White Paper: Does Image Quality Matter?

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

Dr. Ralph Schaetzing, Manager, Strategic Standards & Regulatory Affairs, Carestream

The answer to the title question may not be what you think it is. It depends critically on clear definitions of numerous technological and human factors that influence the image during its journey along the imaging chain.

The white paper covers several key topics along this journey

  • The three different “flavors” of image quality—objective, subjective, and performance-based—and their interrelationships
  • Where image quality is created and/or destroyed in the radiographic image chain
  • The role of medical image processing in determining image quality of a displayed image
  • The quantitative characterization of reader error in radiology

The white paper is embedded below and can be downloaded when visiting this page. You can also view a recording of a webinar I hosted that sought to answer the same question.

Image quality is a tool. It can be used, for example, to trade-off against dose, or to improve diagnostic confidence. But, it must be balanced against the natural limitations of the human observer at the end of the imaging chain. Higher image quality does not necessarily produce better performance. So, while high image quality is a desirable goal, it should not become a goal in itself.

Radiology and Macro Healthcare Trends Part I: Access to Care

Access ti healthcare via mobile devices

Mobile devices are important technologies that are improving access to healthcare for patients.

Access to quality care is a popular trend that shows no sign of fading. The Affordable Healthcare Act, the millions still unable to obtain quality care and rapid changes in healthcare technology lead to heated discussions.

For high-quality care to be accessible, facilities must be able to provide the services that meet the population’s need and expectations. Rationing, the integration of radiology and the use of teleradiology in the delivery continuum all have an impact on access.


With the rise in self-rationing and changes in insurer-rationing, imaging’s role is more important than ever.  Imaging is a key data input to the evaluation of patients’ needs and, ultimately, treatment.  Radiologists need a voice in the process and find ways to be included in communication with physicians.

This is where the Integration in the delivery continuum comes into play.

For radiologists to have a more present, active role in diagnoses and treatment facilities must ensure that they are included.

New technology is working to address this while helping to put patients more in direct communication with their healthcare providers. For example, online patient portals have proven to be effective by health facilities that use them, and radiology is becoming integrated into the information accessible via these patient portals.

Patient portals that include radiologic information significant potential to:

  • Provide patients with a more holistic view of their medical histories, thereby meeting expectations in access to personal healthcare information, and
  • Integrate radiology into the delivery continuum by including the images and analyses within the rest of the patients’ histories.


This technology facilitates the delivery of images from one location to another.  This includes the transmission, reception and then review of the images.  When done right, teleradiology is a key aspect of access as it can speed the diagnostic process and support better patient communication.

Teleradiology, in particular, is one trend that can be seen across the globe.  It has transformed healthcare delivery through a cost-effective and flexible online platform.  Success stories on the implementation of teleradiology in India, Australia and Europe are easy to find.  In fact, Carestream, in March of this  year, highlighted ESR’s report on best practices in teleradiology and Aunt Minnie reported on how Russia views teleradiology as a bridge-builder in healthcare.

What do you think? Are you seeing radiology become an integrated, vital component of healthcare delivery? If not, what are the major roadblocks stand in its way?

In part two of this series, we will focus the costs of healthcare, and how radiology can change cost for the better.

Carestream CMONorman Yung is the CMO for Carestream. His series about macro trends in healthcare will be published in three parts throughout 2014. Parts II and III being published in October and November.



Access, Cost and Quality: Macro Trends in Healthcare

Technological evolution, government legislation and industry regulations continually change the ability of our industry to provide the best, most affordable care to patients.

Today’s patient expectations are that they will get high quality care, be able to choose from health care providers and get care at a reasonable price.  In addition to reasonable healthcare costs, patients also expect that there will be transparency so that they are fully aware of their investment.

TrendsThe expectations do not, however, match the reality of healthcare today.   In the radiology sector, however, there are a number of things happening that address these expectations in a positive way.  In a 3-part blog series, we will take a look at what’s being done and how important radiology’s role plays in today’s changing healthcare landscape.

Blog #1 will focus on access. Access goes well beyond seeing practitioners that are in your neighborhood.  It includes accessing your own healthcare data.  How patient data is captured and shared is becoming more integrated into the healthcare process and, therefore, working to address access concerns.

Blog #2 will focus on cost. At a time when 23% of U.S. adults either had problems paying medical bills or were unable to pay them, cost is top of mind for patients and practitioners.  Imaging costs now vary widely and, money spent on imaging has correlated to a reduction in hospital stays. Data show that radiology is very important to streamlining healthcare costs.

