Forensic Imaging Offers Technologists A Unique Career Path

Beth Schrack,

Editor’s Note: Last month,  our post exploring  Forensic Imaging received lots of interest.  Beth Schrack, a technologist with a passion for advancing the field, answers reader questions about opportunities in the growing industry. 

Q. How did you get interested in forensics?

In 2004, I had the opportunity to see my first virtual autopsy, led by Dr. Brian Hoey, who had been conducting them since 2001 using CT and MRI. I became very interested in it, but quickly found that there was no one else doing these studies except for Professor Thali’s group, Virtopsy, which was located in Bern, Switzerland. I made it a goal to attend one of his courses, which I did in 2010.  Although I was the only American,  I had the chance to speak with Professor Thali and his group about how to form a similar program in the US.  Their advice: prove that virtual autopsy is a valid study that can assist or replace the traditional autopsy.

Here in America, we watch television shows and read books all about forensic studies presented in the courtroom. Yet, presently, we are still behind the rest of the world in developing this field. European countries, as well as Japan and Australia, are using post-mortem imaging in a majority of their studies. I believe that medical examiner’s offices in America also need to use imaging equipment in their autopsy suites.

Beth Schrack participating in a Death Scene Investigation and Identification Course.

Q. Why does forensic imaging deserve more attention?

With a challenging job market, I want to open the door to other opportunities for people to step outside the hospitals and become a part of something amazing – to be a part of a forensic team. There are other career avenues for technologists than just scanning. More importantly, though, is that there are over 11,000 unidentified men, women and children who are in boxes or pauper’s graves, while families grieve their absence and hope for their eventual return. I want to use 3D and PM studies to help identify these individuals and send them home to give families the closure they deserve. There are too many questions left unanswered.

Q. With new technologies emerging every day, what do you think the future has in store for Forensic Imaging?

As digital radiography continues to grow, it will obviously have an impact on forensic imaging. I also see portable units being deployed in the field, actually on site of mass disasters, crime scenes and even archeological digs. There is no limit to how useful forensic imaging can be.

In addition to new technologies, I think the future also holds a more connected community for professionals in this field.


Imaging IT Strategies Q&A Highlights CMIO / CIO Priorities

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Last week, we sponsored a dynamic presentation and Q&A with three healthcare and radiology thought leaders: Kristina Kermanshahche, Chief Architect of Health for Intel Corporation, Maureen Gaffney, RN, the CMIO at Winthrop University Hospital in Mineola, New York, and Dr. Eliot Siegel, Professor and Vice Chair University of Maryland School of Medicine Department of Diagnostic Radiology and Nuclear Medicine, and Chief of Imaging at VA Maryland Healthcare System in Baltimore.

Moderated by Mary Tierney, VP, Chief Content Officer, of Clinnical Innovation & Technology Magazine, the Webinar offered best practices and insight for new approaches to medical imaging operational design that address both healthcare reform and the proliferation of big data.

But it was the the Q&A that particularly struck me. Webinar attendees had the chance to submit questions for the panelists and for the next 30 minutes the dialogue addressed what’s on the mind of CXOs and radiologists as they navigate this new world.

Here are the top 10 questions from attendees:

  1. Can the cloud help you achieve stage 2 meaningful use measures?
  2. How will you address patient engagement?
  3. What makes cloud a less expensive approach operationally? Do the cost savings apply to facilities of all sizes?
  4. Is it possible to use the cloud to share images across institutions?
  5. Are there any benefits to the cloud in mobile device deployment?
  6. What are the challenges of managing “bring your own device” in the healthcare environment?
  7. What vision do you have for closed loop communication among clinicians? For example in lesion tracking?
  8. How will radiology workflow evolve to be more patient-centric?
  9. What are the benefits of giving radiologists access to more raw data?
  10. What impact will social media have on the future of image sharing?

What followed was a thoughtful discussion on how facilities are storing and receiving images at both the hospital and HIE; how patient portals are just one piece of patient engagement; how the cloud can improve performance and access outside the enterprise,  and how making information more accessible across the care continuum is central to improving patient outcomes.

