Radiology Trends from AHRA 2011

AHRA is always a valuable opportunity for us to hear from the radiology community and learn what’s really important to hospitals and radiology administrators.  In addition to meetings with customers, we talked with representatives from some of the key radiology publications to understand what hot topics were on their radar.  Lisa Fratt, Health Imaging & IT, and Cat Vasko, Imagingbiz, shared their impressions of the major trends this year:

  • Healthcare reform and how hospitals can get ahead of the curve
  • Regulatory and reimbursement changes and how facilities can adapt
  • Imaging department and marketing efficiencies


Were you at AHRA?  What was the most important thing that you saw?

Is film-screen mammography a technology of the past?

Anne Richards, Carestream HealthUsed correctly and regularly, studies have proven that screening is a key tool in the early detection of breast cancer.  Early detection enhances a woman’s chances for survival.

Film-screen mammography has a deep heritage and long been the gold standard for breast cancer screening.  While more than 77% of mammograms in the U.S. are captured digitally, many of the statistics about the benefits of mammography are from studies that used film.

Even with recent developments in other technologies, film-screen mammography remains a great tool for detecting breast cancer in its earliest stages. Plus, it offers practitioners a financially viable option for effective screening. Outside of the U.S., the numbers skew even greater for film-based mammography over other technologies.

Manufacturers such as Carestream—the world leader in breast imaging—continue to invest in the development of film-screen mammography through ongoing research and new product development like our New MIN-R 2000 Plus Film. Today’s products yield better resolution, greater contrast and finer details than ever before. We’re dedicated to further improving the capabilities of film-screen mammography as a screening and diagnostic tool.

Whatever technology you use—film-screen, computed radiography or full-field digital—the most important thing is to do it right. That means adhering to the manufacturer’s recommendations and following proper quality control procedures, ensuring that your system is within compliance, etc.

And keep in mind that the technology you choose for capture is only one part of the imaging chain. The technologist plays a key role in proper positioning, compression, and quality control. Likewise, the radiologist is critical in interpreting the results. It’s how you put it all together that you deliver the greatest benefit to your patients.

How long do you think film will have a place in early breast cancer detection?

Rural Healthcare Reform Lags in China Beyond Third and Fourth Tier Cities

Carestream CMO

Norman Yung, Chief Marketing Officer, Carestream Health

In my previous posts, I took a look at the impact China’s investment in rural healthcare is having on third and fourth-tiered cities like Nan Chang and Ying Tan. My latest visit to Ta Qiao, an agricultural village with 6,500 residents, however, indicates there’s still a tremendous amount of work that needs to be done to improve the 620,000 village clinics in rural China.

In Ta Qiao, there are a total of five medical clinics, one government sponsored and four privately owned and operated, that treat simple illness and medical problems. I visited the government-sponsored clinic located within one kilometer of village square.  The largest medical facility in Ta Qiao, comprised of a two-story building owned by the government, it stood in stark contrast to the small store-front private clinics.

Trained as physicians, the couple who runs the Ta Qiao medical clinic sees approximately 20 to 30 patients per day.  When I arrived at the clinic around 9 am there were already 10 patients in the reception area with another three to four in the semi-private patient rooms.

The Ta Qiao village clinic is a basic medical facility equipped to treat common illness, deliver children and take vital signs.  It has a reception area, admission office, rooms for dedicated departments (e.g., internal medicine, maternity, pharmacy, etc.) and about 10 patient beds.  The clinic has some rudimentary medical equipment, but does not have any X-ray imaging equipment.

Ta Qiao Government Medical Clinic

Ta Qiao Government Medical Clinic

To get an X-ray, a villager would travel by car to a neighboring hospital in a city like Ying Tan. A taxi costs about 75 RMB each way.  Compound that cost with the fact that the villager will be responsible for paying the medical services rendered.  A common treatment for the administration of shots (e.g., antibiotics) ranges in cost from 30 to 50 RMB.  For someone who is making only 1,200 to 1500 RMB per month, healthcare costs add up quickly.

