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.


AHRA 2014 Keynote Highlights: Lessons for Your Radiology Department from a Fighter Pilot

Radiology’s “top guns” are being tested and success in the changing healthcare environment is dependent on your commitment to yourself, the mission and your team.  This was the message from AHRA 2014 keynote speaker Lieutenant Colonel Rob “Waldo” Waldman, a decorated fighter pilot and the author of the New York Times and Wall Street Journal bestseller, Never Fly Solo.

Think the experience of radiology administrators and fighter pilots are worlds apart? Not so, says Waldman.  The fear he felt on his 65 combat missions – sometimes dodging missiles – is the same stress radiology directors feel as they are tasked to deliver excellence in patient care while facing obstacles like declining reimbursement, dose regulations, the ICD-10 roll out, patient satisfaction improvements and staffing challenges.

AHRA 2014 Day 1 Keynote Speaker Lieutenant Colonel Rob “Waldo” Waldman.

AHRA 2014 Day 1 Keynote Speaker Lieutenant Colonel Rob “Waldo” Waldman. [Photo credit to, Layne Mitchell:]

The training fighter pilots receive to be mission-ready can be applied by radiology department leadership to adapt to change and push performance to the next level.

Waldman urged AHRA attendees to:

  • Convert fear into focus – Commit. Commit. Commit. Place trust in yourself and your team. Identify your target and never fly solo. You can’t overcome obstacles without your wingman – be confident in their skills and training, establish clear objectives, roles and responsibilities, ensure you have the technology you need to succeed and develop contingency plans to ensure you don’t lose focus.
  • Lift Others – Your department team needs to know they can depend on you. You must think outside your cockpit. Foster trust through communication and connection that makes it clear you will not let them fail and will get them to the target. Always “Check 6” or look behind to ensure your wingmen are still with you.  Look for opportunities to recognize the unsung heroes in your service line – like those who ensure your mission critical equipment is maintained.
  • Recalibrate your attitude – Your wingmen are watching and see if you are pulling back.  Be confident that your mission is achievable.  Be willing to take risks and set a team culture for success.

Waldman’s motto “Push it Up” –  a reminder to overcome your fear and fight the urge to pull back on the throttle in tough times – gave AHRA attendees an inspired rallying cry for their hospital and departmental missions.

Radiology administrators, how do you plan to “Push It Up” in your department?


Erica CarnevaleErica Carnevale is the social and content marketing manager for Carestream. She is currently attending AHRA 2014 and reporting back to us from the Carestream booth, #212, in Washington D.C., August 10-13.


Infographic: Traumatic Brain Injuries (TBI) are a Major Public Health Problem

We have written before about the importance of sports medicine, and how it doesn’t apply only to athletes but to recreational enthusiasts too. One of the areas we highlighted was traumatic brain injuries (TBIs), and they occurring more often, among athletes across the spectrum–from professional to youth.

The infographic below highlights how serious TBIs have become in our society. In addition to show how they affect athletes, young and old, there is also information on symptoms to watch for, as well as what could happen if TBIs are left untreated.

With the Centers for Disease Control and Prevention (CDC) estimating that at least 1.7 million TBI every year, it shows that this is an issue that cannot be pushed aside. You can click the infographic below to view it in a larger format.

Infographic - TBI Are a Major Public Health Concern

Implementing Effective Ways to Reduce and Track Radiation Dose for X-ray Exams

DRX-Revolution Mobile X-ray Unit

El Camino uses two DRX-Revolutions as part of its conversion to DR technology.

El Camino Hospital has made dramatic decreases in patient dose in recent years. We use Bayer Radimetrics dose management software to track dose for all CT exams and we are now starting to collect dose for our room and portable X-ray exams and for fluoroscopy and interventional radiography procedures. We are especially proud of our accomplishments in the area of portable imaging, where we have made a significant reduction in dose.