For a pulse on what’s working TODAY and how imaging IT will evolve over time, you can watch the Webinar On Demand at Clinical Innovation & Technology.

iHT2 New York: Balancing Cutting-Edge Informatics and Patient Care

Julia Weidman, Marketing Manager, Women’s Health & Healthcare Information Solutions, Carestream

Over 280 senior healthcare IT executives, thought leaders and vendors convened at the New York Academy of Medicine yesterday to exchange information and opinion on the technology forces of change that will drive improvements in healthcare delivery.

Meaningful Use, cloud security, HIEs and improved patient care were just a selection of the topics from the first day at the Institute for Health Technology Transformation (iHT2) New York Health IT Summit. But quickly one overriding theme emerged – maintaining the critical balance between patient care and cutting-edge informatics.

At the Meaningful Use panel, discussion centered as much on the patient experience as on data collection and analysis.  For patients, MU will succeed if there is an increase in their engagement with their own healthcare data through tools like patient portals. For providers, they must have both confidence in the data and the ability to modify workflow so that collecting patient data becomes an activity that engages the patient.

Dr. John Lumpkin’s keynote centered on the power of technology to ignite monumental change, far beyond what we’re seeing today.  He stressed that the electronic health record is not the end point.  Rather it’s the foundation that will enable the liberation of patient data from the constraints of the system that generated it, so that data can be used for predictive modeling to identify potential problems and develop solutions before there’s a health crisis.

During the cloud computing panel discussion, the importance of data security, business continuity and seamless user experience generated a spirited back-and-forth between attendees.  One thing the panel agreed on was the key to cloud success is in the planning with clinicians, vendors and IT stakeholders working together to develop “out of the box” answers that break down old ways of thinking and bring about a new vision for patient care coordination.

A session on workflow tips for clinicians emphasized that simple improvements in IT processes can win the commitment of clinicians – an easier logon process, better system stability, reliability and speed and the minimization of downtime. A happier clinician is more engaged in the technology, and supportive of its success and impact on patient care.

There’s still a lot of work to be done to prepare, implement and deliver the technologies that will revolutionize healthcare in the US.  Judging from the enthusiasm evident at iHT2 in New York, these healthcare professionals and IT industry leaders are up to the challenge.

Visit the Institute for Health Technology Transformation blog for more event information.

Stage 2 and the Shift to a Patient-Centric Radiology Workflow

Doug Rufer

Doug Rufer, North American Business Manager, RIS, Healthcare Information Solutions, Carestream

The final measures of stage 2 meaningful use start the 2nd chapter in changing the way all specialties will practice medicine.  For radiology, incorporation of patient images into the patient’s clinical record as a specific measure opened the door for future legislation that will take into account other specialty needs as future stages are rolled out.

The goal of meaningful use has always been to provide both clinical and technological avenues to share patient medical information without boundaries to those who require it to improve quality of care and reduce overall costs.  By adding medical images to the mix, the door has been opened for improved access to patient images, thereby reducing repeat exams; and from the patient perspective, decreasing overall patient exposure to radiation.  However, these changes are sure to propose challenges for radiology going forward.  Radiology is typically practiced as a departmental approach, not a patient centric approach.  Additionally, radiology has been the gatekeeper of the medical imaging record, not the EHR; and to date, there are no standard-based image archives and viewing platforms that allow any EHR access to patient images regardless of vendor or location; and this is where the opportunity for medical imaging vendors begins.

Providing measures to incorporate medical images into the EHR sets the stage for better image access, but one major hurdle still exists: how does one access the thousands of imaging silos of information?  Additionally, how do we create a standards-based, not simply vendor-neutral, open access image archive accessible by those who need it the most – the patient and their primary caregiver?

Meaningful Use will forever change radiology’s workflow. The new path keeps the patient at the center of care. This paradigm shift will prompt new technologies and new methods for practicing radiology as the future unfolds.

