Uppsala University Hospital: Ultrasound System Clinical Trial Results

CARESTREAM Touch Prime Ultrasound System delivers high resolution image at good frame rate with minimal artefacts

Ultrasound developments over the last decade have made leaps and bounds in improving the accuracy of diagnoses, particularly in difficult-to-scan conditions. The creation of countless modalities on the backbone of the B-mode image has created a culture where clinicians expect top-quality images, even in suboptimal imaging scenarios.

Illustration of technologies converging

However, given the complex and intersecting properties of ultrasound, any change must be synchronized with other parameters. For example, the high-quality images achieved today are dependent upon a high density of scan lines that capture an increasing volume of data. Duplex modes, such as color flow (Doppler imaging), increase the quantity of information captured. So it follows that the frame rate – the temporal resolution – must be accelerated to keep pace with the data being captured.

Additionally, the increased speed and the amount of data captured have the potential to create artefacts. These might be difficult to notice but will impair image resolution nonetheless. This occurrence tasks the ultrasonographer to constantly apply knowledge to avoid misdiagnosis of artefacts as pathologies (false positives), and to uncover pathologies that could be hidden by artefacts (false negatives).

Ultrasound system clinical trial

The challenge, therefore, for ultrasound manufacturers is to build a machine that gives a high resolution image at a good frame rate, and can maintain this performance when the patient is difficult to scan and/or we add other modalities like Doppler.

Based on our clinical trial, we believe Carestream Health has met the challenge with its CARESTREAM Touch Prime ultrasound system. In the spring of 2016, we put the system through the paces of a clinical trial for four months, performing about 800 exams during that time.

SynTek architecture is departure from serial line-by-line acquisition

A narrow beam is one of the important factors of B‑mode image quality as many artefacts have their origin in beam thickness (1). This is why many systems have focal zones even though they can produce a narrow beam at one depth only.

The SynTek beamforming architecture in the CARESTREAM Touch Prime is a departure from scanline-by-scanline image acquisition. Instead, SynTek insonates the tissue under examination in multiple directions, using near synchronous, independent ultrasound pulses. It then compensates for the differences in the round trip travel times of the returning echoes before combining the data into a coherent image.

When these multiple transmit events are combined, the result is an ultrasound beam that is uniformly narrow from nearfield to the deeper portions of the image whilst retaining a very high frame rate. The system is not dependent on one scan line being formed before the next acquisition starts. Also, this performance is independent of the use of Doppler, and provides the image quality shown in the example at a high frame rate.

Simplified control for sonographer

Images are enhanced further with Smart System Control (SSC), a real-time optimisation technique. In color, Doppler, and B-modes, the SSC algorithm takes a user’s preference for frame rate or resolution, and continuously optimizes it over 25 other system parameters (including some that are not under user control).

For example, for B-mode this includes the number of focal zones, transmit beams, and compounding angles, as well as the line density. The Smart System Control optimizes the parameters in the background, in real time, and automatically. It provides the necessary adjustments to ensure optimized images without requiring keyboard controls that distract the sonographer.

We found that Smart System Control along with the SynTek architecture helped lighten the load on our ultrasonographers. Instead of addressing factors that can hinder the image resolution, they can concentrate on creating quality images that result in fast and more accurate diagnosis.

Clinical trial conclusion

Smart System Control and the SynTek architecture enable the CARESTREAM Touch Prime Ultrasound System to produce a B-mode image with:

  • Good uniform spatial resolution throughout the image
  • An improved contrast resolution as artefacts resulting from beam thickness are reduced, and
  • A very high frame rate not compromised by the addition of Doppler or other modalities.

Learn more about SynTek architecture. #ultrasound

Dr. Anders Nilsson, MD, PhD, is Head of Ultrasound in the Department of Surgical Sciences, Radiology, at Uppsala University Hospital in Sweden. It is Sweden’s oldest university hospital, with a distinguished history in developing innovative solutions that make the best use of new technology, new scientific findings, and new ways of working.

Reference: Nilsson A., Artefacts in sonography and Doppler. European Radiology, Volume 11, Issue 8, 2001



Diagnostic Reading #20: Five “Must Read” Articles on HIT and Radiology

PACS, cyber attacks, and mergers are in the news this week

Articles this week in Diagnostic Reading include: why radiology needs to define image storage guidelines; PACS alerts can boost communication with referrers; health services in the UK are recovering from last Friday’s cyber attack; hospital merger mania continues throughout the country; and registries can have real-time benefits for rads.

