Nearly Forty Years of Radiology Experience: Three Questions with Gary Allbutt

Gary Allbutt

Gary Allbutt, visiting relief radiographer in North Dandenong, Victoria, Australia

Editor’s note:  We sat down with Gary Allbutt, who is currently a visiting relief radiographer in Cath Labs, Angiography and General Radiography, in North Dandenong, Victoria, Australia.  We asked him a few questions to get his thoughts on changes in radiology over the past 40 years, observed from his vast experience across commercial and regulatory roles as well as administration, training and other specialties.

Q:  You’ve been involved in radiology for nearly forty years. What was radiology like when you embarked in this profession 38 years ago?

I entered Radiography in  1975 as a student in the Royal Melbourne Institute of Radiography (RMIT) three year course for  “External Studies Students,” who were employed outside of metropolitan hospitals across Australia.

From day one, students undertook an apprenticeship, working side by side with experienced Radiographers, absorbing the culture and work practices.  Logbooks listed required examinations and procedures to be observed and conducted with a progression through general radiography of extremities increasing in complexity to procedures such as Angiography, in the final year.

Modalities such as CT and Ultrasound had just started to appear. Early Angiography was undertaken by “Direct Stick” in Carotids and Trans–Lumbar Aortograms. The Seldinger Technique and selective catheterisation was just emerging overseas and major metropolitan departments here inAustralia.  Manual cassette changers and rapid serial film changers acquired sequential images of the contrast bolus’ passage through the vessels.

Looking back the introduction of new technologies and techniques has been dazzling and un-abated. Take radiographic support in theatre for a hip pinning — radiographs from two mobile machines and manual film processing! The advent of Mobile Image Intensifiers made the guidance of internal fixations more accurate and reduced the patient’s time under anaesthetic.

Compound that now with the advent of hybrid theatres with systems supporting neuro surgeons, as well as vascular, orthopaedic and others. This is just one phenomenal area of growth let alone Ultrasound, 3D and Cone Beam technologies. From my early days in 1975 these developments would have been almost inconceivable.

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Harnessing diagnostic imaging for preventative medicine

Greg Freiherr

Greg Freiherr, Medscape and Diagnostic Imaging Europe contributor, and consultant to the medical imaging industry.

Guest Post:  Greg Freiherr, a frequent contributor to Medscape and Diagnostic Imaging Europe, as well as a consultant to the medical imaging industry

The medical community goes through phases, usually sparked by a technological advance or change in sociopolitical thought.  The most recent, preventative medicine, evolved from the age-old idea that a stitch in time saves nine. This might be true…but conventional thinking is not going to make it so.

A case in point is the work of Dr. Robert Grant, a UCSF professor of medicine and researcher at Gladstone Institute of Virology and Immunology. Grant and colleagues proved more than a year ago that gay men who were HIV negative could substantially decrease their risk of contracting the AIDS virus by taking the antiretroviral drugs otherwise used for treatment. The same arguably might be accomplished by heterosexuals. The problem is money.

Antiretroviral drugs are not cheap. If their prophylactic use were applied widely at current drug prices, preventing HIV would be more expensive than treating its victims. Money aside, however, Grant’s research proved that prevention is possible. All it needs is a politico-economic catalyst. This got me thinking.

I was reminded of how great ideas start. From the light bulb to the airplane, early attempts have always produced less than practical results. Who of us would try to read beside a light bulb whose filament burned out in seconds or get on an airplane that crashes less than a minute after takeoff?   The point is that first attempts are just that – starting points from which the underlying idea is refined. In most of these, it’s the technology that advances.  But why not the politico-economics?

Medical imaging cannot play a substantial role in preventative medicine of the future, if applied conventionally.  By definition, medical imaging is diagnostic. And it’s expensive. Efforts are underway to refine the use of PET to use biomarkers of disease that may appear years before clinical symptoms.  But, like the antiretroviral drugs that prevent HIV infection, a new generation of PET agents will be deemed too expensive to use to screen for the earliest signs of disease.

If imaging is to be a tool in preventative medicine, more than just the underlying technology needs to develop. The imaging community has to think unconventionally to find cost effective ways to apply “diagnostic” technologies to prevent disease.  We must define the advantages that the visualization of these biomarkers provide over simple in vitro tests and then come up with a strategy for their use as part of an intelligent approach to reducing the overall cost of medicine.

