Diagnostic Reading #17: Five “Must Read” Articles

Health imaging, contact sports and patient engagement are in the spotlight

This week’s articles include: a radiologist spearheads improvements at a Texas hospital; measurable changes can occur inside young athletes’ brains in a single season of contact sports; patient engagement is becoming essential to getting maximum payment for services; a study reports that one-third of radiology recommendations went unacknowledged at a Boston facility; and admissions growth for U.S. hospitals is unlikely to be repeated in 2016.

How radiologists can lead the way in healthcare quality improvement – Health Imaging

When quality improvement efforts at the Baylor College of Medicine stalled out due to multiple staffing disruptions and a general lack of coordination, it was a radiologist who took the challenge head-on, according to Emily Sedgwick, MD, an assistant professor and author of a recent article in the Journal of the American College of Radiology.

Changes to brain cells measurable after one season of high school football – Health Imaging Carestream-head-trauma

A single season spent playing contact sports is all it takes for measurable changes to occur inside young athletes’ brains, according to results of a study recently published in the Journal of Neurotrauma. Researchers from the University of Texas Southwestern Medical Center in Dallas used helmets capable of recording data related to head impacts, then used MRI and diffusional kurtosis imaging to measure changes in neural cellular structures. They found that even when no concussion occurs, athletes experience neurological changes at the cellular level after just one season. Continue reading

Overcoming Angle Dependence in Doppler Ultrasound

Carestream’s Smart Flow technology enables detection and visualization of complex flows independent of Doppler angle

Looking at a compass, a difference of one degree seems inconsequential. Yet being off one degree on a flight path and traveling 60 miles an hour will put a plane 1 mile off course after 60 minutes. And in conventional Doppler imaging of blood flow, the wrong angle can lead to large discrepancies in results.

Ordinary color and spectral Doppler ultrasound measure the velocity of flow components only toward or away from a transducer. In conventional implementations, they use the angle of the ultrasound beam relative to the flow direction to calculate the actual flow velocity through the vessel. Thus, the accuracy of Doppler computations depends on precise knowledge of the direction of the ultrasound beam and direction of the flow in the vessel (and the angle α between them).

As the following Doppler equation illustrates, when the ultrasound beam is perpendicular to the vessel (90°), this computation is impossible, because there is no flow component in the direction of the beam.

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Diagnostic Reading #16: Five “Must Read” Articles on Radiology and Health IT

Radiology consults, healthIT data breaches and telemedicine make the news

This week’s articles include: study shows that delivering personalized care to patients could increase revenues; referring physicians appreciate the value of virtual consultations with radiologists; genomic sequencing is becoming an attractive option; the healthcare industry accounted for the highest number of data breaches among service industries in 2015; and big data analytics, telemedicine and wearables rank high among $1.4 billion worth of healthIT investments in 2016.

Study finds cutting-edge customer experience could boost revenue by 16% – Clinical Innovation+Technology

A more individualized customer experience could drive revenue up by 16 percent, according to C-suite executives in a study conducted by Oracle. Healthcare organizations could avoid missed opportunities by implementing tools for self-service to better serve the 77 percent of patients who say they want a more personalized Virtual health consultantsexperience.

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CIO eBook Chapter 7: Planning the Information Archive of the Future

The image archive: today through 2020

One of the most challenging aspects of healthcare is planning for the future. In particular, information systems that include images require an understanding not just of the most useful information for today, but also a vision of the projected needs of our many stakeholders in five, 10 or even 20 years from now.

While wPlanning VNA of the Futuree don’t claim to know it all, it is clear that the stakeholders in an information system of the future will include many more collaborators than it does today. Also, the role of the patient will become even more critical as more patients take responsibility to report their own clinical data through wearable devices that send data directly to the electronic health record (EHR). Meanwhile, our clinicians grow in appreciation of the value of access to a complete patient record, including images. And we haven’t yet mentioned the need to provide access to genomic data to inform clinical decision support.

Our CIO eBook chapter on this topic is a good “thought starter”, whether you’re a CIO, a clinician or a professional engaged in healthcare.  Here are a few highlights from the chapter.

To help scope the discussion of planning the archive of the future, we called on two experts—Dr. Mark Blatt, MD, now retired, formerly Worldwide Medical Director, Intel; and Dr. Marco Foracchia, Medical IT Systems Manager, Santa Maria Nuovo Hospital in Reggio Emilia, Italy. Dr. Blatt talked about the trends and developments in technology that enable an institution to organize and access the growing amounts of data that the future will require. Dr. Foracchia gave us an extremely practical view of the experience of planning and implementing an enterprise-wide image-enabled information system. vna_image_input_sources

At Reggio Emilia, the Vendor Neutral Archive (VNA) enables intelligent storage of data to support collaboration. The VNA supports storage of various types of images including radiology DICOM data, multi-frame cine loops and images from other sources. This year, they will add genomic information to the VNA.

