Diagnostic Reading #18: Five Must Read Articles from the Past Week

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It’s Friday, which means it’s time for a new edition of Diagnostic Reading. This week’s articles focus on the standardization of reporting structures, how big data is used within a large health system, mobile technology in healthcare, imaging appropriateness, and an Imaging 3.0 case study.

1) Standardization Moves Streamline Europe’s Reporting Structures – AuntMinnie Europe

A joint initiative between the European Society of Radiology (ESR) and the Radiological Society of North America (RSNA), RadReport (www.radreport.org), introduced two years ago and formalized last year, aims to promote and facilitate structured reporting through the creation of a joint open repository for radiology report templates. The initiative will be announced during ECR 2015.

2) UPMC Taps Big Data for Cancer Research, Cardiac Care – Information Management

UPMC provides researchers and physicians access to structured and unstructured data, including x-rays, CT scans, MRIs, pathology reports, physician notes, histopathology reports and post-op notes. The health system has a total of 8 petabytes of data that is readily accessible online, plus an additional 14 petabytes in long-term storage.

3) Making Mobile Work in Health – RealBusiness.com

Carestream’s Cristine Kao, global marketing directore, healthcare information solutions, talked with the publications about the company is working to improve clinician communication and handling data in the era of “plug and play” mobile devices and telemedicine. She goes on to discuss team-based care, the evolution of technology, physician access to data via mobile devices.

4) ACR Updates Appropriateness Criteria, Adds News Topics – Health Imaging

Included in the new criteria are breast pain, occupational lung diseases, and metastatic epidural spinal cord compression and recurrent spinal metastasis. There are now a total of 208 topics with 1,014 variants available. People can visit the ACR website for more information.

5) Imaging 3.0 Case Study: A Simulated Experience – American College of Radiology

The University of Florida developed “Simulation in Emergent and Critical Care Imaging” — a web-based program that tests residents by simulating a typical call rotation in an emergency room. The university is now working with the ACR to deliver its simulation product to radiology resident programs nationwide through the ACR Radiology Curriculum Management System (RCMS), which is a cloud-based platform that allows radiologists to collect, develop, distribute, and access educational materials and simulations.

Telemedicine Growth Points to Increased Adoption of Teleradiology

On-site or cloud-based teleradiology can provide effective patient care.

An on-site or cloud-based teleradiology system can connect radiologists to reports, images, and patient history to provide efficient and effective care.

If venture funding is any indication, we are in store for another year of impressive growth for telemedicine. It was the fastest growing category in digital health last year, increasing 315 percent with nearly $300 million in aggregate funding. This included funding for both new companies and current companies in the space.

In the U.S., licensure and reimbursement are the two key issues that surround telemedicine practices. A statement from the American Telemedicine Association said:

“The fact that every state medical board decides on their own what they believe best practice in medicine is, which is going to vary from state to state, presents a real problem.”  – Jonathan Linkous, CEO, American Telemedicine Association.

While this, and restrictions within Medicare and Medicaid, have limited the use of telemedicine within some U.S. states, it is promising that patients are responding favorably to the technologies.

Meanwhile in Europe, the telemedicine market is growing at a healthy rate every year. It is predicted that by 2019 the European telemedicine market will almost triple to $12.6 billion at a CAGR of 12.82%.

What does this growth in telemedicine mean for teleradiology?

As telemedicine expands, so will the need for images to be included in exams and patient diagnoses done via broadband.

The biggest area that is contributing to teleradiology’s growth is in rural areas. Last year at ECR, Russian presenters explained how teleradiology is contributing to providing care and analyses to sparsely populated areas in the county. While there are still a number of needs that must be addressed such as improving network infrastructure, training, and expertise, the country is devoted to expanding its use of the technology.

Adding on to rural areas, hard-to-reach locations also benefit from the ability to transmit medical images from one place to another. One example was when MSC Cruises became the first cruise line in the world to offer a multilingual pediatric teleradiology service on board, so care could be provided while out at sea.

It is becoming clear that as telemedicine offerings expand, teleradiology is expanding alongside. The technology is able to provide a vital service to many who may not have access to quality care, particularly those living in rural or hard-to-reach areas.

