RSNA 2015: Radiology & Innovation Must Go Hand in Hand

RSNA 2015RSNA 2015 officially kicked off yesterday, and as usual, brought with it a first day full of inspiration and a call-to-action for the radiology community.

RSNA President Ronald L. Arenson, M.D., gave the opening keynote and provided a “State of the Union” for radiology. He explained how the specialty is in a time of challenge and change, with this comes the time for opportunity. The major challenges that Dr. Arenson highlighted include the growing demand for personalized medicine, healthcare payer expectations, massive expansion of data, integrated healthcare delivery, the growth of telehealth, and an aging population.

After going through radiology’s challenges, he segued into explaining how radiology has often been at the forefront of innovation in healthcare. He highlighted the initiative Integrating the Healthcare Enterprise (IHE), which included radiology working to maximize the impact of the DICOM standard, and how during that time radiology also made giant steps in reducing dose delivered to patients in exams.

Ronald L. Arenson, M.D., FACR, is president of the Radiological Society of North America (RSNA).

Ronald L. Arenson, M.D., FACR, is president of the Radiological Society of North America (RSNA).

To close out his talk, Dr. Arenson encouraged attendees to become agents of change in their organizations by becoming adapters of technology and becoming more patient-centric.

Continuing the trend of innovation in radiology, Darrell G. Kirch, M.D., president and chief executive officer of the Association of American Medical Colleges (AAMC) in Washington, D.C., gave a talk on how vital innovative leadership is in the transformative age of  healthcare.

In his talk, Dr. Kirch highlighted the importance of collaboration and team building, not just in radiology, but within the healthcare enterprise. As has been a common topic, he also highlighted to role physicians play in being able to provide quality healthcare to a wider population at a reasonable cost. To make this a reality, Dr. Kirch said physicians must move beyond the old school mentality, which involves physicians focused on individualism and competition. In order to move beyond this outdated way of thinking, radiologists and health providers must take the lead in developing and implementing cutting edge technology.

As we continue throughout RSNA 2015, we will be sure to see more presentations and posters given that highlight innovation in radiology. The opening sessions from Sunday set the stage for an exciting week.

Video: Testing the New DRX Plus Detectors

The road to superb durability, reliability, and image quality can be a little bumpy. That is why we do extreme testing with our DRX Plus detectors to ensure that they are durable and able to provide reliable quality in the healthcare environment.

Checks such as the Bump Test, Vibration Test, Load Test, Humidity Test, Drop Test, and Water Resistance Test put the DRX Plus detectors in the most intense conditions. You can watch the video below for more details and see the tests in action.

Diagnostic Reading #53: Five Must-Read Articles From the Past Week

Carestream LogoTime for another issue of Diagnostic Reading! This week we have included articles about using ultrasound for pediatric intussusception, big data, telehealth biggest roadbock, cloud security, and EMR adoption.

Skip Abdominal X-ray for Pediatric Intussusception – AuntMinnie

According to a new study published in the journal Pediatric Surgery International, there’s no need to use abdominal radiography to diagnose pediatric intussusception — ultrasound is better, and it does not expose children to radiation. Over the past three decades, ultrasound has been shown to perform better than abdominal x-ray, with a sensitivity rate of nearly 100% and a false-negative rate of less than 1%.

Big Data ‘Long-Way’ From Being Harnessed for Population Health – Healthcare IT News

As they look to population health management, nearly two-thirds of hospitals and healthcare systems and have adopted remote patient monitoring and analytics into their care processes, but there’s a long journey ahead before many get their strategies down. Physicians often lack the training to account for the right ways to access data. But they’re headed in the right direction. The results of a Spyglass study revealed 84 percent of providers are investing in remote patient monitoring solutions to support patients after hospital discharge, with 79 percent of providers using analytics and big data to support population health.

Telehealth’s Biggest Roadblock: Physician Reimbursement – Healthcare IT News

Arguably one of the largest roadblocks to full telehealth implementation is the lack of standardized payment methods. Physicians want to be reimbursed for their time, just as they would in a traditional office visit. The results of a survey conducted by Anthem and the American Academy of Family Physicians’ Robert Graham Center revealed 9 out of 10 physicians would use telehealth, if they were properly reimbursed.

