Not a Typical Day at the Office: Application Engineers Taking Steps to Improve Customer Experience

Laurie Cesar, Application Engineer, DMS, Carestream Health

Laurie Cesar, Application Engineer, DMS, Carestream Health

Jenn Thwaits, Application Engineer, DMS, Carestream Health

Jenn Thwaits, Application Engineer, DMS, Carestream Health

Customers have never had more access to information than they do today. Everything they need is at their fingertips- product reviews, testimonials, competitor information. It’s a key factor driving companies to deliver stronger incentives to their customers because if they can’t provide them with what they want, someone else can and will.

Staying at the forefront of technology in this day and age is almost impossible as it seems to change daily, but keeping your customers happy is a lot simpler. How? By just listening to them. Communication barriers no longer exist between consumers and big companies making it easier than ever to connect with each other.

As application engineers, we’re involved in the design and implementation of products, training, troubleshooting, and product enhancement. Much of our product enhancements come straight from our customers. We gather their feedback and information about their needs and work with our team to develop and enhance our products with our customers in mind.

It’s not every day that we get to be on the sidelines at an NFL game or X-ray an African Guinea Pig, but we’ve had some pretty interesting days outside of our four walls and it was all to better our customers experience with our products. Here are some of our most memorable moments:

*JT (Jenn Thwaits) & LC (Laurie Cesar)

  • (JT & LC) Buffalo Bills: We announced our partnership with the Bills back in August 2013 and installed the DRX-Ascend System and DIRECTVIEW CR System at Ralph Wilson Stadium. They’re not using our equipment every day like facilities are; they’re using them every Sunday. We were present on the sidelines for the first three games of the season to ensure their radiologist tech, Gary Celotto, knew how to work the equipment in order to properly treat a player because if someone gets injured, Celottoneeds to get to them so that the trainers can immediately assess their injuries. During the pre-season game against the Lions, We ended up X-raying about five players (ribs, knees, feet, etc…) but luckily none were seriously injured.
  • (JT & LC) Spurwink Farms We partnered with Idexx to develop image processing for veterinary DR (digital radiography). We worked on equine image processing at Spurwink Farms in Maine and were able to acquire all imaging needed by X-raying three horses. When you get image data off a CR/DR plate there are so many shades of grey that the human eye cannot distinguish the details in an image. Image processing enhances the darkness, contrast, sharpness and noise to optimize the image so that the eye can differentiate the bone structure and soft tissue, etc. Image processing is an intense task that requires lots of images to do well, which is why it took us multiple horses in order to get the correct images for our software.
  • (LC) Animal Kingdom: While I was working in the field as an Applications Consultant I had the opportunity to go behind the scenes at Disney’s Animal Kingdom. We were developing an early version of our vet product. I was tasked to optimize the existing human image processing that was in the current product to make it work for animals – large, small & exotic animals. The novelty of being in an unusual environment made the trip very interesting. It also provided an opportunity to see how medical care is provided in an environment different than the one I’d worked in for all those years.
  • (JT & LC) URMC MorgueIn order to receive FDA clearance for a new product you must demonstrate substantial equivalence to a legally marketed product to ensure it’s as safe and effective (or more so) as one that is already in clinical use. This is often established by taking images acquired from both the previous and new product. Since it’s not a good idea for people to have two x-rays when one is sufficient for their diagnosis, cadavers [those who agreed to donate their bodies to science] are often used. When the 2530C detector first came out, we wanted to ensure both specifications were met. We contacted one of our research partners access their morgue where we were able to acquire pairs of anatomical images using two receptor types. Once we confirmed the intended improvements of the new detector we were able to file the appropriate paperwork with the FDA and received clearance for the detector.

JAMA Study Showcases the Benefits of 3-D Mammography

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

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

The case for the importance and relevance of mammograms has had its battles in 2014. The CNBSS announcement sought to prove that mammograms do not result in better detection and essentially, do not save lives. Those working in women’s health were up in arms about this study, claiming it as being dangerous and working to discredit it. With an announcement made yesterday by the Journal of the American Medical Association, the pro-mammogram field has secured a victory.

3-D mammography, known in the medical field as breast tomosynthesis, was the focus of a study released on June 24, 2014 in JAMA. The results of the study showed that using 3-D mammography resulted in a 15% reduction in recall rates and a 41% increase in the detection of potentially lethal cancers. These results are certainly positive, especially as millions of women will be having the mammograms and/or digital breast tomosynthesis this year.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.