We have lowered dose by replacing CR with DR technology—and by implementing software that enhances visualization and reduces the need for repeat exams.

We installed three new wireless DR portable systems that are used for imaging of critical care patients in our neonatal ICU, ER and OR as well as bedside exams for our main Mountain View campus. We have two Carestream DRX-Revolution portables and have retrofitted two existing mobile imaging systems with DR detectors to perform ER, OR and bedside exams at our Los Gatos campus.

Since critical care patients require more images than other patients, they benefit most from dose reduction as well as the enhanced image quality we are now able to provide to our physicians. We use grids for 90 percent of adult exams and our new imaging software lines up the grid with the tube head. This makes it much easier for technologists to achieve an excellent quality image and reduces the need for repeat exams. The grid improves details in the chest and abdomen as well as thicker body parts and provides better diagnostic data for physicians.

We now use a cesium iodide DR detector that fits into the incubator tray to image fragile neonatal ICU patients. This enables us to produce excellent quality images at a very low dose. Our imaging software includes pediatric settings that help technologists use the correct technique for each patient.

Both adult and pediatric critical care patients benefit from imaging software that helps enhance visualization of pneumothorax as well as tubes and lines by producing an image that is optimized to display the chest and tubes/lines from the original image. This also eliminates repeat exams and reduces dose.

Patient care is also improved by the higher power generators offered by modern portable X-ray systems. These generators enable us to image heavy or obese patients at a lower dose and provide better quality images at a lower dose for all our patients.

Have you converted all your X-ray imaging systems from CR to DR? As part of this transition, are you retrofitting existing systems, purchasing new DR systems or both?

Howard Sanford, El Camino Hospital


Howard Sanford, R (MR), is the imaging operations manager at El Camino Hospital.

Guess The X-Ray- August’s Image Challenge

Happy August everyone! Time for a new image challenge.

Last month’s flashlight image was pretty easy, and we think that this month’s image will be a little tougher. The image for August is below. Please enter your guesses in the comments below or on our Facebook page. The challenge will run until August 31, or until the first person enters the right answer. Good luck!

As always, Carestream employees and their agencies are prohibited from entering.


August Image Challenge

Patient Care Over There: A Talk About Global Radiology Practices

GlobeTodd Minnigh is a familiar face in the AHRA community. As a frequent conference attendee and speaker, he has presented on a variety of topics because he has seen and experienced a great deal throughout his career. In a new role within Carestream, Minnigh’s responsibilities have allowed him to travel the world to get a closer look at how other countries are practicing medical imaging and addressing important trends such as dose reduction and process efficiency.

He took the time to answer a few questions related to the presentation he will be giving at AHRA 2014, “Patient Care, Over There: What We Can Learn from Radiology Practices Around the Globe.” The presentation will be taking place on Monday, Aug. 11, from 4:00-5:00 p.m. and Wednesday, Aug. 13, from 10:00-11:00 a.m.

When it comes to patient care, is there a difference in defining patient satisfaction among countries? Are they looking at different factors? 

Minnigh: The biggest difference is probably not what satisfies the patient, but how it is measured.  In the U.S., under the ACA, we use the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. It looks at things like responsiveness of the staff and the quietness of the hospital. In many industries, Net Promoter Score (NPS) is considered a best practice. It measures the likelihood that customers will recommend you or refer others to you.  In the end, folks will move their efforts toward improving whatever they measure.

What are the biggest challenges facing productivity and workflow issues today? 

Minnigh: The most common challenge is having sufficient budget for expertise and technology. This is true everywhere, more in some locations than others. The technology and processes exist today to make almost any place more productive. The trick is to know exactly what you need, how to implement it and how to pay for it.

What are some of the differences in technology adoption you have seen from around the world?

Minnigh: There are many. The most interesting for folks from the new world may be that many countries overseas have PACS, but still print all their images to film. In some cases this is for archive, referring physicians and/or because the patient expects a copy.

