Tube & Grid Alignment Necessary to Improve Portable Image Quality

Xiaohui Wang, Ph.D., Senior Research Associate
Clinical Applications Research, Carestream

Grid usage in portable radiography is often sporadic and inconsistent. This causes greater variability in image quality, and a greater number of radiographs of poorer quality than those captured in the radiology department being delivered for interpretation.

From the perspective of the radiographic technologist, using grids for portable exams involves a variety of time-consuming workflow implications:

  • Attaching and detaching the add-on grids to the X-ray detector.
  • The stringent requirements to properly position and align the X-ray source relative to the detector behind the patient to avoid grid cutoff.
  • The increased probability that repeated exposures will be required due to grid-cutoff artifact.

In addition, there is the misperception that grids are not required in digital radiography because increasing the exposure can overcome the scatter-noise level, and that image processing adjustments, such as window and level manipulations, can sufficiently compensate for the quality losses that are introduced by scattered radiation. With all of these considerations in mind, there would seem to be little motivation for the technologists to use grids in portable digital radiography.

However, anti-scatter grids improve radiography image quality, and the benefit of grid usage can be realized in digital radiography with less exposure technique increments.  These benefits can be achieved without disrupting technologist workflow with the Tube and Grid Alignment (TGA) System for the DRX-Revolution Mobile X-ray System. Our TGA provides easy and intuitive guidance for X-ray-source alignment relative to the grid-detector to achieve consistent and optimal image quality–no additional operational steps are required.

Staff members at Hamilton General Hospital have experienced how the optional Tube and Grid Alignment System for the CARESTREAM DRX-Revolution has impacted technologist efficiency and image quality:

DOWNLOAD our tube and grid whitepaper to learn more. 

From Departmental Silos to Streamlined Patient-Centric Workflow

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

A recent Auntminnie article spotlights the challenges of storing documents in PACS or RIS and encourages healthcare facilities to instead turn to vendor-neutral archiving (VNA).

As the world’s second largest supplier of vendor-neutral archiving (InMedica Report, April 2012), Carestream manages more than 2 petabytes of managed data and 80 million studies managed at 10 data centers.  We’ve seen interest in VNAs grow as they offer the ability to collect images and data from a variety of departmental systems to create a cohesive patient portfolio that contains imaging exams, lab and pathology data, video files, and JPEG images. A VNA can provide the patient’s clinical record via the Web or existing EHR/HIS virtually anytime, anywhere – no matter where images, documents and data originate or are stored.

radiology information lifecycleHowever, it’s important to note that healthcare providers will understandably favor data storage platforms that deliver information access without the need to migrate existing archives. Integrating or replacing legacy RIS/PACS or Archive systems can be costly. One option is to select a platform that synchronizes multi-vendor and multi-site RIS+PACS  to create a streamlined multi-site workflow to leverage your existing investment. Solutions like Vue Connect allow you to:

  • Synchronize patient data from multiple sites in real time, including metadata, with or without image data
  • Handle DICOM and non-DICOM images, regardless of vendor platform, age, location or network speed
  • Manage multiple patient IDs via MPI systems; accommodates IHE profile compliance such as XDS repository
  • Permit retention of autonomous, single-site reporting while allowing the  referring community to view all patient data, regardless of originating site
  • Automatically retrieve studies from their most accessible locations
  • Expand the system organically as new sites are added to your enterprise

Eliminating departmental silos of information is an urgent goal for healthcare providers worldwide. Meaningful use requirements and the desire to offer access to patient data through an EHR are both spurring the implementation of both vendor-neutral archives AND alternative platforms that can help deliver a cohesive, patient-centric view of medical data within your budget.

Schedule an appointment at RSNA 2012 to speak with our healthcare IT solutions architects about vendor-neutral archives and synchronizing multi-vendor and multi-site RIS+PACS.