The benefits of tomosynthesis do not come without issues. First off, the machines are expensive upfront costs for facilities. The New York Times article about the study estimated the tomosynthesis machines to cost about $500,000—almost double the cost of digital mammography machines. Reimbursement is an issue in some facilities—both in terms of the technology and from insurance companies since tomosynthesis exams are new to women’s health initiatives.

Second, the images captured by 3-D mammography machines create bigger volumes of data since the file size of a 3-D image is exponentially larger than a 2-D one. This creates the need for more storage space, resulting in higher IT costs for the facility.

Third, 3-D mammography images are creating a bottle-neck in terms of efficiency in reading and analyzing the exams. There is more substance to study and analyze in a tomosynthesis exam, so initially it takes longer for the radiologist to read and report the exam. Workstations with dedicated tools for tomosynthesis are helping to reduce this reading time.

Even with these three issues, the benefits that 3-D mammography provides to the patients outweighs each one. Providing quality care to the patient should always be the number-one priority for medical professionals. If it takes more expensive equipment, then the facility should make the investment because the benefits has the potential to save lives. Giving that up to save money and time is not worth the risk.

Dose Efficiency and Reduction Remain Vital Issues in 2014

Helen Titus

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

In 2014, the phrase “safe imaging” means more now than ever. Across the world we are seeing organizations and governments working to ensure that patients are kept safe while simultaneously ensuring that imaging quality is not compromised.

At ECR 2014, we saw the launch of EuroSafe Imaging, which works to improve safe imaging practices across Europe. In the U.S., the Image Gently campaign created by the Society of Pediatric Radiology has been a powerful movement in the U.S.’s pediatric medical imaging sector.

Now as we move toward the halfway point of 2014 we are about to see updated standards for diagnostic imaging. The Joint Commission announced these new standards at the end of 2013 and they will go into effect on July 1, 2014. Additionally, a second round of accreditation announcements will be phased in by 2015.

According to the Joint Commission, new areas addressed in the standards are:

Society of Pediatric Radiology official logo

The Society of Pediatric Radiology (SPR) has taken great measures to educate the medical imaging industry about the importance of safe imaging.

  • Minimum competency for radiology technologists, including registration and certification by July 1, 2015
  • Annual performance evaluations of imaging equipment by a medical physicist
  • Documentation of CT radiation dose in the patient’s clinical record
  • Meeting the needs of the pediatric population through imaging protocols and considering patient size or body habitus when establishing imaging protocols
  • Management of safety risks in the MRI environment
  • Collection of data on incidents where pre-identified radiation dose limits have been exceeded

Even with these updates to standards and creation of mission-oriented organizations there are those arguing that there is not enough being done for radiation safety.

This study conducted at Emory University’s School of Medicine says it all:

“Even though the residents believed there to be a link between radiation exposure and cancer, many of them–including radiology residents–couldn’t demonstrate knowledge related to specific estimated dose effects. For example, just 22 percent of the residents surveyed (and only 29 percent of radiology residents) could estimate the lifetime risk of cancer mortality from a single abdominal CT scan in pediatric patients.” – April 19, 2014, Mike Bassett, FierceMedicalImaging

If we are to see improvements made in radiation safety, while also providing quality imaging service to patients for the most effective care, then it all starts with education—both current and tomorrow’s radiologists. As we move forward in 2014, we must embrace the standards put in place that keep patients safe and work to stay up-to-date about why safe imaging is so valuable to our profession. It improves the radiology profession, the technologies used in medical facilities, and the care provided to the patient.

Highlights from the MDCT 2014 Workstation Face-off

Menashe Benjamin.gif

Menashe Benjamin, Vice President, HCIS, Carestream

This year marked the 12th annual International Society for Computed Tomography’s (ISCT) Workstation Face-off at Multidtector-row CT (MDCT) 2014. Doctors representing four vendors (Siemens, Phillips, TeraRecon and Carestream) worked on four different cases with the vendor’s workstation to put each system to the test in terms of speed and accuracy of diagnosis. Once again, Carestream was the only vendor that used a PACS workstation to complete all the cases, while the other vendors used highly specialized, dedicated 3D workstations.