What are some approaches to radiation dose management that you have seen around the world but are not as prominent in the U.S.?

Minnigh: In Germany, radiation dose is very carefully managed. This is one reason portables are limited in the emergency department. Scatter reaches other patients even though they may be ‘far away’ by our way of thinking. Also every machine has a DAP, or Dose Area Product Meter, right on the collimator to determine the amount of radiation the machine produced. Carefully tracking this is a common practice in Europe and is becoming much more common here now too.

What’s the most important lesson AHRA members can take away from the practices you’ve seen around the world?

Minnigh: The most important lesson is to think outside the box.  There are other ways to do things, other priorities to consider.  We get very focused on what we do and doing it better, we often don’t consider if it could be done in an entirely different way or if it really needs to be done at all.

Todd Minnigh, VP, CarestreamTodd Minnigh is the vice president of worldwide sales  and marketing development at Carestream. His talk at AHRA 2014,  “Patient Care, Over There: What We Can Learn from Radiology Practices Around the Globe.” will be taking place on Monday, Aug. 11, from 4:00-5:00 p.m. and Wednesday, Aug. 13, from 10:00-11:00 a.m.

Video: How an Organization Uses Teleradiology to Become Independent from RIS

Innovative Radiology covers a couple of hospitals, and Houston Medical Imaging, which is its primary medical imaging facility. The organization also provides readings for about 30 other facilities, which adds up to about 250,000-300,000 readings per year.

The video below is a case study on how Innovative Radiology uses teleradiology to become independent from specific RIS vendors. Now the organization can work with various RIS vendors, creating an easier, more efficient workflow.

Challenges to RIS+PACS Integration

Makori Arnon, Clalit Health Services

Makori Arnon, MD, MHA, Director of Imaging Informatics, Clalit Health Services, Tel Aviv, Israel

The world of radiology sees frequent use of the term “integration,” but this term can easily mean many things to different people. When used in conjunction with describing implementation of a RIS+PACS platform at a hospital, it demands we clearly define our expectations up front to minimize the challenges and disruption that can accompany integrating a new RIS+PACS platform into our workflow.

In the current environment we see that RIS, PACS and capture modalities are separate yet complementary entities that are really more bundled than they are integrated. We all know that RIS is a separate platform that is slowly being absorbed into the PACS or into EMR. PACS joins together both clinical information systems with the organization’s IT network and a successful implementation should have a very positive impact upon workflow.

Radiologists need to read images and dictate their findings, and being able to easily integrate images directly into the report via the RIS will help improve workflow. Integrating images into a RIS means that vendors will need to put more emphasis on developing improved RIS technology to provide higher-end throughput. By improving the RIS interface to better address workflow issues, a single-platform vendor will have a big advantage over another third party.

Carestream Radiology Information System

Integrating images into a RIS means that vendors will need to put more emphasis on developing improved RIS technology to provide higher-end throughput.

In the contemporary radiology department, knowledge is everything. This knowledge goes outside the walls of the healthcare facility with the advent of patient portals that allow patients to electronically access, store and share their medical images. With a well-integrated RIS+PACS platform, radiology professionals expect amplified clinical, business and IT benefits that include:

  • Greater value and insight resulting from the generation of clinically-rich reports
  • Improved workflow
  • Greater cost control and a streamlined data flow
  • Increased patient engagement and satisfaction with an intuitive patient portal; and
  • The ability to foster clinical collaboration without boundaries.

To achieve this, we need to improve upon the current integration process by providing a system or single platform for the reading and distribution workflow. Successful RIS+PACS vendors are making this a key focus of future product development activities.

Another issue to consider is that radiologists continue to change how they work. We are now seeing more “point of care” imaging where you have physicians creating medical images by capturing images with handheld ultrasound or endoscopy units. These physicians (not radiologists) are creating a workflow that is “orderless” or “non-scheduled”—and the organization will need to accommodate this workflow by supporting the input of these images into the PACS. Point-of care imaging is an integration point that we will need to see in future development efforts since it is clearly on the rise.

