Guess the X-ray – October’s Image Challenge

It’s a new month so that means it is time for a new “Guess the X-ray” Image Challenge. September’s Image Challenge, a ball in a baseball mitt, was never guessed correctly (although there were some good guesses), so let’s see if we can make things a little more difficult this month..

The x-ray image for October is below. The challenge will run until the end of the month or until the first person guesses correctly.

To participate this month, leave your guess in the comments below or on our Facebook page. Good luck!

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

October Image Challenge

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Diagnostic Reading #46: Five Must-Read Articles From the Past Week

Carestream LogoThis week in Diagnostic Reading, we are looking at ICD-10, as yesterday marked the deadline for the code implementation. We also look at the effects of patient consultations, breast computer-aided detection, and the security of medical imaging technology.

1. ICD-10: Inside the War Rooms – Healthcare IT News

A closer look at how consultants, hospitals, and IT vendors are working on ICD-10, the new-to-us 20-year old classification system that U.S. healthcare payers and providers must start using as of October 1, 2015.

2. Health IT Leaders Call ICD-10 Transition “A Step Forward” – Healthcare Informatics

Yesterday marked the deadline for ICD-10 code implementation and many health IT leaders have applauded the nationwide transition as a necessary step to build more robust medical records. In a statement, the Coalition for ICD-10, a broad-based healthcare industry advocacy group, said the transition to ICD-10 “is a historic moment for U.S. healthcare and a major milestone in the evolving transformation of our 21st century healthcare delivery system.”

3. Patient Consultations Boost Pediatric US Experience – AuntMinne

According to a study published in the American Journal of Roentgenology, when it comes to the parents of children receiving ultrasound studies patients really want to get imaging findings directly from radiologists. Researchers from Stanford University School of Medicine implemented radiologist-patient consultations after routine outpatient pediatric ultrasound studies at Lucile Packard Children’s Hospital. They found that more than 90% of parents indicated they would prefer to meet directly with the radiologist at every visit going forward.

4. Study Raises New Doubts About Value of Breast CAD – AuntMinnie

According to a new study published online Monday in JAMA Internal Medicine, radiologists who used computer-aided detection (CAD) software to read screening mammography exams had no better accuracy than those who didn’t.

5. Are Your Secure? PACS, MRIs and Other Medical Devices at Risk of Being Hacked, Says Security Experts – Radiology Business

According to a presentation made by two security researchers at DerbyCon 5.0 in Louisville, Ky., many healthcare provider computer systems and medical devices in the U.S. are vulnerable to hackers. Using the search engine Shodan, which finds computers based on software, operating software or other specific details, the researchers found access to tens of thousands of hospital computer systems and medical devices. This included a “very large U.S. healthcare system” with more than 12,000 employees and more than 3,000 physicians. The system included 97 MRI systems, 323 PACS Systems, and hundreds of other devices.

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Video: Ergonomics Using the CARESTREAM Touch Ultrasound System

Carolyn T. Coffin, MPH, RDMS, RVT, RDCS, Sound Ergonomics, LLC, is seen in this video demonstrating the ergonomic design of the CARESTREAM Touch Ultrasound System.

We have discussed the importance of ergonomics in ultrasound system design before, but now you can see it in action.

Coffin goes through how each of the three major components of the ultrasound workstation–the ultrasound system, the chair, and the exam table–interact with each other for the best possible experience.

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The Potential Value of Weight Bearing Images Acquired by Cone Beam CT

Carestream cone beam CT

Prototype image of the Carestream cone beam CT system (INVESTIGATIONAL: Not available for commercial sale).

Many orthopedic conditions are best evaluated by imaging studies acquired to simulate functional positions and weight bearing activity.  This is especially true of diseases that involve the articular surfaces of the joints, such as fractures, malalignment syndromes, and degenerative diseases.  For example, radiologists and orthopedists both prefer to evaluate patients with knee arthritis by acquiring weight bearing images, as they more accurately reflect simple functions like walking and using stairs.

UBMD Orthopedics and Sports Medicine is a large academic practice plan that provides comprehensive musculoskeletal care to more than 40,000 patients per year.  Our clinical sites offer digital X-ray and MRI imaging, but we do not operate a CT scanner.

We have partnered with Carestream Health to evaluate the ability of a new portable cone beam CT (CBCT) scanner (INVESTIGATIONAL: Not available for commercial sale) to acquire 2D and 3D images of the extremities.  Of its many capabilities, the CT scanner can acquire images while the patient is weight bearing and with the extremities in various positions while they are under physiological load. A good illustration of the potential utility of this type of imaging is when it is applied to clinical cases of patellofemoral instability.