National Institutes of Health Lesion Management Presentations at RSNA 12

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Precise lesion measurement is critical for reliable evaluation of metastatic disease and faster assessment of patient response to cancer treatment. This topic is heavily featured at RSNA next month, where National Institutes of Health (NIH) researchers are giving three RSNA presentations that involve use of Carestream’s new lesion management application:

  • “Comparison of Tumor Size Measurements in Simulated Metastatic Lesions on Serial CT in a Phantom”   (Tuesday, Nov. 27, 11:20-11:30 AM, Room S104A)
  • “Semi-Automatic Target Lesion Localization, Segmentation and RECIST Measurements on Serial CT Studies” (Tuesday, Nov. 27, 11:30-11:40 AM, Room S402AB)
  • “Optimizing Efficiency and Consistency of Metastatic Disease Treatment Evaluation Using CT Semi-Automated Lesion Analysis” (Tuesday, Nov. 27, 11:40-11:50 AM, Room S104A)

For radiologists and oncologists, simple quantitative comparisons of historical exams – especially those imported from disparate PACS or modalities – have been a challenge in a traditional PACS, causing many to turn to dedicated workstations.

Our new lesion management application, used by NIH in their research studies, is an embedded application in Vue PACS that enhances assessment of oncology patients by:

  • Providing lesion management as a native PACS clinical tool
  • Accepting prior exam results as baseline images from 3rd-party PACS and from numerous modalities
  • Helping boost  radiologist productivity by simplifying segmentation and analysis
  • Delivering volumetric data with PowerViewer to simplify the comparison process between different data sets
  • Supporting oncology follow up with bookmarking and tracking of general anatomy over time
  • Helping reduce the cost associated with dedicated Workstations

If you are at RSNA the NIH presentations shouldn’t be missed.

Unable to attend NIH’s lesion management presentations at RSNA?  You can see a quick video demonstration below that illustrates how the tool is designed to help to provide faster localization, measurements, and follow-up that could help minimize subjective variation and enhance consistency.

How would consistent, standardized oncology image reporting impact communication and collaboration between physicians at your facility? 

Six IT Principles to Encourage Online Patient Engagement

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Patient engagement measures have the potential to be one of the most transformative aspects of reform on the quality of care, but but we must recognize the challenge they pose to a provider’s IT strategy. The operational design of a patient engagement portal must provide enough value for patients to go online, and stay online.

In the lead up to Intel’s Healthcare Innovation Summit webcasts on October 23, I was invited to share with their community of healthcare IT professionals best practices for developing a patient engagement strategy or selecting a technology platform:

1. Offer access to full patient information.
2. Integrate core patient services
3. Deploy a simple and intuitive user interface that reduces need for support
4. Implement a device neutral solution that does not require installation or download
5. Include customizable sharing settings for administrators (critical results release) and patients (consent to access).
6. Carestream MyVueDistribute security protocols

You can read the full post here. These guiding principles serve as an important foundation as healthcare’s C-Suite balances compliance with Stage 2 meaningful use in the context of broader patient satisfaction goals.

What best practices are your facility grounding your patient engagement technology strategy in? What advice would you add to this list?

Schedule a demonstration of Carestream’s MyVue, a works-in-progress patient portal, at RSNA 2012. 

A Journées Françaises de Radiologie (JFR) Preview and Look at Healthcare in Europe

Ludovic d’Apréa, General Manager, Digital Medical Solutions, Europe, Carestream

Q: Ludovic, with the Journées Françaises de Radiologie (French Radiology Congress) (JFR) approaching, if you had a quick look back how would you sum up the last 12 months in the industry of medical imagery?

A: The European medical imaging market is gloomy, mainly because of a difficult economic environment, slow growth, very high debt, and high unemployment. Governments have taken measures to reduce the deficit linked to healthcare; in Italy the hospitals must reduce the cost of existing contracts by 5%, in France the PHARE project is encouraging purchase cuts of 5% over 3 years. Despite these restrictions, the European market remains one of the most important in the world. The States continue to invest heavily in caring for their ageing population.

Q: Next year will be a very challenging year, but according to you, what positive trends will take shape?

A: The European market is hugely diverse; the companies that shall progress will be those that manage to support their clients in their new practices, by improving their productivity and taking into account the current situation and investment capacities of healthcare establishments. At Carestream we are able to offer CR systems in Eastern countries, digital radiology  (DR) in Nordic countries, replacement PACS in the United Kingdom, and cloud computing archiving solutions for regional French projects…all at once.