Finally, blog #3 will focus on quality. New regulations, controlled costs for facilities and patients, and technological innovations have given healthcare providers the ability to more easily provide patients a high-quality level of care. Particularly in radiology, we see significant advances in the products and software that support the capture and delivery of images.

Use our sign up box to receive the blog posts in your inbox or come back tomorrow for Part I of this series when we will look at how radiology’s role improves access to healthcare.

Carestream CMONorman Yung is the CMO for Carestream. His series about macro trends in healthcare will be published in three parts throughout the rest of 2014. Part I will be posted tomorrow, with Part II and III being published in October and November.

Two Heads are Better than One in Radiology Informatics

While attending this year’s NYMIIS conference in New York City—an annual radiology informatics gathering hosted by Dr. David Hirschorn that has easily become a must see event—I was awed by the refreshing insight displayed by the distinguished lineup of presenters.

Each of the speakers discussed realistic and achievable opportunities to harness the power of healthcare IT systems to increase access to care, lower costs, shorten wait times and improve the delivery of care—all while highlighting that it cannot be done alone. Dr. Kathy Andriole of Brigham and Women’s Hospital summed it up in near perfect form in her presentation on improving decision support through innovative use of information technologies by saying that partnering with a vendor is more “than just doing business, it is about how to make optimal use of resources.”

Dr. Eliot Siegel, Baltimore VA

Dr. Eliot Siegel, Baltimore VA, giving his talk at Nymiis 2014 titled, “How Big Data is Changing the Practice of Radiology.”

Upon hearing that simple yet exacting description of what it really means for technology companies and care providers to truly work together, I was reminded of the phrase “What we’ve got here is failure to communicate” from the 1967 film Cool Hand Luke, spoken by Paul Newman in the role of Luke Jackson. Far too often we have all heard the words “partner” and “partnership” tossed about like rice at a young couple’s wedding. These terms are often taken to mean: “We’ll sell you something at a discounted price and you guys send us our check on time and let’s keep in touch…” A true partnership formed around a common cause and committed to the success of both parties is much deeper and significantly more valuable than such a simplistic treatment implies.

Having a reliable and trusted technology partner that will guide your organization on what is often a complex, multi-year journey to improve the management of medical imaging and information is a critically important relationship. A true technology partner will invest the time necessary to understand the unique needs and challenges faced by IT staffs, radiology managers, physicians and other decision-makers and can be counted on to make the right decisions. This enables the partner to put their knowledge and expertise to work to develop the right healthcare IT systems for your organization, using a well-structured implementation plan that optimizes precious resources while making things better for both the medical staff and their patients.

Healthcare IT innovations have made dramatic improvements in the practice of radiology and have heightened the value that radiology professionals provide to referring physicians and specialists that lead to a better experience for patients. But there is still much more to be done. Do you have the right partner for the journey?

What is your organization doing to harness the benefits that new information technologies can provide? How have you benefited from a successful supplier partnership?

Robert SalmonRobert Salmon, APR,  is director of corporate communications for Carestream, and attended the NYMIIS 2014 event in New York City on September 18, 2014.



[eBook] The Three-Phase Process to Implement a PACS-Driven Teleradiology Service

A PACS-driven workflow has proven to be beneficial in offering teleradiology services, while still allowing referrers to use the HIS/RIS they prefer.

The story of Innovative Radiology is a common one experienced in the diagnostic imaging sector. The organization was experiencing an increasingly busy workload serving over 40 Houston-based hospitals, physicians’ offices, clinics, and imaging centers, which totaled about 300,000 procedures per year.

For about 10 years, Innovative Radiology was linked electronically to referring physicians through a single RIS to create multiple registration centers. Physicians had to manually register patients in the RIS and workflow was guided by it since the images and patient information went right to the radiologist. This was arduous and required an immense amount of coordination and system integration. On a given day, thousands of images would be sent to the organization from dozens of different systems. Since reporting was not integrated, the radiologists would have to log on to the RIS, select the study, then log on to the PACS to read the cases.

It was the adoption of Meaningful Use that forced Innovative Radiology to move away from its RIS and look for a PACS-driven system. By accomplishing this, the organization now has options—a referrer can still communicate with Innovative Radiology with its HIS/RIS, but it is no longer mandatory.

On-site or cloud-based teleradiology can provide effective patient care.

