AHRA 2013: IRIS and the Importance of Dose Reduction Initiatives in Medical Imaging

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

IRIS (Image Right, Image Safe) is a commitment that started at Dartmouth-Hitchcock Medical Center (D-H) to ensure that not only was dose being reduced, but that patients were receiving only necessary medical imaging exams. Karen Burgess, M. Ed., RTRM, of D-H presented on Monday, July 29, about IRIS and how it takes awareness and education to properly reduce dose to patients while still providing them with quality care.

IRIS was inspired by the Image Gently campaign, which seeks to promote radiation protection in the imaging of children. This is not a new cause in the medical imaging field, but Burgess explained how D-H was a textbook example of how dose reduction can be achieved within a large medical system, and how it takes many processes to make it happen.

Burgess commented on how the medical imaging field has seen a near doubling in ionization exposure over the past three decades. One area this continues to grow is in relation to sports injuries, particularly in children ages 5-14. In total, about 750,000 medical images are conducted per year in this age group on account of sports injuries and that number is only growing larger. With a trend like this, efforts are needed to reduce unnecessary imaging and that involves including the healthcare provider as well as the patient in the education about medical imaging exams.

In 2010, Burgess’s colleague, Dr. Peter Spiegel addressed the imaging controversies and emphasized the need for a more enforced and balanced approach. D-H needed to improve on addressing patient concerns about radiation safety, and from that, IRIS was born. It’s mission statement reads as such:

Promote patient safety in medical imaging by initiating, supporting and coordinating  activities designed to reduce radiation dose while maintaining appropriate standards of imaging quality; ensure that referring clinicians have all necessary resources and incentives to make appropriate decisions in the ordering of imaging procedures; and raise public awareness of the uses, benefits, limitations, and risks of medical imaging.

From this, D-H instituted several key procedures to ensure it was living up to the IRIS mission statement. These included such activities as creating a dedicated position of “radiation safety officer,” requests for CT must be subject to a verification protocol to ensure that low dose or radiation free alternatives (MRI, ultrasound) are ruled out prior to the CT, and adherence to voluntary ACR and TJC guidelines, which are more comprehensive and stringent than required by regulations in New Hampshire.

In her conclusion, Burgess left off with key points that attendees could take away to institute their own initiative similar to IRIS to help reduce dose in their hospitals. These included seeking a physician project champion who could lead the initiative, creating a mission statement, and defining clear and attainable goals for the initiative.

Dose reduction, while an ever-important trend in the medical imaging landscape, can be difficult to achieve on account of the exams being a necessity to diagnostics and patient health. Careful planning and organizational initiatives to make dose reduction a reality can be to the key to accomplishing this and ensuring that patients are taken care of to the highest degree in our facility.

AHRA 2013: Creativity and Overcoming Fear in Medical Imaging—Is It Possible?

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

“Follow the breadcrumbs from any unmet goal and it usually leads fear.” – Erik Wahl, graffiti artist and business strategist

This was one of the lines that stuck out the most from the keynote session of day one at AHRA 2013 in Minneapolis. FEAR, as Wahl noted, can stand for False Evidence Appearing Real, and it is the main roadblock that holds many back from innovation and new ideas. His message yesterday is one that is valuable to a variety of industries, but tailoring it specifically for medical imaging shined a spotlight on just how difficult it can be getting over fear, and the advantages that come once that is achieved.

Erik Wahl, Keynote Speaker, AHRA 2013

To demonstrate how meaningful it can be to take a risk, he encouraged an audience member to participate in a “Fear Factor” task. The participant, nervous to perform such a task in front of a room full of people, was allowed to delegate the task to any audience member of his choosing. Once he chose someone, the woman who was now assigned the task was ushered up to the main stage where she would perform the “Fear Factor” task in front of everyone. However, when she opened the envelope to reveal her task, it simply stated that she could keep the Abraham Lincoln painting Wahl drew during the introduction of his speech. The lesson: taking a risk can lead to big rewards.

