New Dashboards Designed to Streamline Workflow Can Also Expedite Meaningful Use Reporting

Rick Sera

Rick Sera, PACS/RIS Administrator, Valley Presbyterian Hospital, Van Nuys, Calif.

One of the biggest changes for PACS administrators is the amount of reporting that’s now required to meet meaningful use initiatives. In the past, most administrators generated individual reports from each system—including RIS, PACS and EHR/EMR—to monitor data on patient exams, equipment and personnel utilization, delivery times/methods for radiology reports and other service parameters.

Meaningful use regulations demand collecting and reporting data on specific areas related to the quality and timeliness of service delivery. This creates a burden for PACS administrators because required data is typically collected by different systems and is not always easy to access, since current reporting systems were designed long before meaningful use initiatives were even on the horizon.Vue Beyond

I spend hours each month compiling data to generate required reports, but fortunately help is on the way. New radiology dashboards not only offer a real-time view of how the department is functioning (and bottlenecks that need attention) but some also have comprehensive reporting capabilities. These systems allow users to design reports and then collect desired information from multiple systems and build the report to order.

This next generation dashboard could quickly become a PACS administrator’s best friend. It can collect and track required data, present  create accurate presentations of real-time workflow, and save dozens of hours spent on tedious reporting tasks every month.

From my perspective, this new technology couldn’t have come at a better time.

Editor’s Note: Do you already have a method that collects and automates meaningful use reports? Are you in the market for a more efficient way to generate reports? Come talk to us at  AHRA 2012 about real-time business intelligence and departmental reporting.  

Myth Buster: “Dose Increases with CR & DR System Grid Alignment”

David H. Foos, Clinical Applications Research, Carestream

In recent conversations with clinical colleagues, the comment was made that “our sickest patients get the worst imaging.” On further investigation I found that in portable chest imaging, anti-scatter grids are infrequently used, despite their ability to improve image quality. To understand this situation better, a team from Carestream Health and Mount Sinai Hospital collaborated on a line of research that became the subject of a joint scientific poster at the recent United Kingdom Radiological Congress (UKRC) 2012. The poster, “The Bucky stops here: redefining the Bucky factor for digital portable chest radiography,” summarized what our investigation found: quality of digital portable chest radiographs can be improved for a large fraction of intensive care (ICU) patients by using a grid, and without increasing patient dose.

To set the context, our research team has been systematically optimizing exposure and image processing techniques for CR and DR systems, with the objective of recommending optimal techniques for different exam types that deliver diagnostic quality imagery at the lowest possible dose to the patient. With this goal in mind, we wanted to understand whether grids could be used more generally for ICU chest imaging with digital radiography systems.

Through discussions with practitioners at a variety of hospitals, we found that there is ostensibly a general acceptance that portable chest radiographs will simply have lower quality. In addition, there are workflow complexities when using grids for portable chest imaging, perhaps with the key issue being the difficulty of grid alignment. We also found that from the perspective of dose, the Bucky factor, defined as the reciprocal of the total attenuation of X-rays by the grid, seemingly continues to be the general basis for making upward technique adjustments when using grids with digital systems. These technique adjustments can be as large as X2 to X5, depending on grid characteristics and patient thicknesses. We suspected that these patient dose increases might be unwarranted when using a digital system.

Because the technique increase associated with the Bucky factor is a consequence of a screen-film imaging paradigm, we decided to take a closer look at its relevance for digital systems. Historically, when a grid was used in combination with a screen film-system, the sensitometric response of film required an increase in technique corresponding to the total X-ray attenuation from the grid, in order to produce a film having diagnostic quality density and contrast. This requirement doesn’t exist to the same degree for digital systems, where image brightness and contrast are determined by image processing, and where image quality is limited by signal to noise ratio (SNR). Interestingly, it can be shown that because grids preferentially transmit primary versus scattered radiation, using a grid with a digital system actually has the potential to improve SNR in certain situations.

To determine the relevance of the Bucky factor in digital imaging, we explored image quality differences between digital portable chest X-ray images that were captured of ICU patients with and without a grid. The images captured with the grid were acquired using the same standard exposure techniques as were used for the corresponding images captured without the grid. We used two different approaches to quantify the image quality differences between the grid and non-grid images.

