Europe is Rising…and why that’s good for radiology…

A few weeks ago, I returned from attending the European Congress of Radiology (ECR) in Vienna. I’ve been covering this meeting as a journalist since 1995, and it’s been gratifying to see ECR evolve from a sleepy, biennial show lost in the shadow of the RSNA meeting into a vibrant annual event that unites more than 20,000 delegates from across the European continent and beyond.

The ECR’s growth largely parallels Europe’s growing prominence within radiology. Of course, Europe has always been a focus of innovation in medical imaging — the discipline itself sprang from research conducted by German physicist Wilhelm Conrad Röntgen — and numerous other advances, such as the invention of CT and MRI, also have European roots.

But for a time the Continent was eclipsed by more rapid developments in the U.S. Americans have an innate ability to adopt technology conceived elsewhere and figure out how to make money from it — often to the chagrin of its original inventors. This occurred in radiology as myriad technologies developed elsewhere were most aggressively commercialized in North America.

But that trend is shifting across the Atlantic. For the past several years, the U.S. radiology community has been preoccupied with fighting off relentless pressure to cut reimbursement and unnecessary imaging utilization. At the same time, confusion over the federal government’s approach to drug and device regulation has prevented a number of innovative new products from reaching the U.S. market.

In the meantime, European radiologists have steamed ahead with new technologies such as ultrasound contrast for radiology applications, new computer-aided detection software, and digital breast tomosynthesis in mammography.

Nowhere was this trend more evident than at this year’s ECR. There were dozens of presentations from European researchers who are getting their feet wet with products and procedures that are still works-in-progress in the U.S. In fact, one American radiologist in Vienna was even overheard exclaiming that his European counterparts were years ahead of the U.S. in a number of important areas. (The vibrant European market is a major reason why we launched our new portal in March.)

Should a rising Europe be seen as a threat to the U.S.? Not at all. Medical imaging is a healthier discipline for having more than one driver of innovation and growth. After all, who would want to cross the Atlantic in a jumbo jet with just one engine?

Meetings like RSNA and ECR will continue to promote cross-pollination between the U.S. and Europe in the traditional sense, while new technologies like social media will foster collaboration in ways never imagined just 10 years ago. And in the end, radiology will be better for it.

Guest Post: Brian Casey, Editor in Chief,

Clinic delivers mammography results to patients in 15 minutes

Guest Post: Jennings Pressly, MD
Diagnostic Centers of the Carolinas

At our facility, every woman who has a mammogram gets an immediate diagnosis as part of her office visit. We believe in delivering real-time results because it eases our patients’ fears. Many come in for a mammogram because a friend or family member has been diagnosed with breast cancer. Others come back because a previous mammogram was inconclusive. The last thing they need is to wait days or even weeks for a diagnosis.

With PACS and digital mammography systems, there is no reason for any mammography patient to wait. Our radiology group’s office recently implemented a CR system from Carestream Health that performs both mammograms and general radiology exams. This CR system, along with CT and MR systems, is linked to our miniPACS. Our radiologists read exams in real-time and then discuss the results with patients. We believe this develops trust and enhances patient care.

The clinic conducts images for about 60 patients a day, including 20 mammograms. In these difficult financial times, reducing uncertainty in health care and other areas of life is especially important.      

How long do your patients wait for imaging results? Do patients exhibit concern over waiting for a diagnosis

—Radiologist Jennings Pressly, MD, Diagnostic Centers of the Carolinas, Simpsonville, SC

Editor’s Note: The views expressed by guest bloggers are soley those of the author, and do not necessarily reflect those of Carestream Health.

ECR 2011: Wireless DR workflow study, University of Frankfurt

With the dust now settled from ECR 2011, we offer this video interview from the Carestream booth, featuring Drs. Thomas Lehnert, MD and Thomas Vogl, MD, University of Frankfurt, Germany. A recent study comparing workflow productivity of wireless digital radiography (DR) detectors with traditional computed radiography (CR) is discussed.

Questions or comments on the study? Post them in the comments section!

Mammography Outcome Data: How much is enough?

Tracking mammography outcome data has changed dramatically over the last 30 years. We used to simply ask… benign or malignant, how small and what type? 

This level of generality in mammography screening is long gone. In its wake, we have dozens, even hundreds, of data points that can be assimilated into tracking reports… granular measurement of specificity, sensitivity, recall rate, number of biopsies, biopsy type, size and type of cancer, high-risk assessments and patient history, just to name a few—all tracked across different sites down to the individual radiologist.

Some facilities try to track everything, and many do. Others prefer to take a narrower approach, sticking to the minimum requirements in their particular country and/or state. 

Which approach is better? What’s the right balance? 

Unfortunately, there’s no single answer. It partially depends, of course, on the local/regional laws that apply to your health facility or imaging center and what type of interpretation you do (double read, double blind read, etc.)

That said, there are some best practices that work well for many sites I’ve worked with—regardless of location or screening type. Much of it comes down to your preferred workflow, the needs of your patient population and, most important, what metrics you’re trying to move the needle on. This should always include some level of detail around productivity requirements and documented goals for radiologists, technologists and other staff, balanced with quality metrics like recall rate, specificity and sensitivity.  Adding other modalities besides mammography such as MRI, ultrasound and nuclear medicine only increases the number of metrics needed to follow.

