[Video] Replacing Analog to Allow for DRX-1 Detector Sharing

Karen Swanson, R.T. (R) (M), Director of Medical Imaging, at Platte Valley Medical Center in Brighton, CO, shares her feedback about wireless detector sharing at her facility and the CARESTREAM DRX-Revolution.

The medical center replaced three analog portables with two DRX-Revolution Mobile X-Ray Systems. They share the DRX-1 detector between the portables and the RF room – making the best use of the most expensive piece of the system at peak times.

Cost Control and Efficiencies for Medical Film Usage

The Spanish translation for this post can be found after the English version of this post. / La traducción al español de este post se puede encontrar después de la versión en Inglés de este post.

There are numerous variables that go into effectively managing the use of medical film in an imaging organization. Along with film usage, managers must also be able to track inventory, billing, and procurement. All of these factors added together can make for a hectic environment if not properly organized.

The following four steps can assist you in effectively managing your film usage.

  1. Managing Director Gregorio Mayor

    Managing Director Gregorio Mayor using Carestream’s Managed Print Solutions.

    Assess current technologies: What does your organization require from its equipment? Investigating and addressing the facility needs allow for facilities to appropriately address current issues and prevent futures one from forming.

  2. Tie the monitoring and tracking to usage: The ability to track and monitor the usage of film and cost per print becomes attainable by attaching film printers to the appropriate software. Tracking the information allows for more efficient budgetary decisions to be made.
  3. Ensure information and data is available in a single location: Using a technology that tracks and monitors many different factors needs to reside in one location. With no capital investment, lower administrative costs, reduced operational costs, and simpler budget planning, facilities can efficiently obtain the data and prevent staff from searching for it in multiple areas.
  4. Optimize workflow and billing according to data trends: The data must be analyzed once it is collected if facilities are to experience improved budget planning and potential cost savings. From the collected data, facilities could reduce time spent on placing purchase orders and tracking shipments, delivery and purchasing fees, writing and mailing checks, and reconcile invoices. From the technological data, additional savings opportunities exist in the form inventory management costs, replacement costs of printers, and film stock outs. All of this is dependent on how the data is collected and analyzed.

 As our healthcare systems evolve, data and reporting is becoming a more integral part of the decision-making process. It is our duty to ensure that we are using the available data to the best of our ability, because the key to running an effective, well-operated department is transparency, and access to data can provide it. By aligning the right hardware with the right services, facility managers will be able get the most cost-effective use out of their equipment without compromising image quality and patient care.

For more information about managing your medical film, inventory, costs, and billing, you can visit Carestream’s Managed Print Solutions site at carestream.com/mps.

Joaquim Franch, Carestream Territory ManagerAuthor, Mr. Joaquim Franch, works for Carestream Health and is the Iberia MFAPS Territory Manager.  He lives in the Barcelona, Spain area and has deep experience in film.

 

 

Eficacia y control de gastos en el uso de la película médica

En una clínica médica hay numerosas variables que afectan a una buena  gestión  en la utilización  de la película radiológica. Además del uso de la película, los gerentes también deben ser capaces de realizar el inventario, llevar el control de la facturación, y  el seguimiento  de los pedidos.

Todos estos factores  pueden crear un entorno estresante y poco propenso para una buena organización.

Con el sistema de impresión Managed Print Solutions de Carestream los siguientes cuatro pasos le  ayudaran  para que la  gestión sea eficaz.

  1. Director General Gregorio Mayor

    Director General Gregorio Mayor utilizando soluciones de impresión gestionados de Carestream.

    Evaluar las tecnologías actuales. ¿Que hace su equipo por su organización? Hay que investigar y saber que necesitamos en nuestras instalaciones para abordar los problemas actuales y prevenir los problemas futuros.

