New image challenge! What is it?

Radiology challenge image—this one is even harder than the last one (which nobody guessed correctly!).

Step up to it, radiologists, technologists, RAs, MDs, PAs – guess the subject of this educational x-ray quiz and we’ll send you an Everything Rad coffee mug—definitely a status symbol on any desk or table. Competition will be a little stiffer on this contest, too—so be warned—we’re also inviting Aunt Minnie and RadRounds readers to weigh in with their best guess. Good luck!

(Sorry, employees of Carestream Health—and their agencies—are prohibited from entering—go back to work!)

Harnessing the data stampede: Moving to shared workflow

Rounding the clinical data "herd" presents unique challenges and opportunities

The healthcare industry is facing a stampede of data in the form of both images and information. In a prior post, we discussed how multiple storage silos and dedicated departmental solutions create a “herd effect” that is difficult to control. Modern clinical data management solutions help healthcare providers share data, and that’s important. But the next step—a shared workflow—promises to achieve even greater overall efficiency and cost savings.

With a shared workflow, a dispersed group of clinicians and healthcare staff can function as though they are all sitting in the same room at the same time using a single system and user interface.

The basics for achieving this virtual community include:

  • A global patient worklist that allows radiologists to read exams captured at any location from any on-site or remote workstation. This eliminates bottlenecks in workflow and eliminates the need for radiologists to travel to specific locations just to read that site’s exams.
  • A consolidated patient portfolio that includes data from different departments, hospitals and other healthcare providers, and is delivered through a single user interface.
  • Advanced techniques that facilitate the interconnection of incompatible DICOM devices so that information is both available and accurate.

A shared workflow not only rounds up the required data, it equips healthcare providers to harness its collective power. This next-generation workflow improves productivity for individuals and groups while trimming the cost of managing, storing and sharing data.

Are you able to share patient data easily across multiple locations? Have you achieved a consolidated workflow that serves multiple sites?

–          Elad Benjamin, General Manager, Carestream Health

How long should mammograms be kept?

Today we’re dealing with a confusing topic with significant clinical, technical and legal ramifications. Specific retention requirements—like screening conventions themselves—vary widely by country as well as locally at the province/state level.

In general, retention of prior film and digital images falls into two very different camps: one puts responsibility on the healthcare facility to retain the images and make them available for a set number of years. Countries such as the U.S., Canada and many European countries mandate this. The other places the onus on the woman being screened to store and retrieve prior images, as in Mexico, South America and India.

For this discussion, we’ll focus on U.S. requirements since they are among the more confusing. For starters, U.S. facilities providing mammography must follow the Mammography Quality Standards Act (MQSA). This law mandates that mammograms be retained for a period of not less than five years and, in some cases, at least 10 years if no additional mammograms of the patient are performed at the facility. But remember, individual state laws may require even longer retention and are equally important to follow.

Many facilities end up retaining prior films for the life of the patient (or longer). This might be due to litigation concerns that could result from missed cancers, lack of understanding of state requirements or the fear of quality inspections. Many are instructed (or choose) to retain film indefinitely, rather than risk making a mistake that could put themselves or their organization at risk. This can result in a huge amount of wasted storage and resource usage that could be avoided—especially since many older mammographic images have been rendered virtually “undiagnostic” by technology advances over the last 10 years.

When organizations transition to digital imaging, this issue is further compounded by questions regarding the digitization of prior images. It’s important to understand that digitized images of prior film mammograms can be extremely useful and can be used for comparison purposes, but cannot be used to fulfill retention requirements as the FDA mandates that the original film mammogram must remain archived and available.

With all of this in mind, my guidance is to always understand your local and state laws regarding retention of prior mammography images. It’s also essential to have a sound strategy for digitizing analog images that aligns with your workflow, patient needs and country and local mammography quality standards laws. This knowledge, and planning, will serve you and your patients well—and just might help you avoid storing “ancient” films longer than you need.

How does your organization/facility deal with this issue?

– Anne Richards, Clinical Development Manager, Women’s Health

New “meaningful use” EHR rule released by HHS on Tuesday simplifies applying for incentives.

What is your opinion about the new meaningful use guidelines?

After taking cognizance of 2000 comments on the preliminary rule, HHS has defined meaningful use for Eligible Professionals (EPs), hospitals and Critical Access Hospitals (CAHs) in two stages. Stage I, for which you can apply for incentives now and receive payments as early (for hospitals) as October, has simplified the eligibility and built in some choice as to the way you can qualify—though it is still far from simple.