Cloud Forward: CIOs Overcome IT Security Concerns – Healthcare Informatics

The widespread adoption of health information technology by patient care organizations in the past 10 years has been transformative to the healthcare industry. In 2008, only 9 percent of hospitals in the U.S. had a basic electronic health record (EHR) systems; by 2014, that had increased eight-fold with 76 percent of hospitals using a basic EHR system and 97 percent utilizing certified EHR technology, according to figures from the Office of the National Coordinator for Health Information Technology (ONC) and the American Hospital Association. With this surge in digitized patient data comes the challenge, for hospitals and health systems, to efficiently and cost effectively store and manage that data.

KLAS: Global EMR Adoption Rates Continue to Grow – Healthcare Informatics

Providers around the globe are continuing to adopt electronic medical record (EMR) technology at a rapid rate, with Cerner and InterSystems standing out as the top-performing fully rated multiregional vendors, according to a new report from Orem, Utah-based KLAS Research. The report, “Global EMR Performance 2015,” highlights vendor performance by region, and shows that Epic performs best in large organizations across the globe, with providers citing strong implementations, functionality and support. What’s more, provider surveys and commentary show that Cerner performs very well in Europe and the Middle East, while InterSystems performs well in Asia/Oceania and the Middle East.

Carestream Content to be Presented in Four Scientific Sessions at RSNA 2015

RSNA 2015The RSNA annual meeting brings about excitement each year as we get to learn about the latest research, advancements, and trends happening in medical imaging.

Carestream will participate in four scientific sessions at RSNA 2015. Each one will showcase research conducted in collaboration with some of the top medical institutions in North America. These include Johns Hopkins University, Penn State’s Milton S. Hershey Medical Center, University of Michigan’s Medical School, and Toronto General Hospital.

The details for each presentation are provided below:

  • Scientists from Johns Hopkins University School of Medicine and Carestream will present a paper entitled “Development of a Dedicated Cone-Beam CT System for Imaging of Intracranial Hemorrhage,” on Wednesday, Dec. 2, from 11:00-11:10 am (Room S403B). This paper reports that a CBCT head scanner designed according to task-based performance optimization and physical experimentation exhibited image quality suitable for detecting intracranial hemorrhages. A scanner prototype is being developed for use in clinical studies.
  • Lynn La Pietra from Carestream is presenting a scientific poster entitled “Pediatric Fracture Detection Study: A Task-Based Observer Study Evaluating Enhanced Image Presentation and Potential Dose Reduction,” on Thursday, Dec. 3, from 12:15-12:45 pm in Learning Center, Hall D. This work was conducted in collaboration with researchers from the Penn State Milton S. Hershey Medical Center. This poster describes use of digital radiography (DR) to capture diagnostic-quality pediatric images using exposures that can be equivalent to 720 film-screen exposures. Enhanced image processing may be used to mitigate noise and improve the visibility of bone disruptions in these images.
  • Scientists from University of Michigan Medical School and Carestream will present a scientific poster entitled “The Complementary Roles of Computer-Aided Diagnosis and Quantitative Image Analysis: Similarities and Differences in Assessment, Quality Assurance and Training.” Attendees can meet with researchers to discuss the poster from 12:15-1:15 p.m. on Monday, Nov. 30, Tuesday, Dec. 1, and Wednesday, Dec. 2 in Learning Center, Hall D. This poster reviews the methods discussed by the Computer Aided Detection in Diagnostic Imaging Subcommittee (CADSC) for assessment, quality assurance, and user training in CAD and highlights parallels and distinctions between CAD and Quantitative Image Analysis.
  • Scientists from Toronto General Hospital and Carestream created a scientific poster entitled “Dual-Energy Imaging and Digital Tomosynthesis: Innovative X-ray Based Imaging Technologies for Rapid and Accurate Diagnosis of Thoracic Disease in Critically Ill Patients.” The poster reviews recent advances in dual-energy imaging and digital tomosynthesis and discusses how a system with both technologies could deliver advanced options for chest imaging. It will be displayed on monitors in Learning Center, Hall D.