An on-site or cloud-based teleradiology system can connect radiologists to reports, images, and patient history to provide efficient and effective care.

To implement the PACS-driven teleradiology system and services, Innovative Radiology needed to partner with Carestream to go through a three-phase transition process, which is outlined in the eBook, “Increased Capabilities: Do More with Vue for Teleradiology”:

Transition Phase #1: Innovative Radiology’s use of teleradiology began August 4, 2013. Phase 1 lasted two weeks during which two radiologists at Innovative Radiology were connected with two low-volume sites. About 40 studies from up to seven referring physicians were read daily. All involved digital radiography (DR). Report request order entries were created at Houston Medical Imaging (HMI) using Carestream’s Vue Motion. Report distribution was by fax. There was no email distribution and neither billing nor interface with the Houston healthcare information exchange (HIE) was possible.

Transition Phase #2: Continuing for two weeks, there was a leap forward in both study volume and sophistication. About 25 studies, including DR, PET, CT and ultrasound, were interpreted daily by three radiologists at Innovative Radiology. Studies were referred by 16 physicians from a single site, Oncology Consultants. Report request order entries using Vue Motion were created at the client site. Emails notified referring physicians that results were available via fax and Vue Motion. Billing and HIE HL7 interfaces were established.

Transition Phase #3: During this phase, the network was expanded to include about 30 client sites, including HMI and other large imaging centers. Within one week, 14 radiologists at Innovative Radiology were filing between 300 and 400 DR, PET, CT, ultrasound, MRI and nuclear medicine reports. Any of up to 2,000 physicians were referring studies for interpretation.

Today, Innovative Radiology uses a teleradiology solution that allows for an increase in study volume, workflow, and overall productivity. In early 2014, more than 40 sites were connected to Innovative Radiology via the teleradiology offering from Carestream.

For more information about Innovative Radiology’s story, and Carestream’s Vue for Teleradiology service, you can download this eBook, “Increased Capabilities: Do More with Vue for Teleradiology.”

What do you think about teleradiology? How is it improving care for the patients while also benefiting the providers that offer it? Did you experience roadblocks when implementing a teleradiology service? If so, what were they and how did you overcome them?

Kiran Krishnamurthy, Worldwide Product Line Manager, HCIS, CarestreamKiran Krishnamurthy is the Worldwide Product Line Manager for Carestream’s HCIS business.


[Video] Replacing Analog to Allow for DRX-1 Detector Sharing

Karen Swanson, R.T. (R) (M), Director of Medical Imaging, at Platte Valley Medical Center in Brighton, CO, shares her feedback about wireless detector sharing at her facility and the CARESTREAM DRX-Revolution.

The medical center replaced three analog portables with two DRX-Revolution Mobile X-Ray Systems. They share the DRX-1 detector between the portables and the RF room – making the best use of the most expensive piece of the system at peak times.

Cost Control and Efficiencies for Medical Film Usage

The Spanish translation for this post can be found after the English version of this post. / La traducción al español de este post se puede encontrar después de la versión en Inglés de este post.

There are numerous variables that go into effectively managing the use of medical film in an imaging organization. Along with film usage, managers must also be able to track inventory, billing, and procurement. All of these factors added together can make for a hectic environment if not properly organized.

The following four steps can assist you in effectively managing your film usage.

  1. Managing Director Gregorio Mayor

    Managing Director Gregorio Mayor using Carestream’s Managed Print Solutions.

    Assess current technologies: What does your organization require from its equipment? Investigating and addressing the facility needs allow for facilities to appropriately address current issues and prevent futures one from forming.

  2. Tie the monitoring and tracking to usage: The ability to track and monitor the usage of film and cost per print becomes attainable by attaching film printers to the appropriate software. Tracking the information allows for more efficient budgetary decisions to be made.
  3. Ensure information and data is available in a single location: Using a technology that tracks and monitors many different factors needs to reside in one location. With no capital investment, lower administrative costs, reduced operational costs, and simpler budget planning, facilities can efficiently obtain the data and prevent staff from searching for it in multiple areas.
  4. Optimize workflow and billing according to data trends: The data must be analyzed once it is collected if facilities are to experience improved budget planning and potential cost savings. From the collected data, facilities could reduce time spent on placing purchase orders and tracking shipments, delivery and purchasing fees, writing and mailing checks, and reconcile invoices. From the technological data, additional savings opportunities exist in the form inventory management costs, replacement costs of printers, and film stock outs. All of this is dependent on how the data is collected and analyzed.