Villages like Ta Qiao, which is up to an hour by car from nearby hospitals, have to rely on government-sponsored and private clinics to receive the most basic healthcare services. These rural clinics need more medical equipment and trained professionals to provide more critical healthcare services affordably to villagers.  This will only become more important as China’s population ages.

Five Reasons to Step Out of the Shadows and Into Cloud Computing

The cloud computing sessions at AHRA have been a hot ticket. Attendees are eager to hear opinion from peers, learn more about medical imaging opportunities and determine if it is time to stop dodging the clouds.

For many healthcare facilities the hesitancy to embrace cloud computing is driven by concerns about patient privacy and standards compliance and complacency with current systems. But some early adopter hospitals are seeing success, and cloud computing demand is poised to reach its tipping point by 2015.

Let’s look at one early adopter hospital – Winthrop University Hospital in Mineola, N.Y. The 591-bed university-affiliated medical center recently made the decision to take a walk in the clouds and purchased cloud-based RIS/PACS and vendor-neutral archiving services.

Maureen Gaffney, R.N., RPAC, CMIO,Winthrop University Hospital shares five reasons why her facility thought it was time to move to the cloud:

  1. Anywhere Access – Rapid access to patient data and images along with advanced reading and viewing tools for onsite or remote radiologists and clinicians was crucial for Winthrop’s growing outpatient facilities and physician network.
  2. Reliable Archive – Complying with continuous health reform, preparing for meaningful use and accountable care organization regulations means EMR and imaging data storage needs an uptime guarantee.
  3. Diversified Disaster Recovery – Moving away from the redundant data center approach requires a cost-effective option to protect assets.
  4. Predictable Expenditures – The pay-per-study usage charge is a safety net for controlling operational costs because capital expenditure is not tied up in investments in building, maintaining and upgrading a large internal IT infrastructure.
  5. Flexible Growth – RIS/PACS cloud-based services flex as priorities change and provide a strategy for growth when a healthcare facility grows rapidly and brings on more specialties, etc.

Sound like the needs of your organization? If you determine cloud-based services are the right fit for your organization, be sure to look for a vendor partner who understands the healthcare environment and has experience managing and protecting medical imaging studies in the cloud. The best cloud-based services vendor understands that cloud-based services are not so much about what you need the system to do today, but what it needs to do in the future.

Ms. Gaffney is a member of Carestream’s advisory board.

Professional Organizations: Staying the Course in Tough Times

Robert Salmon

Robert Salmon, Carestream Health

At the opening session of the annual meeting of AHRA: The Association for Medical Imaging Management, Edward J. Cronin, Jr., Chief Executive Officer of AHRA warned some of his comments would address a very serious situation facing AHRA.

The thoughts running through the heads of hundreds of members in attendance probably included wondering what somber, scandalous or now emerging crisis would soon be revealed. You could sense the quiet pall that descended quickly upon the assembled group as many of us pondered where his ominous remarks would likely lead.

While certainly not scandalous, clearly a bit somber—and not yet a nasty crisis but could easily become one—Mr. Cronin disclosed a disturbing trend facing AHRA: Tight budgets and scarce dollars for professional education and development are contributing to a decline in AHRA membership.

AHRA is not unique in facing a downward trending membership spiral—as many other professional healthcare organizations are challenged to simply maintain let alone grow their membership ranks. The fact remains that the impact of too few dollars and too many mouths to feed nearly always translates into fewer resources for professional development no matter where you work. In fact, as healthcare organizations in particular face enormous budget challenges not previously seen, professional development is often the very first to go in trying to manage an ever dwindling pool of resources in world that only seems to get more expensive overnight.

The many benefits to membership in AHRA and other well-run medical imaging and healthcare IT organizations unquestionably contribute to the ongoing and much needed development of professional leadership. Participating members and sponsoring organizations are exposed to new technologies; presented with opportunities for continuous professional improvement through education; and given access to real-life examples of leadership, innovation and successful financial management that can be hard to acquire during the day-to-day challenges that come with providing high-quality patient care or developing the technology and the products that make that all possible.

AHRA and other organizations are rising to the challenge by developing grass roots plans to grow membership; reaching out to volunteer and sponsorship networks to boost visibility and generate interest; and by ensuring that the value offered to their members continues to improve. With much hard work, success may be attainable.