  2. Relacionar la observación con la utilización: con el software adecuado se tiene la capacidad de medir y supervisar el consumo de la película y saber el coste por impresión. La información permite tomar decisiones económicas  más eficientes
  3.  Asegurar que la información y los datos están disponibles en un solo lugar: La utilización de la tecnología que mide  y supervisa varios factores diferentes tiene que almacenarse en un solo lugar. Con el servicio de MPS no es necesaria la inversión de capital previo, con  costes administrativos menores y operativos reducidos, permite una planificación sencilla del presupuesto, facilitando los datos al personal de una manera eficaz, sin tener que buscar en diferentes lugares
  4. Optimizar el proceso del trabajo y  la facturación de acuerdo con las tendencias de datos: Las cargas de trabajo deben ser analizadas para ver si el uso de las instalaciones se maximiza, para obtener mayor rendimiento del presupuesto y ahorrar en costes. A partir de los datos recogidos, el personal de la clínica podría reducir el tiempo dedicado a la tramitación  de órdenes de compra ,  ahorrar en el seguimiento de los envíos, la recepción ,  en gastos de compra y pagos; facilitándose la contabilización. A partir de los datos electrónicos, existen  formas de tener oportunidades adicionales de ahorro de gastos de gestión de inventario, también  los costes de sustitución de impresoras, y en las rupturas de stock de pedidos. Todo esto depende de cómo se recopila y se analizan los datos.

A medida que  nuestros sistemas sanitarios evolucionan, los datos y la presentación de informes se está convirtiendo en una parte esencial del proceso en la  toma de decisiones. Es nuestro deber garantizar que estamos utilizando los datos disponibles en la medida de nuestras posibilidades, porque la clave para gestionar un departamento eficaz, es la transparencia, y el acceso a los datos. Al dimensionar y establecer el hardware adecuado, con los servicios necesarios, los directivos de las clínicas podrán conseguir un uso más rentable de su equipamiento sin poner en peligro  la calidad de imagen,  ni la atención al paciente.

Para obtener más información acerca de la gestión de su película médica, el inventario, los costes y la facturación, puede visitar el sitio Soluciones Managed Print de Carestream en carestream.com/mps.

Joaquim Franch, Carestream Territory ManagerAutor, el Sr. Joaquim Franch, trabaja para Carestream Health y es el Gerente de Territorio Iberia MFAPS. Él vive en el área de Barcelona España y tiene una amplia experiencia en el cine.

 

 

[Q&A] Chiropractic and Diagnostic Imaging: Evolving Trends

Dr. Chad Warshal, NYCCDr. Chad Warshal is a Doctor of Chiropractic and Diplomate of the American Chiropractic Board of Radiology and teaches as an Associate Professor at New York Chiropractic College where he also serves as the Director in Diagnostic Imaging Residency. We sat down with him for our most recent edition of an Inside Look magazine to hear his views on the current role of diagnostic imaging within the Chiropractic field.

1. Let’s start by asking you about the continuing focus on evidence-based practice guidelines. Do you see this having an effect on the use of diagnostic imaging by chiropractors to aid in clinical decision-making?

The continued evolution of evidence-based practice has had a significant effect on the use of imaging procedures in chiropractic. With most research demonstrating the limited utility of conventional radiography in spinal pain patients, I’ve seen a general decrease in taking radiographs, as well as fewer requests for advanced imaging modalities. The positive side of this is that with greater use of ‘red flag’ based guidelines, there are fewer ‘normal’ studies. I’ve found that using clinical decision tools has resulted in more studies with findings that affect the prognosis or management of the patient.

2. Chiropractors have several ways they can integrate imaging into their care plans – including referring the patient to an imaging center or offering onsite exams. Do you expect to see more practices bringing imaging in-house?

The trend demonstrated by the NBCE Practice Analysis shows a shift toward fewer chiropractors that own radiographic equipment in favor of referring patients to imaging centers. There are multiple reasons for this shift, such as the ability to refer to an imaging center for high-quality imaging, digital access to imaging via online portals, and the professional interpretation of a radiologist. Other reasons include the overhead costs of in-house imaging, the increasingly stringent quality-assurance/quality-control procedures required and decreasing reimbursements.

3. Many practices that offer onsite imaging use film. What advantages does digital imaging bring to practices?

Having worked in radiology when film was the only option, it’s easy to sing the praises of digital radiographs over film. With film, the only options you have for changing how it looks after the exposure is to use a brighter viewbox or a hot light. Of all the benefits of digital, I believe the greatest is the ability to manipulate the contrast and brightness of the images. Add to that the decrease in patient radiation exposure due to retakes, space savings from records storage, and the long-term cost savings of digital over film, and it makes the conversion to digital a fantastic choice.