Two of the challenges of this condition are identifying the cause of patella subluxation or dislocation, and then calculating the amount of correction that would be necessary when tibial tubercle transfer surgery is planned.

In the past several years the tibial tubercle-trochlear groove offset (TT-TG) distance has been relied upon as an objective measure of the Q angle, and when excessive, results in the lateral vector that pulls the patella over the lateral femoral trochlea.  Even though the TT-TG offset is an objective measure, studies have shown that the absolute value can be affected by the method of image acquisition.

Practically all conventional CT scans of the knee are obtained with the patient lying supine on the table with the leg in full extension and the muscles relaxed.  Because of the natural screw home mechanism of the knee, the tibial tubercle rotates externally in relation to the femoral trochear groove during the final few degrees of knee extension.  The active quadriceps exerts a medial vector on the patella. These two factors are reported to falsely elevate the TT-TG offset distance as measured when the CT scan is acquired in the conventional way.

UBMD Orthopaedics and Sports Medicine and Carestream Health are conducting an institutional IRB-approved clinical study to compare measures of TT-TG offset obtained on a conventional CT scanner to those obtained on the prototype portable CBCT scanner – while the patient is standing, the quadriceps is active, and the knee is flexed to 30 degrees.  The hypothesis is that the average TT-TG offset distance measured by CBCT will be less than that measured on regular CT scan.  If the hypothesis is proven, this will have significant implications on defining abnormal TT-TG offset, and on calculating the amount of surgical correction when tibial tubercle transfer is the required procedure for patellar instability.

A second clinical study will evaluate the ability of weight bearing CT scan to more accurately image(2D and 3D) the ankle and tibiofibular syndesmosis.  This type of evaluation may be crucial to determining which ankle injuries are unstable, and allow clinicians to stabilize those that need surgery and avoid surgery on those that do not.

Other researchers at UB and Carestream are looking to validate computational measures of joint surface area of contact and joint surface pressure when obtained while subjects are weight bearing in the cone beam CT scanner.  This has the potential to become a non-invasive tool to evaluate a host of orthopedic conditions that affect the biomechanical behavior of the joints, such as arthritis, meniscus loss, instability, and malalignment syndromes.

Dr. John Marzo, UBMDJohn M. Marzo, MD, is an associate professor of clinical orthopaedics at the State University of New York at Buffalo’s Jacobs School of Medicine & Biomedical Sciences. His research interests in the basic sciences relate to the biomechanics of the shoulder and the knee, with the most recent project sponsored by Carestream Health to investigate the advantages of a new prototype portable 3D cone beam CT scanner.

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Diagnostic Reading #45: Five Must-Read Articles From the Past Week

Carestream LogoThis week’s Diagnostic Reading focuses on duplicate imaging on emergency patients, medjacking, the cost doctors are paying for technology, tomosynthesis implementation, and the importance of setting up a data security plan.

1. Study: Emergency Patients Get Duplicate X-ray, CT Exams – AuntMinne

Researchers from Emory University examined the cases of more than 3,600 patients who underwent both x-ray and CT studies on the same body part as part of their workup after admission to the emergency department (ED). The team found that many of these exams were unnecessary, with both x-ray and CT sometimes ordered simultaneously, or CT ordered before results from an initial x-ray study were received.

2. Medjacking: The Newest Healthcare Risk? – Healthcare IT News

A recent article in WorldNow proclaimed, “It may sound like a science fiction novel, but medical devices could someday be the target of hackers.” But the fact is that these devices are already being hacked, a trend that is alarming hospitals and other healthcare organizations. In fact, this kind of hacking is already widespread enough to have a new name: medjacking.

3. Docs are Paying More for Technology Than Ever Before – Healthcare IT News

According to a new MGMA report, medical practices across the U.S. are now spending a lot more on technology this year, up nearly 34 percent from four years ago. The annual report published by Medical Group Management Association shows that just from last year alone, physician-owned multi-specialty groups reported nearly a 12 percent increase in technology-related operating costs.

4. Imaging Department Reaps Benefits of Tomo After Careful Implementation – Radiology Business

The Baylor College of Medicine department of radiology recently implemented DBT at their breast imaging department. They wrote about the experience for the  Journal of the American College of Radiology, stressing the importance of taking things one step at a time. Ebuoma and colleagues wrote that the first step was getting staff fully prepared for the transition. From the person answering questions from behind the front desk to the radiologists interpreting the images, each staff member had to adapt to this new technology and how it would impact their day-to-day operations.