We found that image quality was improved for 80% of patients when their images were captured with the grid without increasing the patient dose.

The chest images shown in the example below qualitatively demonstrate the image quality improvement obtained by use of a grid. It should be kept in mind that the appropriate acquisition techniques, when using digital systems, depends on many factors including the image quality performance of the detector, grid performance, the scattering characteristics of the patient, imaging geometry, image processing, and the degree to which grid alignment can be assured. Appropriate choice of the relevant “digital” Bucky factor is necessary to obtain the best quality diagnostic image at the lowest possible patient dose.

Grid Alignment

It was an honor to learn last week that our work received validation from The Institute of Physics and Engineering in Medicine, which awarded the poster its President’s Prize at UKRC 2012. We believe the results from this work, coupled with the newly available grid alignment feature with the Carestream DRX Revolution System, will help promote increased grid usage in digital portable chest X-ray imaging.  This should result in an associated improvement in portable chest X-ray image quality without requiring the traditional increase in patient dose.

Are you using an anti-scatter grid for portable chest radiography? Why not? 

Bedside Imaging at San Antonio’s University Hospital

Andy Mendoza

Andy Mendoza, Medical Sales, Carestream

Living in Helotes, Texas – a suburb of San Antonio – I, like many residents, have sense of pride about the hospitals in our area.  U.S. News & World Report’s ranking of “best hospitals” for 52 U.S. metropolitan areas, featured five San Antonio hospitals, placing University Hospital  at #1 and ranked nationally. We can feel good about the care available to us in this area.

On Friday, San Antonio’s local news station, KENS 5, took a look at new bedside imaging technology at University Hospital that is speeding the radiology process and allowing radiologists and physicians to make faster diagnosis. [ Click the Image Below to View]

Click to ViewI worked closely with the hospital on their decision to invest in this Carestream DRX-Revolution Mobile X-Ray System.  As KENS 5 reported, with 12 floors to tackle on rounds, 140 patient x-rays per day and more than 4,000 images a month, the hospital needed a portable unit that was easy to transport and could transmit images in seconds for real-time decisions.

It was nice to see medical imaging getting some mainstream attention. University Hospital’s director of radiology Rick Pena said it best: “When you have good image quality, you feel good about the diagnostics that you provide.”

As a member of the local community, I also hope stories like these make us feel good about the caliber of care available to us in San Antonio.

What role does bedside imaging play in your department’s approach to patient care? 

Attending AHRA 2012 in August? Schedule a DRX-Revolution test drive.

UKRC Reflection – Image Storage & Access Advancements

Becky McCall

Becky McCall, freelance medical journalist, London, UK

As a relative newcomer to radiology, I was impressed by the range of advanced imaging technologies showcased at the recent UKRC meeting in Manchester. But in practical terms, it could be argued that the images are only as good as a system’s ability to store them and make them readily available to clinicians (and even patients) when and where needed.

I can only comment that from a journalist’s perspective, but my productivity is tightly associated with my access to information wherever I am in the world – so much so that my lap top is the first thing packed in my suitcase. Forget the toothbrush- just not my indispensable means of accessing the Internet.

And that’s just journalism. It begs the question of how clinical medicine with consequences for patient lives has managed with paper and film until so recently? Perhaps the answer is simply that they haven’t, and rather that they have struggled, and that cloud technology could not come quick enough.

It’s timely for other reasons, too. Accessing images and patient reports over the Internet goes hand in hand with the explosion in data volumes. As testament to this unprecedented growth in the need to document patient data, a recent analysis by researchers Frost & Sullivan estimates the European patient data storage market will reach $2,473.0 million in 2017.

Quoted in the analysis press release, Frost & Sullivan Research Analyst Somsainathan says, “as the resolution of images becomes higher, data volumes swell, thereby increasing the need for advanced data storage. Data sharing is becoming a vital component in healthcare delivery to ensure uninterrupted and highly efficient treatment of patients, irrespective of their demographic location.”