 As our healthcare systems evolve, data and reporting is becoming a more integral part of the decision-making process. It is our duty to ensure that we are using the available data to the best of our ability, because the key to running an effective, well-operated department is transparency, and access to data can provide it. By aligning the right hardware with the right services, facility managers will be able get the most cost-effective use out of their equipment without compromising image quality and patient care.

For more information about managing your medical film, inventory, costs, and billing, you can visit Carestream’s Managed Print Solutions site at carestream.com/mps.

Joaquim Franch, Carestream Territory ManagerAuthor, Mr. Joaquim Franch, works for Carestream Health and is the Iberia MFAPS Territory Manager.  He lives in the Barcelona, Spain area and has deep experience in film.



Eficacia y control de gastos en el uso de la película médica

En una clínica médica hay numerosas variables que afectan a una buena  gestión  en la utilización  de la película radiológica. Además del uso de la película, los gerentes también deben ser capaces de realizar el inventario, llevar el control de la facturación, y  el seguimiento  de los pedidos.

Todos estos factores  pueden crear un entorno estresante y poco propenso para una buena organización.

Con el sistema de impresión Managed Print Solutions de Carestream los siguientes cuatro pasos le  ayudaran  para que la  gestión sea eficaz.

  1. Director General Gregorio Mayor

    Director General Gregorio Mayor utilizando soluciones de impresión gestionados de Carestream.

    Evaluar las tecnologías actuales. ¿Que hace su equipo por su organización? Hay que investigar y saber que necesitamos en nuestras instalaciones para abordar los problemas actuales y prevenir los problemas futuros.

  2. Relacionar la observación con la utilización: con el software adecuado se tiene la capacidad de medir y supervisar el consumo de la película y saber el coste por impresión. La información permite tomar decisiones económicas  más eficientes
  3.  Asegurar que la información y los datos están disponibles en un solo lugar: La utilización de la tecnología que mide  y supervisa varios factores diferentes tiene que almacenarse en un solo lugar. Con el servicio de MPS no es necesaria la inversión de capital previo, con  costes administrativos menores y operativos reducidos, permite una planificación sencilla del presupuesto, facilitando los datos al personal de una manera eficaz, sin tener que buscar en diferentes lugares
  4. Optimizar el proceso del trabajo y  la facturación de acuerdo con las tendencias de datos: Las cargas de trabajo deben ser analizadas para ver si el uso de las instalaciones se maximiza, para obtener mayor rendimiento del presupuesto y ahorrar en costes. A partir de los datos recogidos, el personal de la clínica podría reducir el tiempo dedicado a la tramitación  de órdenes de compra ,  ahorrar en el seguimiento de los envíos, la recepción ,  en gastos de compra y pagos; facilitándose la contabilización. A partir de los datos electrónicos, existen  formas de tener oportunidades adicionales de ahorro de gastos de gestión de inventario, también  los costes de sustitución de impresoras, y en las rupturas de stock de pedidos. Todo esto depende de cómo se recopila y se analizan los datos.

A medida que  nuestros sistemas sanitarios evolucionan, los datos y la presentación de informes se está convirtiendo en una parte esencial del proceso en la  toma de decisiones. Es nuestro deber garantizar que estamos utilizando los datos disponibles en la medida de nuestras posibilidades, porque la clave para gestionar un departamento eficaz, es la transparencia, y el acceso a los datos. Al dimensionar y establecer el hardware adecuado, con los servicios necesarios, los directivos de las clínicas podrán conseguir un uso más rentable de su equipamiento sin poner en peligro  la calidad de imagen,  ni la atención al paciente.

Para obtener más información acerca de la gestión de su película médica, el inventario, los costes y la facturación, puede visitar el sitio Soluciones Managed Print de Carestream en carestream.com/mps.

Joaquim Franch, Carestream Territory ManagerAutor, el Sr. Joaquim Franch, trabaja para Carestream Health y es el Gerente de Territorio Iberia MFAPS. Él vive en el área de Barcelona España y tiene una amplia experiencia en el cine.



[Q&A] Chiropractic and Diagnostic Imaging: Evolving Trends

Dr. Chad Warshal, NYCCDr. Chad Warshal is a Doctor of Chiropractic and Diplomate of the American Chiropractic Board of Radiology and teaches as an Associate Professor at New York Chiropractic College where he also serves as the Director in Diagnostic Imaging Residency. We sat down with him for our most recent edition of an Inside Look magazine to hear his views on the current role of diagnostic imaging within the Chiropractic field.