Quote from Dr. Chad Warshal, NYCC4. Do chiropractors tend to read their own X-rays, or are the images sent to a radiologist and a report provided to the chiropractor?

The answer to that question is twofold. First, chiropractors receive intensive education in the interpretation of musculoskeletal radiographs. Because of that education, there is a certain degree of comfort in reading their own studies. However, one of the important points stressed in chiropractic education is the use of specialists. I had a diagnostic-imaging consultation practice before moving to academia, and I still maintain an imaging-consultation practice with New York Chiropractic College. I’ve noticed there are two major patterns when chiropractors refer studies for interpretation.

The first (and most common situation) is doctors of chiropractic who read their own films, but refer the problem cases or those with questionable findings to the radiologist for interpretation. The second scenario involves doctors who prefer to have all their imaging read by radiologists. This tends to be seen more with large medical-legal practices.

 5. There’s a perception that when an X-ray exam is needed, it’s usually best to have the exam interpreted by a radiologist and then have the report made available to your chiropractor. How has digital technology changed this?

Digital technology has made professional interpretation simple and convenient in a way that was unimaginable with analog film. If a field practitioner wants an interpretation on film-based images, the films have to be delivered or shipped to the radiologist, leading to a substantial lag in diagnostic evaluation. And there’s always the concern of films being lost or damaged in the mail. With the continued expansion of digital imaging, this allows essentially one-button pushing of images to a radiologist, even allowing reads from 3,000 miles away, two minutes after the images are taken. The interpretation is quick, there’s no chances of lost studies in the mail, and there are cost saving – not only in terms of postage, but also in terms of less staff time packaging and refilling films.

6. You head the radiology residency at New York Chiropractic College. Are you seeing interest grow in chiropractic imaging? What’s driving your students to choose this path?

Chiropractors have always had a strong interest in imaging. Over the years, that has evolved along with radiology, as we discover more about what imaging is – and is not – good for. The people who enter the postgraduate diagnostic imaging residency programs are those who have a strong academic talent, a good eye for interpretation, and have discovered a passion about the diagnostic aspect of health care.

Guess The X-Ray – September’s Image Challenge

Happy September everybody! Time for a new Image Challenge. Last month we had a clock radio, and we think we have another good image for September.

This month’s image is below; please leave your guesses below or on our Facebook page. The challenge will run until September 30, or until the first person correctly names the image. Good luck!

 

Sorry… Carestream employees and their agencies are prohibited from entering.

September Image Challenge

Dream Job: Applications Engineer, Digital Medical Solutions

Marty Pesce, Applications Engineer, CarestreamAfter receiving his X-ray certification, Marty Pesce worked in a hospital for 10+ years as a chief technologist and was cross-trained in different modalities. He became an applications consultant in 2000 and transitioned to Carestream in 2007. When an opportunity arose to be an applications engineer, Marty moved his office base from Philadelphia to Rochester, NY, and shifted his focus from U.S. to Worldwide Operations.

Q: What made you decide to become a Radiologic Technologist?

To answer with a short response: my mom. When I was in college, I changed my major a lot. I went from art, to art history and then to physics and was still unsure about my decision. One summer I was home from college and my mom, an ER nurse at the local hospital, got me a job doing CAT scans. My hometown was in rural Pennsylvania so at that time the CAT scan would come in on a truck to the hospital. Pennsylvania was one of five states that had no requirements for licensure. I did this job for 6 months until the law changed which required technologists working for a private company to be registered, though technologists in the hospital still did not need to be.  So, I went to get my X-ray Certification at Bradford Hospital School of Radiologic Technology. I had to go to school to keep my job rather than go to school to get a job.   After my first year, I also worked a Baylor position as a technologist on the weekends at another hospital so I worked 16 hours a day, 7 days a week.

Q: What is your favorite part about your job?

