What is nighthawk radiology?
The short answer
Nighthawk radiology is the remote interpretation of a hospital’s imaging overnight, typically from about 10 PM to 7 AM, by a radiologist licensed in the patient’s state and credentialed at the hospital. The nighthawk radiologist reads the emergency and inpatient studies that can’t wait for morning, calls critical results to the care team, and hands the night back to the day radiologists.
- Overnightroughly 10 PM to 7 AM
- Remoteimages and reports travel electronically
- ED-heavystroke, trauma, CT, CTA, X-ray, ultrasound
“Nighthawk” and “overnight teleradiology” mean the same thing in practice. A nighthawk radiologist is the physician who does the reading; nighthawk radiology is the service a hospital buys.
Where does the term “nighthawk” come from?
The term shares its name with NightHawk Radiology, one of the first companies built around overnight reads for US hospitals. According to its SEC registration statement, the operating company was founded in Coeur d’Alene, Idaho, in 2001, and read mainly from centralized facilities in Sydney, Australia, and Zurich, Switzerland, time zones where a US night falls during the local working day (NightHawk S-1, 2006). It was founded by a radiologist, Paul Berger, MD (American Medical News, 2005).
- 01
2001: founded
NightHawk Radiology Services is founded in Coeur d’Alene, Idaho (S-1).
- 02
2005: the word becomes generic
Business press describes “a practice known as nighthawking”: sending images over the internet to radiologists several time zones away for preliminary overnight reads (New Hampshire Business Review, 2005).
- 03
2006: public company
NightHawk prices its initial public offering in February 2006 and lists on Nasdaq as NHWK (Renaissance Capital).
- 04
2010: acquired by vRad
Virtual Radiologic (vRad) completes its acquisition of NightHawk on December 22, 2010, and NightHawk becomes a wholly owned subsidiary of vRad (joint release).
- 05
2020: part of a larger group
Radiology Partners completes its acquisition of MEDNAX Radiology Solutions, which included vRad, effective December 15, 2020 (vRad).
Today “nighthawk” is commonly used for overnight teleradiology in general, whoever provides it.
How has nighthawk coverage changed?
The early model was built on preliminary reads. NightHawk’s 2006 filing describes its core service as off-hours preliminary reads for emergency conditions, with final reads also offered (S-1), and contemporary reporting describes the hospital’s own radiologist producing the final diagnosis the next day (NHBR, 2005). The alternative is a signed final read overnight, so the report in the chart at 3 AM is the report of record and the day group doesn’t re-read the night.
Preliminary nighthawk model
- A quick interpretation to guide the ED overnight
- The hospital’s radiologists re-read and sign in the morning
- Two reports per study, and any discrepancy has to be reconciled
Final-read nighthawk model
- A complete, signed report overnight: the report of record
- The day group starts with a handoff note, not a re-read stack
- One report per study
Neither model is wrong for every hospital. Our guide to preliminary vs final radiology reads covers when each one fits. The ACR practice parameter on communicating imaging findings treats the final report and preliminary reports as separate communications, which is why a preliminary model needs a clear process for discrepancies.
How does nighthawk radiology work today?
A nighthawk night follows the same path for every study. None of it depends on hospital staff doing anything special after hours:
- 01
Order sent
The ED or floor orders an exam, and the order reaches the nighthawk group electronically, usually by HL7, so the radiologist knows a study is coming.
- 02
Images routed
The technologist scans as usual and the images route securely to the PACS the radiologist reads from.
- 03
Worklist triage
Stroke alerts and other time-critical studies go to the top of the list, ahead of routine inpatient work.
- 04
Read and report
A radiologist licensed in the patient’s state reviews the images, priors and history, and issues a preliminary or final report, depending on the contract.
- 05
Critical results called
Findings that need action now are called directly to the care team, read back, and documented. The Joint Commission National Patient Safety Goals include reporting critical results of tests and diagnostic procedures on a timely basis.
- 06
Report returns
The report flows back into the hospital’s system, attached to the order, in the hospital’s format.
- 07
Morning handoff
At the end of the shift the day radiologists receive a handoff: what was read, what was called, and anything still open.
For the details of the phone call itself, see critical results communication.
What should a hospital require from a nighthawk provider?
The technology is similar across providers. What differs is how the night is run. Put these in writing before you sign:
- Report type
- Signed finals, or preliminaries your group must re-read. If preliminaries, how discrepancies are found, communicated and documented.
- Who reads
- Named radiologists, board certified, licensed in your state and privileged at your hospital, not whoever is free that night.
- Backup
- A named backup reader every night, already credentialed at your hospital, so a sick call doesn’t leave a gap.
- Subspecialty questions
- How neuro, pediatric, body or musculoskeletal questions are handled overnight, and who the reader can consult.
- Turnaround
- Targets by priority (stroke, STAT, ED, inpatient), reported as medians and as the share of studies inside target, and what happens when a read is late.
- Stroke timing
- Stroke studies read first. CMS OP-23 tracks head CT or MRI interpretation within 45 minutes of ED arrival for eligible stroke patients, so the overnight read sits inside that window. See our OP-23 guide.
- Critical results
- Called directly with a read-back, logged with the name, role and time of the person who took the call, and reported monthly.