Q: You are very involved in the development of digital technology at Carestream. What technologies today make a difference in a radiology department and what does the future hold?

A: The key word is support! It is necessary to offer innovative systems capable of increasing productivity while limiting investment. For example, providing the option of upgrading equipment at a department, institute or regional level; or solutions that enable  “mobility.” From this perspective we are offer the DRX-1 System which facilitates upgrade of existing radiology tables or mobiles and can be shared within a department with other DRX systems. Likewise our post-processing consoles allow one radiologist to manage examinations in all procedures from wherever he or she may be. By the same token our online image viewing solution Vue Motion may be added to an existing PACS and operates on tablets.

Q: To finish, a few words on the Journées Françaises de Radiologie starting very soon?

A: We are particularly pleased to be part of the 60th JFR Congress, which has become a key meeting place in the world of radiology for Europe, Africa, the Near and Middle East. We will be presenting almost our entire range of solutions and in particular the new MyVue application, which enables patients to view their radiology images on-line, thanks to a secure access portal as well as our new digital radiology mobile, the DRX-Revolution, which you can see for yourself by trying it out at the stand.

Carestream will present it’s latest innovations at the 60th Journées Françaises de Radiologie in Paris at Stand 1T06A French version of this post can be found below.


Ludovic, nous approchons du congrès des Journées Françaises de Radiologie, si on fait un rapide flash-back, comment résumeriez-vous les 12 derniers mois dans l’industrie de l’imagerie médicale ?

Globalement, le marché européen de l’imagerie médicale est morose, principalement à cause d’un environnement économique difficile, peu de croissance, une dette très élevée, un chômage fort…Les gouvernements ont pris des mesures pour diminuer le déficit lié à la santé ; en Italie les hôpitaux doivent diminuer le coût des contrats existants de 5%, en France le projet PHARE impose une diminution des achats de 5% sur 3 ans. Malgré ces restrictions, le marché européen reste un des plus important au monde. Les Etats continuent d’investir massivement pour soigner leur population vieillissante.

L’année prochaine sera sans contexte une année avec de nombreux challenges, mais, d’après vous, quelle sont les tendances positives qui se dessinent ?

Le marché européen se caractérisant par une grande diversité, les sociétés qui progresseront seront celles qui réussiront à accompagner leurs clients dans leurs nouveaux usages, en améliorant leur productivité, et en tenant compte de l’existant et des capacités d’investissement des établissements de santé. Chez Carestream nous pouvons proposer à la fois des systèmes CR et des reprographes dans les pays de l’Est, des salles de radiologie numériques ultra-automatisées (DR) dans les pays nordiques, le remplacement de PACS au Royaume-Uni, et des solutions d’archivage de type Cloud Computing pour les projets régionaux français…

Vous êtes très impliqué dans l’évolution de la technologie numérique chez Carestream. Quelles sont, aujourd’hui, les technologies qui font la différence dans un service de radiologie et quels sont les développements futurs ?

Le mot clé c’est l’accompagnement ! Il faut pouvoir proposer des systèmes innovants capables d’augmenter la productivité tout en limitant l’investissement ; par exemple des solutions permettant  d’upgrader le matériel en place, des solutions mutualisables à l’échelle d’un service, d’un établissement ou d’une région, et des solutions apportant de la « mobilité ». Dans cette optique, nous proposons au sein du portefeuille Carestream le capteur plan DRX-1 qui permet d’upgrader des tables ou des mobiles de radiologie existants et qui peut être partagé au sein d’un service avec d’autres systèmes de la gamme X-Factor. Aussi, nos consoles de post-traitement permettent à un seul Radiologue de gérer les examens de toutes les modalités, quel que soit l’endroit où il se trouve. De même notre solution de visualisation d’images en ligne Vue Motion peut être ajoutée à un PACS existant et fonctionne sur des smartphones et tablettes.

Pour finir, quelques mots sur les Journées Françaises de Radiologie qui commencent prochainement?