All cases were complex and required advanced and fast image processing, measurement and reporting capabilities. The cases included:

  • Following a lesion in the abdominal wall across four time points based on two PET-CT and two CT studies;
  • Segmenting two lesions in the liver and segmenting the whole liver into nine segments according to the Bismuth classification;
  • Providing a set of measurements from a CT scan to plan a transcatheter aortic valve replacement; and
  • Highlighting multiple rib fractures of a severely injured man following a motor vehicle accident.

Dr. Michalle Soudack, Head of Pediatric Radiology at the Safra Children’s Hospital in Israel, was our experienced representative on the Carestream Vue PACS system. As always, she demonstrated the various applications in a clear, concise and precise manner, all within the allotted time.

Three areas that stood out in this year’s face-off:

  1. Polling. These were not scientific, official polls, but questions were posed to the audience and they could text in their answers.  The questions and results are below and these findings, while not conclusive, are interesting in terms of the audience makeup at MDCT 2014. For instance, the first poll question, 11 respondents say they have never been asked to measure liver volume and, surprisingly, 10 respondents answered “Yes” to the fourth poll question. This is a promising sign that collaboration and cooperation are gaining ground in the medical imaging space.MDCT
  2. The case results. These differed widely among the vendors in the second case, where the competitors were asked to measure the whole liver volume and the tumor burden per liver segment.


While the judges did not provide an official answer on which vendor was the most accurate, they did comment that validating the reproducibility and accuracy of automatic measurement results is an important factor in assessing workstation segmentation performance.

3. New product and application. During the presentation of the fourth case, Dr. Soudack was able to provide a look at two of Carestream’s newest technologies for radiology IT.

 a. The first was a work-in-progress called radial view. Dr. Soudack worked through a case focused on rib fractures and showed a new view that more clearly depicts the fractures, as can be seen below:

MDCT Radial View

Radial View is a special form of MIP (Maximum Intensity Projection) showing the ribs spread out as if they were looked upon from inside the body.

b. The second and more important new technology demonstrated by Dr. Soudack was a complete workflow highlighting Vue Reporting as a key tool for communicating findings and promoting collaboration between all radiology stakeholders. Vue Reporting brings radiology reporting into the rich, multimedia and interactive world. This new technology allows radiologists to couple findings and images into a single interactive report, as well as to inject into the report measurements and calculations created during image interpretation, thus helping to minimize chances for errors. Dr. Soudack demonstrated features such as live hyperlinks that enable instant access to live images and complete patient portfolios from the web, including validated mobile devices such as iPad and iPhone (for which Carestream has FDA clearance).


As always, the workstation face-off was a thrill to watch because we were not only able to see expert radiologists maneuver throughout the different platforms, but we were able to see how the workstation technologies and applications are evolving. These advances are being made with the purpose of helping create a more efficient and error-free work environment for the radiologist, which can in turn provide better care to patients. The unique design of Carestream Vue PACS, with its unified backend and data model, strives to expand this environment to ALL radiology stakeholders, addressing the needs of referring physicians, administrators, and patients as well.

Where do you see PACS workstations in the future? Are there applications you hope to see added to your system down the road?

[eBook] From Trust to Use and Beyond: The Road to Clinical Decision Support

Diana Nole, Carestream Health

Diana L. Nole, President, Digital Medical Solutions

Healthcare is in store for its biggest transformation over the next few years. Between the evolution of technologies and laws, facilities are looking at a new age of patient care—one that is involves interaction, and is proactive thanks to the vast increases in patient data physicians have access to.

We created an eBook titled, From Trust to Use and Beyond: The Road to Clinical Decision Support to show how industry thought leaders are currently addressing or have addressed today’s IT issues

Information technology in healthcare is already playing a vital role in this change. Electronic medical data is moving past petabytes. Analytic tools and distributed platforms provide real-time access. The environment is ripe for this data to positively affect the quality of care provided to patients, but providers have hit a wall. Reporting has shifted to focus on the need to screen and manage the information flow to clinicians, while the value of information extends to what we make available to patients and how they can interact with their physicians about it.

The first chapter of From Trust to Use and Beyond: The Road to Clinical Decision Support focuses on fostering clinical trust via data. The chapter contains remarks from Maureen Gaffney, MHS, PA-C, RN, senior vice president patient care services and chief medical information officer, Winthrop-University Hospital, in Long Island, NY.

Gaffney explains how the facility achieved HIMSS Electronic Medical Record Adoption Model (EMRAM) Stage 6 recognition with a hybrid environment and is working its way to becoming entirely paperless.