Radiology Information Systems that are customized for mammography, such as CARESTREAM RIS, provide robust platforms for conveniently integrating patient data with ongoing tracking mechanisms that can be tailored for individual workflows. These systems automate many tasks that used to be handled manually, and bring the added benefit of keeping up with ongoing screening requirements that can change over time.  Gone is the little black book listing your biopsy cases and pathology reports!

Based on their flexible nature, these systems enable you to establish a baseline for your facility, so you can focus on items that can actually drive better care and lower costs. This flexibility also lets you apply my golden rule… do what makes the most sense for your facility, based on your patients’ needs, and always use common sense. 

What’s your golden rule?

Imaging IT and the EMR: Podcast with Carestream’s Elad Benjamin

In the past, imaging IT and the EMR were two separate systems – but days of exclusive IT platforms are history.  Hospitals are finding that they can provide better patient care by incorporating imaging results into patient records, challenging IT vendors to create solutions that integrate seamlessly with neighboring systems.  Elad Benjamin, General Manager of Carestream’s Healthcare Information Solutions business, discusses the increasing need for integration of IT solutions.

Click on the link below to access the Podcast, or right-click to download/save.

CarestreamCAST_Imaging IT and the EMR

Examination of wireless flat-panel DR systems: Initial workflow results versus CR

Guest post: Dr. Thomas Lehnert, MD
Institute for Diagnostic and Interventional Radiology, University of Frankfurt, Germany

It’s well known that the immediate image capture provided by digital radiography (DR) delivers enhanced productivity when compared to film imaging and even computed radiography (CR). Less familiar are the precise workflow and time-saving benefits of portable, wireless DR detectors over their predecessors.

To determine whether wireless DR detectors have significant workflow benefits over CR, my team at the University of Frankfurt presented the results of a time-motion study comparing Carestream’s wireless, cassette-size DRX-1 detectors to our existing CR systems. This study, which I will present at next week’s 2011 European Congress of Radiology, found a statically-significant improvement in productivity when using the wireless DRX-1 detectors. Further, the image quality was higher when using the DRX-1 technology.  

Our study of 941 total examinations (CR, n=474; portable DR, n=467) showed an average time savings of 26.44 seconds per examination when using the wireless DR detectors. We saved nearly one minute for every two x-ray exams, or approximately one hour per day based on our patient volume. The single largest contributor to the time difference between CR and portable DR was post-acquisition processing (mean, 26.58 s; median, 25.91 s), a composite of multiple individual steps, including cassette transport, cassette readout, and post-processing.  

Although we expected some workflow and image quality improvement, we were surprised at the extent of the benefits. With this data, we decided to replace all of our traditional x-ray room CR technology with wireless DR detectors. We are still using CR technology in our Intensive Care unit and Emergency Care departments.

The question now is what guidelines hospitals can use to manage the purchase and placement of CR and DR technologies. What criteria should be used to govern placements of CR and DR systems?

– Dr. Thomas Lehnert, MD

Editor’s Note: The views expressed by guest bloggers are soley those of the author, and do not necessarily reflect those of Carestream Health.

Digital Mammography – Further confusion for women

Emily Crane, KLAS

Guest post: Emily Crane, Research Director, KLAS

Recently Newsweek ran a story proposing that digital mammography has no added benefit to plain film mammography for women 65 years of age and upward.  I had a very strong emotional reaction to this story initially given the large amount of focus and research I do within the realm of women’s imaging as well as due to the fact that I have a mother who falls in to this category.  I also know that there is a great deal of confusion in healthcare right now in this space.  I’d like to share a few thoughts on the article and hopefully provide some insight to women who fall within this category.

Digital mammography is a proven life saver.  Breast cancer is most treatable when detected early.  Digital mammography offers a treating physician the ability to more clearly discern any possible lesions in the breast using digital manipulation as well as CAD.  It also allows for mammograms to be more easily transmitted to referring physicians.  Digital mammography also provides the radiology technologist with an instant image to ensure that the best image was taken.  All of these benefits that digital mammography provide allow for lesions to be detected when they are smaller and more easily treated.

A few years ago my mother was diagnosed with a lump in her breast only found by palpitation.  Once the physicians knew where to look for it was visible on the plain film mammograms going back several years.  As it was still very difficult for the physicians to know much about the lump they had found in my mother the proposed next step was a surgical removal of the lump.  As a precaution we opted to gather her plain films and meet with our local cancer center.  Their immediate recommendation was that we obtain a digital mammogram.  Once they had reviewed the digital mammogram they knew more about the lump and could also tell that a needle biopsy was possible.  The results of the needle biopsy showed no cancerous tissue and they recommended monitoring the lump.  Since then the lump has dissipated and we were able to dodge an unnecessary surgery as well as any possible side effects of surgery.

Recently, we published a very comprehensive study on women’s imaging and I had the opportunity to speak with numerous healthcare providers passionate about this area.  Not one recommended moving backwards in technology for these women.  In fact, these healthcare providers dedicated to women’s imaging are pushing for additional resources to help them in their battle to protect women against breast cancer.  I am personally in debt to their dedication to this area and strongly opposed to any limitation of digital mammography.  I am disappointed at Newsweek’s lack of concern for the women of this country and for their willingness to add to confusion in an already difficult area of medicine.  To those of you dedicated to improving our ability to save women’s lives I thank you.

For any questions about the research that KLAS has done in Mammography don’t hesitate to email me:

– Emily Crane, Research Director, KLAS

Editor’s Note: The views expressed by guest bloggers are soley those of the author, and do not necessarily reflect those of Carestream Health.