A: Getting to travel all over the world to work with customers. I have been to 17 countries across Europe, Asia, and Central America. I haven’t gotten to see South America or Africa yet. My favorite trip has to be to Salt Lake City, Utah for the 2002 Winter Olympic Games. I arrived two weeks before the games to train the staff in the Olympic Village and had the opportunity to see the opening ceremonies, and different events.  As a former college athlete, it was a thrill to be so close to the games, the participants, and dignitaries that came through the facility.  It was a once in a lifetime experience.

Applications Engineer Marty Pesce using the Carestream DRX-Evolution.

Applications Engineer Marty Pesce using the Carestream DRX-Evolution.

Q: Outside of work, how have you been involved in the profession?

A: I’ve been involved in State & National X-ray societies. I served two terms on the Board of Directors for the Pennsylvania Society of Radiologic Technologists (PSRT). I recently attended the American Society of Radiologic Technologists (ASRT) House of Delegates meeting in Florida as the PA Delegate. On behalf of the ASRT, I lobbied for the CARE (Consistency, Accuracy, Responsibility and Excellence in Medical Imaging and Radiation Therapy) Bill which sought to protect patients by way of better education. In April I did a presentation to the Pennsylvania State Society about the history of radiology and how the things we did 100 years ago still influence what we do today. I dedicated the presentation to John (“Jack”) Cullinan.  Jack was a former PSRT president, an author, and my predecessor.  He was known as “Mr. X-ray” and made a big impact on the field of radiology as well as me personally. Jack passed away about a year and a half ago but his book still remains on my desk and I refer to it often.

Q: Tell us some stories relating to the history of X-ray imaging

A: When X-ray technology was new, people feared that X-rays could see through their clothing. As a result, there were companies that manufactured and sold lead lined underwear. An Assemblyman in New Jersey went so far as to enter legislation to make X-ray opera glasses illegal. The funny thing is that concerns over privacy haven’t changed. Just last year the TSA pulled out backscatter scanners from airports because they were too intrusive.

Another story, that pre-dates X-ray regulation, is a documented case about a man from Rochester, NY, that made his own X-ray machine.  His wife was experiencing hip problems so he wrote to a prominent doctor in NYC. After 10 hours of trying to take a good X-ray image, he finally got one and sent that image to the doctor along with an inquiry on how to treat his wife’s burns.

Q: What last question…I heard that you like to dance?

A: Well, only when I am demoing products. One year at RSNA, before I did a product demo with our portable X-ray unit, our CEO said, “Marty, make this thing dance!” It took off from there and I made a full routine!

Enterprise Dose Management Is Radiology’s Opportunity to Lead

AHRA2014Radiology administrators looking to raise the visibility and value of their department should seize the opportunity to lead an enterprise dose initiative.

In a session at last week’s AHRA annual meeting titled, “An Executive Guide to Implementing a Successful Enterprise Dose Solution,” Chris Tomlinson, MBA, director of radiology at the Children’s Hospital of Philadelphia, urged administrators to not be myopic. By extending beyond the radiology department to a truly enterprise program that brings together other service lines like cardiology, oral surgery and oncology, dose becomes aggregate across the care continuum.

To successfully lead an enterprise dose program, Tomlinson shared best practices for radiology administrators:

  1. Ensure radiation safety committee is diverse: Include representation from IT, legal, the C-suite, and a medical physicist. Tomlinson noted a C-Suite stakeholder can help inform the larger health system of changing regulations and program status.  The medical physicist, he shared, has an opportunity to demonstrate their expertise and can often be the unsung hero of the committee.
  2. Understand all clinical workflows involved: An enterprise program must optimize all provider workflows. This cannot be done by radiology dictating protocols, procedures and policies to others. All workflows must be understood and documented in detail for an enterprise program to succeed.
  3. Foster more physician to physician communication: In alignment with ACR’s Imaging 3.0 initiative, radiologists can be leaders in a dose program by outreaching to referring physicians to discuss the necessity of tests, the technology available to lower dose and regulatory guidelines.

Dose was clearly a hot topic at AHRA with Tomlinson’s session being one of several.  You can find more dose management guidance, specifically a slide share from Shawn McKenzie of Ascendian Healthcare Consulting’s “Radiation Dose Safety: Defining and Implementing an Enterprise Dose Management Program” presentation on DiagnosticImaging.com.