Nous sommes particulièrement heureux de participer au 60ème congrès des Journées Françaises de Radiologie, congrès  qui est devenu un des lieux de rencontres incontournable de la radiologie pour l’Europe, l’Afrique, le Proche et Moyen Orient. Nous présenterons la quasi-totalité de notre gamme de solutions et notamment la nouvelle application MyVue qui permet aux patients de voir leurs images de radiologie en ligne, grâce à un portail d’accès sécurisé, ainsi que notre nouveau mobile de radiologie numérique, le DRX-Revolution, dont vous pourrez juger des qualités exceptionnelles en l’essayant sur le stand.

ACR Panel: Physician, Patient Demand Driving Mobile Application Adoption

Jeff Fleming, Vice President of Healthcare IT Sales/Service, Carestream

Today I’m speaking on a panel about the clinical value of mobile imaging, moderated by Dr. David Hirschorn, at the American College of Radiology’s Imaging Informatics Summit.

As the medical industry embraces mobile applications, healthcare providers need a strategy that delivers access to radiology reports and images “on the go” to radiologists and referring physicians and extends image sharing to patients. This new workflow can expedite patient treatment decisions. Faster decisions—along with access by patients to their own records—can deliver higher satisfaction and greater loyalty to a healthcare provider.

Recently, Imaging Economics looked at provider interest in mobile technology and the diverse choices available from diagnostic imaging vendors.

Two key challenges driving technology selection are how providers can support a wide variety of mobile platforms and offer patient image sharing. With user flexibility in mind, Carestream developed a vendor-neutral platform that uses HTML5 to communicate with any operating system. Our Vue Motion universal image viewer has many built-in security features and has been FDA cleared for iPad use. This image viewer acts as the foundation to Carestream’s MyVue patient portal (Available February 2013) that empowers patients to access, manage and share their imaging results between facilities, physicians, specialists and other healthcare providers from a variety of Web-browser enabled devices, including the iPad. Access to data from an EMR is also an important component, so our viewer links to the EMR so users-both physicians and patients-don’t have to download multiple applications.

Other companies have developed dedicated mobile applications and some suppliers offer specific applications tailored for Windows, Macintosh, and iOS platforms.

Regardless of the platform, every mobile application in the medical industry should deliver secure, on demand access, simple user deployment, and control mechanisms that do not allow data to be stored on the device.

It’s easy to see the advantages of mobile access for physicians and patients. Fortunately delivering mobile access also offers advantages to healthcare providers. Costs are reduced by a more automated, streamlined workflow—and support for patient engagement is required to satisfy Stage 2 Meaningful Use requirements. Healthcare providers that support convenient mobile applications have a lot to gain.

Speeding Trauma Care with Digital Radiography

Editor’s Note: The following is a guest blog post by Gillian Tickall, Chief Radiographer at The Alfred. The Alfred is a major tertiary referral teaching hospital that provides the most comprehensive range of specialist medical and surgical services in Victoria, Australia. Tickall kindly shares how converting to digital radiography has helped to shave off 9 to 10 minutes when working on trauma patients.

A pacesetter in Australia’s national healthcare system, The Alfred Hospital in Melbourne sees 60 percent of the traumas in Victoria. For our radiology department, this equates to about 2,400 exams per year.  Like any public hospital, one of our key challenges is increasing patient throughput while also improving the patient experience and outcome. This challenge is no small feat as capital funding decreases, pushing the lifespan of our equipment from 10 to 15 years.

One way we’ve addressed this challenge and financial constraint has been to use CARESTREAM DRX detectors and mobile retrofit kits to bring our imaging technology in both the main department as well as the emergency department, into the realm of modern technology.  For example, we were able to convert a conventional x-ray room, to a fully functional DR x-ray room, capable of meeting the demands of inpatient, outpatient and emergency examinations in a way that is of benefit to our patients.

Carestream detectorIn addition to inpatients from the hospital’s burns and trauma units, the room also supports a large population of outpatients, used for multiple exam types, from elderly patients in traction with broken limbs who have to be lifted onto the table to follow-up multi-trauma traffic accident victims. In these cases, it’s particularly helpful to have a wireless detector that you don’t have to reposition between projections.  If the detector is positioned incorrectly, the image is accessible immediately and if anatomy is clipped, the radiographer can retake the image after slight repositioning of the detector, which is already behind the patient, thus less distress to the patient.