This is by no means impossible. Diagnostic imaging has already played this role, dramatically reducing the cost of healthcare while increasing patient safety compared  to practices common only a few decades ago, when exploratory surgery was the go-to modality for resolving clinical unknowns. Succeeding at this next challenge could redefine medical imaging for generations to come.

Innovative Technology Makes Dose Reduction Affordable

Houston HealthcareEditor’s Note:  Houston Healthcare in Warner Robins, Ga.  recently installed six CARESTREAM DRX Systems to streamline image delivery. We asked Tim Sisco, Director of Cardiovascular and Imaging Services at Houston Healthcare, to talk about the impact converting from CR to DR systems has had on their dose reduction efforts. 

Our diagnostic imaging team at the 237-bed Houston Medical Center and Houston Healthcare outpatient imaging center knew that when we converted our CR systems to digital radiography with Carestream wireless DRX detectors we’d see a dramatic difference in how quickly we can provide access to images—an important asset for critically ill and injured patients.

But we didn’t anticipate the dose reduction would be equally dramatic: 40% for in-room and portable systems.

We converted two portable imaging systems serving ER and ICU patients and three general radiology rooms, along with the installation of a new automated DR suite in Houston Medical Center’s busiest exam room that handles ER patients.

As we implemented the new wireless detectors, our staff immediately recognized the potential for dose reduction. We recalibrated our X-ray systems to create an accurate automatic exposure control (AEC) for procedures that use the bucky. Our technologists have also reduced exposure techniques for tabletop and portable exams.

This dose reduction supports our efforts to comply with the Joint Commission’s Sentinel Event Alert on Radiation Risks of Diagnostic Imaging. Our radiology managers and technologists have been educated on how to discuss dose reduction with patients and when speaking with representatives from state, Joint Commission, FDA or other regulatory agencies involved in patient care.

Carestream DRX-1 SystemOur staff is pleased that we are able to enhance patient care by implementing technology that reduces dose.

What have you done to reduce patient dose?

Finding a PACS that Supports Mammography Modalities; It’s Not As Easy As You Think

Encompass Medical CenterEditor’s Note:  Encompass Medical Group recently installed a CARESTREAM Vue PACS to serve its eight locations in the greater Kansas City area.  Susan Stidham, Director of Ancillary Services at Encompass Medical Group shares her thoughts on PACS support for breast imaging modalities and how it impacted their PACS selection in the guest blog post below. 

Our medical group has six imaging centers (located within our 8 primary care physician offices)  and conducts 12,000 screening and diagnostic mammography exams a year—about one-fifth of our total workflow. When our staff evaluated suppliers for a new PACS, we were shocked to discover how hard it is to find a PACS that supports an efficient mammography workflow.

Some PACS do not support all breast imaging modalities. Demonstrations revealed that others could not display breast exams in full resolution or required five minutes or more to display each exam. The good news is that we found a PACS platform that delivers all the mammography reading capabilities we need:

  • Reading of all breast imaging modalities, including FFDM, CR, MR and general and vascular ultrasound
  • Rapid delivery of full-resolution images to ensure a streamlined reading workflow
  • Specialized mammography reading features and tools including a prelabeled keypad with the most commonly used commands (save, finish exam, mark as read, go to next workflow, turn CAD on/off, etc.) and a programmable mouse. These features facilitate fast, efficient reading for on-site and off-site radiologists.

Our new PACS–CARESTREAM Vue PACS–met our budget requirements and is flexible and scalable enough to serve us for many years. If your staff doesn’t initially find a PACS that meets CARESTREAM Vue PACSall your mammography  needs, keep looking. The PACS of your dreams is out there—you just have to find it.

Does your current PACS address your mammography workflow?

If you are replacing your PACS, have you had a difficult time finding a new PACS that streamlines mammography reading?

April X-Ray Image Challenge – What Is It?

Sam Friedman, M.D. is our March radiology image challenge winner. He correctly identified the x-ray as a CABBAGE. Thanks for all the great guesses!

Here’s the image for April’s challenge:

April Image Challenge



This month’s “Guess the X-ray” challenge runs until May 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.