Erica CarnevaleErica Carnevale is the social and content marketing manager for Carestream. She attended AHRA 2014 in Washington, D.C. from August 10-13 and reported back from the Carestream booth.

 

FDA Regulations Benefit the Medical Profession and Improve Patient Care

The U.S. Food and Drug Administration (FDA) branch named the “Center for Devices and Radiologic Health” regulates manufacturers, distributors and importers of medical devices.  Carestream Health follows FDA regulations and guidance relating to the design, manufacture, distribution, servicing and maintenance of its products. In addition, many of Carestream’s products are subject to FDA review for safety and effectiveness prior to receiving permission to market those products in the United States.

FDA  “Center for Devices and Radiologic Health”

The FDA’s “Center for Devices and Radiologic Health” branch regulates manufacturers, distributors and importers of medical devices.

Premarket submissions to the FDA include:

  • Various administrative documents.
  • Evidence that the product performs in a safe and effective manner.
  • In most cases, clinical evidence of the product’s performance must be gathered, analyzed and submitted to demonstrate safety and effectiveness of the device to the FDA reviewer.
  • Evidence that the product was designed and validated for proper performance against its specifications.
  • User documentation to ensure that users of the product are provided with adequate instructions for operating the device.
  • Depending on the level of regulatory control for a particular product, inspection of the manufacturing operation by the FDA may also be required prior to gaining approval to market a device.

Compliance with FDA regulation and guidance is a benefit to our customers and ultimately to the patients whose medical care is aided by the use of our products. Carestream has established and maintains a quality system for the medical devices it manufactures. This quality system consists of procedures and guidelines that are in accordance with the requirements put in place by the FDA. Some requirements apply generally to all devices and some are specific to the types of devices we produce (i.e. radiation emitting devices). The purpose of these requirements is to ensure that every stage of product design, manufacture, distribution, installation and servicing is structured and completed in compliance with processes proven to result in high-quality, safe and effective products.

FDA requirements are not limited to the design, production and sale of the medical device to the customer. As a manufacturer of medical devices, Carestream also maintains established procedures for installing and servicing its products at customer sites. These procedures must be documented, validated and controlled to ensure that the products are properly serviced and maintained.

Procedures are in place to ensure that any complaints or issues reported to us about our products are properly addressed and corrected in a timely manner. Any issues that could impact safety or effectiveness of the device are documented and considered in the ongoing analysis and mitigation of any risks associated with the device.

Carestream is dedicated to ensuring customer satisfaction and improving patient care.  Embracing FDA regulations is one way we continue to provide the medical profession with innovative, well-designed, high-quality products that benefit healthcare providers and the patients they serve.

Do Carestream medical imaging systems aid in the delivery of care at your facility? Are you satisfied with Carestream’s level of service and support? 

Carolyn L. Wagner Regulatory Affairs Manager, X-ray Solutions, CarestreamCarolyn L. Wagner is the Regulatory Affairs Manager for the X-ray Solutions business at Carestream.

Uncompromised Quality: Bone Suppression and Chest X-Ray Images

No one would claim that any part of a radiologist’s job is easy, but there are some aspects of their work that pose greater challenges than others. The interpretation of chest X-rays, the most common way to screen and diagnose lung diseases, is one of those tasks that can often frustrate a radiologist.

The average radiologist has probably viewed thousands of chest X-rays over the course of a career, and is well acquainted with the challenges they pose.  A traditional 2-D image of the chest will include all of the different bones surrounding the patient’s chest cavity, often obscuring the lungs. There are ways to see around the bones, but these systems often require the use of large imagining equipment that make it difficult to get an image of an immobile patient.

Carestream Bone Suppression Software

The bone suppression software can potentially improve the detection of both lung nodules and pneumothorax.

