Printing’s Place in Digital Medical Imaging

Joseph Maune, Global Business Manager, Advanced Printing Solutions, Carestream Health

The digitalization of medical imaging and the adoption of PACS and EHRs have created a common misconception that there’s no longer a need to print medical images. Yes, with digital imaging radiologists and physicians have instant access to images in their offices, but they still have needs for hard copy prints.

The radiology practices that we’ve talked to suggest that the need for diagnostic printing isn’t going away, but rather is shifting towards a mix of diagnostic and referral printing.  When consulting with colleagues and patients many referring physicians still prefer a print to share images.  In turn, many radiology practices are looking for new ways to provide their referring physicians with high quality prints.

A high quality, color print is a great  way to present advanced visualization studies, and can provide a way for the radiologist to differentiate himself to referring physicians.  For grayscale images, some of our customers indicate that providing images only on a CD is less efficient for referring physicians.  Providing a hard copy print of the key images adds value to the radiologist’s report and allows the referring physician to quickly see the images of interest.

This shift toward referral printing requires different printing solutions with lower total cost of ownership. The DRYVIEW Chroma prints both grayscale film and color paper prints – so facilities can use one printer to meet all of the needs of their referring community.  In this digital case study, Dr. Alberto Sahagún, radiologist and owner of Radiología y Ultrasonido San José SA de CV, Mexico, explains how his facility is currently using printing solutions, and shares the value that color printing brings to his practice:

Medical Printing eBook

view digital case study

Are you meeting all of the imaging needs of your referring community?  Are you sure?

What should we do with dense women?

Anne Richards, Carestream Health

Anne Richards, Clinical Development Manager, Women’s Healthcare, Carestream Health

Women with dense glandular breast tissue present a challenge—and one with high stakes.

Their tissue type is capable of hiding small abnormalities, they have a documented increased risk of breast cancer, and should they have a tumor it is more likely to have certain aggressive characteristics (as reported recently in the Journal of the National Cancer Institute).

As radiologists, you’re aware of these facts. But what about the women whose mammograms you interpret?

My recent post about breast density focused on the Governor of California’s decision to veto legislation that mandates that we inform “dense” women following their mammograms of their breast type and the implications, including the possible benefit of additional screening.

Similar legislation has passed or is pending in several U.S. states, but this veto highlights the importance of radiologists voluntarily providing this information.

Informing a woman of her breast density presents another dilemma. How useful is that information without recommendations on what to do next? What’s more, the medical community has yet to establish a protocol for them, including what modality should be used for follow-up.

For example, trials indicate that ultrasound combined with mammography provides increased detection in dense breast tissue. So should asymptomatic women with dense breasts be screened will full ultrasound in addition to their annual mammogram? Will insurance companies pay for the radiologist’s additional time? Can and should technologists be trained to do this screening instead?

In my opinion, we should not wait for mandates from the government to address this issue. Insurance companies, radiologists, and physicians need to work together to develop a standard of care for women with dense breast tissue. It’s a new horizon for our field—but one that will lead to brighter futures for the patients we treat.

What steps is your practice taking to notify women about the risks associated with dense breast tissue?

Lessons from China’s Radiology Technologists

My colleague, Norm, wasn’t the only one who spent time this summer seeing China’s healthcare reform firsthand. I also traveled to the region with Chuck Schneider, Software Lead of our User Experience team, for a usability project that looked at the micro behaviors of radiology workflow at large hospitals in Shanghai and Hong Kong.

Four large hospitals graciously allowed us to shadow their rad techs’ use of Carestream technology during patient imaging studies. This gave us a detailed look – down to user touches and timing – at their radiology departments’ high-volume workflows.  These observations provide opportunities to look for greater efficiency that could be driven by design changes.

Our time at these hospitals left an indelible mark on us, and the contrast between this healthcare system and the situation in the U.S. was striking.