Consider the following:

  • Radiologists must focus more on the overall clinical condition of the patient when making an exam diagnosis, rather than the short patient history taken at the time of exam.  This change emphasizes overall patient outcomes, not just imaging outcomes.
  • Access to the complete patient record and forthcoming decision support rules will aid radiologists in taking a more holistic approach to image diagnosis.  While this will take more time in exam interpretation, overall patient outcomes can improve significantly.
  • Barriers to image access that exist today must be overcome to allow easier access across any platform for viewing.
  • New mobile technology must be developed to provide anytime/anywhere access to the patient record and images, further reducing the barrier to information.  This will further virtualize the medical industry.
  • Technologists must now focus on capturing better patient histories using a structured data approach during the exam to help radiologists better collaborate with the overall patient record and produce better reports that provide better data mining capabilities.

Although we’re still in the infancy of rolling out a more patient centric model of care that encompasses all medical specialties, radiology must begin to adapt today to prepare for the changes of tomorrow.  No longer can a radiology practice afford to focus on the inherent imaging needs of the patient, but rather the overall goal of improved patient outcomes needs to take front and center stage going forward.  The advent of new technology must take place for our reformed healthcare model to succeed. As you consider technology purchases today, make sure your vendor is devoted to developing the tools necessary for the future.

Webinar: IT Strategies for Imaging Growth & Quality Outcomes

Mary Tierney

Mary Tierney, VP, Chief Content Officer, TriMed Media Group

Earlier this month CMIO Magazine unveiled a new name, Clinical Innovation + Technology, and website, Our new focus mirrors healthcare’s technology-fueled transformation where C-suite executives are tasked with blending clinical and technological innovations to deploy new care processes and practices, evidence-based medicine and decision support, and enhancing communication and information access  across the care continuum through interoperability of clinical devices and IT systems.

Next week in a free Webinar, sponsored by Carestream, we’ll be looking at how this new environment – spurred by the convergence of reform and big data – is impacting the CXO’s approach to operational design in medical imaging.

You’ll hear from:

Kristina Kermanshahche, Chief Architect of Health for Intel Corporation

Maureen Gaffney, RN, the CMIO at Winthrop University Hospital in Mineola, New York


Dr. Eliot Siegel, Professor and Vice Chair University of Maryland School of Medicine Department of Diagnostic Radiology and Nuclear Medicine, and Chief of Imaging at VA Maryland Healthcare System in Baltimore.

Our panelists will detail how CXOs can collaborate with radiology and IT on intelligent IT strategies that do far more than improve department or hospital productivity and efficiency. These strategies must also facilitate image exchange, mobile access and patient empowerment, while unlocking new financial models for growth and scale and supporting imaging’s inclusion in health reforms like meaningful use Stage 2 and the position within the broader picture of health IT.

Please join us and participate in our live Q&A on September 18 at 2 p.m. EST.  Register for the event today!

UZ Brussel Hospital Goes Fully Digital with DRX

Wim Op de Beeck, Major Accounts Manager, Carestream Belgium

A complete change in imaging strategy for a teaching and research hospital with nearly 800 beds and 200,000 radiology patients a year is no small feat.

For the Universitair Ziekenhuis Brussel (UZ Brussel) Hospital,  its digital transition began a decade ago with the addition of a CARESTREAM PACS. Next came the conversion of existing Siemens and Philips mobile units with CARESTREAM DRX-Mobile Retrofit Kits. And soon the hospital’s final digital piece will be place as part of construction of a new Emergency Department—two DRX-1 Systems becoming mobile x-ray rooms, going wherever imaging is required.

Digital has dramatically changed technologist productivity and patient care. Radiographers previously took 25-30 phosphor plates with them on intensive care round for chest x-rays. Now they take 1 wireless DR detector and doctors can see the results immediately at the bedside to speed treatment.

The flat panel detector with higher DQE allows clinicians to take images at a lower dose than with phosphor plates and helps guide procedures like positioning of catheters, inter-aortic balloon pumps and line control.

Hear first hand from the staff at UZ Brussel about their digital radiography conversion:

UZ Brussel anticipates their capacity will double with the DRX-1 Systems – treating an estimated 300 to 400 patients – per day when the Emergency Room is complete.

If you’re thinking of making the conversion to digital – here are three takeaways from UZ Brussel’s experience:

  1. You don’t have to go digital all at once – select compatible, scalable components that can meet today’s needs and grow with you.
  1. Protect your investment – retrofit kits can allow you to convert your existing equipment in lieu of a complete replacement.
  1. Find a technology partner you can trust – look for a vendor partner who understands your challenges and has a vision to meet your evolving needs.