To provide people with the high quality of care we all deserve, it goes beyond the need of technology. It extends into the realm of building quality broadband infrastructure to provide the access, and appropriate training for medical professionals to use the technology. With these three areas fulfilled, teleradiology will only continue its growth as an important component within telemedicine.

Cristine Kao, Healthcare IT, CarestreamCristine Kao is the global marketing director for Carestream’s Healthcare Information Solutions business.



Global Worklist and the Connected PACS

Cheshire & Merseyside PACS sites

Dark blue crosses are Carestream sites, and light blue other PACS sites.

I will be taking part in two presentations at the European Society of Radiology’s ECR 2015 Congress, and each one will be related to the use of our Carestream Multisite Virtual PACS.

The first is a poster titled, “Establishing a regional on-call radiology service using a shared virtual PACS,” and was completed with co-workers K. Slaven, S. Dyce, and L. Anslow

Out-of-hours radiology has been delivered by radiology residents working on-call rotations in individual hospitals. As the intensity of work has increased, out-of-hours work has seriously impacted time spent during the day in the department. The need for compensatory rest has led to significant loss of training in what is already a relatively short training scheme.

Cheshire and Merseyside is a small but complex health economy in the North West of England. The system has the following facilities:

  • Seven acute hospitals
  • One tertiary cardiac hospital
  • One neurosciences centre
  • One tertiary paediatric centre
  • One cancer centre
  • One specialist obstetrics/gynaecology hospital

Six acute sites have resident radiology specialist registrars in rotations between four and nine in size.

None of the rotations were compliant with the European working time directive (EWTD). Four of the sites were on shared RIS/PACS, and the other two had PACS from different vendors.

The move to a shared global worklist (Vue Connect) and shared RIS has meant that the acquisition of images and reporting can be accomplished on separate sites. This also means that one resident can be on-call for more than one site at a time.

By combining the registrar workforce, we have been able to achieve compliance with the EWTD and significantly reduce the number of nights worked, hence allowing for a significant increase in training hours within the base  departments.

We are about to incorporate the last two acute sites. We have placed a Carestream agent on the last two sites, which allows image sharing seamlessly across all the sites including systems from other vendors. We plan to move to PACS-based reporting soon, so the residents will have a single workflow for their out-of-hours work, and to avoid having to work in three different PACS and three different RIS.

Our PACS has some unique features that makes this possible, and will be presented in the second presentation:

“Development of a shared multi-site virtual PACS”PACS - Cheshire & Mersyside

The co-authors for this presentation are S. Dyce, N. Pfirsch and S. Lomax.

As mentioned previously, Cheshire and Merseyside is a complex health economy. The previous system procured during the National PACS programme in England had PACS supplied by a single vendor in our region. However, image sharing was never a part of the programme and images had to be transferred by CD, DICOM push and latterly by a bespoke email-like system—the Image Exchange Portal.

There was a huge movement of patients from one acute site to another, or to specialist centres. Frequently, previous imaging was not available in a timely fashion, studies were reported in isolation, or even repeated when they could not be accessed. Regional multidisciplinary meetings were a massive effort to ensure all imaging was available for discussion, and image transfer was a huge overhead for all of our departments.

The goal was for all 10 trusts to have left the national PACS programme by June 2013 and this was achieved.

During procurement, we looked for a system that would behave as a single virtual PACS with seamless display of all current and prior studies. There was also a requirement to be able to view and report images from any site, and a requirement to support images from the two hospitals that had PACS from other vendors. A single mega PACS was a possible solution, but individual institutions wished to keep ownership of the images.

We selected our vendors based on these requirements:

  • Single master identifier – the NHS number
  • Acquisition and reporting are kept separated
  • Single instance of a study so annotations and reformats are applied to a single study
  • Seamless display of priors; the reporter could be unaware of the location of prior studies, but they appeared in local PACS

Carestream was chosen as a vendor that could support this workflow and deliver it in the six-month fixed timetable. The system was delivered before the cut-off date, and over 100TB of data was migrated into the system.

All of the above objectives were achieved, as well as the following:

  • Seamless multidisciplinary meetings with display of priors
  • Major reduction in overhead of image transfer
  • Specialist reporting e.g. paediatric, neuro is supported
  • Centralised on call centre for radiology residents
  • Significant Cost Reduction

The live presentation for “Development of a shared multisite virtual PACS,” will be given at ECR 2015 in SS 1805, on Sunday morning from 1030-1200.