The recent FDA-approved Carestream Bone Suppression Software, now gives radiologists a better solution for chest X-rays—a clear image of the lungs without the expense of difficulties of a full 3-D image. Employing machine learning and pattern recognition technologies, the software accurately detects a patient’s ribs and clavicle structure and suppress these structures on the X-ray image, giving the radiologist an unobstructed view of the lung tissue. By focusing on the ribs and clavicle—the two most distracting bone structures—the software provides a high-quality, clear image that stays as close as possible to the quality of the original image. Five board certified radiologists put the bone suppression software to the test.  They were asked to interpret a series of chest x-rays with and without the bone suppression software, and to rate any change they may have noticed. In studies measuring both lung nodule detection and pneumothorax detection the radiologists recorded a statistically significant increase in detection sensitivity, with no significant increase in false positives when using Carestream’s bone suppression software.

On average, the radiologists who participated in the study reported being 58% more confident in their ability to accurately diagnose patients when presented with the images generated by Carestream’s software.

In addition to the advantages of image interpretation, the bone suppression software works in tandem with traditional 2-D x-rays.  Therefore, there is no need to subject a patient to any additional radiation.   Further, thanks to the portability of 2-D x-ray systems, such as Carestream’s DRX-Revolution, ICU patients no longer need to be physically brought to imaging equipment in order to get a reliable chest x-ray; a reliable chest x-ray can be taken right in the patient’s room.  Radiologists should not be forced to compromise between image quality and practicality when it comes to the health of their patients. Applications such as the bone suppression software are designed to help alleviate the need for compromise by providing a high-quality, low-dose image in a manner that is efficient and practical for both radiologists and patients.

Additional details about Carestream’s bone suppression software can also be found in the white paper, Bone Suppression for Chest Radiographic Images.

Zhimin Huo, Carestream

Zhimin Huo, Ph.D., is a lead scientist at Carestream. She participated in and co-authored the study, Bone Suppression Technique for Chest RadiographsShe also presented a paper at RSNA on this topic, as well as the paper, Computer-Aided Detection of Malpositioned Endotracheal Tubes in Portable Chest Radiographs for ICU Patients.

Improving Image Access and Transfer with Online Applications

The efficiency and effectiveness of viewing and sharing diagnostic images are vital when you handle the imaging process for 24,000 exams on annual basis, with 18,000 of those also including reporting.

Our facility, Cobalt Health, has had the hardware and software in place to properly handle the massive volume of images we collect throughout a given year, but new needs have arrived where what we had was no longer enough. These needs stemmed from two major issues:

  1. Referrers may not have had access to our PACS: This resulted in a staggered, inefficient process in providing them with access to needed images and reports.
  2. Images were transferred via CD/DVD: This resulted in issues related to information governance (privacy), losing image quality in transfer to CD/DVD, and high costs related to purchasing CDs, postage, etc.
Vue Motion

Cobalt Health received positive feedback from referrers who used Vue Motion to access medical images.

We solved both of these issues through the implementation of Vue Motion and MyVue. With the Vue Motion image viewer, we needed to address the issue of providing referrers with easy and access to images and exam results. The solution needed to be intuitive to view images from anywhere, at any time. We targeted MSKCAT (MusculoSKeletal Clinical Assessment and Treatment) referrers and received feedback that the image viewer was easy to use, provided access to previous imaging exams and reports, was easy to navigate, and was seen as a clear preference over using CDs.

With MyVue, the patient portal, we saw a positive result from patients who used it. From the 31 patients who responded back to us about its use, 85% said that the portal worked well. The use of the portal was able to streamline the image access and sharing processes, and thanks to its security, provided a vast improvement in information governance.

By providing this type of ubiquitous image access via web browsers—be it on desktop PCs, or on mobile devices such as an iPad—we were able to remove our worries about referrers not being able to see the images, while the patient access eliminated the need to use CD or DVDs.

What are your thoughts on improving image access and transfer capabilities? Have you been moving toward online/mobile applications instead of hard copy or CD/DVD? If so, what success and issues have you experienced?

 

Peter Sharpe, CEO, Cobalt HealthRoisin Dobbin-Stacey, Cobalt HealthPeter Sharpe (left) is the CEO of Cobalt Health, and Roisin Dobbin-Stacey (right) is the PET/CT operation manager and PACS manager at Cobalt Health. Together, they presented on their use of Vue Motion and MyVue at UKRC 2014.