- Credentialing
- Who builds each radiologist’s file and how fast. Under 42 CFR 482.22(a)(3)–(4), a hospital’s medical staff may rely on the credentialing and privileging decisions of a distant-site hospital or telemedicine entity, if the agreement meets the rule’s conditions. See our credentialing guide.
- Reachability
- One number your ED can call that is answered by a person.
- Reporting
- A monthly scorecard showing turnaround, critical calls and misses, not only averages.
- Pricing
- How studies are billed (per study or per wRVU) and whether STAT, after-hours or weekend reads carry surcharges. Our pricing page explains how TeleRads bills.
For a longer buyer’s checklist, see how to choose a teleradiology company.
Nighthawk vs in-house overnight vs locum radiologist
| Nighthawk (remote overnight) | In-house overnight | Locum radiologist | |
|---|---|---|---|
| Who reads | A remote radiologist or group contracted for the night | Your own radiologists, on site or on call from home | A temporary radiologist placed with your hospital |
| Where | Off site, on the provider’s PACS or yours | Your reading room, or remote access to your PACS | Usually on site, sometimes remote |
| Best fit | Hospitals whose group covers days and wants nights covered | Groups large enough to staff nights without burning out | Short gaps: vacancies, leave, recruiting periods |
| Day group workload | Depends on report type: none with finals, a morning re-read with prelims | Night work stays with the group | Covers a slot in the group’s schedule |
| Procedures on site | No | Yes, if the radiologist is on site | Yes, if on site |
| Credentialing | Each reader licensed in your state and privileged at your hospital | Already on your medical staff | Licensed and privileged for each placement |
| Scaling hours | Can extend to evenings, weekends or 24/7 | Limited by the group’s size | One radiologist at a time |
Many hospitals combine them: the group keeps the days and procedures, a nighthawk service covers the night, and a locum fills a vacancy in the day schedule. The right mix depends on your volume, your group’s size and how much night work your radiologists want to keep.
How TeleRads does nighthawk radiology
TeleRads provides overnight teleradiology from 10 PM to 7 AM, final reads only, never preliminaries. Here is what every night includes:
- Signed final reads by board-certified radiologists licensed in your state, in your report format
- Orders by HL7 and images by secure routing to our PACS, with nothing for your staff to install
- Stroke studies read first, ahead of routine work
- Critical results called within 15 minutes, read back, and logged with name, role and time
- A named backup reader every night, already credentialed at your hospital
- One number answered by a person when your ED needs the reader
- A 7 AM handoff note to your day group: what we read and what we called
- A monthly scorecard; any read outside our turnaround isn’t charged
Credentialing runs through an NCQA-certified credentials verification organization, built to Joint Commission standards, and we sign a HIPAA Business Associate Agreement with every hospital. Most hospitals are live in 30 days. Billing is per study or per wRVU, whichever fits your mix, with no STAT, after-hours or weekend surcharges; the contract is one year, then 90 days’ notice. The same radiologists and templates can extend to evenings, weekends and holidays, daytime overflow or 24/7 on the same agreement.
Questions
What is nighthawk radiology?
Nighthawk radiology is overnight teleradiology: a remote radiologist reads a hospital’s imaging during the hours its own radiologists are off, usually about 10 PM to 7 AM. The radiologist is licensed in the patient’s state and credentialed at the hospital.
Why is it called nighthawk radiology?
The term shares its name with NightHawk Radiology, an early overnight teleradiology company founded in Idaho in 2001 that read US nights from Sydney and Zurich. By 2005 the press was already using “nighthawking” for the practice in general.
Is NightHawk Radiology still a company?
NightHawk Radiology was acquired by Virtual Radiologic (vRad) in December 2010 and became a wholly owned subsidiary. vRad became part of Radiology Partners in December 2020.
What does a nighthawk radiologist do?
A nighthawk radiologist reads a hospital’s overnight imaging remotely, mostly emergency CT, CT angiography, X-ray and ultrasound. They read stroke and critical studies first, call urgent findings to the care team, and hand off to the day radiologists in the morning.
Are nighthawk reads preliminary or final?
It depends on the provider and the contract. The early nighthawk model was mainly preliminary reads re-read by the hospital’s radiologists the next day; some services issue signed finals overnight. Every TeleRads overnight report is a signed final.
What hours does nighthawk radiology cover?
Typically about 10 PM to 7 AM, the stretch when most hospital radiology groups are off. TeleRads covers 10 PM to 7 AM and can add evening, weekend, daytime overflow or 24/7 hours on the same agreement.
How do nighthawk radiologists handle stroke studies?
Stroke studies should go to the top of the worklist and the result should be called to the ED. CMS OP-23 tracks head CT or MRI interpretation within 45 minutes of ED arrival for eligible stroke patients, so the overnight read is part of that window.
Does a nighthawk radiologist need a license in our state?
Yes. The radiologist must be licensed in the state where the patient is and credentialed and privileged at your hospital before reading. Federal hospital rules allow your medical staff to rely on a telemedicine entity’s credentialing decisions under a qualifying agreement.
How long does it take to start nighthawk coverage?
With TeleRads, most hospitals are live in 30 days. Credentialing and the HL7 and image connection run in parallel, and there is nothing for your staff to install.