1. Let’s start by asking you about the continuing focus on evidence-based practice guidelines. Do you see this having an effect on the use of diagnostic imaging by chiropractors to aid in clinical decision-making?

The continued evolution of evidence-based practice has had a significant effect on the use of imaging procedures in chiropractic. With most research demonstrating the limited utility of conventional radiography in spinal pain patients, I’ve seen a general decrease in taking radiographs, as well as fewer requests for advanced imaging modalities. The positive side of this is that with greater use of ‘red flag’ based guidelines, there are fewer ‘normal’ studies. I’ve found that using clinical decision tools has resulted in more studies with findings that affect the prognosis or management of the patient.

2. Chiropractors have several ways they can integrate imaging into their care plans – including referring the patient to an imaging center or offering onsite exams. Do you expect to see more practices bringing imaging in-house?

The trend demonstrated by the NBCE Practice Analysis shows a shift toward fewer chiropractors that own radiographic equipment in favor of referring patients to imaging centers. There are multiple reasons for this shift, such as the ability to refer to an imaging center for high-quality imaging, digital access to imaging via online portals, and the professional interpretation of a radiologist. Other reasons include the overhead costs of in-house imaging, the increasingly stringent quality-assurance/quality-control procedures required and decreasing reimbursements.

3. Many practices that offer onsite imaging use film. What advantages does digital imaging bring to practices?

Having worked in radiology when film was the only option, it’s easy to sing the praises of digital radiographs over film. With film, the only options you have for changing how it looks after the exposure is to use a brighter viewbox or a hot light. Of all the benefits of digital, I believe the greatest is the ability to manipulate the contrast and brightness of the images. Add to that the decrease in patient radiation exposure due to retakes, space savings from records storage, and the long-term cost savings of digital over film, and it makes the conversion to digital a fantastic choice.

Quote from Dr. Chad Warshal, NYCC4. Do chiropractors tend to read their own X-rays, or are the images sent to a radiologist and a report provided to the chiropractor?

The answer to that question is twofold. First, chiropractors receive intensive education in the interpretation of musculoskeletal radiographs. Because of that education, there is a certain degree of comfort in reading their own studies. However, one of the important points stressed in chiropractic education is the use of specialists. I had a diagnostic-imaging consultation practice before moving to academia, and I still maintain an imaging-consultation practice with New York Chiropractic College. I’ve noticed there are two major patterns when chiropractors refer studies for interpretation.

The first (and most common situation) is doctors of chiropractic who read their own films, but refer the problem cases or those with questionable findings to the radiologist for interpretation. The second scenario involves doctors who prefer to have all their imaging read by radiologists. This tends to be seen more with large medical-legal practices.

 5. There’s a perception that when an X-ray exam is needed, it’s usually best to have the exam interpreted by a radiologist and then have the report made available to your chiropractor. How has digital technology changed this?

Digital technology has made professional interpretation simple and convenient in a way that was unimaginable with analog film. If a field practitioner wants an interpretation on film-based images, the films have to be delivered or shipped to the radiologist, leading to a substantial lag in diagnostic evaluation. And there’s always the concern of films being lost or damaged in the mail. With the continued expansion of digital imaging, this allows essentially one-button pushing of images to a radiologist, even allowing reads from 3,000 miles away, two minutes after the images are taken. The interpretation is quick, there’s no chances of lost studies in the mail, and there are cost saving – not only in terms of postage, but also in terms of less staff time packaging and refilling films.

6. You head the radiology residency at New York Chiropractic College. Are you seeing interest grow in chiropractic imaging? What’s driving your students to choose this path?

Chiropractors have always had a strong interest in imaging. Over the years, that has evolved along with radiology, as we discover more about what imaging is – and is not – good for. The people who enter the postgraduate diagnostic imaging residency programs are those who have a strong academic talent, a good eye for interpretation, and have discovered a passion about the diagnostic aspect of health care.

Guess The X-Ray – September’s Image Challenge

Happy September everybody! Time for a new Image Challenge. Last month we had a clock radio, and we think we have another good image for September.

This month’s image is below; please leave your guesses below or on our Facebook page. The challenge will run until September 30, or until the first person correctly names the image. Good luck!


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

September Image Challenge