Dr. Peter Rowlands, NHSDr Peter Rowlands, consultant radiologist at Royal Liverpool & Broadgreen University Hospitals NHS Trust (RLBUHT).



Diagnostic Reading #17: Five Must Read Articles from the Past Week

Carestream logoThis Friday’s Diagnostic Reading includes articles from a busy week in radiology and health IT news. Topics this week include, the FDA and electronic medical records, improving patient safety, radiology IT downtime, outpatient imaging quality, and data security.

1) FDA Calls it Quits on Regulating Medical Device Data Systems- Radiology Business

The FDA has determined that technologies that receive, store or display data from medical devices do not need to be regulated. These medical device data systems are classified as Class I, which means they are low risk devices. The FDA noted that these devices are more important than ever and lifting regulations would be beneficial to achieving interoperability in healthcare systems.

2) Competing Hospitals Work Together to Share Data, Improve Patient Safety- FierceHealthcare

This article highlights the success that hospitals have had when collaborating to improve patient safety. From 2012 until 2015, a network of over 80 hospitals reduced serious safety occurrences in children by 70%. Hospital administrators note that safety is not a point of competition, but a necessity for every healthcare system.

3) Radiology IT Downtimes are Common, but Not Usually Serious- AuntMinnie

A study by the Journal of the American College of Radiology found that the use of several disparate machines and systems can cause downtime due to losing connection with each other. However, the study found that most IT issues can be dealt with in a timely manner and only 3% were considered to have a severe impact.

4) Outpatient imaging: Assessing the Performance of U.S. Hospitals- Health Imaging

Quality and efficiency are becoming points of emphasis in the imaging field. This article addresses the Hospital Outpatient Quality Reporting Program (OQR). The OQR is an incentive program that looks at the efficiency of healthcare systems when ordering certain imaging procedures. The author argues that it might be time for a new metric system—one that is better able to determine the quality of imaging.

5) Data Breach: What’s at Stake for Hospitals-Radiology Today

Thirty million patient records have been exposed through data breaches since 2009. While it is of utmost concern to eliminate data breaches, this article discusses important information for hospitals after experiencing a breach. Topics include notification requirements, financial repercussions and regaining patient trust.

A Closer Look at the New DRX-Evolution Plus System

Helen Titus

Helen Titus, Marketing Director, X-ray & Ultrasound Solutions, Carestream

In an effort to live up to its name, Carestream has produced the next evolutionary stage of the CARESTREAM DRX-Evolution System: the CARESTREAM DRX-Evolution Plus.

The purpose behind these enhancements to the Evolution system was to meet the changing needs and budgets of radiologists and radiographers around the world. We have also worked over the years to enhanced the options, functionality, and software of the system, while maintaining its proven performance. But with so many new features added in this stage, it made sense to offer the Evolution Plus as our next premier system.

The new DRX-Evolution Plus offers:

  • A sleek new design with LED lighting for enhanced functionality and aesthetics
  • Greater flexibility in high-ceiling rooms via an extended tube column
  • A new high performance generator designed by Carestream
  • An optional table to accommodate patients up to 705 pounds (320 Kg); and
  • Forward-looking design specifications to embrace future advanced imaging applications from Carestream as they become available.

Advanced capabilities of the DRX-Evolution Plus include:

  • An innovative wall stand Bucky-angulation feature that expedites cross table and other complex X-ray exams
  • Tube touch screen that allows a technologist to change techniques and view images from the tube
  • Pediatric capabilities including automatic technique and image processing for seven pediatric body size categories
  • Bone suppression software for optimized viewing of soft tissue
  • Fast, secure log-in process using RFID badges
  • A transbay option that enables fast tube movement across multiple trauma bays, which helps expedite treatment while minimizing movement of critically ill or injured patients
  • Automatic acquisition and stitching for long-length and supine imaging exams; and
  • IHE Dose Reporting to facilitate data sharing with a facility’s dose management system.

Finally, the DRX-Evolution Plus offers modular components, configurations and supports a choice of three DRX detectors, including two wireless cesium iodide detectors (35 x 43 cm and 25 x 30 cm) for imaging. For maximum productivity, the DRX-Evolution Plus can be configured with a 43 x 43 cm fixed detector in the wall stand, and one or two additional wireless detectors that can be used for table Bucky and tabletop exams.