How is your organization handling the integration of RIS+PACS?

What will your RIS+PACS platform look like in the next 10 years?

Makori Arnon, MD, MHA, is the Director of Imaging Informatics at Clalit Health Services in Tel Aviv, Israel.

The Top 10 Reasons for Veterinarians to go Digital

Heidi McIntosh, Marketing Manager, X-ray Solutions, Carestream

Heidi McIntosh, Marketing Manager, X-ray Solutions, Carestream

Radiography is a jargon-heavy environment filled with terms and acronyms that can be hard for anyone to follow. The last thing you want to worry about is being confused while taking care of your patients. There is no doubt that technology is changing the way we work and many facilities are upgrading from film-based radiography to digital, but some are still on the fence.

A veterinary practice on the coast of Southern England recently showcased the advanced medical care now available for beloved pets and their owners. Raddenstiles Veterinary Surgery upgraded to digital to deliver access and management of high-quality imaging studies for the 3,500 patients the practice sees each month. Going digital has enabled the practice to engage in remote consultations to better treat their patients.

In a recent case, a Jack Russell Terrier fell off a 150-foot seaside cliff and was rescued by the Coast Guard. The veterinarian at the local practice determined the dog had a broken hip and digitally transmitted the images to the on-call vet at the Raddenstiles practice. There, they were able to devise a treatment plan and successfully repair the injury once the dog was stable and fit for surgery.

An Inside Look: A magazine for veterinarians from Carestream about radiology trends.

V-Inside: A magazine from Carestream about veterinary radiology trends.

There are many benefits that come from making the move to digital from both a business and patient-care perspective. Here are 10 of the best ones:

  1. Speed: Imaging exams are faster and smoother than ever before. X-ray images are displayed almost instantly, enabling veterinarians to accept or retake an image if needed, adding up to faster diagnosis and early treatment.
  2. Quality: Digital imaging provides superb quality, which can mean a higher level of confidence in the diagnoses and potentially, an increased standard of care.
  3. Waste: No more film, storage, toxic chemicals, fumes/odors, or long processing times.
  4. Versatility: Flexible and versatile software enables veterinarians to capture both soft tissue and bone detail in the same image, eliminating the need for multiple exposures with film cassettes.
  5. Sharing: Digital imaging supports increased clinical collaboration because images can be quickly and easily shared electronically.
  6. Application: Digitally captured exam images can be enhanced and manipulated to aid in interpretation.
  7. Space: Save valuable floor space since there is no need for a dedicated darkroom or storage for files because all images can be archived digitally.   
  8. Savings: Advancing technology is making the initial cost of digital systems even more affordable. Over time practices can enjoy a lower cost of ownership and operation.
  9. Transition: The transition is smooth and easy with little to no disruption. Digital imaging fits into existing workflow with an easy-to-use interface, minimizing training time.
  10.  Intuitive: This state-of-the-art technology can differentiate practices from the competition and enhance professional image.

The latest edition of An Inside Look magazine further discusses how Raddenstiles Veterinary Surgery benefits from going digital, along with “RAD 101: Know Your Modalities,” and a closer look at the TDR Detector. You can read the latest edition of the magazine here and subscribe to never miss a new version here.

How can going digital help your veterinary clinic be at its very best?

A Mobile Imaging Efficiency Showdown: CR vs. DR

When it comes to medical imaging it is no secret that every second counts. The modern healthcare environment can be incredibly fast-paced and medical imaging professionals demand, and deserve, the best when it comes to time-saving technologies.

We wanted to compare the efficiency of DR compared to CR using the DRX-1, and with the support of Queen Elizabeth Hospital in Birmingham, UK we were able to record a speed test. In the video, wireless DR is almost twice as fast as standard CR mobile imaging–an impressive performance that could make a big difference in terms of productivity and patient care.