Throughout his keynote, Wahl asked the audience many rhetorical, thought-provoking questions. How do we look for ways to transcend the commoditization and consumerization of healthcare? What will reform look like, internally and externally? How can medical imaging specialists plus into a world of new ideas and creativity? What is an idea worth in healthcare? All meaningful questions that all contain long, difficult answers.

Wahl routinely went back to the point that human beings are naturally resistant to traveling in uncharted waters. He said that it takes three tasks to successfully navigate these waters. One must focus on the mission, commit to it, and ultimately, adapt to any changes. The last responsibility was the one he accented. One cannot evolve if one cannot successfully adapt. The changes we face in healthcare, be it through technology or political reform, are intense challenges, and it will involve getting over fears and adapting appropriately if organizations are to achieve success.

When it comes to relying on creativity to overcome challenges, Wahl led the crowd in an interesting task. He asked everyone who thinks that they can draw/paint to raise their hand. No one did and a laugh was shared throughout the hall. He said he wasn’t surprised but made a couple of key points. When he asks this question to high school students, he said that about 10-20% of students raise their hands. Then he asked us, “If I were to ask this to pre-school students, how many would raise their hands?” At that moment, a light bulb went on over the audience’s collective head.

Everyone is a drawer when younger, and everyone is enthusiastic about it. The key to overcoming fear, embracing creativity, and adapting to change is to sustain that childlike enthusiasm. It can be difficult, and quite scary, but as Wahl stated numerous times throughout his keynote, it is necessary. And those that don’t adapt can be left behind.

The Popularity of RFID Technology is Rising in the Healthcare Industry

Helen Titus, Marketing Director, X-ray Solutions, Carestream

Technology has taken over every aspect of our world and the advancements we’ve seen have truly benefited the healthcare industry. Radiofrequency identification (RFID) readers have become very popular in the field and are being used in a variety of ways—from identifying and tracking items, to doing the same for people. The technology consists of a small memory chip placed on an item and the RFID reader emits radio waves to detect tags and read the data. These storage chips can range from saving serial numbers to several pages of information, and it is all conducted through wireless technology. What follows are a few examples that demonstrate how healthcare facilities and healthcare startups are using RFID technology and how it is benefitting healthcare providers and the patients.

Earlier this year, I wrote about how healthcare facilities use this RFID technology by embedding tags in employee badges to monitor entry into restricted areas. Readers are being built into new generation imaging systems to help streamline workflow by automatically logging authorized users onto X-ray systems. They simply pass their badge containing the RFID chips in front of the system’s radio-frequency reader and they’re good to go. This saves time for both the technologist and the patient, and meets the necessary HIPAA requirements for the privacy of patient records.

Boca Raton Regional Hospital installed DRX-Revolution Mobile X-ray systems that enable technologists to log in by passing their RFID tagged badges in front of the system’s built-in radio-frequency reader. “This is much faster than the manual process of logging in with names and passwords- and it helps us meet HIPAA requirements for the privacy of patient records,” said Gail McNamara, Director of the hospital’s Imaging Services Department. “Now I have an accurate record of which technologist conducted each exam and what files each technologist viewed.”

A recent article from Venture Beat featured how two entrepreneurs invented a new system to track and process pharmacy kits in hospitals through the use of RFID tags. Pharmacy kits contain up to 200 items and can be difficult to routinely manage. The pair created Kit Check, which acts as an inventory aid, tracking expiration dates and monitoring equipment or medication usage. Pharmacists are notified immediately and can restock accordingly. This is extremely beneficial for hospitals- especially in times of emergency- who aren’t able to manage or restock their medications regularly.

Hospitals are also using RFID technology to restrict and monitor access to hospital supplies stored in cabinets and record inventory transactions. An electronic control card is necessary in order to gain entry to the cabinet. Each item is tagged with a RFID chip so when they are removed the system documents it, including the user who accessed the product. The cabinet also monitors its internal temperature and expiration dates of all products.