You can visit Carestream RSNA website to learn more information about us at the meeting, and we look forward to seeing you in Chicago!

David Foos, Director, Research & Innovation, CarestreamDavid Foos, Director, Research & Innovation, Carestream



eBook: Radiology as an Enterprise Model for Collaboration

Collaboration has become a key component of today’s healthcare system. Department silos are breaking down and fading away, and from the rubble is born multidisciplinary teams with a focus on interoperability across departments.

Meaningful Use (MU) has served as a great incentive to make patient information universally available to clinicians through the EHR, but too often the collaborative benefits of the technology fail to become available to the “-ologies” in the health system.

But there are examples of successful collaboration delivering real benefits to the medical community and patients.  One of the best is the University of Virginia (UVA), where the EHR-driven radiology workflow not only provides full clinical information to radiologists, but the collaborative workflow adopted by UVA has also helped the UVA Physicians’ Group attest to MU Stage 1 and receive nearly $1.5 million.

Cree Gaskin, MD, Vice Chair, Informatics at UVA outlines their process in a recent chapter of our CIO eBook. The key to this EHR-driven radiology workflow was the life-cycle of the PACS. Specifically, the fact that it has reached a maturity level that is the third and final phase of the evolution, as seen in Dr. Gaskin’s graphic below.

EHR-driven radiology workflow

This third stage involves the PACS becoming integrated and interoperable with the EHR. This allows workflow to become optimized, and images and reports to become accessible via the EHR. From this, collaboration among clinicians and other stakeholders is supported in full and information can be accessed immediately. This ongoing gathering of data informs clinical decision support and big data analysis.

From within the EHR, the radiologist can identify what would be useful, depending on the case. That information can then be served up to radiologists so they do not have to spend time searching for it. If the information is identified in advance, then it can be made accessible, as almost all of the necessary data is housed in UVA’s EHR.

The key is to establish an EHR-driven workflow, as demonstrated here in Dr. Gaskin’s graphic.

EHR-driven workflow

How it works at UVA is that one central login at a workstation allows access to:

  • Protocoling
  • Reading Studies
  • Chart reviews/search
  • MU
  • Teaching file
  • Tech work lists
  • Manager referrals
  • Audit trail
  • Report creation and signing
  • MD performance metrics
  • Administrative reports
  • Peer review (prior while reading)
  • Charting—orders, notes
  • “Watch patients; results tracking
  • Communication with providers

The interoperability between UVA’s Epic EHR and Carestream PACS permits the EHR-driven workflow or the EHR-enslaved workflow which is PACS-driven. In the PACS-driven workflow, the doctor selects a study from the PACS integrated worklist, and the corresponding patient record will be opened in Epic.

UVA reports that the results of such capability have included improved report turnaround time (RTAT), and more important, with stratification by level of priority, and nearly $1.5 million MU Stage 1 incentives for the UVA Physicians’ Group.

For a more detailed look at UVA’s story, you can read the interactive eBook, “Clinical Workflow in an Era of Interoperability,” which contains interviews and soundbites from Dr. Gaskin, as well as Dan O’Malley, MS, UVA’s director, informatics and business services.

Julia, Weidman, Marketing Manager, Healthcare Information Solutions, CarestreamJulia Weidman is the Healthcare Information Solutions Marketing Manager for the US and Canada at Carestream.


Diagnostic Reading #52: Five Must-Read Articles From the Past Week

Carestream LogoAnother week means another issue of Diagnostic Reading. This week we share articles about DBT cutting recall rates, Yelp revealing patient opinions on imaging services, patient data breaches, mobile health, and EHR adoption.

DBT Cuts Recall Rate in Women with No Prior Mammograms – AuntMinnie

Digital breast tomosynthesis (DBT) cuts the number of recalls in a subset of women vulnerable to higher recall rates: those who have never had a prior mammogram, according to a new study in the November issue of theAmerican Journal of Roentgenology. Baseline mammography studies tend to have significantly higher recall rates than those with available comparisons, so using DBT in this population could be a way to maximize the technology’s benefits. Matching DBT’s strengths to specific patient populations is a crucial “best practice” skill in an environment of decreasing reimbursement and limited resources for implementing new technologies.