We hope you find chapter one to be beneficial and please be on the lookout for chapter two, which will be released in the coming weeks and focus on overcoming clinical resistance to anything that changes the existing workflow.

Access and download the first chapter, “Building Trust,” in the eBook From Trust to use and Beyond: The Road to Clinical Decision Support.

Click the image to access the first chapter of the eBook, From Trust to Use and Beyond: The Road to Clinical Decision Support.

Click the image to access to eBook, From Trust to Use and Beyond: The Road to Clinical Decision Support.

Three Ways to Calm Patients’ Concerns about Patient Portal Security

Cristine Kao

Cristine Kao, Global Marketing Manager, Healthcare IT, Carestream

This story is all too common: another security breach leaking confidential patient information to the masses and another fine totaling in the millions—$4.8 million to be exact.

We found in our study conducted last year that security was the number one reason why participants said they would not use a patient portal. An event such as this security breach is exactly what prevents patients from being open to new technologies. While patient portal may provide benefits, whether it is secure or not is what keeps the patient from using it. HIPAA (Health Insurance Portability and Accountability Act) and HITECH (Health Information Technology for Economic and Clinical Health) are the two most important pieces of U.S. legislation related to patient privacy and information security. Facilities should not only be securing patient information for sake of compliance, but also to show patients that their data is safe, and easily accessible. Here are four ways organizations can work to calm concerns expressed by potential patient portal users:

  1. Educating patients about portal security. Similar to banking online, the key is to educate end users on
    MyVue Patient Portal

    Physicians should educate patients, not only on how to use patient portals, but also how the portals works and protects their information.

    how to protect their log-in information and password. Just as they would not provide someone their banking ID, so should they treat healthcare information the same. Additional education about how information is protected should also be presented to patients.This includes informing them about portal monitoring, but also telling them about security systems in place, such as multi-tiered firewalls, that protect access to the portal and track for intrusions.

  2. Educating patients on the value of a portal versus the conventional method. Compared to the alternative, which is film, paper or CD, which means if lost, that information is more accessible by someone else.While patient engagement is a requirement of Meaningful Use Stage 2, facilities cannot force a patient to use a portal. Keeping the sign-up process voluntary removes the sense of pressure and relieves anxiety felt by the patients when being forced into a situation.
  3. Being proactive with incident and response programs. The portal should be monitored proactively so that risks can be alleviated at a moment’s notice and patients can be informed in a timely manner of any issues of which they need to be aware. Assuring patients that the well-being and security of the portal is looked after 24/7/365 adds an additional level of confidence that can bring in a larger volume of portal users.

Security in the IT space is becoming increasingly complex every day, but that is not slowing down the transition to digital environments. This means that organizations must adapt accordingly, especially with security measures, or else they will continue to see large fines for violating HIPAA and HITECH practices.

What do you currently see as being the biggest barrier to patient portal adoption at your facility? Are security concerns often expressed by patients? If so, what are they and how do you alleviate those concerns?

The Breast Density Notification Train is A-Rollin’

Sean P. Reilly

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

What started with a chug and a whisper is growing in both momentum and volume. Can you hear that whistle blowing?

For years, mammography has been the breast cancer screening standard of care for women over 40 and, to its credit, has saved countless lives by detecting breast cancer early enough to provide life-saving treatment. Despite recent controversial studies that challenge the value of annual screening, or screening of women under 50, mammography has been, and will likely continue to be, the gold standard for breast cancer screening for years to come.

There is, however, a growing population of women, healthcare providers, and legislators who passionately believe mammography screening may not be the ideal solution for all women — particularly for those with dense breast tissue, where cancer is more difficult to detect.. Cancer is being missed and these women are paying a high, and sometimes the ultimate, price.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.

This image shows the difference between digital breast tomosynthesis (DBT) and traditional 2D mammogram technology.


The good news is there are several imaging modalities available today that may more effectively detect early-stage breast cancer in dense-breasted women, including magnetic resonance imaging (MRI), ultrasound or automated breast ultrasound (ABUS), molecular breast imaging (MBI) and breast tomosynthesis, to name a few. The bad news is, with these promising technologies come challenges, not the least of which is increased cost. Providers have been slow to adopt these modalities for initial (or adjunct) screening due to the upstart cost of obtaining the equipment, workflow, staffing and training issues, lack of reimbursement and other challenges. So women with dense breasts, or women with a history of breast cancer, are instructed to continue with annual mammograms—just like forty something-year-old women with no family history of breast cancer.