From a clinical perspective, improved storage and access can only benefit patient care. No more lost images, speed of decision making because data is available across distant locations, and improved patient understanding of their disease are all upsides.

At UKRC I had the opportunity to speak with Patrick Koch, Carestream’s Worldwide Business Director for Vue Cloud Services, about patient empowerment in image sharing.  Patrick says the huge surge in gadgets like smartphones and iPads makes it easy for patients to enter the clinical knowledge framework. “A patient portal like Carestream’s MyVue* allows them to view medical images and reports wherever they can connect,” says Koch. “The general move towards more consumer-led healthcare is putting patients in the driving seat by providing them with the tools to manage their own healthcare data.”

You can read my full interview with Patrick on

What do you think? Is patient empowerment the next step in image sharing?

*MyVue is a works-in-progress

Q&A: Getting a Look at Imaging IT Strategies in Poland

Krzysztof Kęsek

Krzysztof Kęsek, Medical IT Project Consultant

Editor’s Note:  Earlier this summer Carestream hosted a summit  for journalists and industry consultants at Zakopane University Hospital set in the beautiful Tatras mountains of Poland. The two day workshop focused on new imaging technology strategies being deployed in today’s modern healthcare . Prof. zw. dr hab. med. Daniel Zarzycki, director of the hospital,  led key elements of the workshop including a look at hospital performance before and after the implementation of innovative radiography and health IT systems. Krzysztof Kęsek, a medical IT project consultant, attended the summit and shares his feedback on the experience below. 

Q: Krzysztof, please tell us about you, your history and your current role. 

My current areas of interest, both professional and private, are applying IT solutions for technical organization of highly-specialized medical imaging labs. It is also my scientific area of study. The subject of my current PhD thesis is the application of Business Intelligence solutions to optimize the work of a hospital’s medical imaging division (a combination of HIS, radiology software and CAD-like systems).

I’ve developed these interest over the course of my professional career. My Master thesis covered a model of an electronic patient record — which resulted in the Medical Information Systems Department Collegium Medicum Jagiellonian University employing me as an teaching assistant. My later experience includes 3 years in an IT company, and the creation of a complex Diagnostics Imaging Centre and outpatient clinic, where the IT vendor intends to develop its own systems for medical facilities and CAD tools (mainly for cardiology).

I am currently still working in the Zakład Medycznych Systemów Informacyjnych UJ CM (The Medical Information Systems Department, Jagiellonian University, Collegium Medicum), and am also a Tender Specialist for the University Hospital in Cracow (medical imaging equipment only) and a Project Manager for a medical complex being erected by a private investor (Hospital as well as Diagnostics and Therapy Centre with an outpatient clinic).

Q: What struck you most from the radiology workshop?

I can answer with full confidence that the first 6 hours spent in the company of the radiologist. The radiologist, who was in the Emergency Department processed radiographic images acquired by computer tomography and magnetic resonance, often using advanced tools and analyses, convinced me that the domain between informatics and medical equipment is what I want to devote my next few years to. I perceive this domain as one of the pillars of modern medicine.

 Q:  Did the workshop can your opinion on the role of radiology in the modern hospital? 

It would be untrue if I argued that the meeting changed my vision of a modern hospital of the future. It was more of an affirmation of the hospital model I have been maintaining for years. However, it should be noted that the complexity of Carestream solutions (basing them on the newest technologies of transmitting and storage of images) has calmed my fears that there are too few “leaders of change,”  able to deliver complex solutions which are adapted to Polish legislative requirements. Carestream products have all the features I expected them to have in this regard, but they are able to fulfill sophisticated expectations of the most important user group — the doctors. I am also happy about the very fact that such conferences are being organized, since medical circles are often unaware of the existence of products that could significantly reduce the time of medical procedures and cut costs of a modern medical imaging laboratory.

Ask Anne: Changing Mammography Techniques for Digital Technology

Anne Richards, Carestream

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

One of the most common questions I receive for my “Ask Anne” feature here on Everything Rad is, “How will I need to adapt my positioning techniques when I move from analog imaging to digital?”