The benefits in intensive care are significant, through the use of Carestream’s tube and line visualization software, doctors, while by the bedside can see immediately if they have put a nasogastric tube down correctly or not. They can see the image on the monitor allowing them to make an immediate assessment and correction if required. This feature is fantastic. You don’t need another exposure, if you are not quite sure of where the nasogastric tube is going into the stomach you take a copy of the diagnostic image and then apply the software tool and it’s beautiful. The line shows up perfectly and that is a huge benefit. The ICU doctors think it’s fantastic.

Another benefit is when we go to a code blue in the ward, when the patient has just arrested and we are not sure what could have caused it, we do an x-ray. All the necessary doctors and staff are there and they can see the image straight away. They then have the ability to make a decision immediately while the patient is critical. For us to go all the way back to the department , process the image, put it on  the network and bring it back to the code blue team takes time the patient doesn’t have and can result in a negative clinical outcome.  We managed to shave off a good 9 to 10 minutes when working on trauma patients, which is an awful lot of time when you think about the standard golden hour with traumas.

The DRX detectors also allow us to share between the dedicated imaging rooms and ED. For the purpose of ED we have a room that has 2 wireless detectors, 1 for the vertical bucky and 1 for the table bucky, which can be taken out and used on the trauma trolleys For the odd time you need to do a mobile you can take one detector out of the room and the room will still function, the ability to maintain effective concurrent room and mobile workflows is terrific.

We also have 3 of the new cesium iodide [DRX-1C] detectors, which provide the same image quality with a lower dose as compared to detectors in the ED room and retrofit room in the main department. These are used on the mobile units for mostly in the intensive care unit and the wards. The actual exposure is minimal compared to what we used to use. We used to use the exposure settings of 85 KV on 5 or 6 MAS for a chest X-ray and [with the DRX-1C] we are using now 90 KV on 1.6 MAS. This represents a significant dose saving for the patients who may have to have 1, 2, 3 x-rays a day while they are in intensive care. Given, these images are absolutely necessary, all the more reason radiation dose exposures need to be as minimal as possible and monitored.

When it comes to evaluating the value of our conversion to DR, I look at it in terms of its ability to allow more time for my radiographers to spend with the patient, decreasing the pain effect on the patient and also having the ability to see the image instantaneously.  It does mean that we can get more patients through, while still achieving a better patient experience and better outcome.

Reading Digital Breast Tomosynthesis Exams From a Single Desktop

Anne Richards, Carestream

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

A recent article in the Wall Street Journal on 3-D mammography discussed the potential for digital breast tomosynthesis (DBT) to enhance the detection of cancers. I was reminded of how important it is to not only capture the best breast images possible, but also to have an efficient and effective system that helps radiologists make an accurate diagnosis.

As I revisited the accomplishments our team has achieved in designing a new module that displays DBT exams on our mammography workstation—while also displaying digital mammograms, breast ultrasound, breast MRI and general radiology exams from a single desktop—I was struck by how easy it is (or could have been) to add yet another dedicated workstation to the radiology reading environment and then falsely believe we have actually improved the diagnostic workflow.

We resisted that path. Our team has long demonstrated our commitment to supporting multiple digital breast imaging modalities on our mammography workstations, and we have fiercely resisted the temptation add new, single-use workstations that might seem alluring because of their “dedicated” nature—when in fact they add costs and create inefficiency. Supporting multiple breast imaging modalities—as well as general radiology exams—enables radiologists to deliver a faster diagnosis to referring physicians and can ultimately enhance patient care.

Our smartly designed tomosynthesis module streamlines workflow by allowing healthcare providers to store, route, display and query/retrieve DBT exams from DICOM-compliant acquisition devices, so radiologists have all the tools they need on one workstation. Comparison tools enable radiologists to use personalized hanging protocols for DBT exams along with other procedures, especially the 2D mammograms. In addition, specialized tools that further enhance productivity include: automatic positioning of DBT and mammograms that eliminates manual manipulations; automatic “same sizing” of DBT and mammograms that aid in comparing changes in anatomy; and concurrent magnifying glasses that provide close-up comparison of pathology across multiple views and procedures.

With our advanced sys­tem, radiologists can quickly and easily read exams from all modalities and vendors at a single workstation. And working smart is an important element in improving patient care.