Has your rad department gone digital? What advice do you have for a department about the make the transition? 

Name That X-Ray – September’s Radiology Image Challenge

Congratulations to those who correctly identified last month’s image — a coconut — one of our favorite flavors of summer.

We think we have one that will really stump you this time.  Step right up radiologists, technologists, administrators, MDs and PAs.  You can place your guess in the comments.

x-rayThe “Guess the X-Ray” challenge runs until October 2.  The first person to correctly identify the x-ray will be the winner.

Happy guessing!

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

Q&A: Service Agreement Assessment Vital to Cloud Services Success in Europe

Paolo Balboni

Dr. Paolo Balboni, Partner at ICT Legal Consulting & Scientific Director of the European Privacy Association

Editor’s Note: Earlier this year Dr. Paolo Balboni, Partner at ICT Legal Consulting & Scientific Director of the European Privacy Association participated in a Carestream panel discussion, “Clouds in Healthcare: The Evolution of Species.” Dr. Balboni graciously agreed to participate in an additional Q&A for Everything Rad focused on the assessment of cloud services contracts and its importance in the adoption and growth of cloud services in Europe. 

Q: Europe’s regulatory system is being substantially reformed. What makes this healthcare regulatory environment so unique from the rest of the world?
It’s complexity. A legal framework has not been consistent throughout the European Member States.  Healthcare is a domain which largely remains under the competence of the Member States. Before the enactment of the Treaty of Lisbon (1 December 2009), the European Union only had a supporting, coordinating and complementary role in this domain (parallel complementary competence). It could use “soft law” instruments (e.g., recommendations) to coordinate and promote specific actions, yet harmonization measures were explicitly excluded. The Treaty of Lisbon should open a new phase of EU harmonization in this sector, by clarifying and expanding EU competences in the sphere of public health.

Q: What security and compliance assessments do you recommend administrations or healthcare providers begin their cloud service decision making process with?

My experience is that Public Administrations (PAs), and especially healthcare providers are very careful to move critical applications (e.g., Electronic Heath Records, online scheduling of reservation of health examination, provision to the patients of the related examination records online) to the cloud. The forthcoming European Cloud Strategy and European Cloud Partnership may help.

Prior to a cloud migration, the healthcare provider (public or private) should carefully verify the data privacy and data security policy of the Cloud Service Providers (CSP) and choose the one that offers better level of data protection. Healthcare providers should also regularly monitor data protection compliance of the selected CSP and look into limitations and exclusions of liability clauses. CSPs that do not provide transparency and have unreasonable limitations or exclusions of liability clauses in their conditions of service should be avoided. More generally, healthcare providers and PAs should focus on the cloud service agreement. There, clear duties and obligations for the parties needs to be laid down. The Article 29 Working Party recently published an opinion addressing appropriate contractual safeguards. It stated that “security, transparency and legal certainty for clients should be key drivers behind the offer of cloud computing services”. I could not agree more. And healthcare providers and PAs can achieve such objectives by accurately negotiating the right controls on the CSPs and relevant warranties.

Q:  What regulatory, security and resilience progress needs to be made for future adoption of the cloud in Europe?
As lawyer I can provide you with a response from the regulatory perspective, where I think that no specific regulation for cloud is needed. Instead, clear guidelines are needed on how to apply existing rules to cloud computing services. There has been a lot of discussion and concern about a generally unclear (inadequate) legal framework for cloud computing. I do not expect the European Cloud Strategy to solve all the interpretative issues. To see the results of the European Cloud Partnership we will have to wait quite some time. As I already stated, my opinion is that healthcare providers and PAs should focus on the cloud service agreement and look there for security, transparency and legal certainty.

For more information on security and resilience I recommend the  conclusions of these two ENISA studies: ‘Security and Resilience in Governmental Clouds’ and ‘Procure Secure: A guide to monitoring of security service levels in cloud contracts’; in which I developed the legal part and the security and resilience guidance was drafted by a group of very valued experts.

Dr. Paolo Balboni can be reached via email at: