New X-ray Technology for Improved Detection of Lung Diseases in the Developing World

Sam Richard, PhD, Senior Research Scientist, Carestream

Sam Richard, PhD, Senior Research Scientist, Carestream

“People are dying in the developing world from disease that can be diagnosed with advanced imaging technology available in the developed world,” said Dr. Narinder Paul from University Health Network, Toronto, Canada.

Not everyone has access to advanced imaging technologies such as CT scanners. Therefore, in an effort to provide an alternative, a collaborative project between UHN and Carestream will investigate the potential for a simpler and cheaper technology called tomosynthesis.

Tomosynthesis enables the reconstruction of multiple planes though the patient via the acquisition of multiple projection X-rays acquired at different angles around the patient. The projections are reconstructed to allow the user to “focus” at different depth into the patient enabling depth discrimination – similar to CT imaging.  This can help radiologists make diagnoses that aren’t possible with traditional radiography.

In addition, the project will also explore the use of dual-energy X-ray imaging, which is a technique where two X-ray images acquired at different energies (kVp) are combined to generate separate soft-tissue and bone images. This enables improved characterization of soft tissues and conspicuity of pathologies.

This research project is expected to also have an impact on patient care in the developed world. The optimization of tomosynthesis and dual-energy imaging within the context of this project may provide a cheaper and lower dose alternative to CT imaging, thereby offering the potential for reduced patient care cost and lower doses to the patient population. Furthermore, tomosynthesis and dual-energy exams can be performed within a standard radiography room (with the addition of some hardware) which is expected to alleviate the demand for CT exams.

You can view more about the project here. If you wish to show your support, you can click on that link and “Like” the video when you arrive on the page. The more “Likes” a video receive does not guarantee a selection by the Stars in Global Health’s Peer Review Committee, but it is factored into the decision-making process. The UHN video, and all other videos in the initiative will be viewable until May 31, 2013.

The Invisible Gorilla Study and Inattentional Blindness: Are Radiologists at Risk?

Dr. Roger Eng, Chairman of Radiology, Chinese Hospital, and President of Golden Gate Radiology Medical Group

Dr. Roger Eng, Chairman of Radiology, Chinese Hospital, and President of Golden Gate Radiology Medical Group

NPR released an article recently that talked about the Invisible Gorilla Study, which is a piece of research that explains why when you ask someone to perform a challenging task their attention narrows and blocks out other things. This behavior is called “inattentional blindness” and when a similar study was conducted with radiologists, 83% of them missed the gorilla in the image. This was due to the fact that the radiologists in the study weren’t focused on looking for a gorilla, but the lesions, tumors, etc. that they seek out on a routine basis.

A statistic like this can raise some questions among patients and the radiological community in general. The most obvious questions being that if radiologists are looking for something specific, does this mean that they could miss signs that aren’t tied to an exam’s original purpose?

We reached out to Dr. Roger Eng, chairman of radiology, Chinese Hospital, and president of Golden Gate Radiology Medical Group, to get some answers about ‘inattentional blindness’ and what radiologists can do to combat it.

Is there technology available that might help address ‘inattentional blindness?’

Recently, there has been more interest among vendors in addressing performance and quality aspects of the interpretive part of imaging. How does a radiologist approach evaluating an Abdominal CT scan? Followed by: how does he communicate those findings in written format to the referring clinician and/or patient? PACS systems may eventually offer the ability to double check if the radiologist mentioned specific findings or aid in identifying potential pathology outside of the breast and lung. Systems that decrease interruptions and allow the radiologist to focus more on interpretation itself will also help.

Can a radiologist train his/herself to overcome ‘inattentional blindness?’

A large body of evidence has shown there is significant variability in interpreting imaging studies. Part of this is due to inherent limitations in imaging technology differentiating normal from abnormal, along with the human error component. We also cannot underestimate the importance of clinical context of an imaging exam which is the interplay of multiple disparate data points from laboratory to patient history. IBM’s Watson supercomputer can trounce the best Jeopardy champion in raw knowledge, but cannot match the relational capabilities of human brain.

Radiologists may find answers from other industries where organizations and their personnel standardize workflow processes. Airline pilots and their checklists is the most obvious example that comes to mind.

Do you personally do anything to guard against this?

My practice approaches each imaging modality in a consistent algorithm. This workflow process is adjusted as data presents an improved way. Moreover, I am fortunate to be using RIS and PACS technology that minimizes the extraneous steps and distractions that can lead to inattention blindness.



UPDATE: The Wall Street Journal published a similar story here

ECR 2013: R&D Trends and Dose Reduction in Pediatric Imaging

Sam Richard, PhD, Senior Research Scientist, Carestream

Sam Richard, PhD, Senior Research Scientist, Carestream

I recently had the pleasure of presenting research that addressed two key topics in medical imaging at ECR 2013: pediatric imaging and dose reduction. More specifically, reducing dose when capturing pediatric images.

The research I took part in focused on optimizing image quality across a wide range of pediatric patient sizes. It looked at the thickness of the patient and sought to answer which kVp is best for each body size. The study concluded that in order to get the best image quality and lowest dose, pediatric patient size should be taken into account when selecting the kVp. Specifically, we found that the optimal kVp setting should be around 50 kVp for neonate, 60 kVp for young children and around 70 kVp for adolescents (assuming average patient size for each age group).

The second area of research that the team looked into focused on rib suppression in chest imaging. The key point here is that image quality can be improved by removing the ribs. Physics tell us that we get the best contrast if we go to lower kVp, but we use higher kVp to remove rib contrast. By reducing rib contrast, we can then reduce the kVp and improve lesion conspicuity while reducing the radiation dose to the patient.

It’s a fascinating time in the medical imaging space, and the research and technologies that are being released are proving this on a consistent basis. You can watch my complete interview from ECR 2013 below to hear more about the research, and what innovations we’re focusing on here at Carestream.


HIMSS 2013: Radiology’s Place in the Healthcare IT World

Robert Salmon

Robert Salmon, Carestream Health

Radiology IT has left the radiology space and joined the hospital healthcare IT space according to Jim Knaub, editor of Radiology Today, one of the industry’s leading resources on the topic. At HIMSS ‘13, radiology can be a forgotten topic, left in the dust thanks to more prominent topics such as EMRs, IT infrastructure, etc.. But there is a new phase beginning in the profession.

Knaub stated that radiologists are starting to request more information besides what is captured. They are starting to see information besides the images, such as reports and data, starting to flow back to the radiology departments across the IT enterprise network. The thought is that they have the medical images, but if they had better patient histories—all of the data that may exist in an EMR or EHR, for example— radiologists could better interpret medical imaging exams. While this proposition may not be on the table now, Knaub feels it is coming down the road.

Knaub went on to explain that radiology departments should be pressuring IT departments about the flow and access of information throughout the healthcare enterprise. IT needs to be more accessible across networks because there are increasingly more radiologists not onsite to read X-ray exams. If radiologists can’t walk down the hall to consult with someone, the technologies to communicate and share information remotely must be present within the enterprise.

It’s a tough problem to solve, but being able to communicate with everyone you work with will be the key to success in the space.

You can watch the complete interview with Jim Knaub below, and you can follow Radiology Today on Twitter to gain access to its insightful coverage on the radiology profession.


Rethinking Our IT Budgets

Bruce Leidal, CIO, Carestream

Bruce Leidal, CIO, Carestream

In today’s fast-paced business world, companies need to be in a perpetual state innovation and optimization. The goal is to put the best processes and technologies in place, and then track and optimize them along the way to ensure the business receives maximum value. This scenario is common in the IT space and is something my team and I are routinely thinking about here at Carestream.

I spoke with Peter High, a contributing writer to, at length about changes we’ve made in our IT department and the successes we’ve seen through the ongoing conversation with our business colleges. The article—titled, “There’s a Smarter Way to Tighten an IT Budget”—goes into detail about the method we have developed to identify opportunities and risks used to manage our budget, along with the steps that were taken to make the budget more transparent and disciplined.

For more background on Peter, he is the president of Metis Strategy, a CIO advisory firm that he founded in 2001. He has written for the Wall Street Journal, CIO Magazine, CIO Insight, Information Week, and several other periodicals. He is also the author of World Class IT: Why Businesses Succeed When IT Triumphs, a book on leading IT practices.

You can follow Peter on Twitter @WordClassIT and you can read, ““There’s a Smarter Way to Tighten an IT Budget,” in its entirety on

Hospital Staff Cuts Dose for Pediatric Exams in Half with a Testing/Evaluation Process

Casey Dye, (RT) Diagnostic Coordinator, Intermountain Primary Children's Medical Center

Casey Dye, (RT) Diagnostic Coordinator, Intermountain Primary Children’s Medical Center

In keeping with the Image Gently Campaign, our staff reduced dose for pediatric patients by up to half. We image patients on a DRX-Revolution Mobile X-ray system that replaced a CR unit. A cesium iodide detector maximizes resolution. We also installed pediatric optimization and enhancement software that contains techniques for each of the seven pediatric categories.

Equipped with these tools, our technologists began testing lower exposures when exams were ordered for our patients. Each time we lowered the dose, we conferred with radiologists to make sure that the image offered sufficient resolution for optimal diagnosis. We continued lowering dose until the radiologist reported that visualization was impaired, and then we set the default exposure technique at the previous setting. Over the course of several weeks, we imaged enough patients to set new exposure techniques for all seven pediatric categories.

In some cases exposures are altered from the standard dose to accommodate specific needs, such as viewing a PICC line (which requires slightly less dose) or detecting pneumonia (which requires slightly more dose).

Our physicians and radiologists are extremely pleased with the improvement in visualization of soft tissues and small structures for all children, but they report the difference is especially pronounced in premature babies and infants.

Converting from CR to DR is always helpful in lowering dose, but achieving the lowest dose possible requires a concerted effort by each facility’s staff and also depends upon the capabilities of the individual CR or DR platforms at the site.

Intermountain Primary Children’s Medical Center (Salt Lake City, Utah) is a member of Intermountain Healthcare. It is recognized by U.S. News & World Report and other organizations as one of the top children’s hospitals in the United States.

HIMSS 2013: Talking VNAs & Other IT Trends with Brian Casey of

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

Vendor Neutral Archives (VNAs) was a trendy topic at HIMSS13, and we at Carestream can attest to that popularity. To provide an explanation behind this trend, I sat down with Brian Casey, editor in chief for When approaching this offering from a radiological perspective, Casey saw VNAs as the most important topic at the trade show. He said it seemed as if everyone in the medical imaging field was either promoting either a new VNA or updates to an existing one.

Being driven by the IT departments, Casey said that data silos are no longer viable in today’s healthcare landscape. It is no longer just the radiologists who need access to those images, so they better be archived in a format that is usable by multiple offices and facilities.

While there are some people who are a bit uneasy of about the security and access surrounding these images, many companies that are providing VNAs are saying that the benefits outweigh the risks. Universal viewers are providing easier access to these images and this access is now available throughout the enterprise, effectively breaking down walls that commonly exist between departments.

Casey and I also discussed the results of the 2013 HIMSS Leadership Survey, which includes details surrounding the most important issues in healthcare IT. Executives identified staffing as the biggest concern for the second year in a row, saying that the ability to hire the right talent served as a barrier to accomplishing their IT goals. While this seems concerning, Casey went on to describe that there is more stability in the healthcare IT workforce that this statistic leads on.

The video below shows our conversation in its entirety.

What topics did you find as being the most important at HIMSS13 this year? Which ones were the most beneficial to your job or organization?


Lean Manufacturing Produces Excellence across the Board

Ruud Vullers, Director, Global Manufacturing & Supply Chain, Carestream

Ruud Vullers, Director, Global Manufacturing & Supply Chain, Carestream

Excellence has always been a key characteristic of Carestream. From our people, to our products, right down the individual steps in our processes—we ensure excellence is weaved throughout our entire organization. We call this mantra eXceed and it defines the customer centric culture that has been created. The five components of this mission are as follows:

– Commitment to behaviors that create a customer centric culture
– Interviews to collect data on our customers’ experiences
– Analysis to identify and implement customer experience improvements across our organization
– Metrics to track our progress
– Recognition for employees that demonstrate customer focus, and eXceed customer expectations

When it comes to our manufacturing processes, we tackle analysis and metrics with the utmost importance so that we are able to create the best products for our customers in the most efficient way possible. Carestream owns and operates global manufacturing facilities so that products can be produced right where they are being sold. These logistics allow for faster speed of delivery and lower overall costs.

Manufacturing is involved in the earliest phases of the product design process so that cost is affordable and quality is built into the design. We have developed measurement methods for all key focus areas in manufacturing like incoming material quality and on-time delivery. This data is shared every month with our key suppliers to drive improvements. This allows us to live a life of lean manufacturing—a principle that depends on getting rid of all non-value added activities and keep only those that the customer is willing to pay for.

Our production system allows us to manufacture exactly what we need when we need it. Kanban (a proven lean manufacturing concept) allows for automatic replenishment of components.  Each day, inventory is communicated to our suppliers to minimize what is kept on-hand and improves quality since any quality problem is contained to a small number of components.

Morning briefings are held for each product line with a cross-function team so any areas of concern can be immediately assigned and addressed. Anyone on the manufacturing floor is empowered to initiate corrective processes and improvement, and feedback from customer installations are brought forward to the morning markets.

Ongoing quality improvement is built into every step of Carestream’s production process. The “Carestream Manufacturing Focus” video below provides some additional details.

Guess the X-Ray – March’s Image Challenge

Congratulations to those who correctly identified February’s Image Challenge, which was an electric razor:

February Image Challenge

Below is the image for March, 2013, and we think it might stump some of you. The challenge will run until March 31.

Please leave your answer in either the comment section below or on our Facebook page. Good luck!

March, 2013 Image Challenge

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

Patient Engagement – A Healthcare Reform Topic Everyone Can Agree On

Carestream CMO

Norman Yung, Chief Marketing Officer, Carestream

Information is power, but only when used and applied. It is this principle that has healthcare providers (and even politicians) finding rare agreement on one aspect of the polarizing health care reform landscape in the U.S. The common ground is that patient engagement measures have the potential to be one of the most transformative aspects impacting quality of care.

Changing provider behavior to give patients transparent access to their health care information will advance the consumerized health care model where patients are more informed and involved in the direction of their care.

Yet at the end of 2012, health care news headlines lit up with provider concerns about patient engagement measures. Like this story, “CMS official: We might revisit Meaningful Use patient engagement rules,” which indicated that the Centers for Medicare & Medicaid Services may reconsider its requirements for patient engagement in Meaningful Use Stage 2 if complying proves too onerous for care providers.

Lowering measures for patient engagement—which will likely do more to reduce health care costs and improve outcomes than almost anything else—would be a mistake and a disservice to patients. Measures like those outlined by the U.S. Department of Health and Human Services are necessary to drive timely change. And each part of the Stage 2 patient engagement measures compels providers to deliver timely access to patient information and enable that information to be shared.

There is a manageable path to patient engagement and it is gaining ground. Let us take a look at patient engagement motivators and health impact in one clinical specialty: radiology.

New patient portals are being deployed that allow patients to easily and securely download their X-ray exams, review the diagnosis on the radiology report, and share that information with physicians, specialists or others of their choosing. Being able to access both the diagnostic report and the images is vital because this is the starting point for treatment decisions by physicians.

Consider the case of a student athlete whose team physician has been monitoring a knee injury through the season with a series of MRIs. While the athlete previously had relied on the physician to use the images and the radiology report to determine treatment, a patient portal allows the student athlete to engage other physicians as desired or use the information to make their own decisions about physical therapy and surgical options.

Another key benefit of a patient portal is that it can play an important role in reducing the likelihood of unnecessary testing since second opinions can be obtained from viewing the original digital imaging exam. This process can help reduce radiation exposure for the patient and can help lower the costs associated with repeat radiology exams.

Houston Medical Imaging, Inc., an innovative network of diagnostic imaging centers in Texas, tested this technology and reports that patients immediately embraced the portal, which is accessible from their web site. Enabling access to information helps patients feel included and trusted by their doctors. In fact, it lets them partner with their doctors in the management of their health care and further strengthens the physician-patient bond which is a critical foundation for achieving improved outcomes.

A similar patient portal test at Lagosanto Hospital, a large, public health facility in Italy that performs more than 150,000 X-ray exams each year, revealed that the majority of patients were so happy with electronic access to their radiology images that 98% of them chose to continue using the radiology portal.

Informed patients are empowered patients. As physicians’ use of information sharing technology continues to grow, and if the commitment to patient engagement remains steadfast and free from political or bureaucratic entanglements, I am confident we will see proof of how technology can support the vital human connection that is at the core of quality health care.