5. Data Security: The Importance of Planning, Training, and Having a Risk-Management Strategy – Healthcare Informatics

According to a recent report from the Breach Level Index, the healthcare industry had the highest number of data breaches in the first half of 2015 and also led the way in number of records breached by industry, with 84.4 million records. These findings represent a dramatic shift from the past few years when healthcare had relatively small numbers of records involved in data breaches, according to the report. The report findings are just one more reminder of the ongoing threats to healthcare information security and highlight the importance of building a strong information security program.

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What Does Clinical Collaboration Really Mean?

Carestream Clinical Collaboration PlatformWe’ve been talking about clinical collaboration and Carestream’s Clinical Collaboration Platform quite often since before RSNA 2014.

For us, clinical collaboration was born out the use of our vendor-neutral archive (VNA). The VNA served as a housing mechanism for medical images across a variety of –ologies, not just limited to DICOM images. With the VNA, the images remain safe and accessible when necessary, however, to enable intelligent, user-based sharing, more than just storage is needed.

To go beyond the VNA and expand the capabilities that truly lay within its technology, there remained a need to bring in other systems that could result in an enterprise-wide tool to unite departments. With our own Clinical Collaboration Platform, we break down the capabilities in four areas: capture, manage, archive, and collaborate.

Capture. The goal is to provide a unified, patient-centered clinical record that pulls together images and data from departmental systems across the enterprise, and even beyond it. The solution needs to be flexible enough to be where the data acquisition happens: bed-side, by specific modalities, even from mobile devices in a wound care/urgent care environment.

Manage. From a web-based portal the user can now manage clinical imaging data whether it’s at the point of care or as part of the administrative process. Having the right clinical context to each image or clinical data ensures that information can be properly stored, viewed, and share these clinical images and accompanying data. This capability involves advanced metadata tagging, quality control to ensure consistency, and leveraging latest industry standards to ensure interoperability.

Archive. This stage involves the storage and access of clinically meaningful data throughout the enterprise, with access across each patient’s clinical history. This consolidated repository for clinical data helps to support effect collaboration via intelligent lifecycle management, optimized storage and access anytime, anywhere, standards-based and vendor-neutral, and risk-free migration from legacy archives.

Collaborate. This is the ultimate stage that supports dynamic collaboration between providers, patients, payers, administrators and IT managers, with tools and views tailored to each user’s needs. The main goal is to put patients at the center of efficient, effective healthcare. This involves EMR/EHR integration, zero-footprint interface for administrators, user-specific functionality, patient engagement, and payer reporting.

With the evolution of the VNA going beyond the simplicity of storage and access, it is clear that these new capabilities will bring out the value of allowing clinicians to collaborate with each other and take part in valuable communication with their patients. This has been the direction healthcare has been heading in for sometime, and the time is now to embrace these advancements.

You can visit our website for more information about Carestream’s Clinical Collaboration Platform.

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


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Diagnostic Reading #44: Five Must-Read Articles From the Past Week

Carestream LogoIt’s time for a new edition of Diagnostic Imaging. This week we’re looking at medical imaging and pregnant women, digital tomosynthesis and CT lung nodules, how business intelligence affects security, doctors using EHRs, and imaging informatics and archiving in Scotland.

Diagnostic Imaging May Be Safe for Pregnant Women – Diagnostic Imaging

According to a review article published in the Journal of the American Academy of Orthopaedic Surgeons (JAAOS),  some radiologic imaging can be safe for pregnant women who have sustained traumatic injuries. Researchers from the Thomas Jefferson University in Philadelphia, PA, and the Garden State OB/GYN Associates in Voorhees, NJ reviewed the diagnostic dilemma that confronts emergency room physicians when pregnant women present with traumatic injuries that require diagnostic imaging.

Digital Tomo Falls Short of CT Lung Nodules – AuntMinnie

A new study published September 8 in the Journal of Digital Imaging indicates that tomo may have a tough time finding a role in the chest that’s not already well-served by the other two modalities. Researchers from the Mayo Clinic in Rochester, MN, compared digital tomosynthesis with chest x-ray in a population of 82 individuals, while also comparing both technologies to CT as the gold standard. They found that tomo was much better than standard radiography in several areas, such as for detecting nodules larger than 4 mm — considered the threshold for clinical significance.

Security Needs Business Intelligence – Healthcare IT News

A truly risk-based security framework needs more than mere protective measures. It requires awareness. This article features quotes from Ron Mehring, senior director and chief information security officer, Texas Health Resources, who oversees security architecture and operations at the sprawling 25-hospital system/ Mehring explains how large health systems need to escalate up from “baseline security requirements” to something much more robust.

More Than 80 Percent of Docs Use EHRs – Healthcare IT News

More than eight in 10 doctors across the country, or 83 percent, have adopted electronic healthcare record systems, according to a new report from the Office of the National Coordinator for Health IT. Counting only certified EHR adoption, however, that rate goes down to 74 percent. Also, 51 percent of doctors are using only basic EHR functionalities, according to ONC.

Imaging Informatics: Archiving Scotland – Radiology Today

Alan Fleming, program manager for National Health Services (NHS) Scotland, says the process of setting up Scotland’s archive required extensive input from both clinical and business stakeholders. One of the most important tasks was selecting a supplier for PACS, data center storage, and hosting [Disclosure: Carestream was selected to provide the PACS and national image archive]. NHS Scotland also had to specify the services that would be provided by the archive, and the final implementation plan required approval from senior government officials.

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Video: Demo of Carestream’s New Fluoroscopy System

Back in July, we made our announcement that Carestream was officially entering the radiography/fluoroscopy (R/F) market with the introduction of the DRX-Excel Plus and the DRX-Excel.

Below is the first look of the DRX-Excel Plus in action. The demo video will take you through the various capabilities of this new fluoroscopy technology, including the various features and settings on its control panel and the different positions available on the system for a variety of exams.

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Video: The Value of Imaging Sharing in Clinical Collaboration

With Carestream’s Clinical Collaboration Platform, you will see how more images can be shared across the enterprise from more modalities.

The ability to share more image formats across more devices is integral to making collaboration throughout the enterprise a reality.

In the animated video below, learn how image sharing on the Clinical Collaboration Platform is able to give clinicians real time, on-demand access to imaging results, as well as how it can empower patients to share their images between facilities, physicians, and specialists.

You can visit our Clinical Collaboration Platform page to learn more.

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Diagnostic Reading #43: Five Must-Read Articles From the Past Week

Carestream LogoWe are back this week with a new issue of Diagnostic Reading. This week’s topics focus on structured radiology reporting, sonographer health, EMR data security, EHR usability standards, and radiologist performance tied to Physician Compare metrics.

1. Structured Reporting Improves Quality of MRI Reports – AuntMinnie

At Brigham and Women’s Hospital, a structured reporting template yielded a significant improvement in the quality of MRI reports for the crucial task of staging rectal cancer. A team led by Dr. V. Anik Sahni found that the percentage of reports deemed to be satisfactory or optimal nearly doubled after the voluntary adoption of structured reports, reaching more than 70%. Furthermore, more than 40% of reports were judged to be optimal after structured reporting was implemented, whereas none were prior to adoption.

2. Making a Difference as a Sonographer: Pain in the Neck – AuntMinnie

Doug Wuebben, registered echocardiographer and also a consultant, international presenter, and author of e-books in the areas of ergonomics, exercise and pain, and injury correction for sonographers, goes through a number of exercises and stretches sonographers can do in order to prevent injuries.

3. Even with Encryption, EMR Data at Risk – Healthcare IT News

A recent security report by Microsoft finds that, even when cloaked in encryption technology, “an alarming amount of sensitive information can be recovered” from electronic medical record databases. For the report, “Inference Attacks on Property-Preserving Encrypted Databases,” which included 200 hospitals, researchers from Microsoft, University of Illinois and Portland State University examined four types of cyberattacks targeted at EMRs.

4. Study: Large Number of EHRs Do Not Meet Usability Standards – Healthcare Informatics

A significant percentage of electronic health record (EHR) vendors failed to meet federally mandated user-centered design requirements and did not conform to usability testing standards for their EHRs, according to a new report. The report, from the National Center for Human Factors in Healthcare at the Washington, D.C.-based MedStar Health, found that this lack of adherence to usability testing standards by EHR vendors could result in poor usability of EHRs.

5. Are Physicians Compare Metrics Missing the Mark on Radiologist Performance – Radiology Business

According to a recent study published by the  Journal of the American College of Radiology , the CMS Physicians Compare Initiative should include more imaging-specific metrics so it can accurately reflect a radiologist’s overall performance. Andrew B. Rosenkrantz, MD, of the department of radiology at the New York University Langone Medical Center, and colleagues studied how radiologists scored in six different Physicians Compare metrics compared to nonradiologists. In two of the metrics, radiologists significantly outperformed the nonradiologists. Radiologists scored 60.5 percent in PQRS participation, while nonradiologists scored 39.4 percent. And in receipt of PQRS Maintenance of Certification incentives, radiologists scored a 4.7 percent while nonradiologists scored 0.3 percent.

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