In his interview, Dr. Blatt describes the amount of data that can go into the VNA as “enormous”. It includes radiology of course, but also dermatology, cardiology including cath, echo, nuclear, GI labs, ophthalmology, pathology, wound care, otorhinolaryngology, neurosurgery and oncology, including the genomic data that’s now stored as image data.

LISTEN NOW: Dr. Mark Blatt on source data for the VNA.

Where do you start with archive planning? At the beginning by surveying the data sources. Dr. Foracchia’s audit of Reggio Emilia revealed 534 data sources, many of which were not apparent prior to the audit.

For more detail on the planning of an archive of the future, along with interviews of Dr. Foracchia and Dr. Blatt, read the CIO eBook, Chapter 7.

What’s in your enterprise archive?  What have you left out and why?  Please comment!

About the CIO eBook: Carestream publishes an eBook based on issues of importance to CIOs and often based on webinars facilitated by the Institute for Health Technology Transformation (iHT2) Online Thought Leadership Series. It is made possible through an unrestricted grant from Carestream. Read blog posts summarizing earlier chapters of this eBook on Everything Rad.



Jeff Fleming is Carestream’s Vice President of Sales and Services for Healthcare Information Systems


Overcoming Limitations of CT for Orthopaedic Imaging of Extremities

Weight-bearing images show pathologies more clearly

Musculoskeletal and orthopaedic disorders are without prejudice. They plague the sports professional, the weekend athlete and even sedentary office workers.

According to the United States Bone and Joint Initiative, 77% (65.8 million) of all injury health care visits are for musculoskeletal injuries. And OSHA estimates that work-related musculoskeletal disorders in the United States account for over 600,000 injuries and illnesses. The injuries can cause pain, limit activities and require surgical repair and/or physical therapy.

Imaging the extent of these injuries, ranging from carpal tunnel to meniscus loss, has been challenging. The reason: traditional computed tomography (CT) has a significant limitation. It requires multiple rotations –and it cannot capture a weight-bearinCarestream OnSight 3D Extremity Systemg image. However, new cone beam CT (CBCT) technology from Carestream removes these restrictions. In March, we filed a 510(k) application with the FDA for clearance of the CARESTREAM OnSight 3D Extremity System, designed to offer high-quality, low-dose 3D point-of-care imaging  by orthopedic and sports medicine practices, hospitals, imaging centers, urgent care facilities and other healthcare providers.CBCT, first described in the late 1970s, is a variant of traditional computed tomography. The main difference between the two approaches is the volume of the object that is imaged at one time. In traditional CT, a narrow slice of the patient is imaged with a “fan beam” of X-rays. For an extended volume of the anatomy via CT, the patient must be imaged multiple times through the fan of X-rays as it rotates. In contrast, in CBCT, a large-area detector images an extended volume of the patient in a single rotation, reducing the complexity of the mechanical design of the system.

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Diagnostic Reading #15: Five “Must Read” Articles on Brain Injuries in the NFL and Healthcare Data from the Past Week

Unstructured data and radiologists’ adoption of technology are in the news


This week’s articles on #healthcare data and #radiology include: more than 40% of retired #NFL players might have traumatic brain injuries; 80% of big health data is unstructured and “invisible” to healthcare organizations; scientists are gaining unprecedented tools for understanding the genetic roots of cancer; engaging radiologists is key to a successful standardized structured reporting program; and efforts are underway to make customer relationship management a central component in the population health ecosystem.

Imaging study: More than 40% of retired NFL players may have traumatic brain injuries – HealthBrain injuries Imaging

Nearly half of retired National Football League players might suffer from traumatic brain injuries, according to re
sults of a diffusion tensor imaging study scheduled to be presented at the annual meeting of the American Academy of Neurology in Vancouver, Canada.

Providers need new tools to make sense of unstructured data – Health Data Management

Healthcare is being inundated with a deluge of big health data, 80 percent of which are invisible to current computing systems because the data are unstructured, according to IBM. Unstructured data includes doctors’ notes, wearables, X-rays, social media, the weather, sensors and sound.

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CIO Perspective: The IT Value Proposition of Healthcare Technologies

HealthIT technologies that are flexible provide more value to organizations

The right technology solution can be a catalyst for healthcare providers to achieve their goals. That point is not lost on today’s HealthIT leaders who ranked IT Value Proposition Carestream Vue Clinical Collaboration Platform among their top concerns for 2016 in the annual IT Trends Study from the Society for Information Management (SIM).