Yelp Reveals What Patients Value About Imaging Services – AuntMinnie

The online consumer ratings website isn’t just for restaurant reviews: Patients are using it to grade their imaging center experiences, according to a study published online in the Journal of the American College of Radiology. It turns out patients are most focused on service-related factors such as how long they had to wait and whether the receptionist was friendly, rather than issues such as the quality of equipment or the education and training of radiologists.

Patient Data Breaches Widespread, Beyond Healthcare – Healthcare IT News

Some 392 million health records have been accessed in 1,931 protected health information breaches across a staggering 90 percent of industries, according to preliminary findings from a new Verizon report. These industries, across 25 countries, have seen health insurance information, personnel files or other data outside of traditional healthcare settings or industries stolen, the study shows.

Mobile Health: A Largely Untapped Market for Healthcare – Healthcare IT News

A recent study published by the Journal of Medical Internet Research and designed by New York University revealed the consumer perspective of health app use in the U.S. Consumers want health apps to do more for their lives, to “more accurately communicate and monitor their health.” But product sophistication and an accurate understanding of consumer profiles limit capability. More than half of mobile users have downloaded mobile health apps, with the majority seeking fitness and nutrition goals. However, while mobile health app usage is extensive throughout the population and increasing in popularity, there are a vast number of people not engaged. Even more stop using them.

Research: Hospital EHR Adoption Increases, but Challenges Continue – Healthcare Informatics

While electronic health record (EHR) adoption has increased steadily in U.S. hospitals since 2010, challenges—such as getting small and rural hospitals to adopt the technology—do remain, according to new research published in Health Affairs. The research team, led by Julia Adler-Milstein, Ph.D., from the University of Michigan, looked at 2008–14 national data, which includes the most recently available, to examine hospital EHR trends. They found large gains in adoption, with 75 percent of U.S. hospitals now having adopted at least a basic EHR system—up from 59 percent in 2013.


IDoR: Paediatric Imaging a Bright Spot in Advancing Radiology

IDOR Image

In addition to special lectures and courses being held to mark the
International Day of Radiology, hospitals and radiology departments all across the world held open days and special events to make the public more aware of radiology.

Re-posted from Diagnostic Imaging (DI) Europe with permission.

Timed to coincide with the date (8th November) of the discovery of X-rays by Wilhelm Röntgen in 1895, the International day of radiology (IDoR) has now evolved into an annual event of “action and awareness” organized by the main radiological professional societies, such as RSNA, ACR and the ECR, as well as an umbrella radiology organizations on all continents. Thus, throughout the world all sorts of events were organized with the stated objective of “building greater awareness of the value that radiology contributes to safe patient care, and improving understanding of the vital role radiologists play in the healthcare continuum”.

There is no doubting the validity of such a laudable intention, but now in the fourth annual celebration of IDoR (the first was launched amid much pomp in 2012) the real question remains whether the IDoR is actually achieving its objective. Even more practically, just exactly how do you measure whether actions to “alert the world to the stunning medical, scientific and even artistic possibilities of medical imaging, the essential role of the radiologist as a part of the healthcare team in countless medical scenarios, and the high educational and professional standards required of all staff working in medical imaging” are actually succeeding?

It goes without saying (but is nevertheless worth while repeating) that radiology with all its various imaging modalities has become more than ever a central unavoidable facility in modern medicine. This makes it all the more depressing that, time after time, surveys of the general public show that they have indeed very little idea of exactly who a radiologist is (most patients confuse the radiographer with the radiologist) and even less on what the radiologist actually does.

Such misunderstanding on the part of the public is bad enough, but what is perhaps even worse is that the morale of many radiologists themselves is continuing to sag under the pressures of ever-increasing work-loads. Therein lies the paradox of the profession. The more the role of radiology becomes central in medicine, the more the workload increases and the more the radiologist is in danger of being perceived as an out-of-sight anonymous provider of images and reports.