While providers and payers grapple with the possibilities and challenges of personalized breast screening for women (as this interview with Gary Levine, M.D., president, National Consortium of Breast Centers, demonstrates), there is a movement under way to inform women with dense breast tissue of their increased risk factors and screening options. Breast density advocates like Nancy Cappello, Ph.D., founder of Are You Dense, Inc., and JoAnn Pushkin, co-founder of D.E.N.S.E., have led the charge by increasing awareness in women who have, in turn, captured the attention of healthcare providers and lawmakers. Slowly but surely, it seems to be working. To date, 17 states (CT, TX, VA, NY, CA, HI, MD, TN, AL, NV, OR, NC, PA, NJ, AZ, MN, RI) have enacted mandatory density inform laws, six additional states (DE, KY, MA, MI, OH, and SC) have legislation pending and, in time, others will likely follow. Federal legislation is also in play. At the moment, over 50 percent of American women now live in states requiring some level of notification. The train has left the station and is gaining speed.

I’d sure hate to be the governor of the final state to sign off on breast density inform legislation—wouldn’t you?


Sean Reilly is healthcare brands group publisher (Imaging Technology News and Diagnostic and Interventional Cardiology) at Scranton Gillette Communications.

Who is the Winner of the Dose Debate?

Sean Ruck, editor-in-chief, DOTmed Healthcare Business News

Sean Ruck, editor-in-chief, DOTmed Healthcare Business News

Hospitals have a duty to treat patients, but in order to do so, they have to get them in the door. Even though we’ve entered an era of consolidation, there’s still enough competition out there for medical facilities to strive to differentiate themselves and to one-up their rivals. One way to do that is to tout the latest and greatest equipment. In ideal situations, the equipment they tout should be equipment that actually means something to the public. Low-dose CT fits that bill.

Although there were murmurings for some time about patient radiation dose and discussions about ways to lower dose for years, it wasn’t until 2010 when the New York Times broke a story about patients being exposed to excessive radiation from CT scans that the public really got involved in the discussion.

The infamous 2010 New York Times article about CT scans and radiation dose.

The infamous 2010 New York Times article about CT scans and radiation dose.

Since that time, the public outcry has increased as more instances of excessive dosing have come to light. After all, “excessive” and “radiation” are not two words that should ever go together. It has caused many to question any imaging that utilizes radiation and rightfully so. Even if some health care officials (certainly some in the hospitals initially reported on) have downplayed the seriousness of excess dose, it’s ultimately to the public’s benefit to keep dose to a minimum — at least in terms of physical health.

That begs the question: in what ways wouldn’t limiting dose benefit the public? Well, the new low-dose CTs aren’t free of course and someone has to foot the bill and hospitals need to turn a profit to stay in business. So if they’re not saving money somehow, they’re raising prices.

Who’s ultimately responsible for the increased demand in low-dose solutions? The way I see it, there are four players in the story. First, there is the press that informed the public about dose and in a way that was hard to ignore — the story’s intro described one patient’s hair loss and offered images of other patients who lost hair due to excessive dose.

The second and third parties are the public and health care providers. The public of course demanded answers and many readily questioned their health care providers when it came time for an imaging procedure. Hospitals listened to patients and, the fourth party, manufacturers, listened to the hospitals.

I believe in this case, it was a trickle-up effect.  But the winners and losers don’t follow the same line. Manufacturers stand to win big because they’re not spending insane amounts of money to create some new modality to fit a need. They’re improving existing technology, so the hoops they have to jump through are easier to deal with. Patients come in second — costs may be passed on to them, but in theory, they should end up healthier. Finally, the hospitals probably make out the worst. Some with funds to quickly shift to the lower-dose solutions might do alright from an advertising standpoint, but eventually their competition will catch up and the benefit will be nullified. And of course the press did well — four years later and we’re still talking about the story.

Guess the X-ray–June’s Image Challenge

Happy June! A new month means a new Image Challenge.

Last month we had another difficult image–eye makeup–but congratulations to the person who guessed it correctly. Below is the image for June’s “Guess the X-ray”. Please leave your comments below or on our Facebook page. The challenge will run until June 30, or until the first person correctly names the item in the image.  Good luck!

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

June Guess the X-ray Challenge