In a retrospective review of the October 7, 2023 mass-casualty incident, Soroka University Medical Center managed 673 arrivals by rapidly scaling radiology operations—quadrupling technologist staffing (5→20), expanding on-site physicians (to 2 residents/7 attendings with 5 remote), and flexibly redeploying alternative shielded CT scanners (RT sim and PET/CT) 5–10 minutes from the ED. Despite a 69% imaging rate (461 patients; mean age 30; 77% male; gunshot 43%, shrapnel 37%; median ISS 4), CT turnaround fell from 54 to 28 minutes while radiography rose modestly from 43 to 49 minutes, with diagnostic accuracy maintained. Streamlined trauma CT emphasized noncontrast head CT, skull-base-to-groin CTA, and portal-venous abdominopelvic phases; 179 CT exams (51% whole-body) and 739 radiographs (limbs 64%) were completed, with 33% of CT patients severely injured and 22% unable to provide identifiers. Ad hoc triage at distant CT sites used handwritten addenda when ISS>15, reclassifying ~25% of initially “stable” patients as major trauma. An AI safety layer (median alert time 7 minutes) flagged critical findings without discrepancies versus radiologist reports. Identified gaps—standardized handwritten templates, automatic FAST archiving, formal remote-site triage training, dynamic AI-assisted worklist prioritization, and staff-rotation protocols—inform future radiology preparedness for high-casualty events.