The use for RFID readers in the healthcare industry seems endless. From monitoring equipment to tracking medication, there are plenty of ways to incorporate them in your facility to help streamline workflow, increase productivity and enhance security- who doesn’t want that?

RHIOs, SHIN, and the Possibilities of Connected Healthcare

Rich Pulvino, Digital Media Specialist, Carestream

Rich Pulvino, Digital Media Specialist, Carestream

As a patient, I want my physicians and healthcare providers to give me the best care possible when needed. As a marketer in the healthcare industry, I understand the strains and difficulties it takes to make this possible. And however rough the waters may be, it’s clear that there is progress being made. Not only between connecting patients with their physicians, but linking health systems together in an effort to bring quality care to a patient, wherever they may be.

At the New York State HIMSS Conference, Paul Wilder, vice president of product management of New York eHealth Collaborative, provided a regional update on how the state is doing in terms of healthcare unification. The update included adjectives such as “thriving,” “dynamic,” and “evolving” -the last one being the focal point of his presentation. This spotlight on the patient-centered care delivery has allowed health systems to follow the patient and the patient’s data. Wilder mentioned how this data is personal, yet it is not moving well from facility to facility. While proud of the strides New York has made, Wilder was honest in explaining that there is still a long way to go and he believes that eHealth Collaborative will be a key factor thanks to its position as a facilitator of healthcare policy development and a provider of technical services.

Health organizations cannot tone down the liquidity of data, or stop it from moving because of the way data is created and shared today. Wilder emphasized that the technology we have available today can not only create the network for sharing patient data throughout the state, but also facilitate the secure exchange of the data. As of now, regional organizations exist that allow for the smooth exchange of data. These regional health information organizations (RHIOs) serve as effective entities for the smaller areas, but a state-wide information infrastructure must be built to handle state reform goals. The caveat being that this is not only about changes in healthcare, but system changes as well. The goals Wilder discussed for these organizations included:

  • Support clinicians and consumers with information at point of care
  • Advance care coordination
  • Strengthen public health surveillance and response
  • Enhance quality and outcome measures

The solution Wilder presented to meet these goals focuses on making the private network provide the solution to the Department of Health (DoH) instead of the other way around. The RHIOs are built and are more nimble than the DoH. In New York, the Statewide Health Information Network (SHIN-NY) consists of the connected RHIOs. According to Wilder, the advantages that these RHIOs provide are that they possess an understanding of local needs. Because of this, it becomes easier to integrate systems from one RHIO to another. What this means for patients is:

  • Secure messaging with a broader reach
  • Care coordination
  • Results-based delivery
  • General messaging
  • Secure transmission of private health information between covered entities
  • Information exchange via a Healthcare Internet Service Provider (HISP)
  • Subscribing to notification so there is notification when there is an event (admission, inpatient admission, discharge, etc.)

In his conclusion, Wilder encouraged everyone in the room to become part of, and show support for, SHIN-NY. If we work to become connected, it presents the potential to improve the state’s ability in offering quality care to people across the state—from New York City to most western and northern regions. While what he discussed was unique to New York, it provides an excellent model for other states in the U.S. to follow. New York is well connected when it comes to healthcare thanks to the RHIOs and SHIN-NY, and it is to be expected that the connectivity will only be improved in the following months and years.

The Diagnostic Value of a Spinal X-ray: In a Chiropractor’s Office, Every Picture Tells a Story

Scott Evers, President, Genesis Digital Imaging, a Division of Carestream

Scott Evers, President, Genesis Digital Imaging, a Division of Carestream

One of the issues every chiropractor must face is how to explain a course of treatment to a patient who needs it. Chiropractors are much in the news anyway, and the discussion ranges from doubts about the fundamental value of chiropractic treatment to the testimony of legions of patients who swear by it. As with any professionals, chiropractors use many of the same techniques of diagnosis as the rest of medicine, and this often includes an X-ray.