How do you view or plan to view digital breast tomosynthesis? What do you think about 3D breast imaging?

For Mammography Tech Technology Has Changed Everything

Sherri Ford, RT(R)(M)(BD)

Editor’s Note: Sherri Ford is a Mammography Technologist at Premier Imaging in High Point, NC.  She has her A.A.S. degree in Radiological Technology and a B.S. in Health Administration.  She has over 19 years experience in the mammography field ranging from mammo-screenings, diagnostics, stereo biopsies and needle localizations.  She has worked as a PACS systems supervisor and has designed training programs for occupational nurses regarding osteoporosis and bone density testing.  Sherri is also a member of ACR, ASRT and HIMSS.

Q: You have a varied experience as a technologist from a PACs supervisor to mammography.  What are the major changes you have seen in the mammography workflow?

A: Technology changes everything. While technology is almost always eagerly awaited in mammography facilities, implementing new machinery often results in workflow growing pains. When digital mammography was introduced several years ago, facilities frequently floundered, causing workflow to slow down. The past five years has seen department workflow changes as processes were perfected, allowing more patients per hour. Many facilities have moved to a paperless system further speeding up workflow. As technologists, we have had to learn how to manage exam times, review images for technical quality in a new medium and not lose sight of the fact that our patients are individuals with feelings. Technology creates efficiency, confidence in the screening process and improved image quality but the equipment is costly. To offset the increased costs, schedules are packed tight and patients are streamlined from registration to exam result. Over the past several years, the most noticeable change in mammography workflow is undoubtedly the rapid pace. While increased volumes are a positive trend, indicating women are committed to the fight against breast cancer and health administrators are committed to providing the services, technologists must balance efficiency and compassion.

Q: Has the economic situation over the last few years impacted how you do mammography?

A:  Healthcare was one of the last industries to respond to the economic crisis and is one of the last industries to recover as economic conditions slowly improve. When unemployment peaked many lost their health insurance but not their need for healthcare. Health organizations were faced with the problem of meeting level or increased demand for services with severely diminished revenue streams. Mammography tends to be a loss leader for many health organizations to begin with and the downturn in the economy hit just on the heels of acquiring new digital equipment, further compounding financial challenges. Most mammography centers responded to the conditions by increasing volumes and reducing payroll hours to address cost control but savvy administrators marketed the services to attract new mammography patients and retain the existing ones. Programs became available to provide low or no cost mammograms with the expectation these patients would be a source of referrals, sending new patients to the organization for other health needs.

Q: Do women have specific requests for technology they have heard about and if so what are they asking for?

A:  Breast cancer screening relies most heavily on mammography primarily because the system has proven to be successful, accessible and cost efficient. However, mammography does not find all cancers and research continues to find new methods for screening and diagnosis. Periodically, patients will hear or read about new technologies and ask if they are available. Most of the time, patients will ask me about screening methods that do not require compression but rarely mention specific technologies. As healthcare becomes more transparent, however, this may change because the public will have greater access to information about diagnostic testing. Also, patient requests for new technology increase when it is introduced into the community.

Q:   Is your facility doing digital breast tomosynthesis?

A: With the recent FDA approval of Breast tomosynthesis, breast cancer screening has a remarkable new tool to aid in earlier detection, especially in women with dense tissue. Despite the success stories tomo has produced, it is not widely utilized in the US yet. Health insurance does not reimburse for tomo exams at this time, considering the technology investigational and many facilities cannot absorb the cost. Some facilities pass the cost on to the patient as an up charge to a mammogram, usually offering the patient the option of having the tomo and paying or declining the exam. I recently had the opportunity to observe several tomo exams and believe this technology will become the industry standard for screening. My facility is not currently offering tomo but is evaluating the technology. Breast tomo offers new possibilities in breast cancer screenings and should be embraced with excitement and anticipation.

Guess the X-Ray – October’s Image Challenge

Congratulations to those who correctly identified September’s image — a coral.

For those who were stumped – better luck this month!  Radiologists, technologists, administrators, MDs and PAs can all place guesses in the comments.

The “Guess the X-Ray” challenge runs until November 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.