But at the same time, as each of us and the organizations we serve look at budgets, resources, career demands and the need to continuously improve as a professional to excel at what we do—I feel certain that the question in tough financial times is not “Can I afford to support this organization”—and the smarter question to consider is: Can I afford not to?”

AHRA will be featuring this as well as other updates of the annual meeting on the organization’s blog.  Likewise, we’ll continue to reflect upon what we’re learning throughout the week here and on our other online channels. 

Will the Future of Imaging Include the EMR?

One of the most prominent topics since last year’s AHRA has been the meaningful use (MU) of Electronic Medical Records (EMRs).  In the past year it has been established that radiology qualifies to participate in the incentives, but for radiology the real MU opportunity is about more than just incentives.

Stage 1 requirements are clear:  your RIS vendor can either receive modular or complete certification as an EMR, and by taking advantage of exclusions the radiologist can qualify as an eligible professional.

A new dimension was introduced to the ONC HIT Policy Committee Meaningful Use Workgroup and anticipation is shifting towards Stage 2 and the incorporation of imaging data into the EMR.  This signals a critical acknowledgement that imaging data is relevant to physicians outside of the practice of radiology and opportunity to promote the role that radiology plays in providing better patient care.

Keith Dreyer, DO, Ph.D., Massachusetts General Hospital, introduced the concept of Enterprise Imaging at the May ONC meeting focusing on MU for specialties and the implications of including imaging data in the EMR are significant for radiology.

Consider the emergence of zero-footprint technology and an increase in the use of mobile devices in healthcare.  This trend sets the stage to allow images to integrate into the EMR and give physicians access to data across the hospital.  The incorporation of imaging data into meaningful use requirements will reinforce the importance of closed-loop communication between specialties and would go even farther to improve consistency in patient care – at the same time increasing the value of radiology.

How is your facility currently incorporating images into its reporting?

Need to brush up on Meaningful Use for radiology?  Listen to Dr. Dreyer in a series of podcasts explaining how radiologists can qualify for incentives. Part I, Part II, and Part III

Taking an X-Ray at One of 29,000 Township Hospitals in Rural China

Carestream CMO

Norman Yung, Chief Marketing Officer, Carestream Health

As my trip to China continues, this week I had the opportunity to join my brother-in-law at Ying Tan Hospital  for a follow-up X-Ray for his right wrist, which was injured three months ago.

Considered a fourth-tiered city, Ying Tan Hospital serves over 500,000 people from the town population of 250,000 residents and those from surrounding areas coming for care.  The leading medical facility in the area, the hospital recently expanded its operations and moved into its current buildings only a few years ago. I jumped at the chance to see China’s healthcare reform in action.

Admission was fairly efficient. After a few minutes in line, my brother-in-law was registered as a patient, which included having to pay all associated costs – 112 RMB for the imaging procedure plus 5 RMB for doctor’s visit.  While the government covers a portion of inpatient services like complex exams and surgeries, people in rural China with average monthly income from 1,200 to 2,500 RMB, are responsible for paying for the costs of simple exams like x-ray.

A recently renovated facility, Ying Tan Hospital operates CT, ultrasound and x-ray imaging equipment.  In this case it was located in a standalone, nearby facility within walking distance. Once we arrived, we waited about 12 minutes for a radiology technician to see us and take the x-ray (with Carestream technology).

Ying Tan Hospital China

Ying Tan Hospital Entrance

After about 15 minutes, my brother-in-law received the x-ray medical film images and a written report on the diagnosis.  He then returned to the first building to meet with the radiologist, who spent a few minutes reading the X-ray film on a light box, as well as the initial report and gave us his interpretation.  Unfortunately, because my brother-in-law did not bring his original x-ray images, taken at another hospital, we were unable to compare and contrast with the prior images.

This visit echoed my original impression of China’s rural healthcare reform. Clearly investments are being made in improving rural healthcare, as indicated by the expansion of Ying Tan Hospital and its medical equipment.  However, there are many opportunities to deliver more efficient care.