The X-ray can clearly indicate the need for a type of treatment in a way no other diagnostic scheme can provide. Some chiropractors will read the X-ray themselves, while others will have it read by a radiologist. Yet diagnosis is only a small part of the chiropractor’s dilemma—having analyzed a patient’s issue, it is still necessary to explain it in a way that the patient can comprehend and buy into.

This is where the X-ray can play a leading role. Carestream Vita CR and a chiropractic measurement toolset are critical.  With this in place, a chiropractor can often show patients the cause of their pain. From that point, explaining the course of treatment most likely to alleviate the problem is much easier—and with the help of the X-ray the doctor can make the point with a minimum of medical jargon.

You can click on the following link to learn more about the  DirectView Vita CR digital X-ray system.

The Ideal RIS: A Perfect Link Between Clinical and Financial Management

Dr. Ivo A. Bergamo-Andreis C.S., MD, Chairman, Department of Radiology/Diagnostic Imaging, Legnano City Hospital

Dr. Ivo A. Bergamo-Andreis C.S., MD, Chairman, Department of Radiology/Diagnostic Imaging, Legnano City Hospital

The ongoing development over the last 20 years of the radiology information system (RIS) has been a dramatic turning point in the management of the radiology department. What used to be a system meant to be the simple backbone for a way of dealing with radiology in the digital era—allowing rationalization of the daily activities by running them within an IT-based framework—has turned to be a major player in the financial management of the radiology department, no matter the country one works in.

The revolution of the 1990’s, with the goal of turning radiology paperless (as well as filmless) virtually overnight, was the starting point of a completely different way of looking at our daily routine. The web-based scheduling and reporting system, the increasingly sophisticated speech-recognition system, the possibility for every patient to access his/her own medical information (reports and images) via the Internet, have all been aimed at two primary goals:

1)    Improved productivity: On the one side, RIS allowed the increase in overall productivity within the radiology department by reducing the number of time-consuming steps to be followed before a report could be made available

2)    More efficient staffing: On the other side, RIS allowed a more rational use of the staff–a strong front office vs. a no-longer-so-important back-office, since no person other than the radiologist is necessary to type a report. Our ultimate target was actually the patients, independent from the “customer satisfaction” statistics!

If the evolution of RIS had stopped at this point we would have lost vital developments. The world moves on. Other paths have to be forged since the simple outsourcing of some activities as a way to achieve financial savings cannot be considered the ultimate solution to achieve a sound return on investment. We can now achieve advantages in the overall management of the radiology department because of the possibilities the new products provide and the mandatory flexibility of the RIS versus the single customer. It is of critical importance to be able to check with a simple click on the computer to timely detect critical areas which require immediate solutions.

Equally important is the ability to assess the data real-time, sitting at our desks, analyzing the material used and at what price, and keeping the stored material (a cost) to a minimum. Simultaneously, we must allow foresight into which bill will likely be needed for the near- or long-term future.

The fully integrated RIS, comprised of both the clinical and financial management of the radiology department, should be a “must” everywhere. This requires a flexible, user-friendly, “customer-designed” system—no cumbersome or time-consuming systems are welcome.  If this works—and it can work—the hours spent in the past collecting data and analyzing them will soon be history. The possibilities offered by the RIS today will allow for both a sound clinical management of the patient, and a constant, easy control of the complex financial management of the radiology departments we are running, turning both into success stories.

Dr. Ivo A. Bergamo-Andreis is a member of Carestream’s advisory board.