The biggest impact on the typical radiologist’s workload has come from the dramatic increase in the number of cross-sectional imaging studies (i.e. CT or MRI) being carried out. By definition the three-dimensional nature of these modalities means that radiologists are spending more and more time in reading the images. A recent study highlights just how dramatic is the impact of such an increase in workload (McDonald RJ, Schwartz KM, Eckel LJ, Diehn FE, Hunt CH, Bartholmai BJ, Erickson BJ, Kallmes DF The Effects of Changes in Utilization and Technological Advancements of Cross-Sectional Imaging on Radiologist Workload. Acad Radiol. 2015 Sep;22(9):1191-8).

A group of researchers from the Mayo Clinic analyzed the statistics at their institution on the use of cross-sectional imaging over the last decade and found that the combined numbers of CT and MRI carried out over this period doubled but that, over the same period, the number of individual images being interpreted increased more than ten-fold. This translated into the average radiologist at the Mayo Clinic who was reading CT or MRI examinations being required to interpret one image every 3-4 seconds in an 8-hour workday to meet workload demands!

IDOR Image 2

The modern radiologist is facing ever-increasing workloads and is often perceived as an out-of-sight anonymous provider of images and reports.

However there may just be a glimmer of light at the end of the workload tunnel. In one particular sub-field, namely that of pediatric CT— and let’s not forget that the particular focus of this year’s IDoR is indeed pediatric radiology — there may be just a suggestion that the otherwise inexorable growth trend in the number of radiology examinations is being bucked. A recent study in one group of US pediatric hospitals (Parker MW, Shah SS, Hall M, Fieldston ES, Coley BD, Morse RB Computed Tomography and Shifts to Alternate Imaging Modalities in Hospitalized Children. Pediatrics. 2015 Aug 24. pii: peds.2015-0995) showed that, although there still was a steady increase in the total number of imaging studies carried out on children, for several pediatric diagnostic-related groups the number of CT examinations was actually declining.

One explanation for this is that, finally, the incessant banging of the drum through many campaigns such as “Image Gently” about the dangers of ionizing radiation in children is finally bearing fruit. It is still too soon to see whether there is any similar trend in the number of adult CTs. However this mini-trend should not be interpreted as a sea-change in overall radiology trends. On the contrary, it should be remembered that in the study by Parker et al., overall, the number of imaging examinations still rose. Even if pediatric CT was declining, this wasn’t due to fewer overall exams being carried out; instead CT was being replaced by alternative imaging modalities.

In the light of all this it is not surprising that the morale of the profession can suffer. Of course technological innovations and developments provided by the industrial suppliers of equipment and software to the profession can help by providing ever more efficient and powerful systems, but there are limits to workflow improvements in the face of such growing workload requirements.

So maybe the focus of the International Day of Radiology should in future be directed less to convincing the general public of the importance of radiology and more to reminding radiologists themselves of the importance of their profession, a victim of its own success.

Alan Barclay, Diagnostic Imaging EuropeAlan Barclay, Ph.D., is the editor of Diagnostic Imaging (DI) Europe.


White Paper: DRX Plus Detectors – Going from Good to Great

Carestream’s introduction in 2009 of the world’s first portable, wireless, cassette-sized detector – the CARESTREAM DRX-1 Detector – has fundamentally changed the digital radiography market with a versatile and cost-effective imaging solution. Now available, the third-generation design: the CARESTREAM DRX Plus Detector takes DR to a new level.

This white paper, “DRX Plus Detectors: Going from Good to Great,” was authored by Karin Töpfer, imaging physicist in Carestream’s Research and Innovation Laboratories, and Tim Wojcik, program leader for radiographic image capture in Carestream’s Research and Innovation Laboratories. It describes many of the features and benefits of the DRX Plus at a detailed level to demonstrate that the DRX Plus takes digital radiography with portable wireless detectors from good to great.

Carestream pioneered the concept of portable, wireless, cassette-sized DR detectors and this leadership position allowed the company to witness the benefits of the original DRX-1 while learning about opportunities to improve. The DRX Plus represents Carestream’s 3rd generation detector design, reflecting the integration of its knowledge and experience in the market.

You can click the image below to read or download the white paper, “DRX Plus Detectors: Going from Good to Great.”

Carestream DRX Plus Detector White Paper

Diagnostic Reading #51: Five Must-Read Articles From the Past Week

Carestream LogoIn this week’s Diagnostic Reading, we’re looking at the Meaningful Use HIT program, ultrasound mammography, redefining the role of the CISO, patient communication, and patient satisfaction.