Why radiology – and radiologists – need defined image storage guidelines – Radiology BusinessRadiologist reading image

The sheer economy of storing images online should make it standard, but a maze of regulation and expensive penalties make it difficult for imaging providers to navigate the issue, according to a JACR article. Failure to maintain imaging up to state and federal standards can result in penalties up to $10,000 and place radiologists at risk of malpractice suits. If a lost or misplaced image results in patient injury, the radiologist personally bears responsibility. Continue reading

Increase Your Awareness and Understanding of Radiologic Error

15 strategies to help minimize radiological errors in MRI, CT, and ultrasound imaging

Editor’s Note: The authors of this article received a certificate of merit at ECR 2017 in Vienna for their research.

Around 250,000 people die each year in the US because of medical errors, according to a study by researchers at John Hopkins University School of Medicine. This number is bigger than those who die from car accidents, breast cancers, or work accidents. In fact, medical error constitutes the third leading cause of death in the United States.exclamation point depicting an error

Radiologist Leo Henry Garland (1903 – 1966) was the pioneer in the study of radiologic error. The prevalence of radiologists’ errors does not appear to have changed since it was first estimated in 1960. Today, it remains around 10 to 15 percent [1]. Although some diagnoses are missed because of the limitations of the imaging modality, most of them are attributable to image interpretation.

What constitutes an error?

The definition of what constitutes an error in radiologic interpretation is subject to debate. Continue reading

Diagnostic Reading #19: Five “Must Read” Articles on HIT and Radiology

Artificial intelligence in radiology leads this week’s news

This week’s Diagnostic Reading articles include: AI algorithms show promise in performing medical work; many radiologists prefer two monitors or more; AI’s most important application in radiology might be visualizing features on images that reflect genomic or diagnostic properties radiologists don’t see today; radiology residency is changing; and FDA warns natural health company about making marketing claims for a breast thermography system it has not approved.

AI in medicine: rise of the machines – ForbesRadiologist reading image

A radiologist-authored blog discusses how new “deep learning” artificial intelligence (AI) algorithms are showing promise in performing medical work that was believed to only be capable of being done by physicians. For example, deep learning algorithms have been able to diagnose the presence or absence of tuberculosis in chest X-ray images with 96% accuracy. Continue reading

OSF Saint Francis Medical Center Moving from CR to DR Imaging

Patients get less radiation and center gains faster throughput with digital radiography

Light bulb shining

OSF Saint Francis Medical Center hit the trifecta by moving from CR to DR. We gained rapid access to high-quality diagnostic images, our patients are getting less radiation, and we’re moving patients through quicker.Like other facilities, we explored moving from CR to DR in part because of the U.S. Consolidated Appropriations Act. Its provisions include a 20% reduction for reimbursement associated with an X-ray taken using film starting this year.

In 2016, we installed four CARESTREAM DRX-Evolution systems, two CARESTREAM DRX-Revolution Mobile X-ray Systems and five CARESTREAM DRX-Mobile Retrofit Kits  at our primary medical center and two affiliated ambulatory care centers.

The DRX-Evolution system is at our two ambulatory sites: one in Washington, the other in Peoria. At our Washington facility, we have only one room and one technologist, but she is able to image about 22 patients a day. Our second ambulatory center in Peoria has two DRX-Evolution systems and they perform about 1,100 exams a month. The rapid access to high-quality diagnostic images increases our throughput at both centers, reduces patient wait times, and improves the satisfaction of our referring doctors because images and patients are back in their offices sooner.

Our technologists love the ergonomic features of the DRX-Evolution. The system’s auto-positioning feature and remote control eliminate the need for technologists to manually move the X-ray tube into position for each exam, reducing the possibility of repetitive stress injuries. Also, the DRX Plus detectors are lightweight and easy to get in and out of the Bucky.  Both centers have the wall stand mounted on a rail to facilitate capturing cross-table exams as well as bending exams used to detect and treat scoliosis and other conditions.