Accidents Happen. Forgiveness Comes Easy with DRX Protection Plan

Jeffrey Farmer

Jeffrey Farmer, Director Global Customer Care Solutions, Carestream Health

Most DR detectors sold today include coverage for normal equipment failure as part of the standard warranty or service agreement terms. However, failures caused by an accident (dropping, liquid spills, etc…) are excluded. At Carestream, we understand that in the hectic environment of patient care, accident protection detectoraccidents happen. And, with so much riding on your operations, the last thing you want to worry about are unplanned costs, interruptions, and downtime from accidental detector damage. That’s why we created a unique detector coverage option designed specifically to save you both time and money in the event of an accident.

For the industry leading DRX detector, Carestream established the Accident Protection Program to deliver replacement detectors at a fraction of the standard replacement cost if accidental damage occurs in the course of normal clinical use. With Carestream’s Accident Protection coverage you save over 90% versus standard replacement cost when your detector is damaged (assumes one accident per year).


Memorial Medical Center (MMC) of Springfield, Illinois is a teaching hospital that conducts 250,000 imaging exams per year. As you can imagine, in a teaching environment accidents can happen frequently. That’s why MMC purchased an Accident Protection Plan for its 14 Carestream DRX detectors.

“DRX detectors are designed for rigorous use, but as a teaching hospital we have inexperienced technologists handling our detectors,” says Marjorie Calvetti, the Director of Medical Imaging at MMC. The Carestream Accident Protection Plan has helped the Center protect their investments, minimize downtime and save more money than they anticipated.

“We have used the Accident Protection Plan several times. If a detector is damaged, we have a very small replacement cost. This plan has saved us over $275,000, so it’s an excellent investment,” Calvetti adds.

Let’s face it, accidents happen. Fortunately, with the Carestream Accident Protection Plan, they don’t have to be expensive.

What could your hospital do with the savings you realize from a Carestream Accident Protection Plan?

For more details on Medical Memorial Center’s experience and to learn more about Carestream’s DRX Accident Protection Plan, please see the file below.

AHRA 2013: Patient Satisfaction vs. Quality in Bedside Imaging

Todd Minnigh, Vice President of Digital X-ray, Americas, Carestream

Todd Minnigh, Vice President of Digital X-ray, Americas, Carestream

In the 1980s my spelling was marginal. Readers would need to look past it, focusing on the main point of my letters and papers.  Sometimes it would lead to a mistake in understanding, but usually things were okay.  One day the world changed.  Spell checkers.

How often do we sacrifice quality for speed and convenience?    When we take an X-ray the patient’s time, safety and comfort are along for the ride.  Avoiding clinical errors and improving quality are critically important. Technology may be about to make things easier.

I’ll be giving a presentation a couple of weeks from now in Minneapolis, MN, at AHRA 2013 on the importance of bedside imaging and how we can get to the level of quality imaging that we should expect. When the patient is so compromised they cannot  come to the X-ray room, we really need to take the x-ray room to them.  Several technology advancements are getting us closer to just that. . These result in improvements and ensure that radiologists are equipped with the best capabilities available to provide the best care possible.

  • In my CE presentation on Sunday afternoon I’ll be covering the challenges associated with bedside imaging.  These could be driven by exposure, grid cut off, lost identification, positioning or other reasons.  Most mistakes involve a return trip to the room, disturbing the patient or heaven forbid the OR again, and repeating the image.  To  manage these challenges, most folks focus on a few areas:  : proper identification, infection control, and retained foreign body search  in the OR to name a few.Mobile Xray
  • Patient identification is vital  to preventing medical errors. DR allows verification of the image and patient at bedside, scanning wristbands to ID images can take this one step further.  Mixing up paper requisitions between exposing and processing CR cassettes is eliminated. . Infection control and patient satisfaction don’t always go hand in hand. What is sterile is sometimes a bit cold and unfriendly. But a plastic bag and rubber gloves is preferred to a staph infection.  I’ll have a few suggestions from other Radiographers for how to boost comfort.
  • It is important to  use  a grid often for improving the image quality so that radiologists won’t need to rely on repeat images. The capability exists from multiple sources to make grid alignment easier. Along with grid alignment, it’s important that  departments track exposure to prevent “dose creep”. To realize the improvements productivity, thoughtful implementation and the organized tracking of metrics are needed so operational improvements can be made.   Patients can recognize discomfort when it comes to capturing another image, but what they can’t tell is if they have been overexposed.  This must be managed to follow through on our mission to achieving both optimal patient care and patient satisfaction.