Consider my brother-in-law’s experience. While I saw a few uses of digital radiography in the hospital, a networked health IT system would have eliminated the need to print film, allowed the x-ray to be viewed from different buildings to save the radiologist and patient time, and improved diagnostic confidence with quick access to prior images.

I’m headed next to a village clinic in Ta Qiao this week to get a fuller picture of how someone in rural China receives healthcare.

Let me know in the comments if you have questions about village clinics – I’m happy to ask!

INFOGRAPHIC: China’s Rural Healthcare Reform

Carestream CMO

Norman Yung, Chief Marketing Officer, Carestream Health

This summer, I am spending a month in China sightseeing and visiting family and friends.  My in-laws live in a very rural part of China in a village called Ta Qiao with population of roughly 6,500 people.  To give this some perspective, Beijing has about 13 million permanent residents and another 10 million plus folks floating in and out of the capital.  This trip gives me an opportunity to see first-hand the country’s efforts to reform healthcare in rural China.

Before I arrived in China a couple weeks ago, reports indicated that while major progress has been made there is still tremendous work to do.

More than 835 million people, which accounts for 95 percent of rural residents, have joined the New Rural Cooperative Medical System for access to affordable health coverage. But with two-thirds of rural clinics in disrepair, government construction to improve thousands of rural medical centers is just picking up steam.

From what I’ve seen, it is too early to tell how fast and significantly the gap is being narrowed between urban and rural residents’ access to care.  However, one thing is clear: urban medical centers continue to outpace rural facilities in spend on and use of new medical technologies.

During my time in Ta Qiao, I plan to visit a village clinic to see how medical care is being delivered and what advanced technologies, if any, are being used.  I’m also on the hunt for examples of how advanced health IT systems are connecting urban and rural medical facilities and professionals for better diagnosis and patient care.  For that, I will venture to a nearby town, Ying Tan, with population of roughly 250,000 people located closely to Nanchang, a 3rd tier city with roughly 2.5 million people.

Are you following China’s reform? What areas should have greater focus? What lessons can other countries take from China’s successes and struggles?

Need a quick primer on the rural initiatives in China’s healthcare reform? See our infographic below.

China Healthcare Infographic

Special thanks to the Frontier Strategy Group for letting us use their data.

Mammography Screening Matters: Response to British Medical Journal

Guest Post: Laszlo Tabar, M.D., F.A.C.R.(Hon), Emeritus Professor of Radiology, Uppsala School of Medicine, Sweden

Editor’s Note:  Dr. Tabar recently published a study pointing to the long-term benefits of mammography screening.  You can see these results discussed in a previous Ask Anne post.

I am sure you have been disturbed by the media report questioning the value of mammography screening, based on a “publication” in BMJ, therefore I would like to give you a very simple and easily understandable way of looking at the issue. You are one of the experts in your area, so it is important to be able to argue properly.

 A report in the current issue of the British Medical Journal claims that there is no evidence that mammography screening has played a direct role in breast cancer mortality reductions in countries in which screening has been implemented. Lead author Phillipe Autier and his colleagues compared breast cancer mortality trends in three pairs of adjacent countries (Sweden vs. Norway; Northern Ireland vs. Republic of Ireland; and Belgium vs. Netherlands), with each comparison including a country that introduced mammography screening some years earlier than the other. Comparing breast cancer death rates between 1989-2006, the authors observed similar trends in the reduction of breast cancer deaths in each country pair. They conclude that mortality trends are more likely to be influenced by improvements in therapy than the effect of mammography screening.

 One should rely on people’s common sense – and try to ask relevant questions:

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Radiology Image Challenge – What is it?

We had great responses to July’s image, and this time there were a lot of correct guesses!  So, what was it?  Last month’s image was a sea shell! 

Congratulations to Melodie, who was the first person to correctly identify the subject of our challenge.  We’ll be following up with you directly to get your mug out to you soon!

Today is the first day of our challenge for August.  Here’s the next image:

You’ll have until September 6 to correctly identify the subject of this x-ray.  Leave your guess in the comments section for this post and the first person to correctly identify the subject of the x-ray will win an Everything Rad mug.

Looking forward to another month of great guesses!

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