This month, Brigitte Hurtienne, chief radiographer at the Mammography Reference Center at the University Clinic in Munster, Germany, offered to share her experience:

Art of positioning

Whether using an analog or digital mammography system, the art of positioning is very similar. But digital imaging has advantages: the dynamic range afforded by digital mammography (16,000:1) is far superior to analog imaging (100:1).

The optical densities (OD) displayed on film are limited to 100 shades of gray, not all of which can be displayed at any time because the OD of the film is limited and fixed, and is determined by the x-ray exposure technique.

In a digital image the dynamic range depends on the computer’s window/level attribute and the radiologist can

Brigitte Hurtienne

Brigitte Hurtienne, Chief Radiographer, Mammography Reference Center, University Clinic in Munster, Germany

manipulate a digital image through 16,000 shades of white-gray–black.

So, in the digital technique, we often can make more skin wrinkles visible. Skin wrinkles may produce pseudoarchitectural distortions or may obscure surrounding structures.

Good positioning, at least for the mediolateral oblique view without skin wrinkles, is, therefore, very important. If hand pressure is discontinued before sufficient compression is applied, it will result in a poor separation of tissue and a downward-sloping of the breast contour, sometimes creating a skinfold in the inframammary ridge. An inadequate positioning technique in this region using suitable picture processing algorithms can lead to a loss of information.

Careful hand work – smoothing out the breast with the entire palm of the hand forwards and upwards, support with the ball of the thumb during compression, and smoothing out the inframammary ridge – prevent a sagging of the breast to the caudal and a wrinkle-free presentation of this region. Insufficient picture processing can be avoided in most cases.


There are also some differences in the types of artifacts that are seen in analog vs. digital imaging. In the analog world, we differ between film and screen handling artifacts and positioning artifacts. These artifacts are more common and can occur by improper handling of films and screens. Improper handling of films and screens could be exposures from creases, dirty screens, dust, scratches or from the object table, grid and static artifacts.

Some artifacts may be seen on both analog and digital systems, such as patient related artifacts (e.g. motion artifacts) and hardware related artifacts (e.g. x-ray tube filter defects and antiscatter grid defects).

Especially in the digital world, there are artifacts due to software processing errors or digital detector deficiencies. Pixel artifacts such as dead pixels or groups of dead pixels and dead lines can be caused by an imperfect detector.

Dust in the compression paddle, a not properly adjusted exposure, and problems with the image processing to a high noise level are further sources of an improper result. Problems with the reconstruction at the workstation can be the result of an improper display or problem with the sending of the images to the workstation.

Have you adjusted your technique for digital? What advice do you have for other radiographers or mammographers? 

ACA: What Do They Really Think?

Sean P. Reilly

Sean P. Reilly, Publisher, Imaging Technology News and Diagnostic and Interventional Cardiology

Editor’s Note: This is a guest-post by Sean P. Reilly of Imaging Technology News and Diagnostic and Interventional Cardiology

It has been interesting to monitor news outlets and social media since the US Supreme Court ruled the Affordable Care Act was constitutional.

Extremists on both sides excluded, it appears many healthcare providers, associations and the like have made public statements in support of ACA’s promise of affordable healthcare access for all Americans

For the most part, responses have been swift but measured, “politically-correct-speak.”

Behind the scenes, however, there are many, very real concerns about the ACA and what its true cost is going to be.

How will ACA impact the economy, businesses and taxpayers?  Further, how will the ACA impact the US healthcare system, those who provide care and those who develop leading-edge technology?

Make no mistake about it; the real story has yet to be told.  Fasten your seat belts and stay tuned.

Guess the X-Ray – July’s Image Challenge

Congratulations to Erik Vermeire, the winner of June’s X-Ray Image Challenge! Erik was the first to correctly identify the subject of the image as dried figs. Tara Arrowsmith was a close second-place finish.

Can you identify all six items in this shopping bag?

July Image Challenge

You can place your guess in the comments. The “Guess the X-Ray” challenge runs until August 2.  The first person to correctly identify all six items the x-ray will be the winner.

Happy guessing!

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