Below are a number of photos that display the new DRX-Evolution Plus. The technology will be making its debut at ECR 2015 in the Carestream booth, Expo B, #210.

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Enterprise Distribution and Better Patient Care at Sunway Medical Center

Sunway Medical Center in Malaysia is a 350-bed medical facility with a large imaging department that handles more than 75,000 procedures every year and is expected to increase to over 100,000 per year in the near future.

The facility was looking to replace its legacy PACS system as it was hindering the efficient delivery of reports. With CARESTREAM Vue PACS, Sunway Medical Center was able to start using voice recognition, access prior patient data, and use clinical management and viewing tools.

With the installation of the PACS, as well as CARESTREAM Vue Motion zero-footprint image viewing, physicians were able to provide better patient care and discuss images right at the patients’ bedsides thanks to its approved use on iPads, iPhone 4s, Galaxy Note® and Galaxy S® III mobile devices.

Listen to the hospital’s complete story in the video below.

Diagnostic Reading #16: Five Must Read Articles from the Past Week

Carestream logoIt’s Friday and that means that it’s time for a new Diagnostic Reading. This week’s readings includes articles about hospital-physician interactions, radiology analytics, a road map for improving patient safety, and a discussion about imaging appropriateness.

1) Improving Hospital-Physician Engagement – Hospitals & Health Networks

Healthcare reform has made it more important than ever for administrators to engage with physicians. This article discusses the collaboration between health care leaders and physicians, and what can be done to improve their engagement. The author provides a road map of actions that can be taken by administrators and physicians in order to work better together.

2) Radiology Analytics: Bright Future, Dim Present – Diagnostic Imaging

This article addresses the current state of radiology and how the lack of analytics in the field has made it difficult to optimize patient care. Operational, financial and clinical analytics can be used to change the way that radiology is perceived and experts say that analytic tools can be the key to adapt to the new-look healthcare system. Additionally, it is noted that analytics can demonstrate the value that radiology brings to the table.

3) Global Patient Safety Improvement Effort Needed – FierceHealthcare

The World Innovation Summit for Health (WISH) released a report about preventable medical errors. Preventable medical errors are the third leading cause of death in the United States. This is also a global problem. WISH says that current safety initiatives are ‘too narrow.’ The report makes recommendations for global reform. These recommendations include developing a patient safety declaration and forming a committee, among others.

4)  Do Patients Really Demand Unnecessary Imaging Studies? – Radiology Business

According to a study published in JAMA Oncology, patients are not responsible for unnecessary medical imaging. The study found that even if patients request imaging or treatment, the physician most often acts as seen fit. In this study, physicians only complied with .14% of patient requests.

5) Fine Tuning Imaging Utilization – Health Imaging

This article talks about the issue of appropriate imaging. The author says that it is better not to take a broad view on imaging appropriateness. There is a disparity- some regions order less images than others. Rather, he says that interventions should be targeted at healthcare facilities with the highest rates.


Case Study: Clinical Collaboration Across the Enterprise

Reggio Emilia Hospital in Italy is an excellent example of an organized clinical workflow environment. With an annual IT budget making up 3% of total hospital management budget, the infrastructure it has connect 1,500 clients on the local-area-network (LAN), and serves of provide health IT wide-area network (WAN) made up of 1,800 additional clients.

Although it had a solid IT infrastructure, Reggio Emilia Hospital was still looking for a solution for an integrated clinical image repository and distribution system.

In the case study embedded below, you can read how the hospital worked with Carestream to implement an integrated clinical data repository, and how this solution was able to provide collaboration capabilities across the enterprise, no matter where the clinical specialty data was coming from across the network.