(From the CMS Fact Sheet on the final rule:)
“For Stage 1, CMS’s proposed rule called on physicians and other eligible professionals to meet 25 objectives (23 for hospitals) in reporting their meaningful use of EHRs. The final rule divides the objectives into a “core” group of required objectives and a “menu set” of procedures from which providers can choose.  This “two track” approach ensures that the most basic elements of meaningful EHR use will be met by all providers qualifying for incentive payments, while at the same time allowing latitude in other areas to reflect providers’ varying needs and their individual paths to full EHR use.”

CMS estimates that incentive payments under Medicare and Medicaid EHR programs for 2011 through 2019 will range from $9.7 billion to $27.4 billion.

You can download the fact sheet on the new rule at CMS here.

Are you preparing to apply for EHR incentives under ARRA?

Do you find the new definition of meaningful use clear or does it raise as many questions as it addresses?

We’d love to hear your point of view.

Customer spotlight: Penn. medical center uses wireless detector to upgrade one room while building a new one

Robin Wible, Director of Radiology, Memorial Hospital (York, PA):

“So far we have had the DRX-1 up and running since March—to prepare for renovations on a room we were going to replace with the new Carestream DRX-Evolution room. The idea was to step up our turnaround time for patients while we were remodeling. The technologists are really happy with the DRX-1 product—they love it, which is great—and I told them—just wait till you get the new room in, because you’re really going to like that!”

If you were going to remodel an old X-ray room, how would you increase throughput to avoid increasing patient wait time?

Editor’s Note: This is the first in a series of interviews with Robin Wible, Director of Radiology at Memorial Hospital (York, PA), who recently completed the purchase and installation of a CARESTREAM DRX-1.

Customer perspective: New developments in enterprise system integration (video)


Rick Perez, Radiology Administrator, Winthrop University (Mineola, NY), he is also a member of Carestream’s Advisory Group, a collective of medical professionals that advises the company on healthcare IT trends,  discusses new developments in radiology that excite him the the most. Integrated, rule-based systems that can improve productivity and quality of care are discussed.

Multi-modality pre-clinical imaging is aiding, expediting advances in medical research

Advanced techniques like PET/CT image fusion are opening new doors in pre-clinical research

A recent article in Nature magazine said it best, “Dead mice tell too few tales.”

This refers to the notion that we can learn a lot more by studying the biologic processes of live animals via molecular imaging than through invasive techniques that sacrifice animals or utilize surgery. Many recent advances in medical research have been expedited and/or enabled by advanced molecular imaging techniques that often incorporate two or more imaging modalities at the same time (e.g., PET, SPECT, CT, X-ray or optical imaging).

All of these modalities have been around for a while. More recently, advanced multi-modal imaging systems designed specifically for life science and medical research have become much more affordable and practical for the lab environment. With today’s best-in-class in vivo systems incorporating multiple modalities and sophisticated image analysis software, researchers are able to see biological processes never thought possible just a few years ago. Knowledge of these processes is critical for understanding disease states and developing therapeutics for treating them.

This progress has also been aided by image fusion techniques that enable researchers to fuse images and data sets acquired with different modalities. As in the clinical world where image fusion is becoming more common, medical researchers are getting quantitative,  PET and SPECT images that can be co-registered with the precise 3D anatomical information offered by CT. In a similar fashion, researchers are fusing X-ray and optical molecular images to understand the interdependence biological pathways and disease states in living animals rapidly and non-destructively. Optical probes also offer the ability to study not only the location of these biological processes, but can also be used to study directly the change in activity of enzymes found in these pathways.

Quantitative PET imaging studies, that can be conducted in our new Albira PET/SPECT/CT imaging system for example, have been instrumental in precisely quantifying changes in brain metabolism in pre-clinical animal models of aging.* These changes in brain metabolism were then linked to other known important molecular changes during the aging process such as an increase in reactive oxygen species.

The increased ability for both researchers and clinicians to use the same imaging tools will further accelerate the application of successful pre-clinical animal studies in the lab to human clinical applications—a very good thing for all of us.

– John DelliSanti, President, Carestream Molecular Imaging

* Borras C, Stvolinsky S, Lopez-Grueso R, Fedorova T, Gambini J, Boldyrev A, Vina J FEBS Letters 2009, 583, 2287