If you’re interested in attending this presentation to learn more, I will be speaking on Sunday, July 28, from 4:30-5:30 p.m. at the Minneapolis Convention Center in Minneapolis, Minn. Looking forward to seeing you there and to another great year at AHRA.

Doing MORE with Lesion Management and Clinical Applications

Michael Hornback, RIS and PACS Specialist, Carestream

Michael Hornback, RIS and PACS Specialist, Carestream

A health facility’s PACS station should always be equipped with the proper applications to ensure that the administrator can do his/her job to the fullest degree. Workflow is everything to a radiologist, and when time is of the essence, an efficient workflow can lead to a faster diagnosis, which can result in better patient care.

Having the applications to create a seamless workflow within a PACS makes the radiologist’s job more convenient. Take for example lesion management—an application in our Vue PACS that provides native oncology follow-up capabilities. The comparison tools allow the radiologist to automatically register current and prior exams slice by slice. The integrated lesion management tools enable the user to then track and document all of the Response Evaluation Criteria in Solid Tumors (RECIST) criteria.

Some of the more enhanced capabilities include the following:

  • Native MPR – Often, patient movement, position and/or respiration will alter images between prior and current exams.  Significant body tilt can be automatically corrected with MPR by linking the images in 3D which registers the images on the X, Y, and Z planes. The volume rendered image is built into the display protocol for the radiologist to see when the study launches.
  • Bookmarking capabilities are also including in the lesion management tool. In addition to the semi-automatic lesion segmentation tools, manual measurements can be conducted and saved as bookmarks for reference and follow up at a future date.
  • The follow up tool allows the radiologist to see what has changed from one study to the next, note increases or decreases in size and volume of the lesion along with doubling time in days. This information is then charted in a graphical format that can be inserted into the final diagnostic report.
  • Lesion management provides semi-automatic segmentation for three categories—lung , liver, and non-lung-liver. The system is able to extrapolate volumetric measurements, bookmark them, and update the increase or decrease in size, volume and doubling times. The RECIST criteria is then documented and displayed in the context of the final diagnostic report.

The ability to handle so many functions from a single workstation results in EFFICIENCY! The consistency in image analysis and reporting provides meaningful communication and collaboration between radiologists and clinicians for a quality diagnosis and ultimately, better patient care.

For MORE information on lesion management and streamlining workflow with clinical applications, you can download an eBook about the topics and learn about Carestream’s offerings in this area.

To see how facilities are using lesion management, the video below is a testimony from Tufts Medical Center in Boston, MA.


[Infographic] Portals, Access, and Engagement—Patients are Demanding It

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

With healthcare facilities and medical professionals looking for various patient services to improve communication, allowing these patients to track and share their own medical histories via portals and online access could lead to improved healthcare.

At Carestream, we’ve always been fascinated by where medical images fit within the patient engagement and patient portal environment. To truly understand the patient perception and needs, we partnered with IDR Medical to conduct a direct survey of 1000 patients across the US with various backgrounds.

By learning what patients are looking for, we can provide our customers—administrators, radiologists and executives—with the tools and services that could lead to better and more efficient care. This is because we are ultimately providing patients with more access to their personal health information, and helping them to become more aware of their own health and any issues they may be experiencing. This makes for improved communication with their physicians, which can lead to the improved diagnoses.

The survey asked what patients are looking for in terms of medical images, patient portals, and online access to those images. The infographic below provides an overview of the key insights from the study.

You can click on the following link to download the complete study.