surgical planning while strengthening preparation for teaching, case conferences and interdisciplinary review. 

When it comes to clinical impact, point‑of‑care imaging has eliminated delays that traditionally slowed neurosurgical workflows and increased patient risk. Real‑time access to MRI and CT studies improves patient communication and engagement by allowing physicians to visually demonstrate the source of pain, lesion location and available surgical options. In these encounters, imaging becomes a shared reference point rather than a retrospective artifact. 

This effect mirrors broader trends seen across POCUS and visible‑light imaging workflows, where immediate visualization at the bedside or clinic visits supports clearer communication, faster clinical alignment and more informed decision‑making. These more transparent, collaborative conversations help reinforce patient understanding and confidence, strengthening trust while reducing workflow friction. 

Ultimately, access to imaging at the point of care enables better‑informed decisions, more engaged patients and fewer delays across the neurosurgical care continuum.