Retrofit kits and Revolution systems make upgrade easy

We’re using the DRX-Revolution systems and DRX-Mobile Retrofit Kits in our emergency department, operating suite, pediatric, neonatal intensive care, and inpatient areas at our Medical Center. A DRX-Evolution located in the emergency department captures exams for pediatric and other urgent care patients.

Making the move from CR to DR with the Revolution and Retrofit kits was relatively painless. There was little disruption in our operations, and now we are meeting the requirements of the Consolidated Appropriations Act.  More importantly, we’re improving the service and care for our patients. #radiology #DR

Click to tweet! Patients at OSF Saint Francis Medical Center get less radiation with digital #radiography http://ow.ly/mhBO30bz1Sz

Click to tweet! OSF Saint Francis Medical Center gains faster patient throughput with digital #radiography http://ow.ly/mhBO30bz1Sz

Debbie Heinz is the Radiology Manager for Ambulatory Diagnostic Services at OSF Saint Francis Medical Center. With nearly 300 employed physicians, 6,000+ employees and 609 beds, it is the fifth-largest medical center in Illinois.  Watch the video interview with Debbie Heinz at RSNA 2016.

Editor’s note: Want to understand your options for financing the move from CR to DR? Read the blog!

Diagnostic Reading #18: Five “Must Read” Articles on HIT and Radiology

Headlines include interoperability challenges in healthIT, and preventing rad burnout

This week’s articles include: radiology’s journey into transparency; Radiologist reading imagecombining 3D printing and special effects helps
surgeons become proficient by practicing with lifelike ETV training models; healthcare IT can only realize its full potential when the industry overcomes interoperability challenges; how radiologists can prevent burnout; and aging radiologists should consider a “phased in” plan to retirement that benefits themselves and their practices.

Look ahead: radiology’s journey into transparency – RSNA News

Health policy expert Richard Duszak, Jr., MD, offers a glimpse into the next chapter of healthcare where patients will expect transparency in delivery of healthcare systems. Digital forums will be available for patients to post information about their physicians and radiologists. Transparency means that some physicians will look good and some won’t. The opportunity exists to embrace and help lead this movement by developing metrics and platforms that provide meaningful information so patients know who radiologists are and what they do. Continue reading

Guess the X-ray: May Image Challenge

Can you guess the image in the X-ray?

Happy May!

April showers bring May flowers – and a new “Guess the X-ray Image Challenge!” We welcome radiologists, technologists, RAs, MDs, PAs – or anyone who thinks they’re up to the challenge – to guess the subject in this X-ray. Please leave your answer in the comment section below or on our Facebook page. The challenge will stop at the end of the month.

Congratulations to Anne O’Loughlin  who correctly guessed the April image challenge!  The correct answer was — a container of disposable cleaning wipes!

Happy guessing and good luck!

The Impact of AI and Big Data on the Future of Radiology

Radiologists becoming more like information managers and image processing specialists

Haga clic aquí para leer la versión en español de este blog.

for screen readers

Dr. Pablo Valdés is vice-chairman of the Spanish radiologists’ society – Spanish Society of Medical Radiology (SERAM).

In this interview with Everything Rad, he looks at the not-too-distant future of radiology. He proposes that innovations such as artificial intelligence, robotics and Big Data will require radiologists to transform to information managers and specialists in image processing who will contribute decisively to patient well-being and the sustainability of the health care system.   Continue reading

Retos del radiólogo en la gestión de la Inteligencia Artificial y el Big Data

Plantear una radiología no digital es un anacronismo

Click here to read the English version of this Spanish blog.

El Dr. Pablo Valdés, vicepresidente de los radiólogos españoles, analiza en esta entrevista algunos de los aspectos más trascendentales de la especialidad. Con la vista puesta en un futuro no muy lejano, este experto en gestión y calidad en radiología advierte que con la llegada innovaciones como la Inteligencia Artificial, la robótica o el “big data”, el radiólogo se convertirá en un gestor de información y un especialista del  proceso de imagen que va a contribuir de manera decisiva al bienestar de los pacientes y a la sostenibilidad del sistema sanitario.

El Dr. Valdés, que en la actualidad es director de Área de Radiodiagnóstico de la Agencia Sanitaria Costa del Sol, recuerda también el importante papel que sigue jugando la radiografía convencional en el proceso diagnóstico. doctor working on ipad Continue reading