X-ray Pulse Duration and Anatomical Noise Studies at ECR 2015

In March, I will be presenting two papers at the European Society of Radiology’s 2015 European Congress of Radiology. Both papers are in collaboration with Dr. Narinder Paul, Division Chief of Cardiothoracic Radiology and his group at the University Health Network in Toronto, Canada. It is a pleasure to be able to report our team’s studies that take a look at lung nodules, and examine them in two ways:

  1. Measuring the influence of X-ray pulse duration on the module during digital radiography (DR) in a dynamic anthropomorphic chest phantom
  2. Observing anatomical noise and its impact on lung nodule conspicuity by comparing DR, dual-energy X-ray, and digital angular tomosynthesis (3D imaging)

The purpose behind the first paper was to observe the impact of cardiac motion on lung nodule margin. Lung nodule margin is an important component to the evaluation of interval change on surveillance imaging.  Patients that are breathless or anxious may have increased cardiac motion which may impact nodule definition.  As a result, we investigated whether shortening the X-ray pulse duration reduces the impact of cardiac motion on the sharpness of nodule margins for digital radiography.

The method and materials we used to collect our data included an anthropomorphic phantom that was modified to simulate breathing and cardiac motion. Two spherical nodules were placed in the left lung and images were acquired under a range of pulses while adjusting the mA to keep constant mAs. The cardiac rate was set to consistent rates and the exam was repeated 10 times for each ms setting. Ultimately, an algorithm was developed to locate the nodules and derive an average radial profile to yield a sharpness metric generated from the slope of the profile.

From this study, we discovered that pulse duration can impact lung nodule sharpness due to cardiac motion. As a result, care should be taken when assigning protocols for nodule screening.

reduced background anatomical noise in an X-ray

Illustration of tissue discrimination in x-ray medical imaging resulting in reduced background anatomical noise and improved feature conspicuity. DR – Digital radiography, DE – Dual-energy x-ray image.

The second paper that I will be presenting live at ECR, we will be focusing on background anatomical noise as it is a leading cause of reduced object conspicuity in digital radiographic (DR) imaging. Dual-energy (DE) imaging reduces the influence of anatomical noise via tissue discrimination, while digital tomosynthesis (DT) reduces anatomical noise via depth discrimination.

Our methods to the study involved an anthropomorphic chest phantom with a spherical nodule that was imaged with DR, DE, and DT with the same in-room system. DE images were acquired with fixed and differential filtration and DT images were acquired at three dose levels, while a chest DR provided a performance reference.

The study provided a method for comparing performance across X-ray modalities and some insight in terms of optimal acquisition setting for improved image quality and reduced x-ray dose.

The rest of the results for the study, “Anatomical noise and impact on lung nodule conspicuity: comparing digital radiography, dual-energy X-ray, and digital angular tomosynthesis,” will be shared on Sunday, March 8, as part of the Novel Digital Imaging Techniques session, scheduled between 10:30 – 12:00 at ECR 2015.

You can visit Carestream at ECR 2015 in Booth 210, in Expo B.

Sam Richard, PhD, CarestreamSam Richard, PhD, Senior Research Scientist, Carestream


Diagnostic Reading #15: Five Must Read Articles from the Past Week

Carestream logo1) Preparing Radiology For Alternative Payment Models

The Department of Human Health Services (HHS) made an announcement about alternative payment methods. One thing that the report stated was that in 2016, 85% of fee-for-service reimbursements from Medicare will be based on quality or value. The article  goes on to talk about possible problems with this shift and what radiologists should do.

2) Radiology in India: Trends in Medical Imaging Technology

The growth of radiology in India has become a topic of discussion throughout the industry. This article details the radiology market in India. India has high level facilities with top-level x-ray equipment, but there are also villages that do not have access to simple x-ray technologies.

3) NEJM: Are Breast Density Notification Laws Actually Helpful?

Breast density laws are becoming more and more common across the U.S. and for good reason. In an article that may spark debate, Dr. Priscilla Slanetz wrote in the New England Journal of Medicine about the possible downsides of breast density notification laws. Slanetz noted that while these laws may be well-intentioned, they can raise the amount of unnecessary imaging and false positives in patients.

4) Patient Engagement ‘Taking a Backseat’ to Other HIT Priorities

A report from Chillmark Research has found that patient engagement is not the top priority for many healthcare systems. Though developing EHRs is a priority for some healthcare providers, they are typically not very user friendly. Items that might be addressed ahead of patient engagement are defining clinician networks and building analytics capabilities, among others.

5) Obama Budget Heats Up the Issue of Site-Neutral Healthcare Payments

President Obama’s new budget has caused debate– it would equalize Medicare rates for services provided in hospital outpatient departments (HOPD) and physician offices. This article addresses the causes for debate and the reasoning behind the new budget.