Medical Groups Rebel Against Meaningful Use HIT Program – AuntMinnie

The American Medical Association (AMA) and 110 other medical associations have asked U.S. lawmakers to intervene in the meaningful use (MU) program before physicians decide to no longer participate in the initiative, designed to spur the adoption of healthcare IT. In a November 2 letter to leaders of the Senate and House of Representatives, the associations detailed their concerns over the administration’s plans to move ahead with implementing stage 3 of the meaningful use program, “despite the widespread failure” of stage 2.

Breast Ultrasound Mammography Find More Cancer – AuntMinnie

Adding ultrasound to mammography screening detects more early invasive breast cancer and probably reduces mortality, according to a 4 November study in the journal Lancet. The Japanese trial is thought to be the first of its kind in a large randomized multicenter population, and that focused on younger women at average risk with dense breast tissue.

Increased Cyber Risks Redefining the CISO – Healthcare IT News

Increased cyber risks and a recent string of major breaches have changed the game for chief information security officers, making cybersecurity a top priority for board members and helping CISOs more effectively make the case for bigger budgets. A recent IBM-sponsored research project performed by the Darwin Deason Institute for Cyber Security at Southern Methodist University in Dallas sought to explain this new shift. The results concluded there were three types of CISOs effectively innovating the way their firms handle cybersecurity.

Patients Lack Access to Digital Health Communication Tools – Healthcare Informatics

Many Americans lack access to or awareness of digital health tools, such as text appointment reminders and patient portals that can increase communication with their healthcare providers, according to a survey by The Council of Accountable Physician Practices (CAPP) and Bipartisan Policy Center (BPC). The survey also found most physicians don’t recommend using these digital tools, according to the consumer respondents. Just 29 percent receive electronic reminders for appointments, medication refills or suggested care and 14 percent report having the ability to check medications online. In addition, only 15 percent receive communication via online messaging platform and 9 percent get text reminders, and that digital interaction is growing very slowly, such as only 4 percent growth for email correspondence about patient health.

Online Review Show Technologists, Receptionists Impact Patient Satisfaction More Than Radiologists – Radiology Business

Patient reviews are becoming increasingly popular and influential throughout the healthcare industry, but that momentum doesn’t always carry over to radiologists. For example, in a study  published back in August by the Journal of the American College of Radiology,  researchers searched five popular physician-rating websites and only found reviews for 197 of 1,000 randomly selected radiologists.

White Paper: Advantages of Volumetric Cone Beam Imaging for Orthopaedic Extremity Exams

Cone beam computed tomography (CBCT) is a variant of traditional computed tomography (CT) and was first described in the late 1970s. The main difference between the two approaches is the volume of the object that is imaged at one time. In traditional CT, a narrow slice of the patient is imaged with a “fan beam” of X-rays. To image an extended volume of the anatomy via CT, the patient must be moved through the fan beam of x-rays as it rotates around the patient multiple times.  This is known as spiral CT. In contrast, in CBCT, a large-area detector images an extended volume of the patient in a single rotation.  This significantly reduces the complexity of the system design by removing the need for “slip ring” technology that is essential for traditional CT systems.  This is illustrated in the white paper copied below.

The Carestream CBCT system featured in this white paper was specifically developed to image extremities (hands/wrists, elbows, knees, feet/ankles), and utilized a number of unique capabilities related to patient workflow, data acquisition and volume reconstruction. This paper highlights some of the distinguishing features of application-specific CBCT imaging systems, such as the unique ability to image weight bearing extremities (feet, ankles and knees),  something that is not possible with traditional CT.

You can click the image below to read and download the white paper, “The Advantages of Volumetric Cone Beam Imaging for Orthopaedic Extremity Exams.”

Carestream CBCT White Paper

Carestream OnSight 3D Extremity System received FDA 510(k) clearance in September 2016.

John Yorkston, PhD, Senior Research Scientist, Clinical Applications Research, Carestream

John Yorkston, PhD, Senior Research Scientist, Clinical Applications Research, Carestream.