Not only was IT Value Proposition in the top 10 of the most important IT management issues for the organization, it was also in the top 10 of the personally most important IT management issues, coming in at No. 6 and No. 8, respectively. Their personal concern for IT’s value proposition “demonstrates that IT leaders not only consider themselves technology leaders, but also recognize the significant role they play in the achievement of organization goals,” according to the study.

Carestream’s Vue Clinical Collaboration Platform (CCP) is a great example of a technology solution with a strong health IT Value Proposition, equipping those responsible for providing, receiving and reimbursing care with the ability to share and manage clinical data in ways that can help reduce costs and improve care.  Additionally, CCP manages images with a standards-based modular platform, which means an organization can implement the programs it needs in the short term, and add additional modules at a later time as needed.

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Study: Pediatric Fracture Detection

As a research scientist at Carestream Health, my recent work has focused on pediatric X-ray imaging – specifically, on the goal of achieving high-quality diagnostic images while minimizing dose. To explore potential solutions to this challenge, I initiated a study in collaboration with Samuel Richard, PhD, a fellow researcher at Carestream, and Sosamma T. Methratta, MD, of the Milton S. Hershey Medical Center in Hershey, PA. The study had two specific goals: 1) Determine the impact of a simulated reduced dose rendering on the detection of skeletal fractures in children, and 2) Evaluate the effect of enhanced skeletal processing on the same detection task. The methodology and results of this study were on display at RSNA 2015.

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Diagnostic Reading #14: Five “Must Read” Articles on Health IT and Radiology from the Past Week

This week’s articles include: the need for greater integration between PACS and other IT tools in radiology; ability of implantable devices to improve patient care and compliance; accountable care organizations are expected to reduce costs but many patients seek care outside their network; a study examines the movement to incorporate “patient-reported outcomes” into clinical care; and Yelp reviews provide insight into patient experiences.

Survey: The state of system integration in academic radiology departments – Health Imaging

Academic radiology departments report varying levels of integration between PACS and other IT tools such as dictation systems, critical notification systems and electronic medical records, according to results of a study published online in the Journal of the American College of Radiology.

Mobile devices will interface with IT to improve care, save billions –Health Data Management

Implantables are being customized to address specific health issues and can tremendously improve patient compliance. Smart pills can monitor and

Medical concept icons for web and mobile phone.

wirelessly transmit biomedical data to providers and send alerts to patients to take their meds. A dime-sized chip can enable doctors to continually monitor patient vitals. And the list keeps growing: a “bionic eye” that allows the blind to see and a cardioverter-defibrillator to treat sudden heart attacks.

ACOs using analytics, IT to manage out-of-network care – Health Data Management

Accountable care organizations are expected to reduce overall healthcare costs by coordinating care: minimizing ineffective or duplicative services and maximizing communication among the various members of each patient’s care team. At the same time, under current federal ACO rules, providers have no leverage to keep their attributed ACO patients from seeking care outside their network. A June 2014 study of care patterns in 145 ACOs, published in the Journal of the American Medical Association, found that 66 percent of specialist visits took place outside the ACO’s network.

How patients’ reports on their health can help doctors do a better job – NPR

A study published in the April issue of the Health Affairs journal examines the movement to incorporate “patient-reported outcomes” into clinical care. It may seem like a no-brainer to include patients’ assessments of their physical and mental conditions and quality of life into medical care, but such patient-generated data have traditionally been confined to research rather than clinical settings. Clinicians have typically focused more on physical exams, medical tests and biological measures to guide patient care.

Yelp provides untapped insight into patient experience – Modern Healthcare

Excessively pricey bills, long waits for staff, rude doctors and difficulties setting up appointments drove people to rant about their hospitals on Yelp, according to a study. While those issues frustrate patients, most are not tracked on government surveys and ratings programs meant to capture patients’ experiences in U.S. hospitals. Researchers say it’s a missed opportunity for actionable feedback and to identify more robust measures.

#PACS #radiology

CIO Perspective: IDC Predicts Virtual Care Will Become Routine by 2018

Nearly 15 million Americans used telehealth services in 2015

Telemedicine conceptual illustration.

Telemedicine, telehealth, virtual care, teleradiology, telepsych – some of these terms we’ve been learning about for years, others are newer. And if the researchers at International Data Corporation (IDC) are right, we’ll all experience them ourselves, as patients, for years to come.

IDC recently released its healthcare IT predictions for 2016, and among them is a prediction that virtual care will become routine by 2018. Virtual care is defined as the ability to connect with physicians on an anytime, anywhere basis, such as a video visit with your doctor.

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