Mike Venturino, Carestream

Mike Venturino and Chuck Schneider with Carestream Health's software team in Shanghai, China

A few things became immediately clear during our observations:

  • Department Physical Layout Enables High Throughput – These high-volume radiology departments see more than 200 patients per day.  Often a typical department in the U.S. has a layout more like a labyrinth that requires the tech to greet the patient at a waiting room and escort them to the exam room. The outpatient imaging facilities in Shanghai and Hong Kong were designed to enable patient self-queuing and self-escort into the exam room. Technologists remain in the exam room and patients bring themselves to room as soon as the previous patient is finished. At one facility patients needing to change into an exam gown did so before entering the exam room. This difference in layout and patient responsibility allows the radiology department to see more patients each day, often in less time.
  • More Resources and Division of Labor – In the U.S. it’s not uncommon to have 1 technologist perform all steps of a patient exam. In the outpatient facilities we observed, there was a minimum of two rad techs and sometimes as many as four—each with their own responsibility for a specific procedure of the exam. For instance, one technologist positioned the patient while another previewed the previous image and set up the system to capture the next image.  In one hospital, two additional technologists formatted the previous patient’s images and closed out that previous patient’s exam, in essence working two patients in parallel. Performing all these duties simultaneously significantly sped exams. China’s investment in recruiting and training radiology professionals gave these hospitals the staff they need to operate more efficiently.
  • Fractions of a Second Count – The head technologist at one of the hospitals said it best when she shared her team mantra: trimming even fractions of a second off an exam can boost the department’s productivity. We saw this come to life in many ways from a tiled color circle in front of a wall stand that helped patients understand where they needed to be without additional tech instruction to the decision not to wait for a preview before repositioning a patient for the next image (because most of the time a retake won’t be necessary). In some cases these fractions of a second saved allowed exams with 3 views to be completed in as little as 2.5 minutes.

Like Norm, our visit made it clear that there are so many lessons other countries take from China’s healthcare reform successes and struggles.

Mike Venturino, PhD, is Lead Human Factors Engineer, Design and Usability, at Carestream Health.

Bill Veto Fuels Breast Density Discussion

Anne Richards, Carestream Health

Anne Richards, Clinical Development Manager, Women’s Healthcare

California Governor Jerry Brown recently vetoed bill SB 791 that would have mandated medical providers to notify women if they have dense breast tissue.  Brown stated he was not comfortable with language in the proposal that required women be told they might benefit from more screening.  This legislative move has fueled more discussion about density as an independent risk factor, the challenge dense tissue poses to radiologists interpreting images and patient right to more information about their breast health.

Breast density is an important topic, but this discussion is far from a new one. In fact, the Connecticut General Assembly passed their act in 2009 and several other sates have similar legislation pending.

This past summer at the Society of Breast Imaging (SBI) Postgraduate Course, I sat down with Gerald Kolb, Mātakina International’s VP of Business Development, who shared his thoughts on personalized screening and volumetric breast density assessments:

How is your imaging department or center educating and informing patients about breast density? 

Quo vadis PACS?

Meike Lerner

Meike Lerner, Managing Editor, European Hospital Magazine

Editors Note: We asked Meike Lerner, managing editor of European Hospital Magazine,  for her thoughts on the hot topics she expects at RSNA 2011.

Quo vadis PACS?

It was the central issue at the Annual Scientific Meeting Management in Radiology (MIR) of the European Society of Radiology that took place in Nice, France: What will become of PACS?

Will the increasingly patient-oriented allocation and archiving of all data lead to the point where the picture archiving and communication system is entirely integrated into the HIS?

Or will it – quite to the contrary – gain in importance beyond radiology since it allows patient-centered management of image and video data and will thus become the interface to data management?

The participants of the meeting in Nice did not offer a definite answer.

Will the US-American sister organisation—RSNA— zero in on this issue at this year‘s annual congress?

Highland Hospital’s Breast Imaging Center Event Stresses Importance of Mammography

Jennifer Dodd, Carestream Health

Jennifer Dodd, Marketing Analyst, Carestream Health

Hospitals across the country are hosting events this month to raise awareness about the importance of early detection of breast cancer.  Last week I had the opportunity to attend the 18th annual breast cancer education event hosted by Highland Hospital’s Breast Imaging Center here in Rochester.  This event supports the Imaging Center’s mission of providing comprehensive breast care to the community while also reinforcing that annual mammograms remain the best way to fight breast cancer.

Despite the effort to raise awareness for the importance of annual breast screening, Avice O’Connell, M.D., Director of the Highland Breast Imaging Center, shared that 1 in 3 women still don’t get a regular mammogram.  She identified the three most common reasons for this decision, which physicians need to proactively address with their patients:

  1. I’m too young:  18% of breast cancer cases are in women under the age of 50, so it continues to be best practice to advocate for annual mammograms beginning at age 40.
  2. I don’t have a family history of cancer:  75% of women diagnosed with breast cancer are the first person in their family to have cancer.
  3. I don’t have enough time:  Annual mammograms are a commitment to yourself and your loved ones.  The amount of time it takes to be screened is minimal compared to the time lost if breast cancer is diagnosed too late.

O’Connell challenged event attendees to share what we learned to support breast screening.  For physicians this means educating patients about the importance of mammograms.

Like many hospitals across the country, the Highland Breast Imaging Center has been offering free mammograms for the past seven years during Breast Cancer Awareness Month and has served close to a thousand women who may not have been screened otherwise.

This year Highland is also one of more than 130 hospitals participating in this year’s Pink Glove Dance Competition.  Staff and physicians from each hospital submitted a video, and the facility receiving the most votes will receive a donation in their name to the breast cancer charity of their choice.  I placed my vote to support this hospital’s mission!  Check out their fun video below or vote at the link above.


How are you educating patients about the importance of regular breast screening? 

How We Lowered Pediatric X-Ray Exam Dose By One Third

Editors Note: We asked Kathy Hood, Director, and Cathy Atkins and Judy Wilson, Managers of Diagnostic Radiology, at AnMed Health in Anderson, S.C. to share an inside look at how they have lowered pediatric dose.  

Everything about AnMed Health Kids’ Care is tailored to children—from the alphabet puzzle at the check-in desk to the board-certified pediatricians and the x-ray imaging systems. Our urgent care facility is open Monday to Friday from 10 a.m. to 9 p.m. and from noon to 7 p.m. Saturday and Sunday. We treat babies, children and adolescents with a variety of conditions—from flu and asthma attacks to sports injuries, cuts and burns.

AnMed Health Kids' Care Center

AnMed Health Kids' Care Center

We see 5,000 patients a month and conduct an average of 2,000 imaging exams a month. Almost all of those exams are performed with CARESTREAM DRX-1 Systems that recently replaced a CR system used with existing analog radiography equipment.

Converting from CR to DR has resulted in a tremendous advantage for our patients, physicians and staff. Because children are more radiosensitive to radiation and doses are cumulative over a lifetime, our primary goal was to reduce exposure dose wherever possible and the implementation of the DRX systems has allowed us to do that. Since implementing wireless, cassette-size DRX-1 technology in the general x-ray rooms, we have lowered exposures by 30-50%. After conducting tests on phantoms, the equipment was calibrated and our staff set up reduced techniques and reprogrammed the x-ray systems.

The ability to capture, view and transmit images directly to our PACS without the extra processing step required with CR has been a big productivity improvement.  Wait times for the pediatrician and patients have been reduced and diagnosis and treatment can begin immediately. This is especially important when our patients are very ill or in pain.

The Kids’ Care Center is in the same building as AnMed Health Women’s and Children’s Hospital and many of the pediatricians’ offices. The building houses four general radiology rooms, all equipped with DRX-1 detectors that allow us to offer excellent care for our pediatric patients and keep their parents and families from congested emergency rooms.

Radiology Image Challenge – What is it?

This was a fantastic month of guesses for our Image Challenge.  The back to school bag proved to be tricky!  So…what were the 11 items?

  1. Pen
  2. Hole punch
  3. Battery-powered pencil sharpener  (This was the tough one!)
  4. Stapler
  5. Calculator
  6. Glasses in a case
  7. Lifesavers  (This is the one people didn’t see!)
  8. Correction fluid
  9. Tape dispenser
  10. Mechanical pencils
  11. Hair pins

Because this month’s image was so tough, we’ll randomly select one of the participants to receive a mug.  Check your email, everyone!

Here is the next image:

This month’s challenge runs until November 7.  The first person to correctly identify the subject of the x-ray will be the winner.

Happy guessing!

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